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

PubMed

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

2014-04-01

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

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

PubMed

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

2008-03-01

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

Barriers, Challenges, and Decision-Making in the Letter Writing Process for Gender Transition.

PubMed

Budge, Stephanie L; Dickey, Lore M

2017-03-01

This article addresses the challenges that clinicians face in writing letters of support for transgender and gender-diverse clients. It addresses common but challenging clinical representations to help the reader understand the nuances associated with writing letters. Three cases are presented. The first addresses systemic challenges, the second addresses management of care, and the third addresses co-occurring mental health concerns. Recommendations for practice are provided based on the experiences included within the 3 case examples. Copyright © 2016 Elsevier Inc. All rights reserved.

Multiphysics Simulations: Challenges and Opportunities

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

Keyes, David; McInnes, Lois C.; Woodward, Carol

2013-02-12

We consider multiphysics applications from algorithmic and architectural perspectives, where ‘‘algorithmic’’ includes both mathematical analysis and computational complexity, and ‘‘architectural’’ includes both software and hardware environments. Many diverse multiphysics applications can be reduced, en route to their computational simulation, to a common algebraic coupling paradigm. Mathematical analysis of multiphysics coupling in this form is not always practical for realistic applications, but model problems representative of applications discussed herein can provide insight. A variety of software frameworks for multiphysics applications have been constructed and refined within disciplinary communities and executed on leading-edge computer systems. We examine several of these, expose somemore » commonalities among them, and attempt to extrapolate best practices to future systems. From our study, we summarize challenges and forecast opportunities.« less

Orion Entry, Descent, and Landing Performance and Mission Design

NASA Technical Reports Server (NTRS)

Broome, Joel M.; Johnson, Wyatt

2007-01-01

The Orion Vehicle is the next spacecraft to take humans into space and will include missions to ISS as well as missions to the Moon. As part of that challenge, the vehicle will have to accommodate multiple mission design concepts, since return from Low Earth Orbit and return from the Moon can be quite different. Commonality between the different missions as it relates to vehicle systems, guidance capability, and operations concepts is the goal. Several unique mission design concepts include the specification of multiple land-based landing sites for a vehicle with closed-loop direct and skip entry guidance, followed by a parachute descent and landing attenuation system. This includes the ability of the vehicle to accurately target and land at a designated landing site, including site location aspects, landing site size, and landing opportunities assessments. Analyses associated with these mission design and flight performance challenges and constraints will be discussed as well as potential operational concepts to provide feasibility and/or mission commonality.

Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration.

PubMed

Embi, Peter J; Hebert, Courtney; Gordillo, Gayle; Kelleher, Kelly; Payne, Philip R O

2013-08-01

As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues common to such data reuse. After reviewing the current state of knowledge regarding biomedical informatics challenges and best practices related to CER, we then present 2 research projects at our institution. We analyze these and highlight several common themes and challenges related to the conduct of CER studies. Finally, we represent these emergent themes. The informatics challenges commonly encountered by those conducting CER studies include issues related to data information and knowledge management (eg, data reuse, data preparation) as well as those related to people and organizational issues (eg, sociotechnical factors and organizational factors). Examples of these are described in further detail and a formal framework for describing these findings is presented. Significant challenges face researchers attempting to use often diverse and heterogeneous datasets for CER. These challenges must be understood in order to be dealt with successfully and can often be overcome with the appropriate use of informatics best practices. Many research and policy questions remain to be answered in order to realize the full potential of the increasingly electronic clinical data available for such research.

Hepatitis B Virus Infection in Tanzania: Current Status and Challenges

PubMed Central

Bakshi, Fatma A.; Jaka, Hyasinta

2018-01-01

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

Dietary Supplements: Regulatory Challenges and Research Resources.

PubMed

Dwyer, Johanna T; Coates, Paul M; Smith, Michael J

2018-01-04

Many of the scientific and regulatory challenges that exist in research on the safety, quality and efficacy of dietary supplements are common to all countries as the marketplace for them becomes increasingly global. This article summarizes some of the challenges in supplement science and provides a case study of research at the Office of Dietary Supplements at the National Institutes of Health, USA, along with some resources it has developed that are available to all scientists. It includes examples of some of the regulatory challenges faced and some resources for those who wish to learn more about them.

Dietary Supplements: Regulatory Challenges and Research Resources

PubMed Central

Dwyer, Johanna T.; Coates, Paul M.; Smith, Michael J.

2018-01-01

Many of the scientific and regulatory challenges that exist in research on the safety, quality and efficacy of dietary supplements are common to all countries as the marketplace for them becomes increasingly global. This article summarizes some of the challenges in supplement science and provides a case study of research at the Office of Dietary Supplements at the National Institutes of Health, USA, along with some resources it has developed that are available to all scientists. It includes examples of some of the regulatory challenges faced and some resources for those who wish to learn more about them. PMID:29300341

A Hero's Journey: A Freshman Orientation Challenge Course Program.

ERIC Educational Resources Information Center

Fine, L-Jay

At California State University, Fresno, all incoming students take a full-semester, three-unit course that includes topics on academic preparation but also focuses on issues and topics commonly associated with experiential and adventure education. These areas include communication, listening, teamwork, and problem-solving skills. Recognizing the…

A Case Study of a College-Wide First-Year Undergraduate Engineering Course

ERIC Educational Resources Information Center

Aloul, Fadi; Zualkernan, Imran; Husseini, Ghaleb; El-Hag, Ayman; Al-Assaf, Yousef

2015-01-01

Introductory engineering courses are either programme specific or expose students to engineering as a broad discipline by including materials from various engineering programmes. A common introductory engineering course that spans different engineering programmes raises challenges, including the high cost of resources as well as the lack of…

Current issues and challenges in the management of bariatric patients.

PubMed

Bell, Sue Ellen

2005-01-01

Morbid obesity is an increasingly common healthcare problem, and providers and patients currently face numerous challenges in dealing with this problem effectively. Issues addressed in this article include the effect of stigma, the need for more evidence regarding effective management options, and the declining insurance coverage for bariatric surgery. The role of bariatric surgery in effective management of morbid obesity is discussed, along with the effect on and possible reasons for declining coverage. A comparison between benefits and coverage for bariatric surgery and angioplasty/stent placement is included.

An aircraft model for the AIAA controls design challenge

NASA Technical Reports Server (NTRS)

Brumbaugh, Randal W.

1991-01-01

A generic, state-of-the-art, high-performance aircraft model, including detailed, full-envelope, nonlinear aerodynamics, and full-envelope thrust and first-order engine response data is described. While this model was primarily developed Controls Design Challenge, the availability of such a model provides a common focus for research in aeronautical control theory and methodology. An implementation of this model using the FORTRAN computer language, associated routines furnished with the aircraft model, and techniques for interfacing these routines to external procedures is also described. Figures showing vehicle geometry, surfaces, and sign conventions are included.

A decade review of publications in Families, Systems, & Health: 2005-2015.

PubMed

Mendenhall, Tai J; Li, Yiting; Schulz, Catherine L

2016-09-01

The purpose of this investigation was to review recent publication content and trends in Families, Systems, & Health ( FSH ). How do the journal’s articles reflect current and emerging challenges in health care? We hope that our findings can guide special issues and content foci. All work published in FSH between 2005 and 2015 was included (n = 452); each piece was coded for article type, general foci, and specific foci. The most common type of article published over the 10-year time frame was research reports (43%; n = 195), followed by other types (e.g., tribute pieces, poems), commentaries, conceptual/theory papers, literature reviews, and case studies. The most common general focus included family health and/or functioning (28%; n = 128). The most common specific foci centered on children (15%; n = 55). Common themes found in FSH ’s most frequently cited publications included family relationships in care, chronic physical illnesses, and mental health. Marked trends in journal content included increases in articles targeting family health and/or functioning and primary care and decreased attention to theory. FSH’s emphasis on research reports to inform current and evolving interventions that target contemporary health challenges suggests that the journal is keeping stride with the most pressing issues in health care today. Future special issues can continue to serve and meet these needs. FSH’s robust inclusion of other article types sustains the journal’s mission to advance multiple ways of understanding health-care phenomena. PsycINFO Database Record (c) 2016 APA, all rights reserved

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-10-01

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

Barriers to Employment for Transition-age Youth with Developmental and Psychiatric Disabilities.

PubMed

Noel, Valerie A; Oulvey, Eugene; Drake, Robert E; Bond, Gary R

2017-05-01

Youth with developmental and psychiatric disabilities encounter significant vocational challenges, even when they receive supported employment services. We examined the barriers to employment for 280 transition-age youth with disabilities enrolled in supported employment in eight community rehabilitation centers. Employment team members identified each youth's top three barriers to employment using a 21-item checklist. Lack of work experience, transportation problems, and program engagement issues represented common barriers for both youth with developmental disabilities (53, 36, and 25%) and youth with psychiatric disabilities (20, 33, and 26%). Additional common barriers among youth with developmental disabilities included cognitive problems (32%) and lack of social skills (23%) and among youth with psychiatric disabilities included poor control of psychiatric symptoms (23%). Despite receiving evidence-based employment services, youth with disabilities encounter many barriers to employment. Awareness of typical barriers for transition-age youth, including those specific to different disability groups, may help employment programs anticipate challenges and develop strategies that avoid these barriers and their effects on employment opportunities.

Coping and acceptance: the greatest challenge for veterans with intestinal stomas.

PubMed

Krouse, Robert S; Grant, Marcia; Rawl, Susan M; Mohler, M Jane; Baldwin, Carol M; Coons, Stephen Joel; McCorkle, Ruth; Schmidt, C Max; Ko, Clifford Y

2009-03-01

Intestinal stomas (ostomies) create challenges for veterans. The goal of this qualitative analysis was to understand better patients' perspectives regarding their greatest challenge. Ostomates at three Veterans Affairs locations were surveyed using the modified City of Hope Quality of Life-Ostomy questionnaire that contained an open-ended request for respondents to describe their greatest challenge. The response rate was 51% (239 of 467); 68% (163 of 239) completed the open-ended item. Content analysis was performed by an experienced qualitative research team. Coping and acceptance were the most commonly addressed themes. The most frequently expressed issues and advice were related to a need for positive thinking and insight regarding adjustment over time. Coping strategies included the use of humor, recognition of positive changes resulting from the stoma, and normalization of life with an ostomy. Coping and acceptance are common themes described by veterans with an intestinal stoma. Health-care providers can assist veterans by utilizing ostomate self-management strategies, experience, and advice.

Methodological Challenges in Studies Comparing Prehospital Advanced Life Support with Basic Life Support.

PubMed

Li, Timmy; Jones, Courtney M C; Shah, Manish N; Cushman, Jeremy T; Jusko, Todd A

2017-08-01

Determining the most appropriate level of care for patients in the prehospital setting during medical emergencies is essential. A large body of literature suggests that, compared with Basic Life Support (BLS) care, Advanced Life Support (ALS) care is not associated with increased patient survival or decreased mortality. The purpose of this special report is to synthesize the literature to identify common study design and analytic challenges in research studies that examine the effect of ALS, compared to BLS, on patient outcomes. The challenges discussed in this report include: (1) choice of outcome measure; (2) logistic regression modeling of common outcomes; (3) baseline differences between study groups (confounding); (4) inappropriate statistical adjustment; and (5) inclusion of patients who are no longer at risk for the outcome. These challenges may affect the results of studies, and thus, conclusions of studies regarding the effect of level of prehospital care on patient outcomes should require cautious interpretation. Specific alternatives for avoiding these challenges are presented. Li T , Jones CMC , Shah MN , Cushman JT , Jusko TA . Methodological challenges in studies comparing prehospital Advanced Life Support with Basic Life Support. Prehosp Disaster Med. 2017;32(4):444-450.

Forming Effective Partnerships to Facilitate Inclusion of Students with Vision Impairments: Perceptions of a Regular Classroom Teacher and an Itinerant Teacher

ERIC Educational Resources Information Center

Sharma, Umesh; Moore, Dennis; Furlonger, Brett; King, Brian Smyth; Kaye, Linda; Constantinou, Olga

2010-01-01

This qualitative study reports on the perceptions of a regular classroom teacher and an itinerant teacher about the challenges they faced in including a student with vision impairment in regular school in New South Wales, Australia. Some of the common strategies employed by both these teachers to address these challenges are discussed. (Contains 1…

Laboratory challenges conducting international clinical research in resource-limited settings.

PubMed

Fitzgibbon, Joseph E; Wallis, Carole L

2014-01-01

There are many challenges to performing clinical research in resource-limited settings. Here, we discuss several of the most common laboratory issues that must be addressed. These include issues relating to organization and personnel, laboratory facilities and equipment, standard operating procedures, external quality assurance, shipping, laboratory capacity, and data management. Although much progress has been made, innovative ways of addressing some of these issues are still very much needed.

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

PubMed

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

2018-04-18

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

Dizziness and vertigo.

PubMed

Wipperman, Jennifer

2014-03-01

Dizziness is a common and challenging condition seen in the primary care office. Because dizziness is a vague term that can include a wide array of medical disorders, it is important to use a stepwise approach to differentiate between causes. This article focuses on vertigo and its four most common causes: benign paroxysmal peripheral vertigo, vestibular neuritis, vestibular migraine, and Meniere's disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Optimising the use of observational electronic health record data: Current issues, evolving opportunities, strategies and scope for collaboration.

PubMed

Liaw, Siaw-Teng; Powell-Davies, Gawaine; Pearce, Christopher; Britt, Helena; McGlynn, Lisa; Harris, Mark F

2016-03-01

With increasing computerisation in general practice, national primary care networks are mooted as sources of data for health services and population health research and planning. Existing data collection programs - MedicinesInsight, Improvement Foundation, Bettering the Evaluation and Care of Health (BEACH) - vary in purpose, governance, methodologies and tools. General practitioners (GPs) have significant roles as collectors, managers and users of electronic health record (EHR) data. They need to understand the challenges to their clinical and managerial roles and responsibilities. The aim of this article is to examine the primary and secondary use of EHR data, identify challenges, discuss solutions and explore directions. Representatives from existing programs, Medicare Locals, Local Health Districts and research networks held workshops on the scope, challenges and approaches to the quality and use of EHR data. Challenges included data quality, interoperability, fragmented governance, proprietary software, transparency, sustainability, competing ethical and privacy perspectives, and cognitive load on patients and clinicians. Proposed solutions included effective change management; transparent governance and management of intellectual property, data quality, security, ethical access, and privacy; common data models, metadata and tools; and patient/community engagement. Collaboration and common approaches to tools, platforms and governance are needed. Processes and structures must be transparent and acceptable to GPs.

Recruitment and retention monitoring: facilitating the mission of the National Institute of Neurological Disorders and Stroke (NINDS)

PubMed Central

Roberts, J; Waddy, S; Kaufmann, P

2012-01-01

It is commonly accepted that inefficient recruitment and inadequate retention continue to threaten the completion of clinical trials intended to reduce the public health burden of neurological disease. This article will discuss the scientific, economic, and ethical implications of failure to recruit and retain adequate samples in clinical trials, including the consequences of failing to recruit adequately diverse samples. We will also discuss the more common challenges and barriers to efficient and effective recruitment and retention, and the impact these have on successful clinical trial planning. We will explain the newly established efforts within National Institute of Neurological Disorders and Stroke (NINDS) to monitor recruitment and retention with well-defined metrics and implementation of grant awards that include feasibility milestones for continued funding. Finally, we will describe our efforts to address some of the common challenges to recruitment and retention through assistance to investigators and coordinators with evidence-based support, tools, and resources for planning and strategizing recruitment and retention as well as a trans-NIH effort to improve awareness of clinical research in the general public. PMID:23230460

Comparison of Views of the Nature of Science between Natural Science and Nonscience Majors

ERIC Educational Resources Information Center

Desaulniers Miller, Marie C.; Montplaisir, Lisa M.; Offerdahl, Erika G.; Cheng, Fu-Chih; Ketterling, Gerald L.

2010-01-01

Science educators have the common goal of helping students develop scientific literacy, including understanding of the nature of science (NOS). University faculties are challenged with the need to develop informed NOS views in several major student subpopulations, including science majors and nonscience majors. Research into NOS views of…

Measuring and Understanding Education Advocacy

ERIC Educational Resources Information Center

Whitehurst, Grover J.; Stuit, David; Graves, Claire; Shaw, Lauren

2015-01-01

The traditional delivery system for public K-12 education in the U.S. is being disrupted by forces from without (e.g., forms of competition, including charter schools) and from within (e.g., new regulatory requirements, including meaningful teacher evaluation and the Common Core). As in any sizable sector of the economy, challenges to the status…

How diet modification challenges are magnified in vulnerable or marginalized people with diabetes and heart disease: a systematic review and qualitative meta-synthesis.

PubMed

Vanstone, M; Giacomini, M; Smith, A; Brundisini, F; DeJean, D; Winsor, S

2013-01-01

Diet modification is an important part of self-management for patients with diabetes and/or heart disease (including coronary artery disease, heart failure, and atrial fibrillation). Many health care providers and community-based programs advise lifestyle and diet modification as part of care for people with these conditions. This report synthesizes qualitative information on how patients respond differently to the challenges of diet modification. Qualitative and descriptive evidence can illuminate challenges that may affect the success and equitable impact of dietary modification interventions. To (a) examine the diet modification challenges faced by diabetes and/or heart disease patients; and (b) compare and contrast the challenges faced by patients who are members of vulnerable and nonvulnerable groups as they change their diet in response to clinical recommendations. This report synthesizes 65 primary qualitative studies on the topic of dietary modification challenges encountered by patients with diabetes and/or heart disease. Included papers were published between 2002 and 2012 and studied adult patients in North America, Europe, and Australia/New Zealand. Qualitative meta-synthesis was used to integrate findings across primary research studies. Analysis identified 5 types of challenges that are common to both vulnerable and nonvulnerable patients: self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. Vulnerable patients may experience additional barriers, many of which can magnify or exacerbate those common challenges. While qualitative insights are robust and often enlightening for understanding experiences and planning services in other settings, they are not intended to be generalizable. The findings of the studies reviewed here--and of this synthesis--do not strictly generalize to the Ontario (or any specific) population. This evidence must be interpreted and applied carefully, in light of expertise and the experiences of the relevant community. Diet modification is not simply a matter of knowing what to eat and making the rational choice to change dietary practices. Rather, diet and eating practices should be considered as part of the situated lives of patients, requiring an individualized approach that is responsive to the conditions in which each patient is attempting to make a change. Common challenges include self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. An individualized approach is particularly important when working with patients who have vulnerabilities. Health care providers often encourage people with diabetes and/or heart disease to change their diet. They advise people with diabetes to eat less sugar, starch, and fat. They advise people with heart disease to eat less fat and salt. However, many patients find it difficult to change what they eat. This report examines the challenges people may face when making such changes. It also examines the special challenges faced by people who are vulnerable due to other factors, such as poverty, lack of education, and difficulty speaking English. Five themes were common to all people who make diet changes: self-discipline, knowledge, coping with stress, negotiating with family members, and managing the social aspect of food. Members of vulnerable groups also reported other challenges, such as affording fresh fruit and vegetables or understanding English instructions. This report may help health care providers work with patients more effectively to make diet changes.

How Diet Modification Challenges Are Magnified in Vulnerable or Marginalized People With Diabetes and Heart Disease

PubMed Central

Vanstone, M; Giacomini, M; Smith, A; Brundisini, F; DeJean, D; Winsor, S

2013-01-01

Background Diet modification is an important part of self-management for patients with diabetes and/or heart disease (including coronary artery disease, heart failure, and atrial fibrillation). Many health care providers and community-based programs advise lifestyle and diet modification as part of care for people with these conditions. This report synthesizes qualitative information on how patients respond differently to the challenges of diet modification. Qualitative and descriptive evidence can illuminate challenges that may affect the success and equitable impact of dietary modification interventions. Objectives To (a) examine the diet modification challenges faced by diabetes and/or heart disease patients; and (b) compare and contrast the challenges faced by patients who are members of vulnerable and nonvulnerable groups as they change their diet in response to clinical recommendations. Data Sources This report synthesizes 65 primary qualitative studies on the topic of dietary modification challenges encountered by patients with diabetes and/or heart disease. Included papers were published between 2002 and 2012 and studied adult patients in North America, Europe, and Australia/New Zealand. Review Methods Qualitative meta-synthesis was used to integrate findings across primary research studies. Results Analysis identified 5 types of challenges that are common to both vulnerable and nonvulnerable patients: self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. Vulnerable patients may experience additional barriers, many of which can magnify or exacerbate those common challenges. Limitations While qualitative insights are robust and often enlightening for understanding experiences and planning services in other settings, they are not intended to be generalizable. The findings of the studies reviewed here—and of this synthesis—do not strictly generalize to the Ontario (or any specific) population. This evidence must be interpreted and applied carefully, in light of expertise and the experiences of the relevant community. Conclusions Diet modification is not simply a matter of knowing what to eat and making the rational choice to change dietary practices. Rather, diet and eating practices should be considered as part of the situated lives of patients, requiring an individualized approach that is responsive to the conditions in which each patient is attempting to make a change. Common challenges include self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. An individualized approach is particularly important when working with patients who have vulnerabilities. Plain Language Summary Health care providers often encourage people with diabetes and/or heart disease to change their diet. They advise people with diabetes to eat less sugar, starch, and fat. They advise people with heart disease to eat less fat and salt. However, many patients find it difficult to change what they eat. This report examines the challenges people may face when making such changes. It also examines the special challenges faced by people who are vulnerable due to other factors, such as poverty, lack of education, and difficulty speaking English. Five themes were common to all people who make diet changes: self-discipline, knowledge, coping with stress, negotiating with family members, and managing the social aspect of food. Members of vulnerable groups also reported other challenges, such as affording fresh fruit and vegetables or understanding English instructions. This report may help health care providers work with patients more effectively to make diet changes. PMID:24228077

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

Sup wit Eval Ext?

ERIC Educational Resources Information Center

Patton, Michael Quinn

2008-01-01

Extension and evaluation share some similar challenges, including working with diverse stakeholders, parallel processes for focusing priorities, meeting common standards of excellence, and adapting to globalization, new technologies, and changing times. Evaluations of extension programs have helped clarify how change occurs, especially the…

Changing therapeutic paradigms in CMV retinitis in AIDS.

PubMed

Piper, H; Ciulla, T A; Danis, R P; Pratt, L M

2000-12-01

Cytomegalovirus (CMV) retinitis is a common ocular complication of immunosuppression. The management of CMV retinitis has been continuously evolving over the last decade. The mainstay of therapy remains ganciclovir and foscarnet. However, increasing resistance and ongoing toxicities to these agents remain a challenge. Additional frequently utilised agents include cidofovir and fomivirsen. The advent of highly active antiretroviral therapy (HAART) has allowed the restoration of immunocompetency to many patients previously challenged by CMV infection. In some circumstances, HAART has even eliminated the need for ongoing antiviral therapy. This paper reviews the current treatment modalities, including their toxicities and dosing recommendations.

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

PubMed Central

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

2016-01-01

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

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

DOE PAGES

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

2016-12-26

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

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

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

Singhal, Ayush; Leaman, Robert; Catlett, Natalie

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

What are the challenges in developing effective health policies for obesity?

PubMed

Binks, M; Chin, S-H

2017-06-01

Identifying and implementing thoughtful, evidence-based (or at least evidence-informed) public health approaches to influencing obesity is a complex issue fraught with multiple challenges. These challenges begin with determining whether obesity policy approaches should be implemented. This is considered within the broader context of how common public health policy approaches may be relevant and applied to obesity. Additional challenges discussed include inconsistencies in clearly identifying obesity policy targets (for example, prevention versus treatment), selection of appropriate intervention targets and the identification and measurement of meaningful outcomes. Current policy initiatives are drawn upon to illustrate these challenges in the context of promoting solution-focused dialog aimed toward improving current initiatives and informing the development of new programs.

Integrating cultural community psychology: activity settings and the shared meanings of intersubjectivity.

PubMed

O'Donnell, Clifford R; Tharp, Roland G

2012-03-01

Cultural and community psychology share a common emphasis on context, yet their leading journals rarely cite each other's articles. Greater integration of the concepts of culture and community within and across their disciplines would enrich and facilitate the viability of cultural community psychology. The contextual theory of activity settings is proposed as one means to integrate the concepts of culture and community in cultural community psychology. Through shared activities, participants develop common experiences that affect their psychological being, including their cognitions, emotions, and behavioral development. The psychological result of these experiences is intersubjectivity. Culture is defined as the shared meanings that people develop through their common historic, linguistic, social, economic, and political experiences. The shared meanings of culture arise through the intersubjectivity developed in activity settings. Cultural community psychology presents formidable epistemological challenges, but overcoming these challenges could contribute to the transformation and advancement of community psychology.

Assessment of Critical-Analytic Thinking

ERIC Educational Resources Information Center

Brown, Nathaniel J.; Afflerbach, Peter P.; Croninger, Robert G.

2014-01-01

National policy and standards documents, including the National Assessment of Educational Progress frameworks, the "Common Core State Standards" and the "Next Generation Science Standards," assert the need to assess critical-analytic thinking (CAT) across subject areas. However, assessment of CAT poses several challenges for…

Surgical procedures in patients with haemophilic arthropathy of the ankle.

PubMed

Barg, A; Morris, S C; Schneider, S W; Phisitkul, P; Saltzman, C L

2016-05-01

In haemophilia, the ankle joint is one of the most common and earliest joints affected by recurrent bleeding, commonly resulting in end-stage ankle osteoarthritis during early adulthood. The surgical treatment of haemophilic ankle arthropathy is challenging. This review aims to highlight the literature addressing clinical outcomes following the most common approaches for different stages of haemophilia-induced ankle osteoarthritis: arthroscopic debridement, joint distraction arthroplasty, supramalleolar osteotomies, total ankle replacement, and ankle arthrodesis. A systematic literature review was performed using established medical literature databases. The following information was retrieved from the literature: patients' demographics, surgical technique, duration of follow-up, clinical outcome including pain relief and complication rate. A total of 42 clinical studies published between 1978 and 2015 were included in the systematic literature review. Eight and 34 studies had prospective and retrospective design, respectively. The most common studies were level IV studies (64.3%). The orthopaedic treatment of patients with haemophilic ankle osteoarthritis is often challenging and requires complete and careful preoperative assessment. In general, both joint-preserving and joint non-preserving procedure types can be performed. All specific relative and absolute contraindications should be considered to achieve appropriate postoperative outcomes. The current literature demonstrated that orthopaedic surgeries, with appropriate indication, in patients with haemophilic ankle arthropathy result in good postoperative results comparable to those observed in non-haemophiliacs. The surgical treatment should be performed in a setting with the ability to have multidisciplinary management, including expertise in haematology. © 2016 John Wiley & Sons Ltd.

PS1-10: Spiritual Well-being and the Challenges of Living With an Ostomy: Resilience, Adaptation and Loss Among Colorectal Cancer Survivors

PubMed Central

Bulkley, Joanna; McMullen, Carmit; Hornbrook, Mark; Altschuler, Andrea; Grant, Marcia; Herrinton, Lisa; Krouse, Robert

2012-01-01

Background Spiritual well-being (SpWB), defined as hopefulness, inner peace, and sensing a reason to be alive, is integral to health related quality of life (HRQOL). It is only partially related to spirituality and religiosity. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We explored expressions of SpWB reported by CRC survivors with ostomies. Methods We recruited all adult CRC survivors (>=5 years) with permanent ostomies who were members of Kaiser Permanente Northwest, Northern California, or Hawai‘i during 2000–2006 to complete a mailed survey (n=283). We asked participants to respond to an open-ended question about the greatest challenge they encountered in having an ostomy. Responses from the 62% (176 of 283) of patients who answered this question were analyzed based on the City of Hope HRQOL model for content related to SpWB, and to identify and categorize the SpWB themes found. Results The responses of 51% (90 of 176) of participants contained SpWB content. Seventeen SpWB themes were identified, reflecting positive, negative, and ambivalent dimensions. Some responses contained multiple themes but each theme was coded only once for each person. Fifty-three of 90 people (59%) expressed positive themes which included “positive attitude” “appreciate life more” “helping others helps me” “strength through religious faith” “leading an active life” and “I am fortunate.” Negative themes included “struggling to cope” “not feeling ‘normal’” and “loss” and were least common, expressed by only 28 of 90 people (31%). Ambivalent themes were most common (67%; 60 of 90 individuals) and included “learning acceptance” “ostomy is the price for survival” “reason to be around despite suffering” and “continuing to cope and function despite challenges.” Discussion These CRC survivors with ostomies infrequently cited negative SpWB as a major challenge, though the greatest number of SpWB responses were ambivalent. More commonly, SpWB themes were mentioned as a source of resilience or part of the struggle to adapt to their altered body after cancer surgery. SpWB interventions should be broadly constructed to include the many types of SpWB, as opposed to narrowly defining SpWB only in terms of spirituality or religiosity.

A diagnostic and therapeutic approach to primary burning mouth syndrome.

PubMed

Moghadam-Kia, Siamak; Fazel, Nasim

Primary burning mouth syndrome (BMS) is an oral mucosal disorder that is characterized by a chronic and often debilitating intraoral burning sensation for which no localized or systemic cause can be found. BMS most commonly affects postmenopausal women. The pathophysiology of primary BMS is not well understood. Diagnosing BMS can prove to be challenging. BMS patients can also pose a therapeutic challenge to clinicians who are consulted to evaluate these patients. Most commonly used therapies include tricyclic antidepressants, α-lipoic acid, clonazepam, and cognitive-behavioral therapy. Clinical judgment, patient counseling, and monitoring of pain are important. Further research is required to assess the effectiveness of serotonin and newer serotonin-noradrenalin reuptake inhibitors. Copyright © 2017 Elsevier Inc. All rights reserved.

Hemiplegic shoulder pain: a common clinical consequence of stroke.

PubMed

Coskun Benlidayi, Ilke; Basaran, Sibel

2014-04-01

Hemiplegic shoulder pain is common in stroke survivors, developing in up to 54% of patients. The underlying mechanisms include soft tissue lesions, impaired motor function and central nervous system-related phenomena. Hemiplegic shoulder pain has many underlying causes and is challenging to manage, requiring a team approach, including physicians, therapists and caregivers. The management strategy must target the underlying causes. Preventative measures, such as positioning and handling, can reduce the risk of developing hemiplegic shoulder pain. We have reviewed the literature on hemiplegic shoulder pain, and used this to categorise the underlying mechanisms, and to explore the best management strategies.

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.

Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre.

PubMed

Johnston, Sharon; Liddy, Clare; Hogg, William; Donskov, Melissa; Russell, Grant; Gyorfi-Dyke, Elizabeth

2010-12-13

While some research has been conducted examining recruitment methods to engage physicians and practices in primary care research, further research is needed on recruitment methodology as it remains a recurrent challenge and plays a crucial role in primary care research. This paper reviews recruitment strategies, common challenges, and innovative practices from five recent primary care health services research studies in Ontario, Canada. We used mixed qualitative and quantitative methods to gather data from investigators and/or project staff from five research teams. Team members were interviewed and asked to fill out a brief survey on recruitment methods, results, and challenges encountered during a recent or ongoing project involving primary care practices or physicians. Data analysis included qualitative analysis of interview notes and descriptive statistics generated for each study. Recruitment rates varied markedly across the projects despite similar initial strategies. Common challenges and creative solutions were reported by many of the research teams, including building a sampling frame, developing front-office rapport, adapting recruitment strategies, promoting buy-in and interest in the research question, and training a staff recruiter. Investigators must continue to find effective ways of reaching and involving diverse and representative samples of primary care providers and practices by building personal connections with, and buy-in from, potential participants. Flexible recruitment strategies and an understanding of the needs and interests of potential participants may also facilitate recruitment.

Promoting wellbeing and improving access to mental health care through community champions in rural India: the Atmiyata intervention approach.

PubMed

Shields-Zeeman, Laura; Pathare, Soumitra; Walters, Bethany Hipple; Kapadia-Kundu, Nandita; Joag, Kaustubh

2017-01-01

There are limited accounts of community-based interventions for reducing distress or providing support for people with common mental disorders (CMDs) in low and middle-income countries. The recently implemented Atmiyata programme is one such community-based mental health intervention focused on promoting wellness and reducing distress through community volunteers in a rural area in the state of Maharashtra, India. This case study describes the content and the process of implementation of Atmiyata and how community volunteers were trained to become Atmiyata champions and mitras ( friends ). The Atmiyata programme trained Atmiyata champions to provide support and basic counselling to community members with common mental health disorders, facilitate access to mental health care and social benefits, improve community awareness of mental health issues, and to promote well-being. Challenges to implementation included logistical challenges (difficult terrain and weather conditions at the implementation site), content-related challenges (securing social welfare benefits for people with CMDs), and partnership challenges (turnover of public health workers involved in referral chain, resistance from public sector mental health specialists). The case study serves as an example for how such a model can be sustained over time at low cost. The next steps of the programme include evaluation of the impact of the Atmiyata intervention through a pre-post study and adapting the intervention for further scale-up in other settings in India.

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

Keyes, D.; McInnes, L. C.; Woodward, C.

This report is an outcome of the workshop Multiphysics Simulations: Challenges and Opportunities, sponsored by the Institute of Computing in Science (ICiS). Additional information about the workshop, including relevant reading and presentations on multiphysics issues in applications, algorithms, and software, is available via https://sites.google.com/site/icismultiphysics2011/. We consider multiphysics applications from algorithmic and architectural perspectives, where 'algorithmic' includes both mathematical analysis and computational complexity and 'architectural' includes both software and hardware environments. Many diverse multiphysics applications can be reduced, en route to their computational simulation, to a common algebraic coupling paradigm. Mathematical analysis of multiphysics coupling in this form is not alwaysmore » practical for realistic applications, but model problems representative of applications discussed herein can provide insight. A variety of software frameworks for multiphysics applications have been constructed and refined within disciplinary communities and executed on leading-edge computer systems. We examine several of these, expose some commonalities among them, and attempt to extrapolate best practices to future systems. From our study, we summarize challenges and forecast opportunities. We also initiate a modest suite of test problems encompassing features present in many applications.« less

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Selecting Performance Reference Compounds (PRCS)for Polyethylene Passive Samplers Deployed at Contaminated Sediment Sites

EPA Science Inventory

Use of equilibrium passive samplers for performing aquatic environmental monitoring at contaminated sediment sites, including Superfund sites, is becoming more common. However, a current challenge in passive sampling is determining when equilibrium is achieved between the sampl...

REHABILITATION OF AGING WATER INFRASTRUCTURE SYSTEMS: KEY CHALLENGES AND ISSUES

EPA Science Inventory

Presented in this paper are the results of a state-of-the-practice survey on the rehabilitation of water distribution and wastewater collection systems. The survey identified several needs, including the need for rational and common design approaches for rehabilitation systems, ...

Challenges of self-management when living with multiple chronic conditions

PubMed Central

Liddy, Clare; Blazkho, Valerie; Mill, Karina

2014-01-01

Abstract Objective To explore the perspectives of patients who live with multiple chronic conditions as they relate to the challenges of self-management. Data sources On September 30, 2013, we searched MEDLINE, EMBASE, and CINAHL using relevant key words including chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self-care, self-management, perspective, and perception. Study selection Three reviewers assessed and extracted the data from the included studies after study quality was rated. Qualitative thematic synthesis method was then used to identify common themes. Twenty-three articles met the inclusion criteria, with most coming from the United States. Synthesis Important themes raised by people living with multiple chronic conditions related to their ability to self-manage included living with undesirable physical and emotional symptoms, with pain and depression highlighted. Issues with conflicting knowledge, access to care, and communication with health care providers were raised. The use of cognitive strategies, including reframing, prioritizing, and changing beliefs, was reported to improve people’s ability to self-manage their multiple chronic conditions. Conclusion This study provides a unique view into patients’ perspectives of living with multiple chronic conditions, which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with patients’ perspectives on living with multiple chronic conditions. This might be achieved by ensuring a more patient-centred approach is adopted by providers and health service organizations. PMID:25642490

A common agenda of global challenges. Japan and U.S. pool resources to tackle global issues including population and HIV / AIDS.

PubMed

1998-05-01

The Common Agenda for Cooperation in Global Perspective is a bilateral partnership established in 1993 between the US and Japan to address important global challenges of the 21st century such as global health and human development, including population and HIV/AIDS, global stability, protection of the global environment, and the advancement of science and technology. On the fifth anniversary of the agenda, representatives of the Japan and the US governments, international organizations, and private sectors discussed ways to further promote US-Japan cooperation under the agenda at a meeting held in Tokyo during March 12-13. Participants of the Common Agenda Open Forum also reviewed efforts made by Japan and the US under the agenda to address population and the environment. Forum participants focused upon developing new ideas for future cooperation between the governments, the private sector, and other nations, especially in the areas of health and the environment. The meeting was jointly organized by Japan's Ministry of Foreign Affairs and the US Department of State. Attention was also given during talks to diminishing international assistance budgets worldwide.

Relationship challenges and relationship maintenance activities following disclosure of transsexualism.

PubMed

Alegría, C Aramburu

2010-12-01

• Transsexual persons are increasing their visibility in society, and health care providers and others (such as social workers) will be called upon to help with issues that transsexual persons face. Challenges that face transsexual persons often include issues involving relationships. Psychiatric and mental health nurses and other caregivers can increase their therapeutic skills in working with couples that include transsexual persons by becoming aware of these challenges and subsequent activities that can help with them. • This research study looks at couple relationships in which one partner reveals male-to-female transsexual identity. These are relationships that were established as man-woman and now will transition into relationships that include a male-to-female person and a female partner. • Common challenges for these couples include issues related to: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) presenting in public. • Relationship maintenance activities that helped the couples in the study maintain and strengthen their relationships through these challenges include: (1) communication; (2) self-talk (for example, putting the situation in perspective); (3) social networks; (4) positive interactions; (5) impression management (for example, managing displays of affection in public); and (6) social activism. This qualitative study describes the relational dynamics that help sustain relationships of couples that include male-to-female transsexual persons (MTF) and their natal female partners (NF) following disclosure of transsexualism. Relationship challenges and relationship maintenance activities are identified. Each partner in 17 MTF-NF couples participated in individual surveys and interviews. The data were coded for themes related to relationship challenges and activities. MTF-NF couples experience challenges within the contexts of their relationships and of society. These challenges include: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) public presentation. Relationship maintenance activities enabled the study couples to maintain and strengthen their relationships through these challenges. These activities include: (1) communication; (2) self-talk; (3) social networks; (4) positivity; (5) impression management; and (6) social activism. Via this report, psychiatric and mental health nurses can increase their therapeutic skills in working with MTF-NF couples. © 2010 Blackwell Publishing.

Regulatory T-cells in autoimmune diseases: challenges, controversies and--yet--unanswered questions.

PubMed

Grant, Charlotte R; Liberal, Rodrigo; Mieli-Vergani, Giorgina; Vergani, Diego; Longhi, Maria Serena

2015-02-01

Regulatory T cells (Tregs) are central to the maintenance of self-tolerance and tissue homeostasis. Markers commonly used to define human Tregs in the research setting include high expression of CD25, FOXP3 positivity and low expression/negativity for CD127. Many other markers have been proposed, but none unequivocally identifies bona fide Tregs. Tregs are equipped with an array of mechanisms of suppression, including the modulation of antigen presenting cell maturation and function, the killing of target cells, the disruption of metabolic pathways and the production of anti-inflammatory cytokines. Treg impairment has been reported in a number of human autoimmune conditions and includes Treg numerical and functional defects and conversion into effector cells in response to inflammation. In addition to intrinsic Treg impairment, resistance of effector T cells to Treg control has been described. Discrepancies in the literature are common, reflecting differences in the choice of study participants and the technical challenges associated with investigating this cell population. Studies differ in terms of the methodology used to define and isolate putative regulatory cells and to assess their suppressive function. In this review we outline studies describing Treg frequency and suppressive function in systemic and organ specific autoimmune diseases, with a specific focus on the challenges faced when investigating Tregs in these conditions. Copyright © 2014 Elsevier B.V. All rights reserved.

Coping behaviors among sexual minority female youth.

PubMed

Pendragon, Diane K

2010-01-01

This article summarizes data from a qualitative study investigating the ways in which female youth perceive and respond to challenges related to the interplay of late adolescence and a minority sexual orientation. Fifteen sexual minority females in late adolescence were interviewed individually and in focus groups. The interviews focused on participants' perceptions of challenges, the impact those stressors have in their lives, and methods they utilize to cope with them. The most common negative experiences reported were isolation, lack of acceptance, harassment, and violence. Sub-themes include: hearing negative messages about gender and sexual orientation, pressures to conform to a variety of cultural norms including gender norms, fears of future violence, and pressure to identify sexual orientation. Collectively, the participants described these negative consequences of experiences of heterosexism, sexism, and racism as their most difficult experiences. The most common responses to these stressors reported by participants were finding support in relationships, engaging in coping responses, pursuing education and activism, rebellion and resistance, and avoidance and deferment.

International neurosurgical volunteerism: a temporal, geographic, and thematic analysis of foundation for international education in neurological surgery volunteer reports.

PubMed

Sedney, Cara L; Siu, Jennifer; Rosseau, Gail; Dempsey, Robert; Bernstein, Mark

2014-12-01

To examine the experiences of volunteers of the Foundation for International Education in Neurological Surgery. A qualitative analysis of >150 volunteer reports from 2004-2013 was performed using grounded theory. Various themes were explored based on their occurrence in the reports. Volunteer reports of extended trips appeared to peak in 2009, with a heavy emphasis on activity in Africa. Prominent themes in the reports included volunteer contributions, successful strategies, challenges, and future directions. Volunteers demonstrated wide-ranging contributions. Successful strategies included continuity and collaboration with other organizations. Challenges were overwhelmingly related to equipment or infrastructure. Common suggestions for future directions included institutional collaboration and subspecialty development. Copyright © 2014 Elsevier Inc. All rights reserved.

The pain of chronic pancreatitis: a persistent clinical challenge

PubMed Central

2013-01-01

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

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

PubMed

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

2016-01-01

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

Challenges in pediatric ambulatory anesthesia: kids are different.

PubMed

Collins, Corey E; Everett, Lucinda L

2010-06-01

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

Successes, challenges and needs regarding rural health medical education in continental Central America: a literature review and narrative synthesis.

PubMed

Colon-Gonzalez, Maria C; El Rayess, Fadya; Guevara, Sara; Anandarajah, Gowri

2015-01-01

Central American countries, like many others, face a shortage of rural health physicians. Most medical schools in this region are located in urban areas and focus on tertiary care training rather than on community health or primary care, which are better suited for rural practice. However, many countries require young physicians to do community service in rural communities to address healthcare provider shortages. This study aimed to: (a) synthesize what is known about the current state of medical education preparing physicians for rural practice in this region, and (b) identify common needs, challenges and opportunities for improving medical education in this area. A comprehensive literature review was conducted between December 2013 and May 2014. The stepwise, reproducible search process included English and Spanish language resources from both data-based web search engines (PubMed, Web of Science/Web of Knowledge, ERIC and Google Scholar) and the grey literature. Search criteria included MeSH terms: 'medical education', 'rural health', 'primary care', 'community medicine', 'social service', in conjunction with 'Central America', 'Latin America', 'Mexico', 'Guatemala', 'Belize', 'El Salvador', 'Nicaragua', 'Honduras', 'Costa Rica' and 'Panama'. Articles were included in the review if they (1) were published after 1984; (2) focused on medical education for rural health, primary care, community health; and (3) involved the countries of interest. A narrative synthesis of the content of resources meeting inclusion criteria was done using qualitative research methods to identify common themes pertaining to the study goals. The search revealed 20 resources that met inclusion criteria. Only four of the 20 were research articles; therefore, information about this subject was primarily derived from expert opinion. Thematic analysis revealed the historical existence of several innovative programs that directly address rural medicine training needs, suggesting that expertise is present in this region. However, numerous challenges limit sustainability or expansion of successful programs. Common challenges include: (a) physicians' exposure to rural medicine primarily takes place during social service commitment time, rather than during formal medical training; (b) innovative educational programs are often not sustainable due to financial and leadership challenges; (c) the majority of physician manpower is in urban areas, resulting in few rural physician role models and teachers; and (d) there is insufficient collaboration to establish clinical and educational systems to meet rural health needs. Recurring suggestions for curricular changes include: (a) making primary care training a core component of medical school education; and (b) expanding medical school curricula in cross-cultural communication and social determinants of disease. Suggestions for health system changes include: (a) improving living and working conditions for rural physicians; and (b) establishing partnerships between educational, governmental and non-governmental organizations and rural community leadership, to promote rural health training and systems. Expertise in rural medicine and training exists in continental Central America. However, there are numerous challenges to improving medical education to meet the needs of rural communities. Overcoming these challenges will require creative solutions, new partnerships, and evaluation and dissemination of successful educational programs. There is a great need for further research on this topic.

Substance misuse prevention and economic analysis: challenges and opportunities regarding international utility.

PubMed

Guyll, Max; Spoth, Richard; Cornish, Marilyn A

2012-01-01

Economic analyses of substance misuse prevention assess the intervention cost necessary to achieve a particular outcome, and thereby provide an additional dimension for evaluating prevention programming. This article reviews several types of economic analysis, considers how they can be applied to substance misuse prevention, and discusses challenges to enhancing their international relevance, particularly their usefulness for informing policy decisions. Important first steps taken to address these challenges are presented, including the disease burden concept and the development of generalized cost-effectiveness, advances that facilitate international policy discussions by providing a common framework for evaluating health care needs and program effects.

Parallel Frames and Policy Narratives in Music Education and Physical Education

ERIC Educational Resources Information Center

Freer, Patrick K.

2012-01-01

The relationship between music education and physical education has often been portrayed as a competition for financial resources, student enrollment, instructional time, and community support. This article instead explores commonalities between the two disciplines, including their histories, curricular debates, shared concerns, mutual challenges,…

User Authentication and Authorization Challenges in a Networked Library Environment.

ERIC Educational Resources Information Center

Machovec, George S.

1997-01-01

Discusses computer user authentication and authorization issues when libraries need to let valid users access databases and information services without making the process too difficult for either party. Common solutions are explained, including filtering, passwords, and kerberos (cryptographic authentication scheme for secure use over public…

Functional data analysis: An approach for environmental ordination and matching discrete with continuous observations

EPA Science Inventory

Investigators are frequently confronted with data sets that include both discrete observations and extended time series of environmental data that had been collected by autonomous recorders. Evaluating the relationships between these two kinds of data is challenging. A common a...

Managing childhood chronic illness: parent perspectives and implications for parent-provider relationships.

PubMed

Kratz, Lyn; Uding, Nancy; Trahms, Cristine M; Villareale, Nanci; Kieckhefer, Gail M

2009-12-01

When children have special health care needs, parents assume the roles of care coordinator, medical expert, and systems advocate as well as their typical parenting roles. They face many challenges in managing their child's chronic condition in the context of everyday life. Health care providers are uniquely positioned to assist parents in meeting those challenges and to promote parent competency and confidence in their child's care. The data for this analysis were collected during classes for parents of children with chronic conditions who took part in a randomized controlled study of a curriculum's effectiveness. During facilitated discussions, parents discussed challenges they faced and generated strategies they found helpful. Qualitative data analysis revealed dominant themes across subject areas. Challenges included social isolation, strained relationships and ongoing frustrations with health care and educational systems. Helpful strategies focused on being prepared, connecting with peers, becoming an advocate, developing partnerships and caring for one's self. Implications for health care providers include: understanding common challenges parents face; promoting parent-to-parent connections; and building partnerships with parents and their children with special needs.

[Blood culture negative endocarditis: a diagnostic challenge].

PubMed

Wälli, F; Chuard, C; Regamey, C

2005-10-12

Blood culture negative endocarditis (BCNE) account for about 5% of all cases of endocarditis. Diagnosis and initiation of antimicrobial therapy may be delayed, with a negative impact on clinical outcome. The most common cause of BCNE is antimicrobial drug therapy before blood sampling. Other common causes include slow growing and non cultivable organisms. Identification of the etiologic agent is critical in the management of BCNE and molecular tools such as broad range 16SrRNA PCR technique followed by direct automated sequencing and microorganism-specific PCR are promising. Some authors have proposed to include these techniques among major Duke's criteria for the diagnosis of BCNE.

Congenital cystic neck masses: embryology and imaging appearances, with clinicopathological correlation.

PubMed

Gaddikeri, Santhosh; Vattoth, Surjith; Gaddikeri, Ramya S; Stuart, Royal; Harrison, Keith; Young, Daniel; Bhargava, Puneet

2014-01-01

Congenital cystic masses of the neck are uncommon and can present in any age group. Diagnosis of these lesions can be sometimes challenging. Many of these have characteristic locations and imaging findings. The most common of all congenital cystic neck masses is the thyroglossal duct cyst. The other congenital cystic neck masses are branchial cleft cyst, cystic hygroma (lymphangioma), cervical thymic and bronchogenic cysts, and the floor of the mouth lesions including dermoid and epidermoid cysts. In this review, we illustrate the common congenital cystic neck masses including embryology, clinical findings, imaging features, and histopathological findings. Copyright © 2014 Elsevier, Inc. All rights reserved.

Occupational asthma due to turpentine in art painter--case report.

PubMed

Dudek, Wojciech; Wittczak, Tomasz; Swierczyńska-Machura, Dominika; Walusiak-Skorupa, Jolanta; Pałczyński, Cezary

2009-01-01

Turpentine is a fluid obtained by distillation of wood resins containing mixture of terpens. It can act as an irritant and sensitiser. Most common health problem among workers exposed to turpentine is contact dermatitis. Little is know about turpentine to cause type I hypersensitivity reaction. We present a case of a 27-year old art painter using turpentine as a thinner for oil-based paints. She developed asthmatic reactions after 5 years of working with turpentine. A number of clinical procedures were performed, including clinical examination, routine laboratory tests, total serum IgE, skin prick tests to common aeroallergens, metal salts, oil-based paints and balsamic turpentine, resting spirometry test, histamine challenge, and a single-blind, placebo-controlled specific inhalation challenge with balsamic turpentine. Clinical findings and laboratory test results were normal but a significant bronchial hyperreactivity was found. During the specific challenge, dyspnoea and decreased forced expiratory volume (FEV1) were observed in late phase of asthmatic reaction. An increased proportion of eosinophils in induced sputum could also be noted 24 h after the challenge. Positive clinical response to the specific challenge as well as the morphological changes found in induced sputum served as the basis for diagnosing occupational asthma. To our knowledge, this is the first well-documented case of turpentine-induced occupational asthma.

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

Brouillette, Greg A.

These are slides for various presentations on C41SR and urban disasters disasters response and recovery tools. These are all mainly charts and images of disaster response and recovery tools. Slides included have headings such as the following: vignette of a disaster response, situational awareness and common operating picture available to EOC, plume modeling capability, Program ASPECT Chemical Response Products, EPA ASPECT - Hurricane RITA Response 9/25/2005, Angel Fire Imagery, incident commander's view/police chief's view/ EMS' view, common situational awareness and collaborative planning, exercise, training capability, systems diagram, Austere Challenge 06 Sim/C4 Requirements, common situational awareness and collaborative planning, exercise, trainingmore » environment, common situational awareness, real world, crisis response, and consequence management.« less

Munchausen syndrome by proxy: ongoing clinical challenges.

PubMed

Squires, Janet E; Squires, Robert H

2010-09-01

In 1977, Roy Meadow, a pediatric nephrologist, first described a condition he subsequently coined Munchausen syndrome by proxy. The classic form involves a parent or other caregiver who inflicts injury or induces illness in a child, deceive the treating physician with fictitious or exaggerated information, and perpetrate the trick for months or years. A related form of pathology is more insidious and more common but also damaging. It involves parents who fabricate or exaggerate symptoms of illness in children, causing overly aggressive medical evaluations and interventions. The common thread is that the treating physician plays a role in inflicting the abuse upon the child. Failure to recognize the problem is common because the condition is often not included in the differential diagnosis of challenging or confusing clinical problems. We believe that a heightened "self-awareness" of the physician's role in Munchausen syndrome by proxy will prevent or reduce the morbidity and mortality associated with this diagnosis. In addition, we believe contemporary developments within the modern health care system likely facilitate this condition.

Ethics of Social Media Research: Common Concerns and Practical Considerations

PubMed Central

Goniu, Natalie; Moreno, Peter S.; Diekema, Douglas

2013-01-01

Abstract Social media Websites (SMWs) are increasingly popular research tools. These sites provide new opportunities for researchers, but raise new challenges for Institutional Review Boards (IRBs) that review these research protocols. As of yet, there is little-to-no guidance regarding how an IRB should review the studies involving SMWs. The purpose of this article was to review the common risks inherent in social media research and consider how researchers can consider these risks when writing research protocols. We focused this article on three common research approaches: observational research, interactive research, and survey/interview research. Concomitant with these research approaches, we gave particular attention to the issues pertinent to SMW research, including privacy, consent, and confidentiality. After considering these challenges, we outlined key considerations for both researchers and reviewers when creating or reviewing SMW IRB protocols. Our goal in this article was to provide a detailed examination of relevant ethics and regulatory issues for both researchers and those who review their protocols. PMID:23679571

Ethics of social media research: common concerns and practical considerations.

PubMed

Moreno, Megan A; Goniu, Natalie; Moreno, Peter S; Diekema, Douglas

2013-09-01

Social media Websites (SMWs) are increasingly popular research tools. These sites provide new opportunities for researchers, but raise new challenges for Institutional Review Boards (IRBs) that review these research protocols. As of yet, there is little-to-no guidance regarding how an IRB should review the studies involving SMWs. The purpose of this article was to review the common risks inherent in social media research and consider how researchers can consider these risks when writing research protocols. We focused this article on three common research approaches: observational research, interactive research, and survey/interview research. Concomitant with these research approaches, we gave particular attention to the issues pertinent to SMW research, including privacy, consent, and confidentiality. After considering these challenges, we outlined key considerations for both researchers and reviewers when creating or reviewing SMW IRB protocols. Our goal in this article was to provide a detailed examination of relevant ethics and regulatory issues for both researchers and those who review their protocols.

Arthropod-borne bacterial diseases in pregnancy.

PubMed

Dotters-Katz, Sarah K; Kuller, Jeffrey; Heine, R Phillips

2013-09-01

Arthropod-borne bacterial diseases affect more than 25,000 Americans every year and thousands more around the world. These infections present a diagnostic dilemma for clinicians because they mimic many other pathologic conditions and are often low on or absent from the differential diagnosis list. Diagnosis is particularly challenging during pregnancy, as these infections may mimic common pregnancy-specific conditions, such as typical and atypical preeclampsia, or symptoms of pregnancy itself. Concerns regarding the safety in pregnancy of some indicated antibiotics add a therapeutic challenge for the prescriber, requiring knowledge of alternative therapeutic options for many arthropod-borne bacterial diseases. Physicians, especially those in endemic areas, must keep this class of infections in mind, particularly when the presentation does not appear classic for more commonly seen conditions. This article discusses presentation, diagnosis, and treatment of the most common of these arthropod-borne bacterial diseases, including Lyme disease, Rocky Mountain spotted fever, tick-borne relapsing fever, typhus, plague, cat-scratch disease, and Carrión disease.

Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies.

PubMed

Norman, Gregory J; Orton, Kristann; Wade, Amy; Morris, Andrea M; Slaboda, Jill C

2018-01-27

Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide cost-effective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S. Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S. geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC. Six practices varying in size, care team composition and location agreed to participate. At each site we conducted unstructured interviews with key informants and directly observed practices and procedures in the field and back office. The aggregated case studies revealed important issues focused on team composition, patient characteristics, use of technology and urgent care delivery. Common challenges across the practices included provider retention and unmet community demand for home-based care services. Most practices, regardless of size, faced challenges around using electronic medical records (EMRs) and scheduling systems not designed for use in a mobile practice. Although many practices offered urgent care, practices varied in the methods used to provide care including the use of community paramedics and telehealth technology. Learnings compiled from these observations can inform other HBPC practices as to potential best practices that can be implemented in an effort to improve efficiency and scalability of HBPC so that seniors with multiple chronic conditions can receive comprehensive primary care services in their homes.

Item Response Modeling of Multivariate Count Data with Zero Inflation, Maximum Inflation, and Heaping

ERIC Educational Resources Information Center

Magnus, Brooke E.; Thissen, David

2017-01-01

Questionnaires that include items eliciting count responses are becoming increasingly common in psychology. This study proposes methodological techniques to overcome some of the challenges associated with analyzing multivariate item response data that exhibit zero inflation, maximum inflation, and heaping at preferred digits. The modeling…

Collaborative Outcome Measurement: Development of the Nationally Standardized Minimum Data Set

ERIC Educational Resources Information Center

Stephens, Barry C.; Kirchner, Corinne; Orr, Alberta L.; Suvino, Dawn; Rogers, Priscilla

2009-01-01

This article discusses the challenging process of developing a common data set for independent living programs serving older adults who are visually impaired. The three-year project, which included collaborative efforts among many stakeholders that encompass diverse program models, resulted in the development of the Internet-based Nationally…

Classroom Management Idea Book. ICE No. M0088

ERIC Educational Resources Information Center

Peace Corps, 2008

2008-01-01

This book was written in response to feedback from volunteer teachers who feel that the time spent dealing with classroom management issues detracts from the time they spend actually teaching the content. Volunteers and staff members provided practical strategies for dealing with the most commonly reported challenges. Chapters include teaching in…

Dietary Management of Attention Deficit Disorder.

ERIC Educational Resources Information Center

Dengate, Sue

1997-01-01

Claims early studies of diet and ADHD focused irrelevantly on sugar, failing to sufficiently eliminate problem-causing foods, include parental observations, and adequately rate common symptoms. Asserts that recent studies show additive-free diets alone are of little benefit, that a low-chemical elimination diet followed by challenges can identify…

76 FR 17658 - National Forum for State and Territorial Chief Executives (National Forum) Program Cooperative...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

... governors and their senior health policy advisors, including addressing the needs of uninsured, underinsured... addressing similar health policy challenges. A 1-year extension with funds will allow the National Forum to facilitate ongoing communication on emerging strategies addressing common priorities, public health policy...

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

PubMed Central

King, Rauni Prittinen

2015-01-01

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

Infection control for norovirus

PubMed Central

Barclay, L.; Park, G. W.; Vega, E.; Hall, A.; Parashar, U.; Vinjé, J.; Lopman, B.

2015-01-01

Norovirus infections are notoriously difficult to prevent and control, owing to their low infectious dose, high shedding titre, and environmental stability. The virus can spread through multiple transmission routes, of which person-to-person and foodborne are the most important. Recent advances in molecular diagnostics have helped to establish norovirus as the most common cause of sporadic gastroenteritis and the most common cause of outbreaks of acute gastroenteritis across all ages. In this article, we review the epidemiology and virology of noroviruses, and prevention and control guidelines, with a focus on the principles of disinfection and decontamination. Outbreak management relies on sound infection control principles, including hand hygiene, limiting exposure to infectious individuals, and thorough environmental decontamination. Ideally, all infection control recommendations would rely on empirical evidence, but a number of challenges, including the inability to culture noroviruses in the laboratory and the challenges of outbreak management in complex environments, has made it difficult to garner clear evidence of efficacy in certain areas of infection control. New experimental data on cultivable surrogates for human norovirus and on environmental survivability and relative resistance to commonly used disinfectants are providing new insights for further refinining disinfection practices. Finally, clinical trials are underway to evaluate the efficacy of vaccines, which may shift the current infection control principles to more targeted interventions. PMID:24813073

Teaching Real Data Interpretation with Models (TRIM): Analysis of Student Dialogue in a Large-Enrollment Cell and Developmental Biology Course

PubMed Central

Zagallo, Patricia; Meddleton, Shanice; Bolger, Molly S.

2016-01-01

We present our design for a cell biology course to integrate content with scientific practices, specifically data interpretation and model-based reasoning. A 2-yr research project within this course allowed us to understand how students interpret authentic biological data in this setting. Through analysis of written work, we measured the extent to which students’ data interpretations were valid and/or generative. By analyzing small-group audio recordings during in-class activities, we demonstrated how students used instructor-provided models to build and refine data interpretations. Often, students used models to broaden the scope of data interpretations, tying conclusions to a biological significance. Coding analysis revealed several strategies and challenges that were common among students in this collaborative setting. Spontaneous argumentation was present in 82% of transcripts, suggesting that data interpretation using models may be a way to elicit this important disciplinary practice. Argumentation dialogue included frequent co-construction of claims backed by evidence from data. Other common strategies included collaborative decoding of data representations and noticing data patterns before making interpretive claims. Focusing on irrelevant data patterns was the most common challenge. Our findings provide evidence to support the feasibility of supporting students’ data-interpretation skills within a large lecture course. PMID:27193288

Hydrogen sulfide deactivates common nitrobenzofurazan-based fluorescent thiol labeling reagents.

PubMed

Montoya, Leticia A; Pluth, Michael D

2014-06-17

Sulfhydryl-containing compounds, including thiols and hydrogen sulfide (H2S), play important but differential roles in biological structure and function. One major challenge in separating the biological roles of thiols and H2S is developing tools to effectively separate the reactivity of these sulfhydryl-containing compounds. To address this challenge, we report the differential responses of common electrophilic fluorescent thiol labeling reagents, including nitrobenzofurazan-based scaffolds, maleimides, alkylating agents, and electrophilic aldehydes, toward cysteine and H2S. Although H2S reacted with all of the investigated scaffolds, the photophysical response to each scaffold was significantly different. Maleimide-based, alkylating, and aldehydic thiol labeling reagents provided a diminished fluorescence response when treated with H2S. By contrast, nitrobenzofurazan-based labeling reagents were deactivated by H2S addition. Furthermore, the addition of H2S to thiol-activated nitrobenzofurazan-based reagents reduced the fluorescence signal, thus establishing the incompatibility of nitrobenzofurazan-based thiol labeling reagents in the presence of H2S. Taken together, these studies highlight the differential reactivity of thiols and H2S toward common thiol-labeling reagents and suggest that sufficient care must be taken when labeling or measuring thiols in cellular environments that produce H2S due to the potential for both false-positive and eroded responses.

Ethical genetic research in Indigenous communities: challenges and successful approaches.

PubMed

McWhirter, Rebekah E; Mununggirritj, Djapirri; Marika, Dipililnga; Dickinson, Joanne L; Condon, John R

2012-12-01

Indigenous populations, in common with all populations, stand to benefit from the potential of genetic research to lead to improvements in diagnostic and therapeutic tools for a wide range of complex diseases. However, many Indigenous communities, especially ones that are isolated, are not included in genetic research efforts. This situation is largely a consequence of the challenges of ethically conducting genetic research in Indigenous communities and compounded by Indigenous peoples' negative past experiences with genetic issues. To examine ways of addressing these challenges, we review one investigation of a cancer cluster in remote Aboriginal communities in Arnhem Land, Australia. Our experiences demonstrate that genetic research can be both ethically and successfully conducted with Indigenous communities by respecting the authority of the community, involving community members, and including regular community review throughout the research process. Copyright © 2012 Elsevier Ltd. All rights reserved.

Challenges to effective crisis management: using information and communication technologies to coordinate emergency medical services and emergency department teams.

PubMed

Reddy, Madhu C; Paul, Sharoda A; Abraham, Joanna; McNeese, Michael; DeFlitch, Christopher; Yen, John

2009-04-01

The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

Structured literature review of responses of cattle to viral and bacterial pathogens causing bovine respiratory disease complex.

PubMed

Grissett, G P; White, B J; Larson, R L

2015-01-01

Bovine respiratory disease (BRD) is an economically important disease of cattle and continues to be an intensely studied topic. However, literature summarizing the time between pathogen exposure and clinical signs, shedding, and seroconversion is minimal. A structured literature review of the published literature was performed to determine cattle responses (time from pathogen exposure to clinical signs, shedding, and seroconversion) in challenge models using common BRD viral and bacterial pathogens. After review a descriptive analysis of published studies using common BRD pathogen challenge studies was performed. Inclusion criteria were single pathogen challenge studies with no treatment or vaccination evaluating outcomes of interest: clinical signs, shedding, and seroconversion. Pathogens of interest included: bovine viral diarrhea virus (BVDV), bovine herpesvirus type 1 (BHV-1), parainfluenza-3 virus, bovine respiratory syncytial virus, Mannheimia haemolytica, Mycoplasma bovis, Pastuerella multocida, and Histophilus somni. Thirty-five studies and 64 trials were included for analysis. The median days to the resolution of clinical signs after BVDV challenge was 15 and shedding was not detected on day 12 postchallenge. Resolution of BHV-1 shedding resolved on day 12 and clinical signs on day 12 postchallenge. Bovine respiratory syncytial virus ceased shedding on day 9 and median time to resolution of clinical signs was on day 12 postchallenge. M. haemolytica resolved clinical signs 8 days postchallenge. This literature review and descriptive analysis can serve as a resource to assist in designing challenge model studies and potentially aid in estimation of duration of clinical disease and shedding after natural pathogen exposure. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Mining High-Dimensional Data

NASA Astrophysics Data System (ADS)

Wang, Wei; Yang, Jiong

With the rapid growth of computational biology and e-commerce applications, high-dimensional data becomes very common. Thus, mining high-dimensional data is an urgent problem of great practical importance. However, there are some unique challenges for mining data of high dimensions, including (1) the curse of dimensionality and more crucial (2) the meaningfulness of the similarity measure in the high dimension space. In this chapter, we present several state-of-art techniques for analyzing high-dimensional data, e.g., frequent pattern mining, clustering, and classification. We will discuss how these methods deal with the challenges of high dimensionality.

Introduction to the Special Issue: Challenges and Solutions to Implementing Effective Reading Intervention in Schools.

PubMed

Foorman, Barbara

2016-12-01

This special issue focuses on challenges and solutions to implementing effective reading intervention in schools in the United States. Researchers often develop interventions that prove effective in efficacy studies but then show no impact when implemented at scale in public school settings. The authors of the intervention studies presented here describe a number of common implementation problems stemming from research in primary grades, middle grades, and high schools. Solutions to these implementation problems include establishing researcher-practitioner partnerships to address the systems-level challenges, suggestions for how to obtain buy-in from teachers, and recommendations for reforming preservice and in-service teacher education. © 2016 Wiley Periodicals, Inc.

Methodological Challenges in Physical Activity Research with Older Adults

PubMed Central

Chase, Jo-Ana D.

2015-01-01

The aging adult population is growing, as well as the incidence of chronic illness among older adults. Physical activity has been demonstrated in the literature to be a beneficial component of self-management for chronic illnesses commonly found in the older adult population. Health sciences research seeks to develop new knowledge, practices, and policies that may benefit older adults’ management of chronic illness and quality of life. However, research with the older adult population, though beneficial, includes potential methodological challenges specific to this age group. This article discusses common methodological issues in research among older adults, with a focus on physical activity intervention studies. Awareness and understanding of these issues may facilitate future development of research studies devoted to the aging adult population, through appropriate modification and tailoring of sampling techniques, intervention development, and data measures and collection. PMID:21821726

Two complementary personal medication management applications developed on a common platform: case report.

PubMed

Ross, Stephen E; Johnson, Kevin B; Siek, Katie A; Gordon, Jeffry S; Khan, Danish U; Haverhals, Leah M

2011-07-12

Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs. Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet). The applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC. We created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children. These prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.

The diverse landscape of palliative care clinics.

PubMed

Smith, Alexander K; Thai, Julie N; Bakitas, Marie A; Meier, Diane E; Spragens, Lynn H; Temel, Jennifer S; Weissman, David E; Rabow, Michael W

2013-06-01

Many health care organizations are interested in instituting a palliative care clinic. However, there are insufficient published data regarding existing practices to inform the development of new programs. Our objective was to obtain in-depth information about palliative care clinics. We conducted a cross-sectional survey of 20 outpatient palliative care practices in diverse care settings. The survey included both closed- and open-ended questions regarding practice size, utilization of services, staffing, referrals, services offered, funding, impetus for starting, and challenges. Twenty of 21 (95%) practices responded. Practices self-identified as: hospital-based (n=7), within an oncology division/cancer center (n=5), part of an integrated health system (n=6), and hospice-based (n=2). The majority of referred patients had a cancer diagnosis. Additional common diagnoses included chronic obstructive pulmonary disease, neurologic disorders, and congestive heart failure. All practices ranked "pain management" and "determining goals of care" as the most common reasons for referrals. Twelve practices staffed fewer than 5 half-days of clinic per week, with 7 operating only one half-day per week. Practices were staffed by a mixture of physicians, advanced practice nurses or nurse practitioners, nurses, or social workers. Eighteen practices expected their practice to grow within the next year. Eleven practices noted a staffing shortage and 8 had a wait time of a week or more for a new patient appointment. Only 12 practices provide 24/7 coverage. Billing and institutional support were the most common funding sources. Most practices described starting because inpatient palliative providers perceived poor quality outpatient care in the outpatient setting. The most common challenges included: funding for staffing (11) and being overwhelmed with referrals (8). Once established, outpatient palliative care practices anticipate rapid growth. In this context, outpatient practices must plan for increased staffing and develop a sustainable financial model.

3-D Teaching Models for All

ERIC Educational Resources Information Center

Bradley, Joan; Farland-Smith, Donna

2010-01-01

Allowing a student to "see" through touch what other students see through a microscope can be a challenging task. Therefore, author Joan Bradley created three-dimensional (3-D) models with one student's visual impairment in mind. They are meant to benefit all students and can be used to teach common high school biology topics, including the…

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

ERIC Educational Resources Information Center

McCown, Margaret Averill; Thomason, Gina B.

2014-01-01

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

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.

CCSSM Challenge: Graphing Ratio and Proportion

ERIC Educational Resources Information Center

Kastberg, Signe E.; D'Ambrosio, Beatriz S.; Lynch-Davis, Kathleen; Mintos, Alexia; Krawczyk, Kathryn

2013-01-01

A renewed emphasis was placed on ratio and proportional reasoning in the middle grades in the Common Core State Standards for Mathematics (CCSSM). The expectation for students includes the ability to not only compute and then compare and interpret the results of computations in context but also interpret ratios and proportions as they are…

Engineering for Sustainable Development and the Common Good

ERIC Educational Resources Information Center

Kelly, William E.

2006-01-01

In 1994, the American Society of Civil Engineers (ASCE) updated its Code of Ethics to include specific statements on sustainable development and at about the same time, 1994, ASCE adopted its Policy 418 on sustainable development. Sustainable development as defined by ASCE "is the challenge of meeting human needs for natural resources, industrial…

Blended Online Learning in Initial Teacher Education: A Professional Inquiry into Pre-Service Teachers' Inquiry Projects

ERIC Educational Resources Information Center

Hunt, Anne-Marie

2015-01-01

Online and blended learning bring opportunities and challenges, including more opportunities for authentic activities (Gikandi, Morrow, & Davis, 2011). Blended online environments are now a common mode for pre-service teacher education, providing interesting opportunities to develop and showcase alternative approaches that blend with practice…

Counterterrorism: U.S. Agencies Face Challenges Countering the Use of Improvised Explosive Devices in the Afghanistan/Pakistan Region

DTIC Science & Technology

2012-07-12

make IEDs. According to DOD, other products available in Pakistan—such as potassium chlorate , used in making matches, and urea, another commonly used...IED precursor chemicals. According to State officials, other substitutes for CAN, including potassium chlorate and urea, are exported by countries

Good Questions: Great Ways to Differentiate Mathematics Instruction. Second Edition

ERIC Educational Resources Information Center

Small, Marian

2012-01-01

Expanded to include connections to Common Core State Standards, as well as National Council of Teachers of Mathematics (NCTM) standards, this critically acclaimed book will help every teacher and coach to meet the challenges of differentiating mathematics instruction in the K-8 classroom. In this bestseller, math education expert Marian Small…

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

ERIC Educational Resources Information Center

Kezar, Adrianna, Ed.

2012-01-01

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

Treatments for common psychiatric conditions among adults during acute, rehabilitation, and reintegration phases.

PubMed

Difede, Joann; Cukor, Judith; Lee, Francis; Yurt, Roger

2009-12-01

Common and pernicious adult psychiatric disorders consequent to burn injury include post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and new-onset substance abuse disorder. Diagnosing and treating these disorders is complicated by the complex psychosocial issues associated with burns including grief, pain, role impairment, disfigurement, dysfunction, stigma, as well as financial and legal issues. Additionally, pre-morbid psychiatric and neurological illnesses are risk factors for burns, adding to the challenge of diagnosis and treatment. This article will focus on the diagnosis and treatment of PTSD and MDD consequent to burn trauma, as these are the major psychiatric outcomes, addressing the attendant psychosocial problems as threads in this post-trauma tapestry.

Capturing the post-exertional exacerbation of fatigue following physical and cognitive challenge in patients with chronic fatigue syndrome.

PubMed

Keech, Andrew; Sandler, Carolina X; Vollmer-Conna, Ute; Cvejic, Erin; Lloyd, Andrew R; Barry, Benjamin K

2015-12-01

To design and validate an instrument to capture the characteristic post-exertional exacerbation of fatigue in patients with chronic fatigue syndrome (CFS). Firstly, patients with CFS (N=19) participated in five focus group discussions to jointly explore the nature of fatigue and dynamic changes after activity, and inform development of a self-report instrument - the Fatigue and Energy Scale (FES). The psychometric properties of the FES were then examined in two case-control challenge studies: a physically-demanding challenge (moderate-intensity aerobic exercise; N=10 patients), and a cognitively-demanding challenge (simulated driving; N=11 patients). Finally, ecological validity was evaluated by recording in association with tasks of daily living (N=9). Common descriptors for fatigue included 'exhaustion', 'tiredness', 'drained of energy', 'heaviness in the limbs', and 'foggy in the head'. Based on the qualitative data, fatigue was conceptualised as consisting of 'physical' and 'cognitive' dimensions. Analysis of the psychometric properties of the FES showed good sensitivity to the changing symptoms during a post-exertional exacerbation of fatigue following both physical exercise and driving simulation challenges, as well as tasks of daily living. The 'fatigue' experienced by patients with CFS covers both physical and cognitive components. The FES captured the phenomenon of a post-exertional exacerbation of fatigue commonly reported by patients with CFS. The characteristics of the symptom response to physical and cognitive challenges were similar. Both the FES and the challenge paradigms offer key tools to reliably investigate biological correlates of the dynamic changes in fatigue. Copyright © 2015 Elsevier Inc. All rights reserved.

Management of familial benign chronic pemphigus

PubMed Central

Arora, Harleen; Bray, Fleta N; Cervantes, Jessica; Falto Aizpurua, Leyre A

2016-01-01

Benign familial chronic pemphigus or Hailey–Hailey disease is caused by an autosomal dominant mutation in the ATP2C1 gene leading to suprabasilar acantholysis. The disease most commonly affects intertriginous areas symmetrically. The chronic nature of the disease and multiple recurrences make the disease bothersome for patients and a treatment challenge for physicians. Treatments include topical and/or systemic agents and surgery including laser. This review summarizes the available treatment options. PMID:27695354

Acanthamoeba: An Overview of the Challenges to the Development of a Consensus Methodology of Disinfection Efficacy Testing for Contact Lens Care Products.

PubMed

Brocious, Jeffrey; Tarver, Michelle E; Hampton, Denise; Eydelman, Malvina

2018-04-24

With the increasing incidence of more pathogens that can cause microbial keratitis (MK), it is necessary to periodically reassess disinfection multipurpose solutions testing requirements to ensure that relevant organisms to challenge them are being used. Current testing protocols have included common pathogens such as Pseudomonas aeruginosa, Staphylococcus aureus, Serratia marcescens, Candida albicans, and Fusarium solani but have omitted less common pathogens such as Acanthamoeba. Specifically, Acanthamoeba sp. has recently been identified as a prevalent cause of MK in certain countries. Developing an appropriate protocol for this unique organism presents a challenge, given its two distinct life stages, methods to grow the organism, encystment techniques, and many other parameters that can affect testing outcomes. Therefore, the appropriate combination of these parameters is crucial to developing a protocol that ensures consistent, accurate results. The FDA has recognized the importance of establishing a standardized testing protocol for this pathogen and embarked on research efforts to provide a recommended testing protocol for testing contact lens care products.

The benefits and challenges of using computer-assisted symptom assessments in oncology clinics: results of a qualitative assessment.

PubMed

Mark, Tami L; Johnson, Gina; Fortner, Barry; Ryan, Katheryn

2008-10-01

Developed for clinical use in oncology settings, the Patient Assessment, Care & Education (PACE) System is a computer technology tool designed to address the under-identification and treatment of chemotherapy-related symptoms. This system includes general core questions together with the Patient Care Monitor (PCM), a validated questionnaire that assesses patient-reported problems, six symptom burden indices, and one global quality of life index. The system automatically scores the PCM and generates a written report. The objective of this study was to assess the manner in which clinicians use this system and identify the benefits and challenges that oncology clinics may face when adopting this system. The study was part of a larger evaluation of the system that included standardized surveys and chart review. Sixteen providers (physicians, nurses, and physician assistants) at 13 community oncology clinics participated in a 30-minute interview. Responses were coded according to common phrases or concepts. Clinicians indicated that they use the system mainly for symptom assessment or review of systems. The most common benefits identified included the improved ability to identify under-reported symptoms, enhanced communication with patients; increased efficiency; and its ability to highlight patients' most bothersome symptoms. Challenges included patient burden from the frequent need to answer the questionnaires, issues with the wording and formatting of the screening questionnaire, and technical difficulties. In sum, these interviews suggest that electronic symptom assessments offer potential advantages in terms improving the integration of routine assessment of patients' symptoms and health-related quality of life into the daily flow of an oncology clinic. The approach should receive additional research and development attention.

Implementing the community health worker model within diabetes management: challenges and lessons learned from programs across the United States.

PubMed

Cherrington, Andrea; Ayala, Guadalupe X; Amick, Halle; Allison, Jeroan; Corbie-Smith, Giselle; Scarinci, Isabel

2008-01-01

The purpose of this qualitative study was to examine methods of implementation of the community health worker (CHW) model within diabetes programs, as well as related challenges and lessons learned. Semi-structured interviews were conducted with program managers. Four databases (PubMed, CINAHL, ISI Web of Knowledge, PsycInfo), the CDC's 1998 directory of CHW programs, and Google Search Engine were used to identify CHW programs. Criteria for inclusion were: DM program; used CHW strategy; occurred in United States. Two independent reviewers performed content analyses to identify major themes and findings. Sixteen programs were assessed, all but 3 focused on minority populations. Most CHWs were recruited informally; 6 programs required CHWs to have diabetes. CHW roles and responsibilities varied across programs; educator was the most commonly identified role. Training also varied in terms of both content and intensity. All programs gave CHWs remuneration for their work. Common challenges included difficulties with CHW retention, intervention fidelity and issues related to sustainability. Cultural and gender issues also emerged. Examples of lessons learned included the need for community buy-in and the need to anticipate nondiabetes related issues. Lessons learned from these programs may be useful to others as they apply the CHW model to diabetes management within their own communities. Further research is needed to elucidate the specific features of this model necessary to positively impact health outcomes.

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

PubMed

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

2017-07-01

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

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

PubMed

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

2018-05-02

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

Citizenship, Community Mental Health, and the Common Good.

PubMed

Atterbury, Kendall; Rowe, Michael

2017-07-01

In this article, we address the issue of community mental health and the common good via an applied theory of citizenship to support the social inclusion, empowerment, and inclusion of persons diagnosed with psychiatric disorders. We begin by discussing citizenship, and the concept of the common good, in regard to historical conceptions of citizenship, including the historical exclusion of women, people of color, persons with mental illness, and others. We then review the development of our citizenship framework in response to the limitations of even the most innovative community mental health interventions, specifically the practice of mental health outreach to persons who are homeless. We review findings from three citizenship research studies - a community-level intervention, an individual- and group-level intervention, and development of an individual instrument of citizenship - along with brief comments on current citizenship research. We conclude with a discussion of the challenges of realizing both the individual and collective potential of, and challenges to, the citizenship framework in relation to current and future community mental health systems of care. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Developing a National-Level Concept Dictionary for EHR Implementations in Kenya.

PubMed

Keny, Aggrey; Wanyee, Steven; Kwaro, Daniel; Mulwa, Edwin; Were, Martin C

2015-01-01

The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL)/Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework developed by Bakhshi-Raiez et al. Technical and infrastructure-based approaches are also underway to streamline workflow for dictionary management and distribution across implementations. Kenya's approach on comprehensive common dictionary can serve as a model for other countries in similar settings.

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

PubMed

Elmusharaf, Khalifa; Byrne, Elaine; O'Donovan, Diarmuid

2015-09-08

Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

Obstacles to implementation of an intervention to improve surgical services in an Ethiopian hospital: a qualitative study of an international health partnership project.

PubMed

Aveling, Emma-Louise; Zegeye, Desalegn Tegabu; Silverman, Michael

2016-08-17

Access to safe surgical care represents a critical gap in healthcare delivery and development in many low- and middle-income countries, including Ethiopia. Quality improvement (QI) initiatives at hospital level may contribute to closing this gap. Many such quality improvement initiatives are carried out through international health partnerships. Better understanding of how to optimise quality improvement in low-income settings is needed, including through partnership-based approaches. Drawing on a process evaluation of an intervention to improve surgical services in an Ethiopian hospital, this paper offers lessons to help meet this need. We conducted a qualitative process evaluation of a quality improvement project which aimed to improve access to surgical services in an Ethiopian referral hospital through better management. Data was collected longitudinally and included: 66 in-depth interviews with surgical staff and project team members; observation (135 h) in the surgery department and of project meetings; project-related documentation. Thematic analysis, guided by theoretical constructs, focused on identifying obstacles to implementation. The project largely failed to achieve its goals. Key barriers related to project design, partnership working and the implementation context, and included: confusion over project objectives and project and partner roles and responsibilities; logistical challenges concerning overseas visits; difficulties in communication; gaps between the time and authority team members had and that needed to implement and engage other staff; limited strategies for addressing adaptive-as opposed to technical-challenges; effects of hierarchy and resource scarcity on QI efforts. While many of the obstacles identified are common to diverse settings, our findings highlight ways in which some features of low-income country contexts amplify these common challenges. We identify lessons for optimising the design and planning of quality improvement interventions within such challenging healthcare contexts, with specific reference to international partnership-based approaches. These include: the need for a funded lead-in phase to clarify and agree goals, roles, mutual expectations and communication strategies; explicitly incorporating adaptive, as well as technical, solutions; transparent management of resources and opportunities; leadership which takes account of both formal and informal power structures; and articulating links between project goals and wider organisational interests.

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

NASA Technical Reports Server (NTRS)

Sampson, Michael J.

2017-01-01

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

Delegation in Correctional Nursing Practice.

PubMed

Tompkins, Frances

2016-07-01

Correctional nurses face daily challenges as a result of their work environment. Common challenges include availability of resources for appropriate care delivery, negotiating with custody staff for access to patients, adherence to scope of practice standards, and working with a varied staffing mix. Professional correctional nurses must consider the educational backgrounds and competency of other nurses and assistive personnel in planning for care delivery. Budgetary constraints and varied staff preparation can be a challenge for the professional nurse. Adequate care planning requires understanding the educational level and competency of licensed and unlicensed staff. Delegation is the process of assessing patient needs and transferring responsibility for care to appropriately educated and competent staff. Correctional nurses can benefit from increased knowledge about delegation. © The Author(s) 2016.

Carbon Monitoring System Applications Framework: Lessons Learned from Stakeholder Engagement Activities

NASA Astrophysics Data System (ADS)

Sepulveda Carlo, E.; Escobar, V. M.; Delgado Arias, S.; Forgotson, C.

2017-12-01

The NASA Carbon Monitoring System initiated by U.S. Congress in 2010 is developing products that characterize and quantify carbon sources and sinks in the United States and the global tropics. In 2013, an applications effort was selected to engage potential end users and gather feedback about their data needs. For the past four years the CMS applications efforts has expanded and implemented a number of strategies to connect carbon scientists to decision-makers, contributing to the societal benefits of CMS data products. The applications efforts use crowd sourcing to collects feedback from stakeholders on challenges and lessons learned in the use of CMS data products. Some of the most common data needs from engaged organizations include above and below-ground biomass and fluxes in forestlands and wetlands, and greenhouse gas (GHG) emissions across all land use/cover and land use changes. Stakeholder organizations' needs for CMS data products support national GHG inventories following the Paris Agreement, carbon markets, and sub-national natural resources management and policies. The lessons learned report presents stakeholder specific applications, challenges, and successes from using CMS data products. To date, the most common uses of CMS products include: conservation efforts, emissions inventory, forestry and land cover applications, and carbon offset projects. The most common challenges include: the need for familiar and consistent products over time, budget constraints, and concern with uncertainty of modeled results. Recurrent recommendations from stakeholder indicate that CMS should provide high resolution (30m) and frequent data products updates (annually). The applications efforts have also helped identified success stories from different CMS projects, including the development of the GHG emissions inventory from Providence, RI, the improvement of the U.S. GHG Inventory though the use of satellite data, and the use of high resolution canopy cover maps for forestry, conservation, and ecosystem services applications in the tristate area of Maryland, Delaware and Pennsylvania. The presentation will discuss the applications framework methodology and strategy, as well as highlight some of the results and lessons learned from these applications efforts.

The Indian Vocational Education and Training (VET) System: Status, Challenges, and Options

ERIC Educational Resources Information Center

Kotamraju, Pradeep

2014-01-01

India is at the cusp of becoming an economic powerhouse. For that to happen, however, the country needs to alter its workforce education system by reengineering the Indian Vocational Education and Training (VET) System. India's VET strategy includes creating basic work-centered common curriculum for the unskilled; developing a more flexible and…

Tolerance and Liberty: Answering the Academic Left's Challenge to Homeschooling Freedom

ERIC Educational Resources Information Center

Farris, Michael

2013-01-01

Millions of children in the United States are educated in the home. Millions more receive their education from private institutions. For parents, a common reason for seeking alternatives to public education is the desire to ensure that they receive instruction in accord with their religious beliefs. In many cases, these beliefs include exclusive…

Overcoming Problems in Doctoral Writing through the Use of Visualisations: Telling Our Stories

ERIC Educational Resources Information Center

Barrett, Terry; Hussey, Jennie

2015-01-01

Doctoral students experience many challenges on the long journey towards completion. Common problems include: synthesising data, working at a conceptual level, clarifying the relationship of the parts of the thesis to the whole, finding a voice and completing a viva successfully. Few authors have addressed the use of visualisations to meet these…

Are Your Students Ready for Anatomy and Physiology? Developing Tools to Identify Students at Risk for Failure

ERIC Educational Resources Information Center

Gultice, Amy; Witham, Ann; Kallmeyer, Robert

2015-01-01

High failure rates in introductory college science courses, including anatomy and physiology, are common at institutions across the country, and determining the specific factors that contribute to this problem is challenging. To identify students at risk for failure in introductory physiology courses at our open-enrollment institution, an online…

Challenges in identifying and determining the impacts of infection with pestiviruses on the herd health of free ranging cervid populations

USDA-ARS?s Scientific Manuscript database

Although most commonly associated with the infection of domestic livestock, the replication of pestiviruses, in particular bovine viral diarrhea virus (BVDV), occurs in a wide range of free ranging cervids including white-tailed deer, mule deer, fallow deer, elk, red deer, roe deer, eland and moused...

Measures of Disadvantage: Is Car Ownership a Good Indicator?

ERIC Educational Resources Information Center

Johnson, Victoria; Currie, Graham; Stanley, Janet

2010-01-01

A need to better understand the multidimensional nature of disadvantage is leading to the adoption of a wider range of measurement variables. One variable now commonly adopted is zero car ownership. This paper challenges the logic of including "not having a car" as an indicator of disadvantage. It argues that this can distort the real picture of…

Campus Commons? What Faculty, Financial Officers and Others Think About Controlling College Costs

ERIC Educational Resources Information Center

Immerwahr, John; Johnson, Jean; Gasbarra, Paul

2009-01-01

There is emerging consensus that the United States faces major higher education challenges, including: (1) America's fall from first to tenth place internationally in the percentage of the population with higher education degrees at a time when the country faces increased global economic competition in a knowledge-intensive economy; (2) Education…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

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

The Relationship between Student Transfers and District Academic Performance: Accounting for Feedback Effects

ERIC Educational Resources Information Center

Welsch, David M.; Zimmer, David M.

2015-01-01

This paper draws attention to a subtle, but concerning, empirical challenge common in panel data models that seek to estimate the relationship between student transfers and district academic performance. Specifically, if such models have a dynamic element, and if the estimator controls for unobserved traits by including district-level effects,…

The Chicago Handbook for Teachers: A Practical Guide to the College Classroom.

ERIC Educational Resources Information Center

Brinkley, Alan; Dessants, Betty; Flamm, Michael; Fleming, Cynthia; Forcey, Charles; Rothschild, Eric

This book is designed to offer practical advice to beginning, as well as experienced, teachers of college courses on navigating many of the common challenges faced both in and outside the classroom. Chapters include "Getting Ready," which covers three discrete components of course design: deciding what you want students to learn, choosing…

Challenge and Change. Proceedings of the Annual Conference of the Commission of Professors of Adult Education (Nashville, Tennessee, November 4-5, 1994).

ERIC Educational Resources Information Center

Polson, Cheryl J., Ed.; Schied, Fred M., Ed.

This conference proceedings includes the following papers: "Professors of Adult Education, Colleges of Education, and the Transformation of the Research University" (Common); "The Future of Adult Education" (Wisniewski); "Adult Education's Prospects in a Post-University World" (Smith); "Whither the University--Whither Academic Adult Education?"…

Neuromolecular responses to social challenge: common mechanisms across mouse, stickleback fish, and honey bee.

PubMed

Rittschof, Clare C; Bukhari, Syed Abbas; Sloofman, Laura G; Troy, Joseph M; Caetano-Anollés, Derek; Cash-Ahmed, Amy; Kent, Molly; Lu, Xiaochen; Sanogo, Yibayiri O; Weisner, Patricia A; Zhang, Huimin; Bell, Alison M; Ma, Jian; Sinha, Saurabh; Robinson, Gene E; Stubbs, Lisa

2014-12-16

Certain complex phenotypes appear repeatedly across diverse species due to processes of evolutionary conservation and convergence. In some contexts like developmental body patterning, there is increased appreciation that common molecular mechanisms underlie common phenotypes; these molecular mechanisms include highly conserved genes and networks that may be modified by lineage-specific mutations. However, the existence of deeply conserved mechanisms for social behaviors has not yet been demonstrated. We used a comparative genomics approach to determine whether shared neuromolecular mechanisms could underlie behavioral response to territory intrusion across species spanning a broad phylogenetic range: house mouse (Mus musculus), stickleback fish (Gasterosteus aculeatus), and honey bee (Apis mellifera). Territory intrusion modulated similar brain functional processes in each species, including those associated with hormone-mediated signal transduction and neurodevelopment. Changes in chromosome organization and energy metabolism appear to be core, conserved processes involved in the response to territory intrusion. We also found that several homologous transcription factors that are typically associated with neural development were modulated across all three species, suggesting that shared neuronal effects may involve transcriptional cascades of evolutionarily conserved genes. Furthermore, immunohistochemical analyses of a subset of these transcription factors in mouse again implicated modulation of energy metabolism in the behavioral response. These results provide support for conserved genetic "toolkits" that are used in independent evolutions of the response to social challenge in diverse taxa.

Cranberries and lower urinary tract infection prevention

PubMed Central

Hisano, Marcelo; Bruschini, Homero; Nicodemo, Antonio Carlos; Srougi, Miguel

2012-01-01

Lower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials. PMID:22760907

Nutritionally enhanced rice to combat malnutrition disorders of the poor.

PubMed

Potrykus, Ingo

2003-06-01

Major deficiency disorders, including vitamin A deficiency, are especially common in countries in which rice is the staple food. In response to the devastating effects of vitamin A deficiency, which may include blindness and, even death, "Golden Rice" has been developed to deliver this nutrient to those populations who need it most. The case of Golden Rice is used to demonstrate the challenges of radical GMO opposition, consumer acceptance, and regulation of biotechnology-derived foods.

Challenges to Common Core State Standards Implementation: Views from Six States

ERIC Educational Resources Information Center

Smith, Joanna; Thier, Michael

2017-01-01

The implementation of the Common Core State Standards has posed a number of challenges for school leaders. This study applies a policy implementation conceptual framework to analyze data gathered from 46 interviews in six states. Findings suggest the existence of multiple barriers to Common Core State Standards implementation. To promote…

Strategies to Address Common Challenges When Teaching in an Active Learning Classroom

ERIC Educational Resources Information Center

Petersen, Christina I.; Gorman, Kristen S.

2014-01-01

This chapter provides practical strategies for addressing common challenges that arise for teachers in active learning classrooms. Our strategies come from instructors with experience teaching in these environments.

Evaluation and treatment of failed shoulder instability procedures.

PubMed

Ho, Anthony G; Gowda, Ashok L; Michael Wiater, J

2016-09-01

Management of the unstable shoulder after a failed stabilization procedure can be difficult and challenging. Detailed understanding of the native shoulder anatomy, including its static and dynamic restraints, is necessary for determining the patient's primary pathology. In addition, evaluation of the patient's history, physical exam, and imaging is important for identifying the cause for failure after the initial procedure. Common mistakes include under-appreciation of bony defects, failure to recognize capsular laxity, technical errors, and missed associated pathology. Many potential treatment options exist for revision surgery, including open or arthroscopic Bankart repair, bony augmentation procedures, and management of Hill Sachs defects. The aim of this narrative review is to discuss in-depth the common risk factors for post-surgical failure, components for appropriate evaluation, and the different surgical options available for revision stabilization. Level of evidence Level V.

Tuberculosis among nonimmigrant visitors to US Military installations.

PubMed

Aaron, Christopher L; Fotinos, Meletios J; West, Kevin B; Goodwin, Donald J; Mancuso, James D

2013-03-01

Nonimmigrant visitors are not required to be evaluated for tuberculosis (TB) before entering the country. Little literature exists describing the challenges of TB control among this demographic. This report reviews the challenges in managing TB in this population on U.S. military installations. Six cases were identified from reportable medical event reports. Information was obtained from public health personnel via phone interviews. Verified cases from 2004 to 2011 were included. Challenges were congruent among locations including: lack of procedures to screen for infection and disease among individuals at time of entry allowing one case to be admitted with acquired immunodeficiency syndrome and another concurrently on treatment for active TB; delays in the diagnosis of active TB as median time from entry to diagnosis was 62 days; and the need to conduct an effective contact investigation as the mean contact index was 77 including 1 secondary case of active TB. These cases emphasize the need for screening for TB in visitors from high-risk countries at time of entry, prompt diagnosis and treatment if found, procedures for evaluation of contacts, and interjurisdictional cooperation in large contact investigations. These challenges are common to nonimmigrants in both military and civilian settings. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network.

PubMed

Sperber, Nina R; Carpenter, Janet S; Cavallari, Larisa H; J Damschroder, Laura; Cooper-DeHoff, Rhonda M; Denny, Joshua C; Ginsburg, Geoffrey S; Guan, Yue; Horowitz, Carol R; Levy, Kenneth D; Levy, Mia A; Madden, Ebony B; Matheny, Michael E; Pollin, Toni I; Pratt, Victoria M; Rosenman, Marc; Voils, Corrine I; W Weitzel, Kristen; Wilke, Russell A; Ryanne Wu, R; Orlando, Lori A

2017-05-22

To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified by six diverse projects that are part of a National Human Genome Research Institute (NHGRI)-funded network focused on implementing genomics into practice and strategies to overcome these challenges. We used a multiple-case study approach with each project considered as a case and qualitative methods to elicit and describe themes related to implementation challenges and strategies. We describe challenges and strategies in an implementation framework and typology to enable consistent definitions and cross-case comparisons. Strategies were linked to challenges based on expert review and shared themes. Three challenges were identified by all six projects, and strategies to address these challenges varied across the projects. One common challenge was to increase the relative priority of integrating genomics within the health system electronic health record (EHR). Four projects used data warehousing techniques to accomplish the integration. The second common challenge was to strengthen clinicians' knowledge and beliefs about genomic medicine. To overcome this challenge, all projects developed educational materials and conducted meetings and outreach focused on genomic education for clinicians. The third challenge was engaging patients in the genomic medicine projects. Strategies to overcome this challenge included use of mass media to spread the word, actively involving patients in implementation (e.g., a patient advisory board), and preparing patients to be active participants in their healthcare decisions. This is the first collaborative evaluation focusing on the description of genomic medicine innovations implemented in multiple real-world clinical settings. Findings suggest that strategies to facilitate integration of genomic data within existing EHRs and educate stakeholders about the value of genomic services are considered important for effective implementation. Future work could build on these findings to evaluate which strategies are optimal under what conditions. This information will be useful for guiding translation of discoveries to clinical care, which, in turn, can provide data to inform continual improvement of genomic innovations and their applications.

Revisiting "The Master's Tools": Challenging Common Sense in Cross-Cultural Teacher Education

ERIC Educational Resources Information Center

Chinnery, Ann

2008-01-01

According to Kevin Kumashiro (2004), education toward a socially just society requires a commitment to challenge common sense notions or assumptions about the world and about teaching and learning. Recalling Audre Lorde's (1984) classic essay, "The Master's Tools Will Never Dismantle the Master's House," I focus on three common sense notions and…

Evaluation and Management of Patch Test-Negative Patients With Generalized Dermatitis.

PubMed

Spiker, Alison; Mowad, Christen M

Patients with generalized dermatitis are common in dermatology practices. Allergic contact dermatitis is often suspected, and patients frequently undergo patch testing. When the patch testing result is negative, further evaluation and management of these patients are challenging. The purpose of this study was to survey members of the American Contact Dermatitis Society regarding the evaluation and management of patch test-negative patients with generalized dermatitis. Generalized dermatitis was the most common term identified for patch test-negative patients with diffuse dermatitis. After having negative expanded patch testing results, most physicians proceeded with additional testing including skin biopsy, complete blood cell count with differential, and liver and renal function tests. The most commonly used systemic treatment is prednisone, followed by methotrexate. Narrow-band ultraviolet B (UVB) is the most commonly used light source. Antihistamines are frequently prescribed. Food allergy is not felt to be causative. This cohort of patients experiences significant impairment in quality of life, stress on personal relationships, and time off work. The management of patch test-negative patients with generalized dermatitis is challenging. This study provides insight into management of these complex patients. It also demonstrates practice gaps in the management of these patients, indicating a need for further studies to direct the evaluation and management of this patient population.

The common cold: potential for future prevention or cure.

PubMed

Passioti, Maria; Maggina, Paraskevi; Megremis, Spyridon; Papadopoulos, Nikolaos G

2014-02-01

The common cold is the most frequent, although generally mild, human disease. Human Rhinoviruses are the prevalent causative agents, but other viruses are also implicated. Being so common, viral colds, have significant implications on public health and quality of life, but may also be life-threatening for vulnerable groups of patients. Specific diagnosis and treatment of the common cold still remain unmet needs. Molecular diagnostic techniques allow specific detection of known pathogens as well as the identification of newly emerging viruses. Although a number of medications or natural treatments have been shown to have some effect, either on the number or on the severity of common colds, no single agent is considerably effective. Virus-specific management remains in most cases a challenging potential as many factors have to be taken into account, including the diversity of the viral genomes, the heterogeneity of affected individuals, as well as the complexity of this long standing host-virus relationship.

Integration of the concepts of sustainability into teaching at post-secondary institutions

NASA Astrophysics Data System (ADS)

Davis, Sara Allison

The purpose of this study was to examine the incorporation of the concepts of sustainability into teaching at two post-secondary public education residential institutions, Northern Arizona University (NAU) and the University of South Carolina (USC). A total of 17 faculty members, six administrators, and 31 students were interviewed in the study. An individual case record for each participating institution was developed. The two case records were then qualitatively cross-case analyzed to derive crosscutting themes and patterns at the two participating institutions. Based on the findings of this study, several major themes emerged across the two post-secondary public institutions. Sustainability was consistently viewed by faculty members, administrators, and students as a very broad term. While faculty members and administrators differentiated between the ecological, economic, and social dimensions of sustainability, students commonly associated sustainability more narrowly with an ecological meaning. Several common factors that influenced faculty members' and administrators' understanding of sustainability included literature, campus-wide training, personal influences, and professional networking. Common methods used by faculty to incorporate the concepts of sustainability into teaching included assigned readings, class discussions, and class projects. Key benefits of incorporating the concepts of sustainability into teaching included increased student awareness, collaboration, vision development, and social implications, while key challenges included time, support, assessment, student understanding, and more realistic classroom experiences. Key driving forces for faculty members and administrators for incorporating the concepts of sustainability into teaching were the initiatives specifically developed at the institutions. Based on the common themes at the two institutions studied, it is recommended that post-secondary institutions desiring to deploy the concepts of sustainability into teaching include the multiple dimensions of sustainability in their campus-wide initiatives, faculty and student development, and policies. In addition, it is recommended that campus-wide sustainability initiatives emphasize the key benefits of increased student awareness, collaboration, social implications, and vision development, and that they consider the challenges of time, support, assessment, and student understanding, while rewarding faculty members for their efforts to incorporate the concepts of sustainability into teaching.

Overcoming the Challenges of Co-creation

NASA Astrophysics Data System (ADS)

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

2016-12-01

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

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

PubMed

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

2016-11-01

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

Implementation of genomics research in Africa: challenges and recommendations

PubMed Central

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

2018-01-01

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

Implementation of genomics research in Africa: challenges and recommendations.

PubMed

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

2018-01-01

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

The male beard hair and facial skin - challenges for shaving.

PubMed

Maurer, M; Rietzler, M; Burghardt, R; Siebenhaar, F

2016-06-01

The challenge of shaving is to cut the beard hair as closely as possible to the skin without unwanted effects on the skin. To achieve this requires the understanding of beard hair and male facial skin biology as both, the beard hair and the male facial skin, contribute to the difficulties in obtaining an effective shave without shaving-induced skin irritation. Little information is available on the biology of beard hairs and beard hair follicles. We know that, in beard hairs, the density, thickness, stiffness, as well as the rates of elliptical shape and low emerging angle, are high and highly heterogeneous. All of this makes it challenging to cut it, and shaving techniques commonly employed to overcome these challenges include shaving with increased pressure and multiple stroke shaving, which increase the probability and extent of shaving-induced skin irritation. Several features of male facial skin pose problems to a perfect shave. The male facial skin is heterogeneous in morphology and roughness, and male skin has a tendency to heal slower and to develop hyperinflammatory pigmentation. In addition, many males exhibit sensitive skin, with the face most often affected. Finally, the hair follicle is a sensory organ, and the perifollicular skin is highly responsive to external signals including mechanical and thermal stimulation. Perifollicular skin is rich in vasculature, innervation and cells of the innate and adaptive immune system. This makes perifollicular skin a highly responsive and inflammatory system, especially in individuals with sensitive skin. Activation of this system, by shaving, can result in shaving-induced skin irritation. Techniques commonly employed to avoid shaving-induced skin irritation include shaving with less pressure, pre- and post-shave skin treatment and to stop shaving altogether. Recent advances in shaving technology have addressed some but not all of these issues. A better understanding of beard hairs, beard hair follicles and male facial skin is needed to develop novel and better approaches to overcome the challenge of shaving. This article covers what is known about the physical properties of beard hairs and skin and why those present a challenge for blade and electric shaving, respectively. © 2016 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

Degrees of Freedom: Varying Routes to Math Readiness and the Challenge of Intersegmental Alignment (Report 2 of a 3-Part Series)

ERIC Educational Resources Information Center

Burdman, Pamela

2015-01-01

The conventional algebra-intensive math curriculum commonly dictates students' options for entering and completing college, including their ability to transfer from two-year to four-year institutions. The assumption that higher-level algebra is necessary for college success has led some equity advocates to promote algebra for all students. Nearly…

Common Challenges for Ecological Modelling: Synthesis of Facilitated Discussions Held at the Symposia Organized for the Conference of the International Society for Ecological Modelling in Quebec City, Canada (October 6-9, 2009)

EPA Science Inventory

The symposia organized for the conference of the International Society for Ecological Modelling (ISEM 2009) included facilitated discussion sessions following formal presentations. Each symposium focused on a specific subject, and all the subjects could be classified into three b...

Autism Spectrum Disorder: Forensic Issues and Challenges for Mental Health Professionals and Courts

ERIC Educational Resources Information Center

Freckelton, Ian

2013-01-01

Autism spectrum disorder (ASD), as defined in DSM-V, can be relevant in a variety of ways to decision-making by courts and tribunals. This includes the family, disciplinary, discrimination and criminal law contexts. By reviewing decisions made by superior courts in a number of common law jurisdictions, this article identifies a pivotal role for…

South Dakota Statewide Core Curriculum, Career Ladder, and Challenge System. A Case History.

ERIC Educational Resources Information Center

Brekke, Donald G.; Gildseth, Wayne M.

The South Dakota Core Curriculum Project involving the career ladder approach to health manpower training, which began in 1970, had seven objectives including the following: (1) To organize a Health Manpower Council for the entire State; (2) to define the areas of basic commonality among the various training programs; and (3) to develop a core…

A Tangled Web of Terms: The Overlap and Unique Contribution of Involvement, Engagement, and Integration to Understanding College Student Success

ERIC Educational Resources Information Center

Wolf-Wendel, Lisa; Ward, Kelly; Kinzie, Jillian

2009-01-01

Established theories and constructs long associated with student success, including involvement, engagement, and integration, provide common language and a body of knowledge to inform understanding of the challenges currently facing higher education. This paper examines how the theories and terms have evolved, explores how the terms are currently…

Challenging Science and Literacy Activities for K-9 Students--The Cricket Chronicles. Teacher Edition

ERIC Educational Resources Information Center

Matthews, Catherine E.

2006-01-01

This book is an extensive integrated unit of study focused on that common and familiar insect--the cricket. In this edition, teachers are given a complete guide and reproducible worksheets for elementary and middle school students. With over 30 different activities on crickets, students learn science content and skills including: (1) Taxonomy; (2)…

Finding Common Ground: Creating the Library of the Future without Diminishing the Library of the Past. The New Library Series.

ERIC Educational Resources Information Center

LaGuardia, Cheryl, Ed.; Mitchell, Barbara A., Ed.

Adapting today's libraries to better serve tomorrow's needs challenges even the most forward-thinking library staff. This book offers practical, workable solutions from several authorities in the industry. Fifty-five conference papers are included and divided into the following subject areas: "Technology and the Network: Daimons or Demons?";…

Workforce Innovation and Opportunity Act: Information on Planned Changes to State Performance Reporting and Related Challenges. Report to Congressional Committees. GAO-16-287

ERIC Educational Resources Information Center

US Government Accountability Office, 2016

2016-01-01

Enacted in 2014, the Workforce Innovation and Opportunity Act (WIOA) brought numerous changes to existing federal employment and training programs, including requiring the Department of Labor (DOL) and the Department of Education (Education) to implement a common performance accountability system across the six WIOA-designated core programs. WIOA…

Challenging Science and Literacy Activities for K-9 Students - The Cricket Chronicles: Student Edition

ERIC Educational Resources Information Center

Matthews, Catherine E.

2006-01-01

This is an extensive integrated unit of study focused on that common and familiar insect-the cricket. In this edition, students are provided with more than 30 activities on crickets, which will help them learn science content and skills including: (1) Taxonomy; (2) Anatomy; (3) Ecology; (4) Mark and recapture techniques for estimating population…

Practice Brief: Modeling Positive Behaviors for Postsecondary Students with Autism/Asperger's--The Use of "Television Coaching"

ERIC Educational Resources Information Center

Trammell, Jack

2013-01-01

Students on the Autism spectrum, including those with Asperger's, are attending postsecondary schools at record rates and bringing with them unique needs and challenges. Although students with this diagnosis qualify for and often use traditional academic accommodations such as testing in a separate room, they also commonly experience academic…

Understanding the Role of Today's School Principal: A Primer for Bridging Theory to Practice, Second Edition

ERIC Educational Resources Information Center

Kellough, Richard D.; Hill, Phillys

2014-01-01

The second edition of this handbook is an easily understood desk companion for new school principals and aspiring school leaders. The common-sense approach of the handbook guides new administrators through daily routines and challenges. In-service and university professionals, who provide coursework that includes a multi-topic overview of the…

Toward True Integration of Academic and Behavior Response to Intervention Systems: Part Two--Tier 2 Support

ERIC Educational Resources Information Center

McIntosh, Kent; Goodman, Steve; Bohanon, Hank

2010-01-01

In the previous article in this series, the authors provided a rationale for integrating academic and behavior response to intervention (RTI) systems. Their rationale included: (1) research showing that challenges in academic and social behavior are linked; (2) a description of the common features that both RTI systems share; and (3) the…

Studying Health Outcomes in Farmworker Populations Exposed to Pesticides

PubMed Central

McCauley, Linda A.; Anger, W. Kent; Keifer, Matthew; Langley, Rick; Robson, Mark G.; Rohlman, Diane

2006-01-01

A major goal of studying farmworkers is to better understand how their work environment, including exposure to pesticides, affects their health. Although a number of health conditions have been associated with pesticide exposure, clear linkages have yet to be made between exposure and health effects except in cases of acute pesticide exposure. In this article, we review the most common health end points that have been studied and describe the epidemiologic challenges encountered in studying these health effects of pesticides among farmworkers, including the difficulties in accessing the population and challenges associated with obtaining health end point data. The assessment of neurobehavioral health effects serves as one of the most common and best examples of an approach used to study health outcomes in farmworkers and other populations exposed to pesticides. We review the current limitations in neurobehavioral assessment and strategies to improve these analytical methods. Emerging techniques to improve our assessment of health effects associated with pesticide exposure are reviewed. These techniques, which in most cases have not been applied to farmworker populations, hold promise in our ability to study and understand the relationship between pesticide exposure and a variety of health effects in this population. PMID:16760000

Controlling weeds with fungi, bacteria and viruses: a review

PubMed Central

Harding, Dylan P.; Raizada, Manish N.

2015-01-01

Weeds are a nuisance in a variety of land uses. The increasing prevalence of both herbicide resistant weeds and bans on cosmetic pesticide use has created a strong impetus to develop novel strategies for controlling weeds. The application of bacteria, fungi and viruses to achieving this goal has received increasingly great attention over the last three decades. Proposed benefits to this strategy include reduced environmental impact, increased target specificity, reduced development costs compared to conventional herbicides and the identification of novel herbicidal mechanisms. This review focuses on examples from North America. Among fungi, the prominent genera to receive attention as bioherbicide candidates include Colletotrichum, Phoma, and Sclerotinia. Among bacteria, Xanthomonas and Pseudomonas share this distinction. The available reports on the application of viruses to controlling weeds are also reviewed. Focus is given to the phytotoxic mechanisms associated with bioherbicide candidates. Achieving consistent suppression of weeds in field conditions is a common challenge to this control strategy, as the efficacy of a bioherbicide candidate is generally more sensitive to environmental variation than a conventional herbicide. Common themes and lessons emerging from the available literature in regard to this challenge are presented. Additionally, future directions for this crop protection strategy are suggested. PMID:26379687

Chronic Pain in the School Setting: The Teachers' Point of View.

PubMed

Solé, Ester; Castarlenas, Elena; Sánchez-Rodríguez, Elisabet; Galán, Santiago; de la Vega, Rocío; Jensen, Mark P; Miró, Jordi

2018-01-01

The aims of this study were to (1) examine the reactions of teachers and student teachers to children experiencing pain, (2) identify the most common challenges and potential resources that are associated to dealing with them, and (3) examine whether their responses differed as a function of their experience or sex. Forty teachers and 318 student teachers completed a survey which included descriptive information, a questionnaire that assesses different responses of participants to children who experience pain, and provides a list of problems and resources that participants might encounter and implement, respectively, when dealing with these children. The study participants most often endorsed use of coping and health-promoting responses. Experienced teachers endorsed solicitous responses significantly more often than student teachers. Women reported responding more with solicitous responses than men. Absenteeism and the negative effect of pain on the ability of students to engage in school activities were the most common pain-related challenges mentioned by the study participants overall. The findings emphasize (1) the need for developing guidelines to help teachers to help students experiencing chronic pain, and (2) the importance of including information about pediatric chronic pain in teachers training. © 2018, American School Health Association.

Community health workers leading the charge on workforce development: lessons from New Orleans.

PubMed

Wennerstrom, Ashley; Johnson, Liljana; Gibson, Kristina; Batta, Sarah E; Springgate, Benjamin F

2014-12-01

Academic institutions and community organizations engaged community health workers (CHWs) in creating a community-appropriate CHW workforce capacity-building program in an area without a previously established CHW professional group. From 2009 to 2010, we solicited New Orleans-based CHWs' opinions about CHW professional development through a survey, a community conference, and workgroup meetings. Throughout 2011 and 2012, we created and implemented a responsive 80-h workforce development program that used popular education techniques. We interviewed CHWs 6 months post-training to assess impressions of the course and application of skills and knowledge to practice. CHWs requested training to develop nationally-recognized core competencies including community advocacy, addresses issues unique to New Orleans, and mitigate common professional challenges. Thirty-five people completed the course. Among 25 interviewees, common themes included positive impressions of the course, application of skills and community-specific information to practice, understanding of CHWs' historical roles as community advocates, and ongoing professional challenges. Engaging CHW participation in workforce development programs is possible in areas lacking organized CHW groups. CHW insight supports development of training that addresses unique local concerns. Trained CHWs require ongoing professional support.

An update on Sarcocystis neurona infections in animals and Equine Protozoal Myeloencephalitis (EPM)

PubMed Central

Dubey, J. P.; Howe, D. K.; Furr, M.; Saville, W. J.; Marsh, A.E.; Reed, S. M.; Grigg, M. E.

2015-01-01

Equine protozoal myeloencephalitis (EPM) is a serious disease of horses, and its management continues to be a challenge for veterinarians. The protozoan Sarcocystis neurona is most commonly associated with EPM. S. neurona has emerged as a common cause of mortality in marine mammals, especially sea otters (Enhydra lutris). EPM-like illness has also been recorded in several other mammals, including domestic dogs and cats. This paper updates S. neurona and EPM information from the last 15 years on the advances regarding life cycle, molecular biology, epidemiology, clinical signs, diagnosis, treatment and control. PMID:25737052

An update on Sarcocystis neurona infections in animals and equine protozoal myeloencephalitis (EPM).

PubMed

Dubey, J P; Howe, D K; Furr, M; Saville, W J; Marsh, A E; Reed, S M; Grigg, M E

2015-04-15

Equine protozoal myeloencephalitis (EPM) is a serious disease of horses, and its management continues to be a challenge for veterinarians. The protozoan Sarcocystis neurona is most commonly associated with EPM. S. neurona has emerged as a common cause of mortality in marine mammals, especially sea otters (Enhydra lutris). EPM-like illness has also been recorded in several other mammals, including domestic dogs and cats. This paper updates S. neurona and EPM information from the last 15 years on the advances regarding life cycle, molecular biology, epidemiology, clinical signs, diagnosis, treatment and control. Published by Elsevier B.V.

Recent developments in the surgical management of perianal fistula for Crohn’s disease

PubMed Central

Geltzeiler, Cristina B.; Wieghard, Nicole; Tsikitis, Vassiliki L.

2014-01-01

Perianal manifestations of Crohn’s disease (CD) are common and, of them, fistulas are the most common. Perianal fistulas can be extremely debilitating for patients and are often very challenging for clinicians to treat. CD perianal fistulas usually require multidisciplinary and multimodality treatment, including both medical and surgical approaches. The majority of patients require multiple surgical interventions. CD patients with perianal fistulas have a high rate of primary non-healing, surgical morbidity, and high recurrence rates. This has led to constant efforts to improve surgical management of this disease process. PMID:25331917

A collaborative interdisciplinary approach to electronic fetal monitoring: report of a statewide initiative.

PubMed

Miller, Lisa A; Miller, David A

2013-01-01

Intrapartum electronic fetal monitoring (EFM) is one of the most common procedures in obstetrics. Current consensus statements provide clinicians with a common language for EFM as well as provide a basis for a simplified approach to interpretation and management. This article presents a summary of the content and implementation of a statewide initiative in interdisciplinary EFM education and training designed to give clinicians of all backgrounds a shared mental model in EFM. Challenges to implementation at individual institutions may include physician and nursing engagement as well as time and cost constraints.

A common evaluation framework for the African Health Initiative.

PubMed

Bryce, Jennifer; Requejo, Jennifer Harris; Moulton, Lawrence H; Ram, Malathi; Black, Robert E

2013-01-01

The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results.

Recommendations for provoked challenge urine testing.

PubMed

Ruha, Anne-Michelle

2013-12-01

"Urine mobilization test," "challenge test," and "provoked urine test" are all terms used to describe the administration of a chelating agent to a person prior to collection of their urine to test for metals. There is no standard, validated challenge test. Despite recommendations by professional and government organizations against the use of provoked urine testing, the tests are still commonly used and recommended by some practitioners. Challenge testing utilizes a variety of chelating agents, including dimercaptosuccinic acid (DMSA), dimercaptopropanesulfonate (DMPS), and ethylenediaminetetraacetic acid (EDTA). The agents are given by a variety of routes of administration, doses used are inconsistent, and urine collection procedures vary. Additional problems with challenge tests include comparison of results to inappropriate reference ranges and creatinine correction of urine obtained within hours of chelator administration. Human volunteer studies demonstrate that mercury is detected in the urine of most people even in the absence of known exposure or chelator administration, and that urinary mercury excretion rises after administration of a chelator, regardless of exposure history and in an unpredictable fashion. Studies also demonstrate that challenge testing fails to reveal a "body burden" of mercury due to remote exposure. Chelating agents have been associated with adverse reactions. Current evidence does not support the use of DMPS, DMSA, or other chelation challenge tests for the diagnosis of metal toxicity. Since there are no established reference ranges for provoked urine samples in healthy subjects, no reliable evidence to support a diagnostic value for the tests, and potential harm, these tests should not be utilized.

Constructibility Challenges for Perimeter Control Blasting and Slope Development in Shale and Other "Weak" Rocks

NASA Astrophysics Data System (ADS)

Scarpato, D. J.

2016-02-01

Slope construction in shale can present some interesting challenges for geotechnical design engineers and contractors alike. There are challenges that can be expected and designed for; however, all too frequently, such challenges manifest themselves as "surprises" in the field. Common constructibility challenges can include drill hole deviation during drilling for controlled blasting; and, excavation slope instability arising from inconsistent perimeter control drilling. Drill hole deviation results from the cumulative effects from both drilling mechanics and rock mass conditions. Once a hole has initiated the deviation trajectory, it is difficult to rectify drill steel position. Although such challenges are not necessarily unique to shale, they are often exacerbated by weak, weathered and transversely isotropic nature of bedrock conditions. All too often, the working assumption is that shale is "soft" and easily excavatable; however, this blanket assumption can prove to be costly. This paper is intended to provide design professionals and contractors with the practical considerations needed to avoid the "surprises" associated with drill hole deviation, and minimize the potential for costly claims.

ENVRI PLUS: European initiative towards technical and research cultural solutions for across-disciplines accessible Research Infrastructure products

NASA Astrophysics Data System (ADS)

Asmi, A.; Kutsch, W. L.

2015-12-01

Environmental Research Infrastructures are often built as bottom-up initiatives to provide products for specific target group, which often is very discipline specific. However, the societal or environmental challenges are typically not concentrated on specific disciplines, and require usage of data sets from many RIs. ENVRI PLUS is an initiative where the European environmental RIs work together to provide common technical background (in physical observation technologies and in data products and descriptions) to make the RI products more usable to user groups outside of the original RI target groups. ENVRI PLUS also includes many policy and dissemination concentrated actions to make the RI operations coherent and understandable to both scientists and other potential users. The actions include building common technological capital of the RIs (physical and data-oriented), creating common access procedures (especially for cross-diciplinary access), developing ethical guidelines and related policies, distributing know-how between RIs and building common communication and collaboration system for European environmental RIs. All ENVRI PLUS products are free to use, e.g. for use of new or existing environmental RIs worldwide.

An investor perspective on forming and funding your medical device start-up.

PubMed

Mas, Juan-Pablo; Hsueh, Brian

2017-06-01

Novel and transformative medical technologies of all forms have the potential to make a significant positive impact on the lives of patients and on the health care system, and one common pathway for guiding such innovations from concept through commercialization is via the formation of a company. For entrepreneurs looking to build a medical technology company, several common challenges await, including questions around how and where to raise funding. Here, we review key considerations for the formation of medical technology companies as viewed through the lens of an investor. We survey common sources of capital for early-stage companies, including grants, angel investors, and venture capital, and offer insights into how to differentiate among them to select the best partners for your start-up׳s needs. Finally, we discuss the critical components of pitching your ideas to potential investors, and offer guidance on best practices and common mistakes. We hope this primer on fundamental concepts and the various health care funding alternatives will prepare entrepreneurs to achieve their mission to improve patients׳ lives through commercialization of their medical innovations. Copyright © 2017 Elsevier Inc. All rights reserved.

Role of nasal challenge and local eosinophilia in indirect exposure to cat in allergic rhinitis patients.

PubMed

Al Ahmad, M; Arifhodzic, N; Nurkic, J; Jusufovic, E; Hanoun, A L; Rodriguez, T

2018-01-17

Introduction. Sensitization to cat allergens is common worldwide. Currently, there is a trend towards costly and often unavailable diagnostic analysis. Objectives. The aim is to assess the reliability of skin prick test (SPT) and serum specific IgE (ssIgE) to cat sensitization, by performing nasal challenge test (NCT) in a community with low cat ownership but common presence of stray cats. Patients and methods. Forty-one pa-tients with perennial allergic rhinitis (AR) who were mono or polysensitized (including cat) were included. We had 31 cat non-owners and 10 present cat owners. SPT (> 5 mm / diameter), ssIgE (≥ 0.70 IU/ml), nasal smear for eosinophil (Eo) and NCT were compared between groups. Outcomes included nasal challenge score, nasal Eo positivity, peak inspiratory and expiratory flow (PIF and PEF) 2 and 8 hours after the NCT, and were compared to baseline. Results. Baseline SPT wheal size and ssIgE level were similar in both groups. NCT positivity was more frequent in cat owners. The strongest nasal reaction was on the top concentration in both groups. Nasal Eo positivity in cat owners was higher before and 2 hours after NCT, but similar to non-owners at last measurement. NCT positive cat non-owners had bigger SPT wheal size than NCT negative non-owners, but smaller than NCT positive cat owners. In contrast to PEF, a significant fall in PIF was noticed in both groups. Mono and polysensitised patients showed similar NCT positivity. Conclusion. Stray cats may pose a relevant risk of developing perennial AR. Regardless of cat ownership status, SPT and ssIgE should be the first diagnostic tool. Nasal Eo and NCT seem to be good diagnostic tools in cat non-owners if diagnosis is elusive.

The Challenge of Managing Psoriasis: Unmet Medical Needs and Stakeholder Perspectives.

PubMed

Feldman, Steven R; Goffe, Bernard; Rice, Gary; Mitchell, Matthew; Kaur, Mandeep; Robertson, Debbie; Sierka, Debra; Bourret, Jeffrey A; Evans, Tamara S; Gottlieb, Alice

2016-12-01

Psoriasis is a debilitating chronic inflammatory autoimmune disease affecting approximately 7.4 million adults in the United States. Plaque psoriasis is the most common form, affecting 80% to 90% of patients. To describe the impact and challenges that psoriasis presents for various stakeholders, and to provide nondermatologist healthcare decision makers with information to enhance their contributions to drug and pharmacy benefit design discussions. Psoriasis carries an increased risk for early mortality and an increased prevalence of comorbidities, including psoriatic arthritis, cardiovascular disease, and diabetes. It is also associated with anxiety, depression, and social isolation, and can negatively impact patients' relationships, productivity, and careers. The physical, psychologic, social, and economic impact of psoriasis, plus the associated stigma, result in cumulative impairment over a patient's lifetime. The current treatments for moderate-to-severe psoriasis include topical therapy, phototherapy, and systemic drugs (nonbiologic and biologic); however, patient satisfaction remains low, combination therapy and treatment switching are common, and many patients remain untreated or undertreated. Clinicians should consider the patient holistically, and should select treatment based on a range of factors, including disease severity (with physical and psychosocial manifestations), susceptibility to cumulative life-course impairment (considering personality, behavior, and cognition), comorbidities, concomitant medication, and patient preference. It is estimated that the total annual direct cost of treating psoriasis in the United States in 2015 exceeded $12.2 billion. Psoriasis is a complex disease, and appropriate management is correspondingly complex. Newer psoriasis treatments provide improved efficacy and safety versus traditional treatments, but challenges remain in ensuring patients access to these medications. An improved understanding of the barriers to appropriate treatment is needed, as well as clear and accessible information for payers and clinicians on current treatment options, to ensure that decision makers can control costs while providing patients with optimal care.

Fostering sustained energy behavior change and increasing energy literacy in a student housing energy challenge

NASA Astrophysics Data System (ADS)

Brewer, Robert Stephen

We designed the Kukui Cup challenge to foster energy conservation and increase energy literacy. Based on a review of the literature, the challenge combined a variety of elements into an overall game experience, including: real-time energy feedback, goals, commitments, competition, and prizes. We designed a software system called Makahiki to provide the online portion of the Kukui Cup challenge. Energy use was monitored by smart meters installed on each floor of the Hale Aloha residence halls on the University of Hawai'i at Manoa campus. In October 2011, we ran the UH Kukui Cup challenge for the over 1000 residents of the Hale Aloha towers. To evaluate the Kukui Cup challenge, I conducted three experiments: challenge participation, energy literacy, and energy use. Many residents participated in the challenge, as measured by points earned and actions completed through the challenge website. I measured the energy literacy of a random sample of Hale Aloha residents using an online energy literacy questionnaire administered before and after the challenge. I found that challenge participants' energy knowledge increased significantly compared to non-challenge participants. Positive self-reported energy behaviors increased after the challenge for both challenge participants and non-participants, leading to the possibility of passive participation by the non-challenge participants. I found that energy use varied substantially between and within lounges over time. Variations in energy use over time complicated the selection of a baseline of energy use to compare the levels during and after the challenge. The best team reduced its energy use during the challenge by 16%. However, team energy conservation did not appear to correlate to participation in the challenge, and there was no evidence of sustained energy conservation after the challenge. The problems inherent in assessing energy conservation using a baseline call into question this common practice. My research has generated several contributions, including: a demonstration of increased energy literacy as a result of the challenge, the discovery of fundamental problems with the use of baselines for assessing energy competitions, the creation of two open source software systems, and the creation of an energy literacy assessment instrument.

Evaluation of Full Reynolds Stress Turbulence Models in FUN3D

NASA Technical Reports Server (NTRS)

Dudek, Julianne C.; Carlson, Jan-Renee

2017-01-01

Full seven-equation Reynolds stress turbulence models are a relatively new and promising tool for todays aerospace technology challenges. This paper uses two stress-omega full Reynolds stress models to evaluate challenging flows including shock-wave boundary layer interactions, separation and mixing layers. The Wilcox and the SSGLRR full second-moment Reynolds stress models are evaluated for four problems: a transonic two-dimensional diffuser, a supersonic axisymmetric compression corner, a compressible planar shear layer, and a subsonic axisymmetric jet. Simulation results are compared with experimental data and results using the more commonly used Spalart-Allmaras (SA) one-equation and the Menter Shear Stress Transport (SST) two-equation models.

The role of architecture and ontology for interoperability.

PubMed

Blobel, Bernd; González, Carolina; Oemig, Frank; Lopéz, Diego; Nykänen, Pirkko; Ruotsalainen, Pekka

2010-01-01

Turning from organization-centric to process-controlled or even to personalized approaches, advanced healthcare settings have to meet special interoperability challenges. eHealth and pHealth solutions must assure interoperability between actors cooperating to achieve common business objectives. Hereby, the interoperability chain also includes individually tailored technical systems, but also sensors and actuators. For enabling corresponding pervasive computing and even autonomic computing, individualized systems have to be based on an architecture framework covering many domains, scientifically managed by specialized disciplines using their specific ontologies in a formalized way. Therefore, interoperability has to advance from a communication protocol to an architecture-centric approach mastering ontology coordination challenges.

Treating Heart Failure with Preserved Ejection Fraction: A Challenge for Clinicians.

PubMed

Howard, Patricia A

2015-06-01

Despite a decline in many forms of cardiovascular disease, heart failure (HF) continues to increase. Heart failure with preserved ejection fraction (HFpEF) is common, especially among persons with multiple comorbidities. HFpEF presents many challenges for clinicians due to the incomplete understanding of the underlying mechanisms and lack of consensus on the most effective strategies for treatment. Angiotensin and beta receptor-blocking drugs, which form the cornerstone for the treatment of systolic HF, have failed to show similar benefits in patients with impaired diastolic function. This article provides an overview of drug therapy for HFpEF, including newer agents now under investigation.

Cognitive and motor symptoms in dementia: focus on dementia with Lewy bodies.

PubMed

Lingler, Jennifer Hagerty; Kaufer, Daniel I

2002-09-01

To describe the clinical syndrome called dementia with Lewy bodies (DLB) and highlight its common and unique characteristics with respect to diagnosis and management. Review of the scientific literature including psychiatric literature, reports of clinical trials, and clinical practice guidelines. DLB is a clinical and histopathologic disease, which is second only to Alzheimer's disease (AD) as a cause of dementia in older adults. The clinical syndrome of DLB includes cognitive and motor deterioration reminiscent of symptoms associated with AD and Parkinson's disease (PD) respectively. The late life intersection of cognitive and motor symptoms can present significant challenges in the primary care setting. Recognizing key features of common neurodegenerative disorders is essential to accurately diagnosing and appropriately treating the growing population of older adults who suffer from AD, PD, and DLB.

Assessment of Foraging Devices as a Model for Decision-Making in Nonhuman Primate Environmental Enrichment

PubMed Central

Bennett, Allyson J; Perkins, Chaney M; Harty, Nicole M; Niu, Mengyao; Buelo, Audrey K; Luck, Melissa L; Pierre, Peter J

2014-01-01

Continued progress to move evidence-based best practices into community and regulatory animal welfare standards depends in part on developing common metrics to assess cost, benefit, and relative value. Here we describe a model approach to evidence-based evaluation and an example of comprehensive cost–benefit assessment for a common element of environmental enrichment plans for laboratory-housed nonhuman primates. Foraging devices encourage a species-typical activity that dominates the time budget of primates outside captivity and provide inherent cognitive challenges, physical activity demands, and multi-sensory stimulation. However, their implementation is not standard, and is challenged by perception of high costs and labor; nutritional and health concerns; and identification of best practices in implementation (that is, device types, food type, frequency of delivery and rotation). To address these issues, we directly compared monkeys’ engagement with different foraging devices and the comprehensive cost of implementing foraging opportunities. We recorded 14 adult male cynomolgus monkeys’ interactions with 7 types of devices filled with a range of enrichment foods. All devices elicited foraging behavior, but there were significant differences among them both initially and over subsequent observations. Devices that afforded opportunity for extraction of small food items and that posed manipulative challenge elicited greater manipulation. The cost of providing a foraging opportunity to a single monkey is roughly US$1, with approximately 80% attributable to labor. This study is the first to perform a rigorous cost–benefit analysis and comparison of common foraging devices included in environmental enrichment. Its broader significance lies in its contribution to the development of methods to facilitate improvement in evidence-based practices and common standards to enhance laboratory animal welfare. PMID:25255067

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.

Complex wound management in ventricular assist device (VAD) patients: the role of aggressive debridement and vascularized soft tissue coverage.

PubMed

Nelson, Jonas A; Shaked, Oren; Fischer, John P; Mirzabeigi, Michael N; Jandali, Shareef; Kovach, Stephen J; Low, David W; Acker, Michael A; Kanchwala, Suhail K

2014-12-01

Infections and complex wounds after ventricular assist device (VAD) placement can result in significant morbidity and mortality. The purpose of this study was to evaluate complex wound management in the VAD patient, and to describe a treatment protocol for these challenging and potentially mortal complications. A retrospective study was performed to examine all patients who underwent continuous flow, second-generation VAD placement at the Hospital of the University of Pennsylvania between March 2008 and April 2013. Overall, 150 VADs were placed, with 12 (8%) patients requiring 15 operative interventions by the plastic surgery services. The most common indication for operative intervention was a complicated wound with VAD exposure (5/12, 41.7%). All patients underwent aggressive operative debridement, and 11/12 (92%) underwent vascularized soft tissue coverage. Flaps commonly utilized included rectus abdominus myocutaneous (n = 4), rectus abdominus muscle (n = 4), pectoralis major (n = 3), and omentum (n = 3). Three patients experienced complications which required a return to the operating room, including 1 flap loss, 1 hematoma, and 1 wound dehiscence requiring further soft tissue coverage. Salvage was achieved, yet a 50% mortality rate in follow-up was noted. Complex wound management in VAD patients can be achieved with aggressive debridement and vascularized soft tissue coverage, most commonly utilizing well-vascularized rectus abdominus muscle or omental flaps. Plastic surgeons should be familiar with the armamentarium at their disposal when approaching these challenging cases as VAD wound complications stand to become an increasingly prevalent issue.

3D Reconstruction in the Presence of Glass and Mirrors by Acoustic and Visual Fusion.

PubMed

Zhang, Yu; Ye, Mao; Manocha, Dinesh; Yang, Ruigang

2017-07-06

We present a practical and inexpensive method to reconstruct 3D scenes that include transparent and mirror objects. Our work is motivated by the need for automatically generating 3D models of interior scenes, which commonly include glass. These large structures are often invisible to cameras. Existing 3D reconstruction methods for transparent objects are usually not applicable in such a room-sized reconstruction setting. Our simple hardware setup augments a regular depth camera with a single ultrasonic sensor, which is able to measure the distance to any object, including transparent surfaces. The key technical challenge is the sparse sampling rate from the acoustic sensor, which only takes one point measurement per frame. To address this challenge, we take advantage of the fact that the large scale glass structures in indoor environments are usually either piece-wise planar or simple parametric surfaces. Based on these assumptions, we have developed a novel sensor fusion algorithm that first segments the (hybrid) depth map into different categories such as opaque/transparent/infinity (e.g., too far to measure) and then updates the depth map based on the segmentation outcome. We validated our algorithms with a number of challenging cases, including multiple panes of glass, mirrors, and even a curved glass cabinet.

Teaching Real Data Interpretation with Models (TRIM): Analysis of Student Dialogue in a Large-Enrollment Cell and Developmental Biology Course.

PubMed

Zagallo, Patricia; Meddleton, Shanice; Bolger, Molly S

2016-01-01

We present our design for a cell biology course to integrate content with scientific practices, specifically data interpretation and model-based reasoning. A 2-yr research project within this course allowed us to understand how students interpret authentic biological data in this setting. Through analysis of written work, we measured the extent to which students' data interpretations were valid and/or generative. By analyzing small-group audio recordings during in-class activities, we demonstrated how students used instructor-provided models to build and refine data interpretations. Often, students used models to broaden the scope of data interpretations, tying conclusions to a biological significance. Coding analysis revealed several strategies and challenges that were common among students in this collaborative setting. Spontaneous argumentation was present in 82% of transcripts, suggesting that data interpretation using models may be a way to elicit this important disciplinary practice. Argumentation dialogue included frequent co-construction of claims backed by evidence from data. Other common strategies included collaborative decoding of data representations and noticing data patterns before making interpretive claims. Focusing on irrelevant data patterns was the most common challenge. Our findings provide evidence to support the feasibility of supporting students' data-interpretation skills within a large lecture course. © 2016 P. Zagallo et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Multi-Source Sensor Fusion for Small Unmanned Aircraft Systems Using Fuzzy Logic

NASA Technical Reports Server (NTRS)

Cook, Brandon; Cohen, Kelly

2017-01-01

As the applications for using small Unmanned Aircraft Systems (sUAS) beyond visual line of sight (BVLOS) continue to grow in the coming years, it is imperative that intelligent sensor fusion techniques be explored. In BVLOS scenarios the vehicle position must accurately be tracked over time to ensure no two vehicles collide with one another, no vehicle crashes into surrounding structures, and to identify off-nominal scenarios. Therefore, in this study an intelligent systems approach is used to estimate the position of sUAS given a variety of sensor platforms, including, GPS, radar, and on-board detection hardware. Common research challenges include, asynchronous sensor rates and sensor reliability. In an effort to realize these challenges, techniques such as a Maximum a Posteriori estimation and a Fuzzy Logic based sensor confidence determination are used.

Assessing governance theory and practice in health-care organizations: a survey of UK hospices.

PubMed

Chambers, Naomi; Benson, Lawrence; Boyd, Alan; Girling, Jeff

2012-05-01

This paper sets out a theoretical framework for analyzing board governance, and describes an empirical study of corporate governance practices in a subset of non-profit organizations (hospices in the UK). It examines how practices in hospice governance compare with what is known about effective board working. We found that key strengths of hospice boards included a strong focus on the mission and the finances of the organizations, and common weaknesses included a lack of involvement in strategic matters and a lack of confidence, and some nervousness about challenging the organization on the quality of clinical care. Finally, the paper offers suggestions for theoretical development particularly in relation to board governance in non-profit organizations. It develops an engagement theory for boards which comprises a triadic proposition of high challenge, high support and strong grip.

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

PubMed Central

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

2013-01-01

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

Intra-muscular and oral vaccination using a Koi Herpesvirus ORF25 DNA vaccine does not confer protection in common carp (Cyprinus carpio L.).

PubMed

Embregts, Carmen W E; Tadmor-Levi, Roni; Veselý, Tomáš; Pokorová, Dagmar; David, Lior; Wiegertjes, Geert F; Forlenza, Maria

2018-03-19

Koi Herpes Virus (KHV or Cyprinid Herpesvirus 3, CyHV-3) is among the most threatening pathogens affecting common carp production as well as the highly valuable ornamental koi carp. To date, no effective commercial vaccine is available for worldwide use. A previous study reported that three intramuscular injections with an ORF25-based DNA vaccine, led to the generation of neutralizing antibodies and conferred significant protection against an intraperitoneal challenge with KHV. In the present study, we set out to optimize an ORF25-based DNA vaccination protocol that required fewer injections and would confer protection upon a challenge that better resembled the natural route of infection. To this end, ORF25 was cloned in pcDNA3 either as a soluble protein or as a full-length transmembrane GFP-fusion protein. We tested our ORF25-based DNA vaccines in multiple vaccination trials using different doses, vaccination routes (i.m. injection and oral gavage) and challenge methods (bath and cohabitation). Furthermore, we analysed local and systemic responses to the i.m. injected DNA vaccine through histological and RT-qPCR analysis. We observed a strong protection when fish received three injections of either of the two DNA vaccines. However, this protection was observed only after bath challenge and not after cohabitation challenge. Furthermore, protection was insufficient when fish received one injection only, or received the plasmid orally. The importance of choosing a challenge model that best reflects the natural route of infection and the possibility to include additional antigens in future DNA vaccination strategies against KHV will be discussed. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Fellowships in community pharmacy research: Experiences of five schools and colleges of pharmacy.

PubMed

Snyder, Margie E; Frail, Caitlin K; Gernant, Stephanie A; Bacci, Jennifer L; Coley, Kim C; Colip, Lauren M; Ferreri, Stefanie P; Hagemeier, Nicholas E; McGivney, Melissa Somma; Rodis, Jennifer L; Smith, Megan G; Smith, Randall B

2016-01-01

To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. Five schools and colleges of pharmacy in the United States. Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Fellowships in Community Pharmacy Research: Experiences of Five Schools and Colleges of Pharmacy

PubMed Central

Snyder, Margie E.; Frail, Caitlin K.; Gernant, Stephanie A.; Bacci, Jennifer L.; Coley, Kim C.; Colip, Lauren M.; Ferreri, Stefanie P.; Hagemeier, Nicholas E.; McGivney, Melissa Somma; Rodis, Jennifer L.; Smith, Megan G.; Smith, Randall B.

2017-01-01

Objective To describe common facilitators, challenges, and lessons learned of five schools and colleges of pharmacy in establishing community pharmacy research fellowships. Setting Five schools and colleges of pharmacy in the United States. Practice Description Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Practice Innovation Community pharmacy fellowships, each structured as two years in length and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill and The Ohio State University. Evaluation Program directors from each of the five community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Results Common characteristics across the programs include length of training, pre-requisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n=4) have been successful in securing pharmacy faculty positions. Conclusion Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice. PMID:27083852

Evaluting the Validity of Technology-Enhanced Educational Assessment Items and Tasks: An Emprical Approach to Studying Item Features and Scoring Rubrics

ERIC Educational Resources Information Center

Thomas, Ally

2016-01-01

With the advent of the newly developed Common Core State Standards and the Next Generation Science Standards, innovative assessments, including technology-enhanced items and tasks, will be needed to meet the challenges of developing valid and reliable assessments in a world of computer-based testing. In a recent critique of the next generation…

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

ERIC Educational Resources Information Center

Reddy, Anugula N.; Sinha, Shantha

2010-01-01

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

Common challenges for ecological modelling: Synthesis of facilitated discussions held at the symposia organized for the 2009 conference of the International Society for Ecological Modelling in Quebec City, Canada

USDA-ARS?s Scientific Manuscript database

The eleven symposia organized for the 2009 conference of the International Society for Ecological Modelling (ISEM 2009) held in Quebec City, Canada, October 6-9, 2009, included facilitated discussion sessions following formal presentations. Each symposium focused on a specific subject, and all the s...

Big Events and Risks to Global Substance Using Populations: Unique Threats and Common Challenges.

PubMed

Mackey, Tim K; Strathdee, Steffanie A

2015-01-01

In this commentary, we review a set of "Big Events" from around the world that have adversely impacted substance using populations by first identifying common thematic areas between them, and then describing the unique challenges faced by the diverse and vulnerable populations impacted. The Big Events reviewed are multifaceted and complex in nature, and include the recent global financial crisis, economic and trade sanctions, political transition and its impact on ethnic minorities, colonialism and indigenous communities, and ecological disasters. All have led to immense trauma, displacement, and disruption to critical healthcare services/treatment for people who use drugs, populations who are left underserved in the midst of these crises. It is our hope that through this comparative assessment, global policymakers will proactively identify Big Events and prioritize the development of interventions and policy that meet the unique and immediate needs of substance using population in order to mitigate the significant negative short- and long-term impacts on global public health.

MRI Segmentation of the Human Brain: Challenges, Methods, and Applications

PubMed Central

Despotović, Ivana

2015-01-01

Image segmentation is one of the most important tasks in medical image analysis and is often the first and the most critical step in many clinical applications. In brain MRI analysis, image segmentation is commonly used for measuring and visualizing the brain's anatomical structures, for analyzing brain changes, for delineating pathological regions, and for surgical planning and image-guided interventions. In the last few decades, various segmentation techniques of different accuracy and degree of complexity have been developed and reported in the literature. In this paper we review the most popular methods commonly used for brain MRI segmentation. We highlight differences between them and discuss their capabilities, advantages, and limitations. To address the complexity and challenges of the brain MRI segmentation problem, we first introduce the basic concepts of image segmentation. Then, we explain different MRI preprocessing steps including image registration, bias field correction, and removal of nonbrain tissue. Finally, after reviewing different brain MRI segmentation methods, we discuss the validation problem in brain MRI segmentation. PMID:25945121

Strategies for integrating personalized medicine into healthcare practice.

PubMed

Pritchard, Daryl E; Moeckel, Franziska; Villa, Mary Susan; Housman, Laura T; McCarty, Catherine A; McLeod, Howard L

2017-03-01

Research and innovation in personalized medicine are surging, however, its adoption into clinical practice is comparatively slow. We identify common challenges to the clinical adoption of personalized medicine and provide strategies for addressing these challenges. Our team developed a list of common challenges through a series of group discussions, surveys and interviews, and convened a national summit to discuss solutions for overcoming these challenges. We used a framework approach for thematic analysis. We categorized challenges into five areas of need: education and awareness; patient empowerment; value recognition; infrastructure and information management; and ensuring access to care. We then developed strategies to address these challenges. In order for healthcare to transition into personalized medicine, it is necessary for stakeholders to build momentum by implementing a progression of strategies.

Computational intelligence in bioinformatics: SNP/haplotype data in genetic association study for common diseases.

PubMed

Kelemen, Arpad; Vasilakos, Athanasios V; Liang, Yulan

2009-09-01

Comprehensive evaluation of common genetic variations through association of single-nucleotide polymorphism (SNP) structure with common complex disease in the genome-wide scale is currently a hot area in human genome research due to the recent development of the Human Genome Project and HapMap Project. Computational science, which includes computational intelligence (CI), has recently become the third method of scientific enquiry besides theory and experimentation. There have been fast growing interests in developing and applying CI in disease mapping using SNP and haplotype data. Some of the recent studies have demonstrated the promise and importance of CI for common complex diseases in genomic association study using SNP/haplotype data, especially for tackling challenges, such as gene-gene and gene-environment interactions, and the notorious "curse of dimensionality" problem. This review provides coverage of recent developments of CI approaches for complex diseases in genetic association study with SNP/haplotype data.

Oncology nurses’ communication challenges with patients and families: A qualitative study

PubMed Central

Banerjee, Smita C.; Manna, Ruth; Coyle, Nessa; Shen, Megan Johnson; Pehrson, Cassandra; Zaider, Talia; Hammonds, Stacey; Krueger, Carol A.; Parker, Patricia A.; Bylund, Carma L.

2016-01-01

The benefits of effective communication in an oncology setting are multifold and include the overall well-being of patients and health professionals, adherence to treatment regimens, psychological functioning, and improvements in quality of life. Nevertheless, there are substantial barriers and communication challenges reported by oncology nurses. This study was conducted to present a summary of communication challenges faced by oncology nurses. From November 2012 to March 2014, 121 inpatient nurses working in the oncology setting participated in an online pre-training qualitative survey that asked nurses to describe common communication challenges in communicating empathy and discussing death, dying, and end-of-life (EOL) goals of care. The results revealed six themes that describe the challenges in communicating empathically: dialectic tensions, burden of carrying bad news, lack of skills for providing empathy, perceived institutional barriers, challenging situations, and perceived dissimilarities between the nurse and the patient. The results for challenges in discussing death, dying and EOL goals of care revealed five themes: dialectic tensions, discussing specific topics related to EOL, lack of skills for providing empathy, patient/family characteristics, and perceived institutional barriers. This study emphasizes the need for institutions to provide communication skills training to their oncology nurses for navigating through challenging patient interactions. PMID:26278636

Communication Challenges and Strategies of U.S. Health Professionals Caring for Seriously Ill South Asian Patients and Their Families.

PubMed

Khosla, Nidhi; Washington, Karla T; Shaunfield, Sara; Aslakson, Rebecca

2017-06-01

While effective communication is important in the care of seriously ill patients, little is known about communication challenges faced by healthcare providers serving U.S. patients of South Asian origin, one of the fastest growing demographic groups in the United States. Researchers sought to examine communication challenges faced by healthcare providers serving seriously ill South Asian patients and their families and present strategies recommended by providers for effective communication. Researchers conducted a thematic analysis of qualitative data obtained through focus groups and individual interviews with 57 healthcare providers, including physicians, social workers, nurses, chaplains, and others drawn from different healthcare settings in one Midwestern city. While acknowledging the considerable diversity within the U.S. South Asian community, participants discussed three types of communication challenges they often encounter when serving this population: ensuring effective interpretation, identifying a spokesperson, and challenges posed by different cultural norms. Participants shared strategies to address these challenges such as proactively inquiring about patients' and families' preferences and encouraging early appointment of a spokesperson. While providers should avoid stereotyping patients, an awareness of common challenges and adoption of recommended strategies to address these challenges may enhance the provision of culturally responsive person-centered services for seriously ill South Asian patients and their families receiving care in the United States.

Oncology nurses' communication challenges with patients and families: A qualitative study.

PubMed

Banerjee, Smita C; Manna, Ruth; Coyle, Nessa; Shen, Megan Johnson; Pehrson, Cassandra; Zaider, Talia; Hammonds, Stacey; Krueger, Carol A; Parker, Patricia A; Bylund, Carma L

2016-01-01

The benefits of effective communication in an oncology setting are multifold and include the overall well-being of patients and health professionals, adherence to treatment regimens, psychological functioning, and improvements in quality of life. Nevertheless, there are substantial barriers and communication challenges reported by oncology nurses. This study was conducted to present a summary of communication challenges faced by oncology nurses. From November 2012 to March 2014, 121 inpatient nurses working in the oncology setting participated in an online pre-training qualitative survey that asked nurses to describe common communication challenges in communicating empathy and discussing death, dying, and end-of-life (EOL) goals of care. The results revealed six themes that describe the challenges in communicating empathically: dialectic tensions, burden of carrying bad news, lack of skills for providing empathy, perceived institutional barriers, challenging situations, and perceived dissimilarities between the nurse and the patient. The results for challenges in discussing death, dying and EOL goals of care revealed five themes: dialectic tensions, discussing specific topics related to EOL, lack of skills for providing empathy, patient/family characteristics, and perceived institutional barriers. This study emphasizes the need for institutions to provide communication skills training to their oncology nurses for navigating through challenging patient interactions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Performing skin microbiome research: A method to the madness

PubMed Central

Kong, Heidi H.; Andersson, Björn; Clavel, Thomas; Common, John E.; Jackson, Scott A.; Olson, Nathan D.; Segre, Julia A.; Traidl-Hoffmann, Claudia

2017-01-01

Growing interest in microbial contributions to human health and disease has increasingly led investigators to examine the microbiome in both healthy skin and cutaneous disorders, including acne, psoriasis and atopic dermatitis. The need for common language, effective study design, and validated methods are critical for high-quality, standardized research. Features, unique to skin, pose particular challenges when conducting microbiome research. This review discusses microbiome research standards and highlights important factors to consider, including clinical study design, skin sampling, sample processing, DNA sequencing, control inclusion, and data analysis. PMID:28063650

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

PubMed Central

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

2015-01-01

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

Positioning challenges in reconfigurable semi-autonomous robotic NDE inspection

NASA Astrophysics Data System (ADS)

Pierce, S. Gareth; Dobie, Gordon; Summan, Rahul; Mackenzie, Liam; Hensman, James; Worden, Keith; Hayward, Gordon

2010-03-01

This paper describes work conducted into mobile, wireless, semi-autonomous NDE inspection robots developed at The University of Strathclyde as part of the UK Research Centre for Non Destructive Evaluation (RCNDE). The inspection vehicles can incorporate a number of different NDE payloads including ultrasonic, eddy current, visual and magnetic based payloads, and have been developed to try and improve NDE inspection techniques in challenging inspection areas (for example oil, gas, and nuclear structures). A significant research challenge remains in the accurate positioning and guidance of such vehicles for real inspection tasks. Employing both relative and absolute position measurements, we discuss a number of approaches to position estimation including Kalman and particle filtering. Using probabilistic approaches enables a common mathematical framework to be employed for both positioning and data fusion from different NDE sensors. In this fashion the uncertainties in both position and defect identification and classification can be dealt with using a consistent approach. A number of practical constraints and considerations to different precision positioning techniques are discussed, along with NDE applications and the potential for improved inspection capabilities by utilising the inherent reconfigurable capabilities of the inspection vehicles.

A common evaluation framework for the African Health Initiative

PubMed Central

2013-01-01

Background The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. Methods This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. Results and conclusions The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results. PMID:23819778

From the Field: Learning Leaders

ERIC Educational Resources Information Center

Weigel, Kathleen; Jones, Richard

2015-01-01

Leadership is essential to successful schools. One of the ways to support effective school leadership is to share ideas and best practices to address the common challenges faced by school leaders. This question and response format addresses common challenges and questions from practicing school leaders in the manner that a mentor might respond to…

Building a Learning Commons: Necessary Conditions for Success

ERIC Educational Resources Information Center

McKay, Richard

2014-01-01

Remodeling an academic library according to the Learning Commons service model will challenge the library staff. This paper gives insight into four of these challenges: Working with the design team, preserving a scholarly environment, ensuring the most efficient arrangement of the library's service centers, and moving the library's collection. It…

Lessons learned from a practice-based, multi-site intervention study with nurse participants

PubMed Central

Friese, Christopher R.; Mendelsohn-Victor, Kari; Ginex, Pamela; McMahon, Carol M.; Fauer, Alex J.; McCullagh, Marjorie C.

2016-01-01

Purpose To identify challenges and solutions to the efficient conduct of a multi-site, practice-based randomized controlled trial to improve nurses’ adherence to personal protective equipment use in ambulatory oncology settings. Design The Drug Exposure Feedback and Education for Nurses’ Safety (DEFENS) study is a clustered, randomized, controlled trial. Participating sites are randomized to web-based feedback on hazardous drug exposures in the sites plus tailored messages to address barriers versus a control intervention of a web-based continuing education video. Approach The study principal investigator, the study coordinator, and two site leaders identified challenges to study implementation and potential solutions, plus potential methods to prevent logistical challenges in future studies. Findings Noteworthy challenges included variation in human subjects protection policies, grants and contracts budgeting, infrastructure for nursing-led research, and information technology variation. Successful strategies included scheduled web conferences, site-based study champions, site visits by the principal investigator, and centrally-based document preparation. Strategies to improve efficiency in future studies include early and continued engagement with contract personnel in sites, and proposed changes to the common rule concerning human subjects. The DEFENS study successfully recruited 393 nurses across 12 sites. To date, 369 have completed surveys and 174 nurses have viewed educational materials. Conclusions Multi-site studies of nursing personnel are rare and challenging to existing infrastructure. These barriers can be overcome with strong engagement and planning. Clinical Relevance Leadership engagement, onsite staff support, and continuous communication can facilitate successful recruitment to a workplace-based randomized, controlled behavioral trial. PMID:28098951

Hair restoration surgery: challenges and solutions

PubMed Central

Rose, Paul T

2015-01-01

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

Environmental Research Infrastructures providing shared solutions for science and society (ENVRIplus)

NASA Astrophysics Data System (ADS)

Kutsch, Werner Leo; Asmi, Ari; Laj, Paolo; Brus, Magdalena; Sorvari, Sanna

2016-04-01

ENVRIplus is a Horizon 2020 project bringing together Environmental and Earth System Research Infrastructures, projects and networks together with technical specialist partners to create a more coherent, interdisciplinary and interoperable cluster of Environmental Research Infrastructures (RIs) across Europe. The objective of ENVRIplus is to provide common solutions to shared challenges for these RIs in their efforts to deliver new services for science and society. To reach this overall goal, ENVRIplus brings together the current ESFRI roadmap environmental and associate fields RIs, leading I3 projects, key developing RI networks and specific technical specialist partners to build common synergic solutions for pressing issues in RI construction and implementation. ENVRIplus will be organized along 6 main objectives, further on called "Themes": 1) Improve the RI's abilities to observe the Earth System, particularly in developing and testing new sensor technologies, harmonizing observation methodologies and developing methods to overcome common problems associated with distributed remote observation networks; 2) Generate common solutions for shared information technology and data related challenges of the environmental RIs in data and service discovery and use, workflow documentation, data citations methodologies, service virtualization, and user characterization and interaction; 3) Develop harmonized policies for access (physical and virtual) for the environmental RIs, including access services for the multidisciplinary users; 4) Investigate the interactions between RIs and society: Find common approaches and methodologies how to assess the RIs' ability to answer the economical and societal challenges, develop ethics guidelines for RIs and investigate the possibility to enhance the use Citizen Science approaches in RI products and services; 5) Ensure the cross-fertilisation and knowledge transfer of new technologies, best practices, approaches and policies of the RIs by generating training material for RI personnel to use the new observational, technological and computational tools and facilitate inter-RI knowledge transfer via a staff exchange program; 6) Create RI communication and cooperation framework to coordinate activities of the environmental RIs towards common strategic development, improved user interaction and interdisciplinary cross-RI products and services. The produced solutions, services, systems and other project results are made available to all environmental research infrastructure initiatives.

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

PubMed Central

2018-01-01

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

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

PubMed

Peelle, Jonathan E

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

Implementing the Community Health Worker Model within Diabetes Management: Challenges and Lessons Learned from Programs across the U.S.

PubMed Central

Cherrington, Andrea; Ayala, Guadalupe X.; Amick, Halle; Allison, Jeroan; Corbie-Smith, Giselle; Scarinci, Isabel

2018-01-01

Introduction/objectives The Community Health Worker (CHW) model has gained popularity as a method for reaching vulnerable populations with diabetes mellitus (DM), yet little is known about its actual role in program delivery. The purpose of this qualitative study was to examine methods of implementation as well as related challenges and lessons learned. Methods Semi-structured interviews were conducted with program managers. Four databases (PubMed, CINAHL, ISI Web of Knowledge, PsycInfo), the CDC’s 1998 directory of CHW programs and Google Search Engine and were used to identify CHW programs. Criteria for inclusion were: DM program; used CHW strategy; occurred in United States. Two independent reviewers performed content analyses to identify major themes and findings. Results Sixteen programs were assessed, all but three focused on minority populations. Most CHWs were recruited informally; six programs required CHWs to have diabetes. CHW roles and responsibilities varied across programs; educator was the most commonly identified role. Training also varied in terms of both content and intensity. All programs gave CHWs remuneration for their work. Common challenges included difficulties with CHW retention, intervention fidelity and issues related to sustainability. Cultural and gender issues also emerged. Examples of lessons learned included the need for community buy-in and the need to anticipate non-diabetes related issues. Conclusions Lessons learned from these programs may be useful to others as they apply the CHW model to diabetes management within their own communities. Further research is needed to elucidate the specific features of this model necessary to positively impact health outcomes. PMID:18832287

An attenuated Shigella mutant lacking the RNA-binding protein Hfq provides cross-protection against Shigella strains of broad serotype.

PubMed

Mitobe, Jiro; Sinha, Ritam; Mitra, Soma; Nag, Dhrubajyoti; Saito, Noriko; Shimuta, Ken; Koizumi, Nobuo; Koley, Hemanta

2017-07-01

Few live attenuated vaccines protect against multiple serotypes of bacterial pathogen because host serotype-specific immune responses are limited to the serotype present in the vaccine strain. Here, immunization with a mutant of Shigella flexneri 2a protected guinea pigs against subsequent infection by S. dysenteriae type 1 and S. sonnei strains. This deletion mutant lacked the RNA-binding protein Hfq leading to increased expression of the type III secretion system via loss of regulation, resulting in attenuation of cell viability through repression of stress response sigma factors. Such increased antigen production and simultaneous attenuation were expected to elicit protective immunity against Shigella strains of heterologous serotypes. Thus, the vaccine potential of this mutant was tested in two guinea pig models of shigellosis. Animals vaccinated in the left eye showed fewer symptoms upon subsequent challenge via the right eye, and even survived subsequent intestinal challenge. In addition, oral vaccination effectively induced production of immunoglobulins without severe side effects, again protecting all animals against subsequent intestinal challenge with S. dysenteriae type 1 or S. sonnei strains. Antibodies against common virulence proteins and the O-antigen of S. flexneri 2a were detected by immunofluorescence microscopy. Reaction of antibodies with various strains, including enteroinvasive Escherichia coli, suggested that common virulence proteins induced protective immunity against a range of serotypes. Therefore, vaccination is expected to cover not only the most prevalent serotypes of S. sonnei and S. flexneri 2a, but also various Shigella strains, including S. dysenteriae type 1, which produces Shiga toxin.

Obesity and polycystic ovary syndrome.

PubMed

Naderpoor, N; Shorakae, S; Joham, A; Boyle, J; De Courten, B; Teede, H J

2015-03-01

Obesity is now a major international health concern. It is increasingly common in young women with reproductive, metabolic and psychological health impacts. Reproductive health impacts are often poorly appreciated and include polycystic ovary syndrome (PCOS), infertility and pregnancy complications. PCOS is the most common endocrine condition in women and is underpinned by hormonal disturbances including insulin resistance and hyperandrogenism. Obesity exacerbates hormonal and clinical features of PCOS and women with PCOS appear at higher risk of obesity, with multiple underlying mechanisms linking the conditions. Lifestyle intervention is first line in management of PCOS to both prevent weight gain and induce weight loss; however improved engagement and sustainability remain challenges with the need for more research. Medications like metformin, orlistat, GLP1 agonists and bariatric surgery have been used with the need for large scale randomised clinical trials to define their roles.

Methodological Challenges in Describing Medication Dosing Errors in Children

DTIC Science & Technology

2005-01-01

recommendations. As an example, amoxicillin is the most commonly used medication in children. This one drug accounts for approximately 10 percent of...and a team intervention on prevention of serious medication errors. JAMA 1998;280(15):1311–6. 13. Bates DW, Teich JM, Lee J, et al. The impact of...barriers include prescribing medication that is not labeled for use in children, discrepancies in published dosing recommendations for many

An Overview on Additive Manufacturing of Polymers

NASA Astrophysics Data System (ADS)

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

2018-03-01

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

Peyronie's Disease: Still a Surgical Disease.

PubMed

Martinez, Daniel; Ercole, Cesar E; Hakky, Tariq S; Kramer, Andrew; Carrion, Rafael

2012-01-01

Peyronie's Disease (PD) remains a challenging and clinically significant morbid condition. Since its first description by François Gigot de la Peyronie, much of the treatment for PD remains nonstandardized. PD is characterized by the formation of fibrous plaques at the level of the tunica albuginea. Clinical manifestations include morphologic changes, such as curvatures and hourglass deformities. Here, we review the common surgical techniques for the management of patients with PD.

Quantitative Outcomes of a One Health approach to Study Global Health Challenges.

PubMed

Falzon, Laura C; Lechner, Isabel; Chantziaras, Ilias; Collineau, Lucie; Courcoul, Aurélie; Filippitzi, Maria-Eleni; Laukkanen-Ninios, Riikka; Peroz, Carole; Pinto Ferreira, Jorge; Postma, Merel; Prestmo, Pia G; Phythian, Clare J; Sarno, Eleonora; Vanantwerpen, Gerty; Vergne, Timothée; Grindlay, Douglas J C; Brennan, Marnie L

2018-03-01

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.

Complexity perplexity: a systematic review to describe the measurement of medication regimen complexity.

PubMed

Paquin, Allison M; Zimmerman, Kristin M; Kostas, Tia R; Pelletier, Lindsey; Hwang, Angela; Simone, Mark; Skarf, Lara M; Rudolph, James L

2013-11-01

Complex medication regimens are error prone and challenging for patients, which may impact medication adherence and safety. No universal method to assess the complexity of medication regimens (CMRx) exists. The authors aim to review literature for CMRx measurements to establish consistencies and, secondarily, describe CMRx impact on healthcare outcomes. A search of EMBASE and PubMed for studies analyzing at least two medications and complexity components, among those self-managing medications, was conducted. Out of 1204 abstracts, 38 studies were included in the final sample. The majority (74%) of studies used one of five validated CMRx scales; their components and scoring were compared. Universal CMRx assessment is needed to identify and reduce complex regimens, and, thus, improve safety. The authors highlight commonalities among five scales to help build consensus. Common components (i.e., regimen factors) included dosing frequency, units per dose, and non-oral routes. Elements (e.g., twice daily) of these components (e.g., dosing frequency) and scoring varied. Patient-specific factors (e.g., dexterity, cognition) were not addressed, which is a shortcoming of current scales and a challenge for future scales. As CMRx has important outcomes, notably adherence and healthcare utilization, a standardized tool has potential for far-reaching clinical, research, and patient-safety impact.

Sector activities and lessons learned around initial implementation of the United States national physical activity plan.

PubMed

Evenson, Kelly R; Satinsky, Sara B

2014-08-01

National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences. During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes. The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals. These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans.

Sector Activities and Lessons Learned Around Initial Implementation of the United States National Physical Activity Plan

PubMed Central

Evenson, Kelly R.; Satinsky, Sara B.

2016-01-01

Background National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences. Methods During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes. Results The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals. Conclusions These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans. PMID:24176800

Why women perform better in college than admission scores would predict: Exploring the roles of conscientiousness and course-taking patterns.

PubMed

Keiser, Heidi N; Sackett, Paul R; Kuncel, Nathan R; Brothen, Thomas

2016-04-01

Women typically obtain higher subsequent college GPAs than men with the same admissions test score. A common reaction is to attribute this to a flaw in the admissions test. We explore the possibility that this underprediction of women's performance reflects gender differences in conscientiousness and college course-taking patterns. In Study 1, we focus on using the ACT to predict performance in a single, large course where performance is decomposed into cognitive (exam and quiz scores) and less cognitive, discretionary components (discussion and extra credit points). The ACT does not underpredict female's cognitive performance, but it does underpredict female performance on the less cognitive, discretionary components of academic performance, because it fails to measure and account for the personality trait of conscientiousness. In Study 2, we create 2 course-difficulty indices (Course Challenge and Mean Aptitude in Course) and add them to an HLM regression model to see if they reduce the degree to which SAT scores underpredict female performance. Including Course Challenge does result in a modest reduction of the gender coefficient; however, including Mean Aptitude in Course does not. Thus, differences in course-taking patterns is a partial (albeit small) explanation for the common finding of differential prediction by gender. (c) 2016 APA, all rights reserved).

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.

Role of computed tomography angiography in detection and staging of small bowel carcinoid tumors

PubMed Central

Bonekamp, David; Raman, Siva P; Horton, Karen M; Fishman, Elliot K

2015-01-01

Small-bowel carcinoid tumors are the most common form (42%) of gastrointestinal carcinoids, which by themselves comprise 70% of neuroendocrine tumors. Although primary small bowel neoplasms are overall rare (3%-6% of all gastrointestinal neoplasms), carcinoids still represent the second most common (20%-30%) primary small-bowel malignancy after small bowel adenocarcinoma. Their imaging evaluation is often challenging. State-of-the-art high-resolution multiphasic computed tomography together with advanced postprocessing methods provides an excellent tool for their depiction. The manifold interactive parameter choices however require knowledge of when to use which technique. Here, we discuss the imaging appearance and evaluation of duodenal, jejunal and ileal carcinoid tumors, including the imaging features of the primary tumor, locoregional mesenteric nodal metastases, and distant metastatic disease. A protocol for optimal lesion detection is presented, including the use of computed tomography enterography, volume acquisition, computed tomography angiography and three-dimensional mapping. Imaging findings are illustrated with a series of challenging cases which illustrate the spectrum of possible disease in the small bowel and mesentery, the range of possible appearances in the bowel itself on multiphase data and extraluminal findings such as the desmoplastic reaction in mesentery and hypervascular liver metastases. Typical imaging pitfalls and pearls are illustrated. PMID:26435774

Epigenome-wide association studies for cancer biomarker discovery in circulating cell-free DNA: technical advances and challenges.

PubMed

Tanić, Miljana; Beck, Stephan

2017-02-01

Since introducing the concept of epigenome-wide association studies (EWAS) in 2011, there has been a vast increase in the number of published EWAS studies in common diseases, including in cancer. These studies have increased our understanding of epigenetic events underlying carcinogenesis and have enabled the discovery of cancer-specific methylation biomarkers. In this mini-review, we have focused on the state of the art in EWAS applied to cell-free circulating DNA for epigenetic biomarker discovery in cancer and discussed associated technical advances and challenges, and our expectations for the future of the field. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Emerging challenges in implementing universal health coverage in Asia.

PubMed

Bredenkamp, Caryn; Evans, Timothy; Lagrada, Leizel; Langenbrunner, John; Nachuk, Stefan; Palu, Toomas

2015-11-01

As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure "supply-side readiness", i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed. On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint. While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia - and across the world. Copyright © 2015. Published by Elsevier Ltd.

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

Widergren, Steven E.; Knight, Mark R.; Melton, Ronald B.

The Interoperability Strategic Vision whitepaper aims to promote a common understanding of the meaning and characteristics of interoperability and to provide a strategy to advance the state of interoperability as applied to integration challenges facing grid modernization. This includes addressing the quality of integrating devices and systems and the discipline to improve the process of successfully integrating these components as business models and information technology improve over time. The strategic vision for interoperability described in this document applies throughout the electric energy generation, delivery, and end-use supply chain. Its scope includes interactive technologies and business processes from bulk energy levelsmore » to lower voltage level equipment and the millions of appliances that are becoming equipped with processing power and communication interfaces. A transformational aspect of a vision for interoperability in the future electric system is the coordinated operation of intelligent devices and systems at the edges of grid infrastructure. This challenge offers an example for addressing interoperability concerns throughout the electric system.« less

Active-comparator design and new-user design in observational studies

PubMed Central

Yoshida, Kazuki; Solomon, Daniel H.; Kim, Seoyoung C.

2015-01-01

SUMMARY Over the past decade, an increasing number of observational studies have examined the effectiveness or safety of rheumatoid arthritis treatments. However, unlike randomized controlled trials (RCTs), observational studies of drug effects face methodological challenges including confounding by indication. Two design principles - active comparator design and new user design can help mitigate such challenges in observational studies. To improve validity of study findings, observational studies should be designed in such a way that makes them more closely approximate RCTs. The active comparator design compares the drug of interest to another commonly used agent for the same indication, rather than a ‘non-user’ group. This principle helps select treatment groups similar in treatment indications (both measured and unmeasured characteristics). The new user design includes a cohort of patients from the time of treatment initiation, so that it can assess patients’ pretreatment characteristics and capture all events occurring anytime during follow-up. PMID:25800216

Overcoming challenges faced by breastfeeding mothers.

PubMed

Amir, Lisa H; Bearzatto, Anita

2016-08-01

Women who are breastfeeding often consult their general practitioner (GP) with concerns about nipple and breast pain, or the adequacy of their milk supply. Common concerns for their breastfed infant include slow weight gain, 'fussiness' with breastfeeding and 'funny stools'. This article offers suggestions for clinicians to support breastfeeding women and their infants. Good attachment to the breast is important to reduce nipple pain and trauma, and to ensure adequate breast drainage and ongoing milk supply. Other causes of nipple pain include vasospasm, dermatitis and infection. Breast pain may be due to blocked ducts, mastitis or abscess. Very early mastitis may be treated by improved emptying. Slow weight gain in a breastfed infant may indicate a medical problem or low supply of breast milk. Some infants have breastfeeding challenges because they are small or premature, or from anatomical issues affecting feeding. In such cases, further help from a lactation consultant may be beneficial.

Challenges and Strategies in Providing Home Based Primary Care for Refugees in the US.

PubMed

Febles, C; Nies, M A; Fanning, K; Tavernier, S S

2017-12-01

The recent crisis in the Middle East has prompted the exodus of millions of refugees from the region who are at present seeking shelter across Europe and in the United States. Among the most immediate needs of refugees upon arrival in a host country is health care, and it is one of the most sustained interactions they experience. Home visits are a common form of primary care for refugees. The authors review the literature to identify themes related to challenges and strategies for providing home based primary care to refugees. The literature review was performed by searching cross-disciplinary databases utilizing Onesearch, but focusing primarily on results produced through CINAHL, EBSCOHOST, and Pub Med databases. To maximize the number of studies included, there was no time frame placed upon publication dates of articles within the search. A total of 55 articles were included in this paper.

Molecular mechanisms underlying chemopreventive potential of curcumin: Current challenges and future perspectives.

PubMed

Kumar, Gaurav; Mittal, Sonam; Sak, Katrin; Tuli, Hardeep Singh

2016-03-01

In recent years, natural compounds have received considerable attention in preventing and curing most dreadful diseases including cancer. The reason behind the use of natural compounds in chemoprevention is associated with fewer numbers of side effects than conventional chemotherapeutics. Curcumin (diferuloylmethane, PubMed CID: 969516), a naturally occurring polyphenol, is derived from turmeric, which is used as a common Indian spice. It governs numerous intracellular targets, including proteins involved in antioxidant response, immune response, apoptosis, cell cycle regulation and tumor progression. A huge mass of available studies strongly supports the use of Curcumin as a chemopreventive drug. However, the main challenge encountered is the low bioavailability of Curcumin. This extensive review covers various therapeutic interactions of Curcumin with its recognized cellular targets involved in cancer treatment, strategies to overcome the bioavailability issue and adverse effects associated with Curcumin consumption. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2012-11-01

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

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

PubMed

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

2011-11-01

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

"Neither we are satisfied nor they"-users and provider's perspective: a qualitative study of maternity care in secondary level public health facilities, Uttar Pradesh, India.

PubMed

Bhattacharyya, Sanghita; Issac, Anns; Rajbangshi, Preety; Srivastava, Aradhana; Avan, Bilal I

2015-09-27

Quality of care provided during childbirth is a critical determinant of preventing maternal mortality and morbidity. In the studies available, quality has been assessed either from the users' perspective or the providers'. The current study tries to bring both perspectives together to identify common key focus areas for quality improvement. This study aims to assess the users' (recently delivered women) and care providers' perceptions of care to understand the common challenges affecting provision of quality maternity care in public health facilities in India. A qualitative design comprising of in-depth interviews of 24 recently delivered women from secondary care facilities and 16 health care providers in Uttar Pradesh, India. The data were analysed thematically to assess users' and providers' perspectives on the common themes. The common challenges experienced regarding provision of care were inadequate physical infrastructure, irregular supply of water, electricity, shortage of medicines, supplies, and gynaecologist and anaesthetist to manage complications, difficulty in maintaining privacy and lack of skill for post-delivery counselling. However, physical access, cleanliness, interpersonal behaviour, information sharing and out-of-pocket expenditure were concerns for only users. Similarly, providers raised poor management of referral cases, shortage of staff, non-functioning of blood bank, lack of incentives for work as their concerns. The study identified the common themes of care from both the perspectives, which have been foundrelevant in terms of challenges identified in many developing countries including India. The study framework identified new themes like management of emergencies in complicated cases, privacy and cost of care which both the group felt is relevant in the context of providing quality care during childbirth in low resource setting. The key challenges identified by both the groups can be prioritized, when developing quality improvement program in the health facilities. The identified components of care can match the supply with the demand for care and make the services truly responsive to user needs. The study highlights infrastructure, human resources, supplies and medicine as priority areas of quality improvement in the facility as perceived by both users and providers, nevertheless the interpersonal aspect of care primarily reported by the users must also not be ignored.

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

PubMed Central

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

2015-01-01

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

Common Challenges Faced by Rural Principals: A Review of the Literature

ERIC Educational Resources Information Center

Preston, Jane P.; Jakubiec, Brittany A. E.; Kooymans, Robin

2013-01-01

Within this article, we thematically present common challenges associated with the role of the rural principal. In this literature review, we delimit our search to work published from 2003-2013. A limitation of this study is that it represents data predominantly from American, Canadian, and Australian rural settings, restricting a global…

Food Allergy: Common Causes, Diagnosis, and Treatment.

PubMed

Patel, Bhavisha Y; Volcheck, Gerald W

2015-10-01

Food allergy is a growing concern, and recognition of symptoms, knowledge of common food allergens, and management of reactions are important for patients and practitioners. Symptoms of a classic IgE-mediated food allergy vary in severity and can include any combination of laryngeal edema, wheezing, nausea, vomiting, diarrhea, urticaria, angioedema, and hypotension. Many foods can induce an allergic reaction, but the most commonly implicated foods include cow's milk, egg, peanut, tree nut, soy, wheat, fish, and shellfish. Milk and egg allergy generally develop and are outgrown in childhood. Peanut and tree nut allergy can occur during childhood or adulthood, are less likely to be outgrown, and tend to cause more fatal reactions. Given the possibility of life-threatening reactions, it is important to recognize the potential for cross-reactivity among food groups. Diagnosis of food allergy includes skin prick testing, specific serum IgE testing, and oral food challenges. Management is centered on avoidance of allergenic and cross-reacting foods and early recognition and immediate treatment of reactions. Treatment protocols to desensitize patients to food are currently under investigation. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity.

PubMed

McFarlane, K; Judd, J; Devine, S; Watt, K

2016-08-01

Issue addressed Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity. Methods A systematic search of peer-reviewed literature was conducted. Articles published between 1990-2014 that focused on a health care-settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included. Results Twenty-five articles met the inclusion criteria. Qualitative (n=18) and quantitative (n=7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities. Conclusions While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges. So what? Primary healthcare organisations wanting to increase their health promotion capacity can pre-empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review.

Perceived benefits and challenges of coordinated approaches to chronic disease prevention in state health departments.

PubMed

Allen, Peg; Sequeira, Sonia; Best, Leslie; Jones, Ellen; Baker, Elizabeth A; Brownson, Ross C

2014-05-08

Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ(2) tests, and analysis of variance were conducted. The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges "lack of communication across programs" (P = .02) and "funding might be reduced" differed by program area (P < .001). Findings can be used by funding agencies and state health departments for planning, training, and technical assistance. The information on perceived challenges demonstrates the need to improve communication across programs, enhance organizational support for coordinated approaches, and create benefits for organizational partners.

Proteomics, lipidomics, metabolomics: a mass spectrometry tutorial from a computer scientist's point of view.

PubMed

Smith, Rob; Mathis, Andrew D; Ventura, Dan; Prince, John T

2014-01-01

For decades, mass spectrometry data has been analyzed to investigate a wide array of research interests, including disease diagnostics, biological and chemical theory, genomics, and drug development. Progress towards solving any of these disparate problems depends upon overcoming the common challenge of interpreting the large data sets generated. Despite interim successes, many data interpretation problems in mass spectrometry are still challenging. Further, though these challenges are inherently interdisciplinary in nature, the significant domain-specific knowledge gap between disciplines makes interdisciplinary contributions difficult. This paper provides an introduction to the burgeoning field of computational mass spectrometry. We illustrate key concepts, vocabulary, and open problems in MS-omics, as well as provide invaluable resources such as open data sets and key search terms and references. This paper will facilitate contributions from mathematicians, computer scientists, and statisticians to MS-omics that will fundamentally improve results over existing approaches and inform novel algorithmic solutions to open problems.

Comprehensive genomic studies: emerging regulatory, strategic, and quality assurance challenges for biorepositories.

PubMed

McDonald, Sandra A; Mardis, Elaine R; Ota, David; Watson, Mark A; Pfeifer, John D; Green, Jonathan M

2012-07-01

As part of the molecular revolution sweeping medicine, comprehensive genomic studies are adding powerful dimensions to medical research. However, their power exposes new regulatory, strategic, and quality assurance challenges for biorepositories. A key issue is that unlike other research techniques commonly applied to banked specimens, nucleic acid sequencing, if sufficiently extensive, yields data that could identify a patient. This evolving paradigm renders the concepts of anonymized and anonymous specimens increasingly outdated. The challenges for biorepositories in this new era include refined consent processes and wording, selection and use of legacy specimens, quality assurance procedures, institutional documentation, data sharing, and interaction with institutional review boards. Given current trends, biorepositories should consider these issues now, even if they are not currently experiencing sample requests for genomic analysis. We summarize our current experiences and best practices at Washington University Medical School, St Louis, MO, our perceptions of emerging trends, and recommendations.

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.

Factors influencing community nursing roles and health service provision in rural areas: a review of literature.

PubMed

Barrett, Annette; Terry, Daniel R; Lê, Quynh; Hoang, Ha

2016-02-01

This review sought to better understand the issues and challenges experienced by community nurses working in rural areas and how these factors shape their role. Databases were searched to identify relevant studies, published between 1990 and 2015, that focussed on issues and challenges experienced by rural community nurses. Generic and grey literature relating to the subject was also searched. The search was systematically conducted multiple times to assure accuracy. A total of 14 articles met the inclusion criteria. This critical review identified common issues impacting community nursing and included role definition, organisational change, human resource, workplace and geographic challenges. Community nurses are flexible, autonomous, able to adapt care to the service delivery setting, and have a diversity of knowledge and skills. Considerably more research is essential to identify factors that impact rural community nursing practice. In addition, greater advocacy is required to develop the role.

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

PubMed

Bays, Harold E

2011-03-01

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

Comprehensive Genomic Studies: Emerging Regulatory, Strategic, and Quality Assurance Challenges for Biorepositories

PubMed Central

McDonald, Sandra A.; Mardis, Elaine R.; Ota, David; Watson, Mark A.; Pfeifer, John D.; Green, Jonathan M.

2012-01-01

As part of the molecular revolution sweeping medicine, comprehensive genomic studies are adding powerful dimensions to medical research. However, their power exposes new regulatory, strategic, and quality assurance challenges for biorepositories. A key issue is that unlike other research techniques commonly applied to banked specimens, nucleic acid sequencing, if sufficiently extensive, yields data that could identify a patient. This evolving paradigm renders the concepts of anonymized and anonymous specimens increasingly outdated. The challenges for biorepositories in this new era include refined consent processes and wording, selection and use of legacy specimens, quality assurance procedures, institutional documentation, data sharing, and interaction with institutional review boards. Given current trends, biorepositories should consider these issues now, even if they are not currently experiencing sample requests for genomic analysis. We summarize our current experiences and best practices at Washington University Medical School, St Louis, MO, our perceptions of emerging trends, and recommendations. PMID:22706855

Deep Learning for Lowtextured Image Matching

NASA Astrophysics Data System (ADS)

Kniaz, V. V.; Fedorenko, V. V.; Fomin, N. A.

2018-05-01

Low-textured objects pose challenges for an automatic 3D model reconstruction. Such objects are common in archeological applications of photogrammetry. Most of the common feature point descriptors fail to match local patches in featureless regions of an object. Hence, automatic documentation of the archeological process using Structure from Motion (SfM) methods is challenging. Nevertheless, such documentation is possible with the aid of a human operator. Deep learning-based descriptors have outperformed most of common feature point descriptors recently. This paper is focused on the development of a new Wide Image Zone Adaptive Robust feature Descriptor (WIZARD) based on the deep learning. We use a convolutional auto-encoder to compress discriminative features of a local path into a descriptor code. We build a codebook to perform point matching on multiple images. The matching is performed using the nearest neighbor search and a modified voting algorithm. We present a new "Multi-view Amphora" (Amphora) dataset for evaluation of point matching algorithms. The dataset includes images of an Ancient Greek vase found at Taman Peninsula in Southern Russia. The dataset provides color images, a ground truth 3D model, and a ground truth optical flow. We evaluated the WIZARD descriptor on the "Amphora" dataset to show that it outperforms the SIFT and SURF descriptors on the complex patch pairs.

Determining if an older adult can make and execute decisions to live safely at home: a capacity assessment and intervention model

PubMed Central

Skelton, Felicia; Kunik, Mark E.; Regev, Tziona; Naik, Aanand D.

2009-01-01

Determining an older adult’s capacity to live safely and independently in the community presents a serious and complicated challenge to the health care system. Evaluating one’s ability to make and execute decisions regarding safe and independent living incorporates clinical assessments, bioethical considerations, and often legal declarations of capacity. Capacity assessments usually result in life changes for patients and their families, including a caregiver managing some everyday tasks, placement outside of the home, and even legal guardianship. The process of determining capacity and recommending intervention is often inefficient and highly variable in most cases. Physicians are rarely trained to conduct capacity assessments and assessment methods are heterogeneous. An interdisciplinary team of clinicians developed the capacity assessment and intervention (CAI) model at a community outpatient geriatrics clinic to address these critical gaps. This report follows one patient through the entire CAI model, describing processes for a typical case. It then examines two additional case reports that highlight common challenges in capacity assessment. The CAI model uses assessment methods common to geriatrics clinical practice and conducts assessments and interventions in a standardized fashion. Reliance on common, validated measures increases generalizability of the model across geriatrics practice settings and patient populations. PMID:19481271

Maternal Plasma DNA and RNA Sequencing for Prenatal Testing.

PubMed

Tamminga, Saskia; van Maarle, Merel; Henneman, Lidewij; Oudejans, Cees B M; Cornel, Martina C; Sistermans, Erik A

2016-01-01

Cell-free DNA (cfDNA) testing has recently become indispensable in diagnostic testing and screening. In the prenatal setting, this type of testing is often called noninvasive prenatal testing (NIPT). With a number of techniques, using either next-generation sequencing or single nucleotide polymorphism-based approaches, fetal cfDNA in maternal plasma can be analyzed to screen for rhesus D genotype, common chromosomal aneuploidies, and increasingly for testing other conditions, including monogenic disorders. With regard to screening for common aneuploidies, challenges arise when implementing NIPT in current prenatal settings. Depending on the method used (targeted or nontargeted), chromosomal anomalies other than trisomy 21, 18, or 13 can be detected, either of fetal or maternal origin, also referred to as unsolicited or incidental findings. For various biological reasons, there is a small chance of having either a false-positive or false-negative NIPT result, or no result, also referred to as a "no-call." Both pre- and posttest counseling for NIPT should include discussing potential discrepancies. Since NIPT remains a screening test, a positive NIPT result should be confirmed by invasive diagnostic testing (either by chorionic villus biopsy or by amniocentesis). As the scope of NIPT is widening, professional guidelines need to discuss the ethics of what to offer and how to offer. In this review, we discuss the current biochemical, clinical, and ethical challenges of cfDNA testing in the prenatal setting and its future perspectives including novel applications that target RNA instead of DNA. © 2016 Elsevier Inc. All rights reserved.

Long-Term Antiretroviral Treatment Adherence in HIV-Infected Adolescents and Adults in Uganda: A Qualitative Study

PubMed Central

Inzaule, Seth C.; Hamers, Raph L.; Kityo, Cissy; Rinke de Wit, Tobias F.; Roura, Maria

2016-01-01

Background Long-term success of HIV antiretroviral therapy requires near-perfect adherence, maintained throughout one’s lifetime. However, perceptions towards ART and patterns of adherence may change during the life course. We assessed challenges to long-term adherence in adolescents and adults in three regional HIV treatment centers in Uganda. Methods We conducted 24 in-depth interviews and 2 focus group discussions with a total of 33 health-care providers and expert clients (HIV patients on long-term ART who assist with adherence support of fellow patients). Interview topics included experiences with patients on long-term treatment with either declining adherence or persistent poor adherence. Transcribed texts were coded and analyzed based on the social-ecological framework highlighting differences and commonalities between adolescents and adults. Results The overarching themes in adolescents were unstructured treatment holidays, delays in disclosure of HIV status by caretakers, stigma, which was mainly experienced in boarding schools, and diminishing or lack of clinical support. In particular, there was minimal support for early and gradual disclosure for caretakers to the infected children, diminishing clinical support for young adults during transition to adult-based care and declining peer-to-peer support group activities. The predominating theme in adults was challenges with treatment access among temporary economic migrants. Common themes to adults and adolescents were challenges with disclosure in intimate relationships, treatment related factors including side effects, supply of single tablets in place of fixed-dose combined drugs, supply of drug brands with unfavorable taste and missed opportunities for counseling due to shortage of staff. Conclusion Adherence counseling and support should be adapted differently for adolescents and adults and to the emerging life course challenges in long-term treated patients. Programs should also address constraints experienced by temporary economic migrants to ensure continuity of treatment within the host country. PMID:27898736

Design and Development of an Equipotential Voltage Reference (Grounding) System for a Low-Cost Rapid-Development Modular Spacecraft Architecture

NASA Technical Reports Server (NTRS)

Lukash, James A.; Daley, Earl

2011-01-01

This work describes the design and development effort to adapt rapid-development space hardware by creating a ground system using solutions of low complexity, mass, & cost. The Lunar Atmosphere and Dust Environment Explorer (LADEE) spacecraft is based on the modular common spacecraft bus architecture developed at NASA Ames Research Center. The challenge was building upon the existing modular common bus design and development work and improving the LADEE spacecraft design by adding an Equipotential Voltage Reference (EVeR) system, commonly referred to as a ground system. This would aid LADEE in meeting Electromagnetic Environmental Effects (E3) requirements, thereby making the spacecraft more compatible with itself and its space environment. The methods used to adapt existing hardware are presented, including provisions which may be used on future spacecraft.

[Adverse muscle effects of a podofyllotoxin-containing cytotoxic drug product with simvastatin].

PubMed

Kaipiainen-Seppänen, Oili; Savolainen, Elina; Elfving, Pia; Kononoff, Aulikki

2009-01-01

With the ageing population, drug interactions pose an increasing challenge to health professionals. We describe four patients, for whom concurrent administration of a podofyllotoxin-containing cytotoxic drug product and simvastatin caused severe adverse effects on muscles, including muscle pain, soreness or fatigue or weakness, and in some patients also disintegration of muscle tissue, i.e. rhabdomyolysis. The metabolism of both drugs proceeds via the common CYP3A4 enzyme pathway.

Peyronie's Disease: Still a Surgical Disease

PubMed Central

Martinez, Daniel; Ercole, Cesar E.; Hakky, Tariq S.; Kramer, Andrew; Carrion, Rafael

2012-01-01

Peyronie's Disease (PD) remains a challenging and clinically significant morbid condition. Since its first description by François Gigot de la Peyronie, much of the treatment for PD remains nonstandardized. PD is characterized by the formation of fibrous plaques at the level of the tunica albuginea. Clinical manifestations include morphologic changes, such as curvatures and hourglass deformities. Here, we review the common surgical techniques for the management of patients with PD. PMID:22956943

Networked Governance in Three Policy Areas with Implications for the Common Core State Standards Initiative

ERIC Educational Resources Information Center

Manna, Paul

2010-01-01

Policy makers and researchers now recognize that designing effective institutions to govern policy networks is a major challenge of the 21st Century. Presently, the Common Core State Standards Initiative resembles an emerging network of organizations united around the goal of developing clear and challenging academic expectations for students in…

Common Challenges for Instructors in Large Online Courses: Strategies to Mitigate Student and Instructor Frustration

ERIC Educational Resources Information Center

Trammell, Beth A.; LaForge, Chera

2017-01-01

Teaching in the online classroom is becoming commonplace for instructors as universities seek to grow enrollments and tap into unexplored markets. Many instructors, however, are often unprepared for the nuances of distance education and apprehensive about making the transition to online learning. This article aims to discuss common challenges for…

Limiting Student Speech: A Narrow Path toward Success. A Response to "Challenging the Common Guidelines in Social Justice Education"

ERIC Educational Resources Information Center

Minnick, Marissa C. A.

2015-01-01

In this response, Minnick asserts that unequal representation of students' voices, an idea presented in Sensoy and DiAngelo's "Challenging the Common Guidelines in Social Justice Education," presents multiple negative classroom implications. Foremost, Minnick argues that Sensoy and DiAngelo's lack of clarity regarding when a teacher…

Schematic driven silicon photonics design

NASA Astrophysics Data System (ADS)

Chrostowski, Lukas; Lu, Zeqin; Flückiger, Jonas; Pond, James; Klein, Jackson; Wang, Xu; Li, Sarah; Tai, Wei; Hsu, En Yao; Kim, Chan; Ferguson, John; Cone, Chris

2016-03-01

Electronic circuit designers commonly start their design process with a schematic, namely an abstract representation of the physical circuit. In integrated photonics on the other hand, it is very common for the design to begin at the physical component level. In order to build large integrated photonic systems, it is crucial to design using a schematic-driven approach. This includes simulations based on schematics, schematic-driven layout, layout versus schematic verification, and post-layout simulations. This paper describes such a design framework implemented using Mentor Graphics and Lumerical Solutions design tools. In addition, we describe challenges in silicon photonics related to manufacturing, and how these can be taken into account in simulations and how these impact circuit performance.

Ultrasound Imaging and Guided Injection for the Lateral and Posterior Hip.

PubMed

Chang, Ke-Vin; Wu, Wei-Ting; Lew, Henry L; Özçakar, Levent

2018-04-01

Ultrasound has emerged as one of the most utilized tools to diagnose musculoskeletal disorders and to assist in interventions. Traditionally, sonographic examination of the hip joint has been challenging because most of the major structures are deeply situated, thus requiring the use of curvilinear transducer for better penetrance. The posterior lateral hip is a frequent area for musculoskeletal pain and nerve entrapments. Common disorders include greater trochanteric pain syndrome, gluteus medius tendinopathy, piriformis syndrome, pudendal neuralgia, and proximal hamstring tendinopathy. The present review article aims to delineate sonoanatomy of the posterior lateral hip and to exemplify several common ultrasound guided procedures at the greater trochanteric, gluteal, and ischial tuberosity regions.

Neurobiological roots of language in primate audition: common computational properties.

PubMed

Bornkessel-Schlesewsky, Ina; Schlesewsky, Matthias; Small, Steven L; Rauschecker, Josef P

2015-03-01

Here, we present a new perspective on an old question: how does the neurobiology of human language relate to brain systems in nonhuman primates? We argue that higher-order language combinatorics, including sentence and discourse processing, can be situated in a unified, cross-species dorsal-ventral streams architecture for higher auditory processing, and that the functions of the dorsal and ventral streams in higher-order language processing can be grounded in their respective computational properties in primate audition. This view challenges an assumption, common in the cognitive sciences, that a nonhuman primate model forms an inherently inadequate basis for modeling higher-level language functions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Transference and Countertransference in the Psychotherapy of Therapists Charged With Sexual Misconduct

PubMed Central

GABBARD, GLEN O.

1995-01-01

When psychotherapists accused of sexual misconduct are referred for personal psychotherapy, formidable challenges are presented to the clinician designated as the psychotherapist. The author outlines common transference-countertransference themes and discusses them in terms of their psychodynamic underpinnings and optimal management. These themes include the therapist as a law enforcement agent, the therapist as a corruptible object, the therapist as a love object, the therapist as a rescuer and absolver, the therapist as an authoritarian parent, and the therapist as a voyeur. A common thread in all of these transference-counter-transference paradigms involves the discomfort experienced by the treating psychotherapists when they recognize aspects of themselves in the accused professional. PMID:22700209

Metabolic and inflammatory responses to the common sweetener stevioside and a glycemic challenge in horses with equine metabolic syndrome.

PubMed

Elzinga, S E; Rohleder, B; Schanbacher, B; McQuerry, K; Barker, V D; Adams, A A

2017-07-01

Extracts derived from the leaves of the stevia plant (stevioside) are commonly used as sweeteners for humans and horses. Stevioside appears to be safe for human consumption, including for individuals with insulin dysregulation. In the horse, the safety or metabolic effects of stevioside on normal animals or on those with metabolic dysfunction are unknown. Furthermore, the inflammatory response to a glycemic challenge or to stevioside in horses is not well defined. Therefore, the objective of this study was to measure the effects of stevioside and a glycemic challenge on insulin, glucose, and inflammatory responses in horses with a common metabolic dysfunction (equine metabolic syndrome or EMS) compared with non-EMS controls. To accomplish this, 15 horses were selected; 8 EMS and 7 age-matched controls. An oral sugar test was performed using Karo corn syrup (karo) or stevioside in a random crossover design. Horses were given 0.15 mL/kg body weight of karo or its equivalent grams of sugar in stevia dissolved in water. Blood samples were collected by jugular venipuncture before administration of either stevia or karo and at 60 and 240 min after administration. Serum was used for glucose and insulin determination and plasma for isolation of peripheral blood mononuclear cells (PBMCs) for inflammatory cytokine analysis via flow cytometry and reverse transcription PCR (RT-PCR). Stevia appeared to stimulate lower glycemic and insulinemic responses when compared to karo, in particular in EMS horses. EMS and control horses had inverse inflammatory responses to administration of either stevia or karo with EMS horses having a proinflammatory response (P ≤ 0.05). These data provide evidence as to why horses with EMS may be predisposed to developing laminitis, potentially as a result of an exaggerated inflammatory response to glycemic and insulinemic responses. Furthermore, the data provide new avenues for exploring mechanisms behind the syndrome, in particular when using a glycemic challenge. Copyright © 2017 Elsevier Inc. All rights reserved.

Preclinical Imaging for the Study of Mouse Models of Thyroid Cancer

PubMed Central

Greco, Adelaide; Orlandella, Francesca Maria; Iervolino, Paola Lucia Chiara; Klain, Michele; Salvatore, Giuliana

2017-01-01

Thyroid cancer, which represents the most common tumors among endocrine malignancies, comprises a wide range of neoplasms with different clinical aggressiveness. One of the most important challenges in research is to identify mouse models that most closely resemble human pathology; other goals include finding a way to detect markers of disease that common to humans and mice and to identify the most appropriate and least invasive therapeutic strategies for specific tumor types. Preclinical thyroid imaging includes a wide range of techniques that allow for morphological and functional characterization of thyroid disease as well as targeting and in most cases, this imaging allows quantitative analysis of the molecular pattern of the thyroid cancer. The aim of this review paper is to provide an overview of all of the imaging techniques used to date both for diagnosis and theranostic purposes in mouse models of thyroid cancer. PMID:29258188

First benchmark of the Unstructured Grid Adaptation Working Group

NASA Technical Reports Server (NTRS)

Ibanez, Daniel; Barral, Nicolas; Krakos, Joshua; Loseille, Adrien; Michal, Todd; Park, Mike

2017-01-01

Unstructured grid adaptation is a technology that holds the potential to improve the automation and accuracy of computational fluid dynamics and other computational disciplines. Difficulty producing the highly anisotropic elements necessary for simulation on complex curved geometries that satisfies a resolution request has limited this technology's widespread adoption. The Unstructured Grid Adaptation Working Group is an open gathering of researchers working on adapting simplicial meshes to conform to a metric field. Current members span a wide range of institutions including academia, industry, and national laboratories. The purpose of this group is to create a common basis for understanding and improving mesh adaptation. We present our first major contribution: a common set of benchmark cases, including input meshes and analytic metric specifications, that are publicly available to be used for evaluating any mesh adaptation code. We also present the results of several existing codes on these benchmark cases, to illustrate their utility in identifying key challenges common to all codes and important differences between available codes. Future directions are defined to expand this benchmark to mature the technology necessary to impact practical simulation workflows.

Social Media: Portrait of an Emerging Tool in Medical Education.

PubMed

Roy, Durga; Taylor, Jacob; Cheston, Christine C; Flickinger, Tabor E; Chisolm, Margaret S

2016-02-01

The authors compare the prevalence of challenges and opportunities in commentaries and descriptive accounts versus evaluative studies of social media use in medical education. A previously published report of social media use in medical education provided an in-depth discussion of 14 evaluative studies, a small subset of the total number of 99 articles on this topic. This study used the full set of articles identified by that review, including the 58 commentaries and 27 descriptive accounts which had not been previously reported, to provide a glimpse into how emerging tools in medical education are initially perceived. Each commentary, descriptive account, and evaluative study was identified and compared on various characteristics, including discussion themes regarding the challenges and opportunities of social media use in medical education. Themes related to the challenges of social media use in medical education were more prevalent in commentaries and descriptive accounts than in evaluative studies. The potential of social media to affect medical professionalism adversely was the most commonly discussed challenge in the commentaries (53%) and descriptive accounts (63%) in comparison to technical issues related to implementation in the evaluative studies (50%). Results suggest that the early body of literature on social media use in medical education-like that of previous innovative education tools-comprises primarily commentaries and descriptive accounts that focus more on the challenges of social media than on potential opportunities. These results place social media tools in historical context and lay the groundwork for expanding on this novel approach to medical education.

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

PubMed

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

2014-12-01

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

Women with epilepsy: clinically relevant issues

PubMed Central

Bangar, Santosh; Shastri, Abhishek; El-Sayeh, Hany; Cavanna, Andrea E.

2016-01-01

Summary Women with epilepsy (WWE) face specific challenges throughout their lifespan due to the effects of seizures and antiepileptic drugs on hormonal function, potentially affecting both sexual and reproductive health. This review article addresses the most common issues of practical relevance to clinicians treating WWE: epidemiology and clinical presentations (including catamenial epilepsy), contraception, reproductive and sexual dysfunction, pregnancy, lactation, menopause-related issues (including bone health), and mental health aspects. Awareness of these gender-specific issues and implementation/adaptation of effective interventions for WWE results in significantly improved health-related quality of life in this patient population. PMID:27678205

Patient-Reported Outcome and Observer-Reported Outcome Assessment in Rare Disease Clinical Trials: An ISPOR COA Emerging Good Practices Task Force Report.

PubMed

Benjamin, Katy; Vernon, Margaret K; Patrick, Donald L; Perfetto, Eleanor; Nestler-Parr, Sandra; Burke, Laurie

Rare diseases (RDs) affect a small number of people within a population. About 5000 to 8000 distinct RDs have been identified, with an estimated 6% to 8% of people worldwide suffering from an RD. Approximately 75% of RDs affect children. Frequently, these conditions are heterogeneous; many are progressive. Regulatory incentives have increased orphan drug designations and approvals. To develop emerging good practices for RD outcomes research addressing the challenges inherent in identifying, selecting, developing, adapting, and implementing patient-reported outcome (PRO) and observer-reported outcome (ObsRO) assessments for use in RD clinical trials. This report outlines the challenges and potential solutions in determining clinical outcomes for RD trials. It follows the US Food and Drug Administration Roadmap to Patient-Focused Outcome Measurement in Clinical Trials. The Roadmap consists of three columns: 1) Understanding the Disease or Condition, 2) Conceptualizing Treatment Benefit, and 3) Selecting/Developing the Outcome Measure. Challenges in column 1 include factors such as incomplete natural history data and heterogeneity of disease presentation and patient experience. Solutions include using several information sources, for example, clinical experts and patient advocacy groups, to construct the condition's natural history and understand treatment patterns. Challenges in column 2 include understanding and measuring treatment benefit from the patient's perspective, especially given challenges in defining the context of use such as variations in age or disease severity/progression. Solutions include focusing on common symptoms across patient subgroups, identifying short-term outcomes, and using multiple types of COA instruments to measure the same constructs. Challenges in column 3 center around the small patient population and heterogeneity of the condition or study sample. Few disease-specific instruments for RDs exist. Strategies include adapting existing instruments developed for a similar condition or that contain symptoms of importance to the RD patient population, or using a generic instrument validated for the context of use. This report provides state-of-the-art solutions to patient-reported outcome (PRO) and observer-reported outcome (ObsRO) assessments challenges in clinical trials of patients with RDs. These recommended solutions are both pragmatic and creative and posed with clear recognition of the global regulatory context used in RD clinical development programs. Copyright © 2017. Published by Elsevier Inc.

Psychogenic Non-epileptic Seizures: An Updated Primer.

PubMed

Baslet, Gaston; Seshadri, Ashok; Bermeo-Ovalle, Adriana; Willment, Kim; Myers, Lorna

2016-01-01

Psychogenic non-epileptic seizures are the most common paroxysmal event misdiagnosed as epilepsy. They significantly affect quality of life, functional status, and use of medical resources. The goal of this review is to provide guidance to psychiatrists and other mental health professionals in the understanding and practical management of this condition. An abundance of new reports on the pathogenesis and effective treatments have become available over the last decade, yet specific barriers impede the fluid transition to treatment and remain an important challenge in the management of patients with psychogenic non-epileptic seizures. In the context of these difficulties, we initially present background information on psychogenic non-epileptic seizures covering their historic context, epidemiology, etiologic factors (including psychiatric, neuromedical, and neuropsychological factors), and current neurobiological models. Updated evidence-based treatments are discussed along with data on long-term outcomes. We also provide practical tools to help clinicians navigate differential diagnoses, establish their interdisciplinary roles, communicate the diagnosis, deliver treatment, and sort out commonly encountered challenges in the management of this condition. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Understanding Nutritional Epidemiology and Its Role in Policy12

PubMed Central

Satija, Ambika; Yu, Edward; Willett, Walter C; Hu, Frank B

2015-01-01

Nutritional epidemiology has recently been criticized on several fronts, including the inability to measure diet accurately, and for its reliance on observational studies to address etiologic questions. In addition, several recent meta-analyses with serious methodologic flaws have arrived at erroneous or misleading conclusions, reigniting controversy over formerly settled debates. All of this has raised questions regarding the ability of nutritional epidemiologic studies to inform policy. These criticisms, to a large degree, stem from a misunderstanding of the methodologic issues of the field and the inappropriate use of the drug trial paradigm in nutrition research. The exposure of interest in nutritional epidemiology is human diet, which is a complex system of interacting components that cumulatively affect health. Consequently, nutritional epidemiology constantly faces a unique set of challenges and continually develops specific methodologies to address these. Misunderstanding these issues can lead to the nonconstructive and sometimes naive criticisms we see today. This article aims to clarify common misunderstandings of nutritional epidemiology, address challenges to the field, and discuss the utility of nutritional science in guiding policy by focusing on 5 broad questions commonly asked of the field. PMID:25593140

Hyperspectral imaging for simultaneous measurements of two FRET biosensors in pancreatic β-cells.

PubMed

Elliott, Amicia D; Bedard, Noah; Ustione, Alessandro; Baird, Michelle A; Davidson, Michael W; Tkaczyk, Tomasz; Piston, David W

2017-01-01

Fluorescent protein (FP) biosensors based on Förster resonance energy transfer (FRET) are commonly used to study molecular processes in living cells. There are FP-FRET biosensors for many cellular molecules, but it remains difficult to perform simultaneous measurements of multiple biosensors. The overlapping emission spectra of the commonly used FPs, including CFP/YFP and GFP/RFP make dual FRET measurements challenging. In addition, a snapshot imaging modality is required for simultaneous imaging. The Image Mapping Spectrometer (IMS) is a snapshot hyperspectral imaging system that collects high resolution spectral data and can be used to overcome these challenges. We have previously demonstrated the IMS's capabilities for simultaneously imaging GFP and CFP/YFP-based biosensors in pancreatic β-cells. Here, we demonstrate a further capability of the IMS to image simultaneously two FRET biosensors with a single excitation band, one for cAMP and the other for Caspase-3. We use these measurements to measure simultaneously cAMP signaling and Caspase-3 activation in pancreatic β-cells during oxidative stress and hyperglycemia, which are essential components in the pathology of diabetes.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration

PubMed Central

Sullivan, Jennifer L.; Adjognon, Omonyêlé L.; Engle, Ryann L.; Shin, Marlena H.; Afable, Melissa K.; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

2018-01-01

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges. PMID:28125459

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

PubMed

Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.

Perceived Benefits and Challenges of Coordinated Approaches to Chronic Disease Prevention in State Health Departments

PubMed Central

Sequeira, Sonia; Best, Leslie; Jones, Ellen; Baker, Elizabeth A.; Brownson, Ross C.

2014-01-01

Introduction Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. Methods A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ2 tests, and analysis of variance were conducted. Results The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges “lack of communication across programs” (P = .02) and “funding might be reduced” differed by program area (P < .001). Conclusion Findings can be used by funding agencies and state health departments for planning, training, and technical assistance. The information on perceived challenges demonstrates the need to improve communication across programs, enhance organizational support for coordinated approaches, and create benefits for organizational partners. PMID:24809362

Building on common ground to address biodiversity conflicts and foster collaboration in environmental management.

PubMed

Lecuyer, Lou; White, Rehema M; Schmook, Birgit; Calmé, Sophie

2018-08-15

Conservation biology faces critical challenges that require collaborative approaches, including novel strategies to support interactions among actors in biodiversity conflicts. The goals of this study were to investigate the concept of common ground across multiple issues and to explore its practical application for the support of environmental management. We conceptually defined common ground as the areas of relevance underlying the suite of issues expressed by people regarding environmental management in a particular context. We then empirically tested this in the Calakmul region of Mexico, where the complex socio-historical context and high biodiversity have created environmental management challenges that are now being addressed by a local, multi-stakeholder management board. We conducted 26 open interviews with members of the board and a further round of quantitative prioritisation of issues raised. Using a coding process designed to reveal common ground, we categorized the issues at four levels ranging from coarse to fine (themes, topics, sub-topics and perspectives). We then analysed two levels, topics (n = 14 issues) and sub-topics (n = 51 issues). To do so, we built common ground matrices to identify and analyze common ground among actors and across issues. First, cluster and non-metrical data analyses revealed the diversity of actor positions and the lack of consistent grouping among actors by occupational activity. This demonstrated that focusing on actors' differences might be misleading, and that actors' views were not closely aligned with their roles. Second, we located issues according to their levels of common ground and importance among actors. We showed that by not focusing on single issue conflicts, the identification of common ground across multiple issues can pinpoint synergies. We then proposed a framework for collaboration that prioritizes issues of high importance with greater common ground (e.g. sustainable resource use activities), to support the development of trust and norms of reciprocity among actors, strengthening the potential for future cooperation. By adopting this approach, environmental managers could support the initial stages of collaborative conservation strategies, engaging with other actors to seek common ground, avoid the creation of polarised groups and help effectively manage biodiversity conflicts. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Challenge of Managing Psoriasis: Unmet Medical Needs and Stakeholder Perspectives

PubMed Central

Feldman, Steven R.; Goffe, Bernard; Rice, Gary; Mitchell, Matthew; Kaur, Mandeep; Robertson, Debbie; Sierka, Debra; Bourret, Jeffrey A.; Evans, Tamara S.; Gottlieb, Alice

2016-01-01

Background Psoriasis is a debilitating chronic inflammatory autoimmune disease affecting approximately 7.4 million adults in the United States. Plaque psoriasis is the most common form, affecting 80% to 90% of patients. Objectives To describe the impact and challenges that psoriasis presents for various stakeholders, and to provide nondermatologist healthcare decision makers with information to enhance their contributions to drug and pharmacy benefit design discussions. Discussion Psoriasis carries an increased risk for early mortality and an increased prevalence of comorbidities, including psoriatic arthritis, cardiovascular disease, and diabetes. It is also associated with anxiety, depression, and social isolation, and can negatively impact patients' relationships, productivity, and careers. The physical, psychologic, social, and economic impact of psoriasis, plus the associated stigma, result in cumulative impairment over a patient's lifetime. The current treatments for moderate-to-severe psoriasis include topical therapy, phototherapy, and systemic drugs (nonbiologic and biologic); however, patient satisfaction remains low, combination therapy and treatment switching are common, and many patients remain untreated or undertreated. Clinicians should consider the patient holistically, and should select treatment based on a range of factors, including disease severity (with physical and psychosocial manifestations), susceptibility to cumulative life-course impairment (considering personality, behavior, and cognition), comorbidities, concomitant medication, and patient preference. It is estimated that the total annual direct cost of treating psoriasis in the United States in 2015 exceeded $12.2 billion. Conclusion Psoriasis is a complex disease, and appropriate management is correspondingly complex. Newer psoriasis treatments provide improved efficacy and safety versus traditional treatments, but challenges remain in ensuring patients access to these medications. An improved understanding of the barriers to appropriate treatment is needed, as well as clear and accessible information for payers and clinicians on current treatment options, to ensure that decision makers can control costs while providing patients with optimal care. PMID:28465778

Delivery of genomic medicine for common chronic adult diseases: a systematic review.

PubMed

Scheuner, Maren T; Sieverding, Pauline; Shekelle, Paul G

2008-03-19

The greatest public health benefit of advances in understanding the human genome may be realized for common chronic diseases such as cardiovascular disease, diabetes mellitus, and cancer. Attempts to integrate such knowledge into clinical practice are still in the early stages, and as a result, many questions surround the current state of this translation. To synthesize current information on genetic health services for common adult-onset conditions by examining studies that have addressed the outcomes, consumer information needs, delivery, and challenges in integrating these services. MEDLINE articles published between January 2000 and February 2008. Original research articles and systematic reviews dealing with common chronic adult-onset conditions were reviewed. A total of 3371 citations were reviewed, 170 articles retrieved, and 68 articles included in the analysis. Data were independently extracted by one reviewer and checked by another with disagreement resolved by consensus. Variables assessed included study design and 4 key areas: outcomes of genomic medicine, consumer information needs, delivery of genomic medicine, and challenges and barriers to integration of genomic medicine. Sixty-eight articles contributed data to the synthesis: 5 systematic reviews, 8 experimental studies, 35 surveys, 7 pre/post studies, 3 observational studies, and 10 qualitative reports. Three systematic reviews, 4 experimental studies, and 9 additional studies reported on outcomes of genetic services. Generally there were modest positive effects on psychological outcomes such as worry and anxiety, behavioral outcomes have shown mixed results, and clinical outcomes were less well studied. One systematic review, 1 randomized controlled trial, and 14 other studies assessed consumer information needs and found in general that genetics knowledge was reported to be low but that attitudes were generally positive. Three randomized controlled trials and 13 other studies assessed how genomic medicine is delivered and newer models of delivery. One systematic review and 19 other studies assessed barriers; the most consistent finding was the self-assessed inadequacy of the primary care workforce to deliver genetic services. Additional identified barriers included lack of oversight of genetic testing and concerns about privacy and discrimination. Many gaps in knowledge about organization, clinician, and patient needs must be filled to translate basic and clinical science advances in genomics of common chronic diseases into practice.

Challenges in the management of exercise-induced asthma.

PubMed

Storms, William

2009-05-01

Exercise and physical activity are common triggers of symptoms in patients with asthma, although some individuals - especially athletes - may have symptoms with exercise alone. Exercise-induced bronchospasm (EIB) describes airway hyper-reactivity that is observed following exercise in a patient who is not otherwise diagnosed with asthma; exercise-induced asthma (EIA) describes airway hyper-reactivity associated with exercise in a patient who has persistent asthma. Specific challenges affecting both the diagnosis and treatment of these conditions are discussed in this review. The past decade has seen substantial advances in our understanding of EIA and EIB, including new guidelines on their management. With appropriate therapy, all patients with exercise-related symptoms should be able to reach their desired level of performance.

Enhancing the Safety, Security and Resilience of ICT and Scada Systems Using Action Research

NASA Astrophysics Data System (ADS)

Johnsen, Stig; Skramstad, Torbjorn; Hagen, Janne

This paper discusses the results of a questionnaire-based survey used to assess the safety, security and resilience of information and communications technology (ICT) and supervisory control and data acquisition (SCADA) systems used in the Norwegian oil and gas industry. The survey identifies several challenges, including the involvement of professionals with different backgrounds and expertise, lack of common risk perceptions, inadequate testing and integration of ICT and SCADA systems, poor information sharing related to undesirable incidents and lack of resilience in the design of technical systems. Action research is proposed as a process for addressing these challenges in a systematic manner and helping enhance the safety, security and resilience of ICT and SCADA systems used in oil and gas operations.

Novel Hierarchical Fall Detection Algorithm Using a Multiphase Fall Model.

PubMed

Hsieh, Chia-Yeh; Liu, Kai-Chun; Huang, Chih-Ning; Chu, Woei-Chyn; Chan, Chia-Tai

2017-02-08

Falls are the primary cause of accidents for the elderly in the living environment. Reducing hazards in the living environment and performing exercises for training balance and muscles are the common strategies for fall prevention. However, falls cannot be avoided completely; fall detection provides an alarm that can decrease injuries or death caused by the lack of rescue. The automatic fall detection system has opportunities to provide real-time emergency alarms for improving the safety and quality of home healthcare services. Two common technical challenges are also tackled in order to provide a reliable fall detection algorithm, including variability and ambiguity. We propose a novel hierarchical fall detection algorithm involving threshold-based and knowledge-based approaches to detect a fall event. The threshold-based approach efficiently supports the detection and identification of fall events from continuous sensor data. A multiphase fall model is utilized, including free fall, impact, and rest phases for the knowledge-based approach, which identifies fall events and has the potential to deal with the aforementioned technical challenges of a fall detection system. Seven kinds of falls and seven types of daily activities arranged in an experiment are used to explore the performance of the proposed fall detection algorithm. The overall performances of the sensitivity, specificity, precision, and accuracy using a knowledge-based algorithm are 99.79%, 98.74%, 99.05% and 99.33%, respectively. The results show that the proposed novel hierarchical fall detection algorithm can cope with the variability and ambiguity of the technical challenges and fulfill the reliability, adaptability, and flexibility requirements of an automatic fall detection system with respect to the individual differences.

Novel Hierarchical Fall Detection Algorithm Using a Multiphase Fall Model

PubMed Central

Hsieh, Chia-Yeh; Liu, Kai-Chun; Huang, Chih-Ning; Chu, Woei-Chyn; Chan, Chia-Tai

2017-01-01

Falls are the primary cause of accidents for the elderly in the living environment. Reducing hazards in the living environment and performing exercises for training balance and muscles are the common strategies for fall prevention. However, falls cannot be avoided completely; fall detection provides an alarm that can decrease injuries or death caused by the lack of rescue. The automatic fall detection system has opportunities to provide real-time emergency alarms for improving the safety and quality of home healthcare services. Two common technical challenges are also tackled in order to provide a reliable fall detection algorithm, including variability and ambiguity. We propose a novel hierarchical fall detection algorithm involving threshold-based and knowledge-based approaches to detect a fall event. The threshold-based approach efficiently supports the detection and identification of fall events from continuous sensor data. A multiphase fall model is utilized, including free fall, impact, and rest phases for the knowledge-based approach, which identifies fall events and has the potential to deal with the aforementioned technical challenges of a fall detection system. Seven kinds of falls and seven types of daily activities arranged in an experiment are used to explore the performance of the proposed fall detection algorithm. The overall performances of the sensitivity, specificity, precision, and accuracy using a knowledge-based algorithm are 99.79%, 98.74%, 99.05% and 99.33%, respectively. The results show that the proposed novel hierarchical fall detection algorithm can cope with the variability and ambiguity of the technical challenges and fulfill the reliability, adaptability, and flexibility requirements of an automatic fall detection system with respect to the individual differences. PMID:28208694

Common challenges for ecological modelling: synthesis of facilitated discussions held at the symposia organized for the 2009 conference of the International Society for Ecological Modelling in Quebec City, Canada, (October 6-9, 2009)

USGS Publications Warehouse

Larocque, Guy R.; Mailly, D.; Yue, T.-X.; Anand, M.; Peng, C.; Kazanci, C.; Etterson, M.; Goethals, P.; Jorgensen, S.E.; Schramski, J.R.; McIntire, E.J.B.; Marceau, D.J.; Chen, B.; Chen, G.Q.; Yang, Z.F.; Novotna, B.; Luckai, N.; Bhatti, Jagtar S.; Liu, J.; Munson, A.; Gordon, Andrew M.; Ascough, J.C.

2011-01-01

The eleven symposia organized for the 2009 conference of the International Society for Ecological Modelling (ISEM 2009) held in Quebec City, Canada, October 6–9, 2009, included facilitated discussion sessions following formal presentations. Each symposium focused on a specific subject, and all the subjects could be classified into three broad categories: theoretical development, population dynamics and ecosystem processes. Following discussions with the symposia organizers, which indicated that they all shared similar issues and concerns, the facilitated discussions were task-oriented around four basic questions: (1) key challenges in the research area, (2) generating and sharing new ideas, (3) improving collaboration and networking, and (4) increasing visibility to decision-makers, partners and clients. Common challenges that emerged from the symposia included the need for improved communication and collaboration among different academic disciplines, further progress in both theoretical and practical modelling approaches, and accentuation of technology transfer. Regarding the generation and sharing of new ideas, the main issue that emerged was the type of positive interactions that should be encouraged among potential collaborators. The usefulness of the Internet, particularly for the sharing of open-source software and conducting discussion forums, was highlighted for improving collaboration and networking. Several communication tools are available today, and it is important for modellers to use them more intensively. Visibility can be increased by publishing professional newsletters, maintaining informal contacts with the public, organizing educational sessions in primary and secondary schools, and developing simplified analytical frameworks and pilot studies. Specific issues raised in each symposium are also discussed.

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria.

PubMed

Sam-Agudu, Nadia A; Aliyu, Muktar H; Adeyemi, Olusegun A; Oronsaye, Frank; Oyeledun, Bolanle; Ogidi, Amaka G; Ezeanolue, Echezona E

2018-04-17

Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.

Social Justice and the Environmental Commons.

PubMed

Flanagan, Constance A; Byington, Rachel; Gallay, Erin; Sambo, Allison

2016-01-01

In this chapter, we build on the scholarship on youth civic engagement by turning attention to the environmental commons as a space for political action. We begin with a definition of the term and arguments about ways that social justice is implied in it. Following that, we raise several psychological challenges to motivating action on behalf of the environmental commons and discuss the critical experiences and actions that can defy those challenges. Finally, drawing from Ostrom's empirical evidence opposing a tragedy of the commons, we discuss practices consistent with a social justice approach that nurture in younger generations an identification with and commitment to the environmental commons and discuss how this orientation would benefit human beings, democracies, and the earth. © 2016 Elsevier Inc. All rights reserved.

Leading Change for the Implementation of Common Core State Standards in Rural School Districts

ERIC Educational Resources Information Center

Lopez, Paul; Wise, Donald

2015-01-01

Rural school districts across the nation, with their limited resources, face daunting challenges posed by the implementation of the Common Core State Standards. This article presents a recent study of 13 rural school districts in the Central Valley of California and how these districts are responding to those challenges. A total of 352 teachers…

Successes and Challenges of HIV Mentoring in Malawi: The Mentee Perspective.

PubMed

Chien, Emily; Phiri, Khumbo; Schooley, Alan; Chivwala, Mackenzie; Hamilton, John; Hoffman, Risa M

2016-01-01

HIV clinical mentoring has been utilized for capacity building in Africa, but few formal program evaluations have explored mentee perspectives on these programs. EQUIP is a PEPFAR-USAID funded program in Malawi that has been providing HIV mentoring on clinical and health systems since 2010. We sought to understand the successes and challenges of EQUIP's mentorship program. From June-September 2014 we performed semi-structured, in-depth interviews with EQUIP mentees who had received mentoring for ≥ 1 year. Interview questions focused on program successes and challenges and were performed in English, audio recorded, coded, and analyzed using inductive content analysis with ATLAS.ti v7. Fifty-two mentees from 32 health centers were interviewed. The majority of mentees were 18-40 years old (79%, N = 41), 69% (N = 36) were male, 50% (N = 26) were nurses, 29% (N = 15) medical assistants, and 21% (N = 11) clinical officers. All mentees felt that EQUIP mentorship was successful (100%, N = 52). The most common benefit reported was an increase in clinical knowledge allowing for initiation of antiretroviral therapy (33%, N = 17). One-third of mentees (N = 17) reported increased clinic efficiency and improved systems for patient care due to EQUIP's systems mentoring including documentation, supply chain and support for minor construction at clinics. The most common challenge (52%, N = 27) was understaffing at facilities, with mentees having multiple responsibilities during mentorship visits resulting in impaired ability to focus on learning. Mentees also reported that medication stock-outs (42%, N = 22) created challenges for the mentoring process. EQUIP's systems-based mentorship and infrastructure improvements allowed for an optimized environment for clinical training. Shortages of health workers at sites pose a challenge for mentoring programs because mentees are pulled from learning experiences to perform non-HIV-related clinic duties. Evaluations of existing mentoring models are needed to continue to improve mentoring strategies that result in sustainable benefits for mentees, facilities, and patients.

Living on a flammable planet: interdisciplinary, cross-scalar and varied cultural lessons, prospects and challenges.

PubMed

Roos, Christopher I; Scott, Andrew C; Belcher, Claire M; Chaloner, William G; Aylen, Jonathan; Bird, Rebecca Bliege; Coughlan, Michael R; Johnson, Bart R; Johnston, Fay H; McMorrow, Julia; Steelman, Toddi

2016-06-05

Living with fire is a challenge for human communities because they are influenced by socio-economic, political, ecological and climatic processes at various spatial and temporal scales. Over the course of 2 days, the authors discussed how communities could live with fire challenges at local, national and transnational scales. Exploiting our diverse, international and interdisciplinary expertise, we outline generalizable properties of fire-adaptive communities in varied settings where cultural knowledge of fire is rich and diverse. At the national scale, we discussed policy and management challenges for countries that have diminishing fire knowledge, but for whom global climate change will bring new fire problems. Finally, we assessed major fire challenges that transcend national political boundaries, including the health burden of smoke plumes and the climate consequences of wildfires. It is clear that to best address the broad range of fire problems, a holistic wildfire scholarship must develop common agreement in working terms and build across disciplines. We must also communicate our understanding of fire and its importance to the media, politicians and the general public.This article is part of the themed issue 'The interaction of fire and mankind'. © 2016 The Author(s).

Living on a flammable planet: interdisciplinary, cross-scalar and varied cultural lessons, prospects and challenges

PubMed Central

Chaloner, William G.; Aylen, Jonathan; Bird, Rebecca Bliege; Coughlan, Michael R.; Johnson, Bart R.; Johnston, Fay H.; Steelman, Toddi

2016-01-01

Living with fire is a challenge for human communities because they are influenced by socio-economic, political, ecological and climatic processes at various spatial and temporal scales. Over the course of 2 days, the authors discussed how communities could live with fire challenges at local, national and transnational scales. Exploiting our diverse, international and interdisciplinary expertise, we outline generalizable properties of fire-adaptive communities in varied settings where cultural knowledge of fire is rich and diverse. At the national scale, we discussed policy and management challenges for countries that have diminishing fire knowledge, but for whom global climate change will bring new fire problems. Finally, we assessed major fire challenges that transcend national political boundaries, including the health burden of smoke plumes and the climate consequences of wildfires. It is clear that to best address the broad range of fire problems, a holistic wildfire scholarship must develop common agreement in working terms and build across disciplines. We must also communicate our understanding of fire and its importance to the media, politicians and the general public. This article is part of the themed issue ‘The interaction of fire and mankind’. PMID:27216517

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.

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

PubMed

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

2017-12-01

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

Common ground for biodiversity and ecosystem services: the “partial protection” challenge

PubMed Central

Faith, Daniel P

2012-01-01

New global initiatives require clarity about similarities and differences between biodiversity and ecosystem services. One argument is that ecosystem services capture utilitarian values, while biodiversity captures intrinsic values. However, the concept of biodiversity equally emerges from anthropogenic use values. Measures of biodiversity indicate broad option values, and so provide different information about future uses and benefits. Such differences nevertheless can be the basis for “common ground” for biodiversity and ecosystem services. Systematic conservation planning and related frameworks acknowledge such differences through effective trade-offs and synergies among different values of society. The early work on regional biodiversity trade-offs includes a little-explored aspect that could enhance this common ground. Regional planning here takes into account the “partial protection” of biodiversity provided by some land uses. Common-ground will be promoted by better integrating the ecosystem services and biodiversity conservation offered by ecosystems at the “natural end of the spectrum” with the partial protection and other benefits/services provided by more intensively-transformed places. PMID:24358821

Unknown risk: co-exposure to lead and other heavy metals among children living in small-scale mining communities in Zamfara State, Nigeria.

PubMed

Bartrem, Casey; Tirima, Simba; von Lindern, Ian; von Braun, Margrit; Worrell, Mary Claire; Mohammad Anka, Shehu; Abdullahi, Aishat; Moller, Gregory

2014-08-01

The lead poisoning crisis in Zamfara State, Northern Nigeria has been called the worst such case in modern history and it presents unique challenges for risk assessment and management of co-exposure to multiple heavy metals. More than 400 children have died in Zamfara as a result of ongoing lead intoxication since early in 2010. A review of the common toxic endpoints of the major heavy metals advances analysis of co-exposures and their common pathologies. Environmental contamination in Bagega village, examined by X-ray fluorescence of soils, includes lead, mercury, cadmium, arsenic and manganese. Co-exposure risk is explored by scoring common toxic endpoints and hazard indices to calculate a common pathology hazard risk ranking of Pb > As > Hg > Cd > Mn. Zamfara presents an extreme picture of both lead and multiple heavy metal mortality and morbidity, but similar situations have become increasingly prevalent worldwide.

Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework

PubMed Central

Corazzini, Kirsten; Twersky, Jack; White, Heidi K.; Buhr, Gwendolen T.; McConnell, Eleanor S.; Weiner, Madeline; Colón-Emeric, Cathleen S.

2015-01-01

Purpose of the Study: To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. Design and Methods: The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. Results: Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. Implications: Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges. PMID:24451896

An architecture for consolidating multidimensional time-series data onto a common coordinate grid

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

Shippert, Tim; Gaustad, Krista

Consolidating measurement data for use by data models or in inter-comparison studies frequently requires transforming the data onto a common grid. Standard methods for interpolating multidimensional data are often not appropriate for data with non-homogenous dimensionality, and are hard to implement in a consistent manner for different datastreams. These challenges are increased when dealing with the automated procedures necessary for use with continuous, operational datastreams. In this paper we introduce a method of applying a series of one-dimensional transformations to merge data onto a common grid, examine the challenges of ensuring consistent application of data consolidation methods, present a frameworkmore » for addressing those challenges, and describe the implementation of such a framework for the Atmospheric Radiation Measurement (ARM) program.« less

Enabling and challenging factors in institutional reform: The case of SCALE-UP

NASA Astrophysics Data System (ADS)

Foote, Kathleen; Knaub, Alexis; Henderson, Charles; Dancy, Melissa; Beichner, Robert J.

2016-06-01

While many innovative teaching strategies exist, integration into undergraduate science teaching has been frustratingly slow. This study aims to understand the low uptake of research-based instructional innovations by studying 21 successful implementations of the Student Centered Active Learning with Upside-down Pedagogies (SCALE-UP) instructional reform. SCALE-UP significantly restructures the classroom environment and pedagogy to promote highly active and interactive instruction. Although originally designed for university introductory physics courses, SCALE-UP has spread to many other disciplines at hundreds of departments around the world. This study reports findings from in-depth, open-ended interviews with 21 key contact people involved with successful secondary implementations of SCALE-UP throughout the United States. We defined successful implementations as those who restructured their pedagogy and classroom and sustained and/or spread the change. Interviews were coded to identify the most common enabling and challenging factors during reform implementation and compared to the theoretical framework of Kotter's 8-step Change Model. The most common enabling influences that emerged are documenting and leveraging evidence of local success, administrative support, interaction with outside SCALE-UP user(s), and funding. Many challenges are linked to the lack of these enabling factors including difficulty finding funding, space, and administrative and/or faculty support for reform. Our focus on successful secondary implementations meant that most interviewees were able to overcome challenges. Presentation of results is illuminated with case studies, quotes, and examples that can help secondary implementers with SCALE-UP reform efforts specifically. We also discuss the implications for policy makers, researchers, and the higher education community concerned with initiating structural change.

Supported employment specialist strategies to assist clients with severe mental illness and criminal justice issues.

PubMed

Whitley, Rob; Kostick, Kristin M; Bush, Philip W

2009-12-01

The aim of this study was to document and analyze common strategies used by supported employment specialists to overcome criminal justice issues among clients with severe mental illness. Semistructured qualitative interviews were conducted with a group of 22 supported employment specialists and their supervisors. Interviews were open ended and supplemented by ethnographic observation. Data were examined thematically by content analysis. Assisting clients with past and present criminal histories to find employment was confirmed as one of the hardest self-identified challenges for employment specialists. Three specific strategies commonly used by specialists for this subpopulation are documented and analyzed. These include taking an incremental approach with clients vis-à-vis obtaining work and career advancement, using a strengths-based model that emphasizes the client's strong points, and focusing the job search on "mom and pop" businesses that typically do not conduct background checks or do not have rigid recruitment policies. Enacting these strategies led to some deviation from the individualized placement and support model of supported employment. Participants noted that they felt most challenged when attempting to serve and assist clients with sex offenses. The findings imply that specialists are challenged when dealing with clients with criminal justice issues and use several approaches to overcome these challenges. Current specialist training may be deficient in preparing staff to effectively serve people with criminal justice issues. Further research should assess the efficacy of the approaches outlined in this article to give more guidance to specialists working with clients with criminal justice issues.

A new framework for the documentation and interpretation of oral food challenges in population-based and clinical research.

PubMed

Grabenhenrich, L B; Reich, A; Bellach, J; Trendelenburg, V; Sprikkelman, A B; Roberts, G; Grimshaw, K E C; Sigurdardottir, S; Kowalski, M L; Papadopoulos, N G; Quirce, S; Dubakiene, R; Niggemann, B; Fernández-Rivas, M; Ballmer-Weber, B; van Ree, R; Schnadt, S; Mills, E N C; Keil, T; Beyer, K

2017-03-01

The conduct of oral food challenges as the preferred diagnostic standard for food allergy (FA) was harmonized over the last years. However, documentation and interpretation of challenge results, particularly in research settings, are not sufficiently standardized to allow valid comparisons between studies. Our aim was to develop a diagnostic toolbox to capture and report clinical observations in double-blind placebo-controlled food challenges (DBPCFC). A group of experienced allergists, paediatricians, dieticians, epidemiologists and data managers developed generic case report forms and standard operating procedures for DBPCFCs and piloted them in three clinical centres. The follow-up of the EuroPrevall/iFAAM birth cohort and other iFAAM work packages applied these methods. A set of newly developed questionnaire or interview items capture the history of FA. Together with sensitization status, this forms the basis for the decision to perform a DBPCFC, following a standardized decision algorithm. A generic form including details about severity and timing captures signs and symptoms observed during or after the procedures. In contrast to the commonly used dichotomous outcome FA vs no FA, the allergy status is interpreted in multiple categories to reflect the complexity of clinical decision-making. The proposed toolbox sets a standard for improved documentation and harmonized interpretation of DBPCFCs. By a detailed documentation and common terminology for communicating outcomes, these tools hope to reduce the influence of subjective judgment of supervising physicians. All forms are publicly available for further evolution and free use in clinical and research settings. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

Patient and Stakeholder Engagement in the PCORI Pilot Projects: Description and Lessons Learned.

PubMed

Forsythe, Laura P; Ellis, Lauren E; Edmundson, Lauren; Sabharwal, Raj; Rein, Alison; Konopka, Kristen; Frank, Lori

2016-01-01

Patients and healthcare stakeholders are increasingly becoming engaged in the planning and conduct of biomedical research. However, limited research characterizes this process or its impact. We aimed to characterize patient and stakeholder engagement in the 50 Pilot Projects funded by the Patient-Centered Outcomes Research Institute (PCORI), and identify early contributions and lessons learned. A self-report instrument was completed by researchers between 6 and 12 months following project initiation. Forty-seven principal investigators or their designees (94 % response rate) participated in the study. MAIN MEASURES Self-report of types of stakeholders engaged, stages and levels of engagement, facilitators and barriers to engagement, lessons learned, and contributions from engagement were measured. Most (83 %) reported engaging more than one stakeholder in their project. Among those, the most commonly reported groups were patients (90 %), clinicians (87 %), health system representatives (44 %), caregivers (41 %), and advocacy organizations (41 %). Stakeholders were commonly involved in topic solicitation, question development, study design, and data collection. Many projects engaged stakeholders in data analysis, results interpretation, and dissemination. Commonly reported contributions included changes to project methods, outcomes or goals; improvement of measurement tools; and interpretation of qualitative data. Investigators often identified communication and shared leadership strategies as "critically important" facilitators (53 and 44 % respectively); lack of stakeholder time was the most commonly reported challenge (46 %). Most challenges were only partially resolved. Early lessons learned included the importance of continuous and genuine partnerships, strategic selection of stakeholders, and accommodation of stakeholders' practical needs. PCORI Pilot Projects investigators report engaging a variety of stakeholders across many stages of research, with specific changes to their research attributed to engagement. This study identifies early lessons and barriers that should be addressed to facilitate engagement. While this research suggests potential impact of stakeholder engagement, systematic characterization and evaluation of engagement at multiple stages of research is needed to build the evidence base.

Developing a Science Commons for Geosciences

NASA Astrophysics Data System (ADS)

Lenhardt, W. C.; Lander, H.

2016-12-01

Many scientific communities, recognizing the research possibilities inherent in data sets, have created domain specific archives such as the Incorporated Research Institutions for Seismology (iris.edu) and ClinicalTrials.gov. Though this is an important step forward, most scientists, including geoscientists, also use a variety of software tools and at least some amount of computation to conduct their research. While the archives make it simpler for scientists to locate the required data, provisioning disk space, compute resources, and network bandwidth can still require significant efforts. This challenge exists despite the wealth of resources available to researchers, namely lab IT resources, institutional IT resources, national compute resources (XSEDE, OSG), private clouds, public clouds, and the development of cyberinfrastructure technologies meant to facilitate use of those resources. Further tasks include obtaining and installing required tools for analysis and visualization. If the research effort is a collaboration or involves certain types of data, then the partners may well have additional non-scientific tasks such as securing the data and developing secure sharing methods for the data. These requirements motivate our investigations into the "Science Commons". This paper will present a working definition of a science commons, compare and contrast examples of existing science commons, and describe a project based at RENCI to implement a science commons for risk analytics. We will then explore what a similar tool might look like for the geosciences.

New Forces Yet Undetermined: The Challenge of Biodefense

DTIC Science & Technology

2009-09-01

processed. Smallpox virus was grown on the allantoic membrane of a fertile chicken egg. After examination of the membrane, it was a simple matter to place...Virologists have observed that it was common to put such vials in the back of a freezer and for old-fashioned-style labels to sometimes fall-off. Small- pox ...concern are naturally occurring. These include, for example, anthrax (in the Western United States), hanta virus (in New Mexico ), and tularemia (in Texas

Rewriting the future? Biomedical advances and legal dilemmas.

PubMed

Bennett, Belinda

2006-02-01

Developments in medical science have sparked public debate about the legal and ethical implications of new technologies. Within these debates a number of distinct discourses are evident, including discourses about the positive and negative implications of technological advances, the influence of globalisation on regulatory choice, and the challenges of articulating common values in a pluralistic society. This article argues that an understanding of these discourses is an essential part of understanding the nature of contemporary regulatory dilemmas.

Vesiculobullous lesions in lipoid proteinosis: a case report.

PubMed

Rao, Raghavendra; Prabhu, Smitha Smitha; Sripathi, H; Gupta, Sachi

2008-07-15

Vesiculobullous disorders in a child can be a diagnostic challenge. Common causes of blisters in early childhood include genodermatoses like epidermolysis bullosa and infections like herpes simplex. Lipoid proteinosis may rarely present with vesiculobullous lesions in childhood. We report a child, who presented in early childhood with blistering dermatosis. On long term follow-up, typical features of lipoid proteinosis developed. A high index of suspicion is required when one deals with blistering dermatosis in a child.

Sublethal effects of iridovirus disease in a mosquito.

PubMed

Marina, Carlos F; Arredondo-Jiménez, Juan I; Castillo, Alfredo; Williams, Trevor

1999-05-01

Recognition of the importance of debilitating effects of insect virus diseases is currently growing. Commonly observed effects of sublethal infection at the individual level include extended development times, reduced pupal and adult weights, and lowered fecundity. However, for the most part, sublethal infections are assumed to be present in survivors of an inoculum challenge, rather than demonstrated to be present by microscopy or molecular techniques. Invertebrate iridescent viruses are dsDNA viruses capable of causing disease with symptoms obvious to the naked eye, a "patent" infection, that is lethal. Furthermore, inapparent "covert" infections may occur that are non-lethal and which can only be detected using bioassay or molecular techniques. In this study, replication of Invertebrate iridescent virus 6 in Aedes aegypti larvae was demonstrated in the absence of patent disease. A sensitive insect bioassay (using Galleria mellonella) allowed the detection of covert infections, which were more common than patent infections. A concentration-response relationship was detected for the incidence of patent infections. Covert infections were up to 2 orders of magnitude commoner than patent infections, but the prevalence of covert infections did not appear to be related to virus inoculum concentration. Exposure of larvae to virus inoculum resulted in extended juvenile development times. A reduction in the mean and an increase in the variability of fecundity and adult progeny production was observed in females exposed to an inoculum challenge, although formal analysis was not possible. Males appeared capable of passing virus to uninfected females during the mating process. Covertly infected females were smaller and had shorter lifespans than control or virus-challenged females. A conservative estimate for the reduction in the net reproductive rate (R 0 ) of such insects was calculated at slightly more than 20% relative to controls.

Across the Atlantic cooperation to address international challenges in eHealth and health IT: managing toward a common goal.

PubMed

Friedman, Charles P; Iakovidis, Ilias; Debenedetti, Laurent; Lorenzi, Nancy M

2009-11-01

Countries on both sides of the Atlantic Ocean have invested in health information and communication technologies. Since eHealth challenges cross borders a European Union-United States of America conference on public policies relating to health IT and eHealth was held October 20-21, 2008 in Paris, France. The conference was organized around the four themes: (1) privacy and security, (2) health IT interoperability, (3) deployment and adoption of health IT, and (4) Public Private Collaborative Governance. The four key themes framed the discussion over the two days of plenary sessions and workshops. Key findings of the conference were organized along the four themes. (1) Privacy and security: Patients' access to their own data and key elements of a patient identification management framework were discussed. (2) Health IT interoperability: Three significant and common interoperability challenges emerged: (a) the need to establish common or compatible standards and clear guidelines for their implementation, (b) the desirability for shared certification criteria and (c) the need for greater awareness of the importance of interoperability. (3) Deployment and adoption of health IT: Three major areas of need emerged: (a) a shared knowledge base and assessment framework, (b) public-private collaboration and (c) and effective organizational change strategies. (4) Public Private Collaborative Governance: Sharing and communication are central to success in this area. Nations can learn from one another about ways to develop harmonious, effective partnerships. Three areas that were identified as highest priority for collaboration included: (1) health data security, (2) developing effective strategies to ensure healthcare professionals' acceptance of health IT tools, and (3) interoperability.

Successful management of severe cow's milk allergy with omalizumab treatment and CD-sens monitoring.

PubMed

Nilsson, Caroline; Nordvall, Lennart; Johansson, S G O; Nopp, Anna

2014-10-01

Food allergy is common in children and young adults and may be difficult to diagnose and is at present treated with avoidance of the food in question. The aim of this report is to share our clinical experiences monitoring omalizumab treatment by basophil allergen threshold sensitivity, CD-sens. Five children, 6-16 years of age, with a severe milk allergy including episodes of anaphylaxis and IgE-antibodies, between 30 and 160 kUA/L to casein and alpha-lactalbumin (milk proteins), were treated with omalizumab. CD-sens, was tested prior to and after 4 months of omalizumab and if turned negative, it was followed by an oral milk challenge. All children became negative in CD-sens and had a negative milk challenge, but one child required doubling of the omalizumab dose to achieve a negative CD-sens before a challenge was done. Omalizumab appears useful in treatment of severe food allergy, e.g., anaphylaxis to milk, and CD-sens monitoring may decide when and how to perform a food challenge.

Successful management of severe cow's milk allergy with omalizumab treatment and CD-sens monitoring

PubMed Central

Nilsson, Caroline; Nordvall, Lennart; Johansson, S.G.O.

2014-01-01

Food allergy is common in children and young adults and may be difficult to diagnose and is at present treated with avoidance of the food in question. The aim of this report is to share our clinical experiences monitoring omalizumab treatment by basophil allergen threshold sensitivity, CD-sens. Five children, 6-16 years of age, with a severe milk allergy including episodes of anaphylaxis and IgE-antibodies, between 30 and 160 kUA/L to casein and alpha-lactalbumin (milk proteins), were treated with omalizumab. CD-sens, was tested prior to and after 4 months of omalizumab and if turned negative, it was followed by an oral milk challenge. All children became negative in CD-sens and had a negative milk challenge, but one child required doubling of the omalizumab dose to achieve a negative CD-sens before a challenge was done. Omalizumab appears useful in treatment of severe food allergy, e.g., anaphylaxis to milk, and CD-sens monitoring may decide when and how to perform a food challenge. PMID:25379486

Parental perceptions in egg allergy: does egg challenge make a difference?

PubMed

Kemp, Andrew Stewart; Allen, Clare Wendy; Campbell, Dianne Elisabeth

2009-11-01

The aim of the study was to determine the effect of an oral egg challenge in egg sensitized children on parental perceptions relating to their child's allergy. A questionnaire was completed by parents for 167 children attending a tertiary paediatric clinic with egg sensitization. The questionnaires included 10 questions concerning parental perceptions of their child's egg allergy. Parental perceptions of those children who had not had an egg challenge (n = 83) were compared with those whose children had a positive (n = 27) and those with a negative (n = 57) egg challenge. A significant difference (p = < or =0.02) was observed between challenge positive(CP) and challenge negative (CN) subjects in reported changes to lifestyle and the fact that more parents in the CN group expected little or no future inconvenience for the child. The responses of parents whose child had undergone an egg challenge differed significantly (p = < or =0.005) from those not challenged with a significant reduction in the following parameters; the effect on out-of-home care arrangements, the perception of being more severe as compared to other common childhood illnesses, whether they found egg allergy to be moderately or very stressful, whether their lifestyle was changed, the expectation of little or no future discomfort for the child and whether others treated the child differently. The performance of an egg challenge was associated with reduced adverse parental concerns. For 6/10 parameters, expectations concerning egg allergy in children who had been challenged were significantly better than those who had never been challenged irrespective of the challenge outcome. The greater certainty provided by the performance of a food challenge may be a positive outcome in both CP and CN children.

Psychosocial interventions for reducing vocal challenging behavior in persons with autistic disorder: a multilevel meta-analysis of single-case experiments.

PubMed

Vanderkerken, Lien; Heyvaert, Mieke; Maes, Bea; Onghena, Patrick

2013-12-01

Vocal challenging behavior (VCB) forms a common problem in individuals with autistic disorder. Since VCB is associated with negative outcomes for the individual and his or her environment, it is important to know how to manage this type of CB. To evaluate the effectiveness of several psychosocial interventions applied to decrease VCB in individuals with autistic disorder, we conducted a meta-analysis of single-case experiments (SCEs). Fifty-two SCEs, including 74 participants, were combined using a multilevel meta-analysis. The overall treatment effect was large and statistically significant. However, the effect varied significantly over the included studies and participants. Examining this variance, evidence was found for a moderator effect of VCB type and intervention type, with, on average, the largest effects for interventions used to reduce VCB including stereotypical VCB and for interventions containing both antecedent and consequence components. Age, gender, primary treatment setting, publication year, and study quality did not significantly moderate the intervention effect. Copyright © 2013 Elsevier Ltd. All rights reserved.

Data Processing and Text Mining Technologies on Electronic Medical Records: A Review

PubMed Central

Sun, Wencheng; Li, Yangyang; Liu, Fang; Fang, Shengqun; Wang, Guoyan

2018-01-01

Currently, medical institutes generally use EMR to record patient's condition, including diagnostic information, procedures performed, and treatment results. EMR has been recognized as a valuable resource for large-scale analysis. However, EMR has the characteristics of diversity, incompleteness, redundancy, and privacy, which make it difficult to carry out data mining and analysis directly. Therefore, it is necessary to preprocess the source data in order to improve data quality and improve the data mining results. Different types of data require different processing technologies. Most structured data commonly needs classic preprocessing technologies, including data cleansing, data integration, data transformation, and data reduction. For semistructured or unstructured data, such as medical text, containing more health information, it requires more complex and challenging processing methods. The task of information extraction for medical texts mainly includes NER (named-entity recognition) and RE (relation extraction). This paper focuses on the process of EMR processing and emphatically analyzes the key techniques. In addition, we make an in-depth study on the applications developed based on text mining together with the open challenges and research issues for future work. PMID:29849998

The challenge of the standardization of nursing specializations in Europe.

PubMed

Ranchal, A; Jolley, M J; Keogh, J; Lepiesová, M; Rasku, T; Zeller, S

2015-12-01

The evolution of health care is driving the need for specialist nursing knowledge. Specialist nurses have undertaken a formal training that focuses on a specific clinical area or population and are legitimated by a professional award or legal status. Specialist nurses are better able to provide the most specific and most appropriate care for both people and populations. This paper considers nursing's loose understanding of 'specialization' and the impact this has on those who seek employment outside their own nation but within the family of nations known as the European Union (EU). There is a lack of standardization for nursing specializations across the European Union that leads to lack of mobility across countries. Reports were reviewed from within the European Union, including specialist nursing groups and regulatory nursing bodies. Nurse specialists can be regarded as operating at nursing's 'leading edge'; however, it is here that nursing lacks organization and common standards. This is readily apparent in a EU bound together by the principle of freedom of movement and common professional and academic standards. It is now time for European Union nurses to look beyond the common standards for pre-registration courses and to consider the development of common standards for specialist nursing. Historical attempts to achieve common standards for specialist nursing have largely been unsuccessful due to the diversity of approaches to nurse specialization. It is time now for this challenge to be re-addressed so that specialist nurses can more freely work throughout the European Union. There is a pressing need for policy makers to define specialist nursing and to enable European Union-wide standards. © 2015 International Council of Nurses.

An Exploration of Challenges Facing Division III Athletic Directors

ERIC Educational Resources Information Center

Engbers, Jeffrey L.

2011-01-01

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

Dual-phase evolution in complex adaptive systems

PubMed Central

Paperin, Greg; Green, David G.; Sadedin, Suzanne

2011-01-01

Understanding the origins of complexity is a key challenge in many sciences. Although networks are known to underlie most systems, showing how they contribute to well-known phenomena remains an issue. Here, we show that recurrent phase transitions in network connectivity underlie emergent phenomena in many systems. We identify properties that are typical of systems in different connectivity phases, as well as characteristics commonly associated with the phase transitions. We synthesize these common features into a common framework, which we term dual-phase evolution (DPE). Using this framework, we review the literature from several disciplines to show that recurrent connectivity phase transitions underlie the complex properties of many biological, physical and human systems. We argue that the DPE framework helps to explain many complex phenomena, including perpetual novelty, modularity, scale-free networks and criticality. Our review concludes with a discussion of the way DPE relates to other frameworks, in particular, self-organized criticality and the adaptive cycle. PMID:21247947

Dual-phase evolution in complex adaptive systems.

PubMed

Paperin, Greg; Green, David G; Sadedin, Suzanne

2011-05-06

Understanding the origins of complexity is a key challenge in many sciences. Although networks are known to underlie most systems, showing how they contribute to well-known phenomena remains an issue. Here, we show that recurrent phase transitions in network connectivity underlie emergent phenomena in many systems. We identify properties that are typical of systems in different connectivity phases, as well as characteristics commonly associated with the phase transitions. We synthesize these common features into a common framework, which we term dual-phase evolution (DPE). Using this framework, we review the literature from several disciplines to show that recurrent connectivity phase transitions underlie the complex properties of many biological, physical and human systems. We argue that the DPE framework helps to explain many complex phenomena, including perpetual novelty, modularity, scale-free networks and criticality. Our review concludes with a discussion of the way DPE relates to other frameworks, in particular, self-organized criticality and the adaptive cycle.

Dynamic Integration of Value Information into a Common Probability Currency as a Theory for Flexible Decision Making

PubMed Central

Christopoulos, Vassilios; Schrater, Paul R.

2015-01-01

Decisions involve two fundamental problems, selecting goals and generating actions to pursue those goals. While simple decisions involve choosing a goal and pursuing it, humans evolved to survive in hostile dynamic environments where goal availability and value can change with time and previous actions, entangling goal decisions with action selection. Recent studies suggest the brain generates concurrent action-plans for competing goals, using online information to bias the competition until a single goal is pursued. This creates a challenging problem of integrating information across diverse types, including both the dynamic value of the goal and the costs of action. We model the computations underlying dynamic decision-making with disparate value types, using the probability of getting the highest pay-off with the least effort as a common currency that supports goal competition. This framework predicts many aspects of decision behavior that have eluded a common explanation. PMID:26394299

Current state of pediatric cardiac transplantation

PubMed Central

2018-01-01

Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing. The biggest gap impacting both waitlist and overall survival remains mechanical support options for infants and patients with single ventricle physiology. Though acute rejection has decreased progressively, both diagnosis and management of antibody-mediated rejection has become increasingly challenging and complex, as has the ability to understand the implication of anti-HLA antibodies detected both pre- and post-transplantation—including when and how to intervene. Trends in immunosuppression protocols include more use of induction therapy and steroid avoidance or withdrawal protocols. Common long-term morbidities include renal insufficiency, which can be mitigated with surveillance and renal-sparing strategies, and infections. Functional outcomes are excellent, but significant psychosocial challenges exist in relation to neurodevelopment, non-adherence, and transition from child-centered to adult-centered care. Cardiac allograft vasculopathy (CAV) remains a barrier to long-term survival, though it is more apparent that objective evidence of an impact on the allograft is important with regards to impact on outcomes. Retransplantation is rare in pediatric heart transplant recipients. Pediatric heart transplantation continues to evolve in order to address the challenges of the diverse group of patients that reach end-stage heart failure during childhood. PMID:29492382

Staphylococcus aureus and Staphylococcal Food-Borne Disease: An Ongoing Challenge in Public Health

PubMed Central

Smith, Tara C.

2014-01-01

Staphylococcal food-borne disease (SFD) is one of the most common food-borne diseases worldwide resulting from the contamination of food by preformed S. aureus enterotoxins. It is one of the most common causes of reported food-borne diseases in the United States. Although several Staphylococcal enterotoxins (SEs) have been identified, SEA, a highly heat-stable SE, is the most common cause of SFD worldwide. Outbreak investigations have found that improper food handling practices in the retail industry account for the majority of SFD outbreaks. However, several studies have documented prevalence of S. aureus in many food products including raw retail meat indicating that consumers are at potential risk of S. aureus colonization and subsequent infection. Presence of pathogens in food products imposes potential hazard for consumers and causes grave economic loss and loss in human productivity via food-borne disease. Symptoms of SFD include nausea, vomiting, and abdominal cramps with or without diarrhea. Preventive measures include safe food handling and processing practice, maintaining cold chain, adequate cleaning and disinfection of equipment, prevention of cross-contamination in home and kitchen, and prevention of contamination from farm to fork. This paper provides a brief overview of SFD, contributing factors, risk that it imposes to the consumers, current research gaps, and preventive measures. PMID:24804250

Image fusion and navigation platforms for percutaneous image-guided interventions.

PubMed

Rajagopal, Manoj; Venkatesan, Aradhana M

2016-04-01

Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets. Navigation tools, including image fusion and device tracking, can enable abdominal interventionalists to more accurately target challenging biopsy and ablation targets. Image fusion technologies enable multimodality fusion and real-time co-displays of US, CT, MRI, and PET/CT data, with navigational technologies including electromagnetic tracking, robotic, cone beam CT, optical, and laser guidance of interventional devices. Image fusion and navigational platform technology is reviewed in this article, including the results of studies implementing their use for interventional procedures. Pre-clinical and clinical experiences to date suggest these technologies have the potential to reduce procedure risk, time, and radiation dose to both the patient and the operator, with a valuable role to play for complex image-guided interventions.

Microglia Transcriptome Changes in a Model of Depressive Behavior after Immune Challenge

PubMed Central

Gonzalez-Pena, Dianelys; Nixon, Scott E.; O’Connor, Jason C.; Southey, Bruce R.; Lawson, Marcus A.; McCusker, Robert H.; Borras, Tania; Machuca, Debbie; Hernandez, Alvaro G.; Dantzer, Robert; Kelley, Keith W.; Rodriguez-Zas, Sandra L.

2016-01-01

Depression symptoms following immune response to a challenge have been reported after the recovery from sickness. A RNA-Seq study of the dysregulation of the microglia transcriptome in a model of inflammation-associated depressive behavior was undertaken. The transcriptome of microglia from mice at day 7 after Bacille Calmette Guérin (BCG) challenge was compared to that from unchallenged Control mice and to the transcriptome from peripheral macrophages from the same mice. Among the 562 and 3,851 genes differentially expressed between BCG-challenged and Control mice in microglia and macrophages respectively, 353 genes overlapped between these cells types. Among the most differentially expressed genes in the microglia, serum amyloid A3 (Saa3) and cell adhesion molecule 3 (Cadm3) were over-expressed and coiled-coil domain containing 162 (Ccdc162) and titin-cap (Tcap) were under-expressed in BCG-challenged relative to Control. Many of the differentially expressed genes between BCG-challenged and Control mice were associated with neurological disorders encompassing depression symptoms. Across cell types, S100 calcium binding protein A9 (S100A9), interleukin 1 beta (Il1b) and kynurenine 3-monooxygenase (Kmo) were differentially expressed between challenged and control mice. Immune response, chemotaxis, and chemokine activity were among the functional categories enriched by the differentially expressed genes. Functional categories enriched among the 9,117 genes differentially expressed between cell types included leukocyte regulation and activation, chemokine and cytokine activities, MAP kinase activity, and apoptosis. More than 200 genes exhibited alternative splicing events between cell types including WNK lysine deficient protein kinase 1 (Wnk1) and microtubule-actin crosslinking factor 1(Macf1). Network visualization revealed the capability of microglia to exhibit transcriptome dysregulation in response to immune challenge still after resolution of sickness symptoms, albeit lower than that observed in macrophages. The persistent transcriptome dysregulation in the microglia shared patterns with neurological disorders indicating that the associated persistent depressive symptoms share a common transcriptome basis. PMID:26959683

Microglia Transcriptome Changes in a Model of Depressive Behavior after Immune Challenge.

PubMed

Gonzalez-Pena, Dianelys; Nixon, Scott E; O'Connor, Jason C; Southey, Bruce R; Lawson, Marcus A; McCusker, Robert H; Borras, Tania; Machuca, Debbie; Hernandez, Alvaro G; Dantzer, Robert; Kelley, Keith W; Rodriguez-Zas, Sandra L

2016-01-01

Depression symptoms following immune response to a challenge have been reported after the recovery from sickness. A RNA-Seq study of the dysregulation of the microglia transcriptome in a model of inflammation-associated depressive behavior was undertaken. The transcriptome of microglia from mice at day 7 after Bacille Calmette Guérin (BCG) challenge was compared to that from unchallenged Control mice and to the transcriptome from peripheral macrophages from the same mice. Among the 562 and 3,851 genes differentially expressed between BCG-challenged and Control mice in microglia and macrophages respectively, 353 genes overlapped between these cells types. Among the most differentially expressed genes in the microglia, serum amyloid A3 (Saa3) and cell adhesion molecule 3 (Cadm3) were over-expressed and coiled-coil domain containing 162 (Ccdc162) and titin-cap (Tcap) were under-expressed in BCG-challenged relative to Control. Many of the differentially expressed genes between BCG-challenged and Control mice were associated with neurological disorders encompassing depression symptoms. Across cell types, S100 calcium binding protein A9 (S100A9), interleukin 1 beta (Il1b) and kynurenine 3-monooxygenase (Kmo) were differentially expressed between challenged and control mice. Immune response, chemotaxis, and chemokine activity were among the functional categories enriched by the differentially expressed genes. Functional categories enriched among the 9,117 genes differentially expressed between cell types included leukocyte regulation and activation, chemokine and cytokine activities, MAP kinase activity, and apoptosis. More than 200 genes exhibited alternative splicing events between cell types including WNK lysine deficient protein kinase 1 (Wnk1) and microtubule-actin crosslinking factor 1(Macf1). Network visualization revealed the capability of microglia to exhibit transcriptome dysregulation in response to immune challenge still after resolution of sickness symptoms, albeit lower than that observed in macrophages. The persistent transcriptome dysregulation in the microglia shared patterns with neurological disorders indicating that the associated persistent depressive symptoms share a common transcriptome basis.

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.

Therapist Perspectives: Wii Active Videogames Use in Inpatient Settings with People Who Have Had a Brain Injury.

PubMed

Putnam, Cynthia; Cheng, Jinghui; Seymour, Gregory

2014-12-01

Brain injuries (BIs) are a major public health issue. Clinical experience and literature have identified that it is often challenging to motivate people who have had a BI to engage in repetitive exercises commonly prescribed for rehabilitation. As a result, some therapists include commercial active videogames (AVGs) in their therapy sessions to help make repetitive actions fun and engaging. In this project, we explored how the therapists used commercial AVGs to better understand the major barriers and enablers of use. We interviewed 17 therapists from two rehabilitation hospitals who work with people who have had a BI. After the interviews were transcribed, we identified salient themes. At the time of the interviews, therapists were using only the Nintendo(®) (Kyoto, Japan) Wii™ console. Common therapeutic goals included balance and weight shifting. Several patient factors, such as cognitive and physical abilities, age, and previous gaming experience, were considered important considerations when deciding to use games. Therapists also indicated many desired changes to games, including better control/interface, better feedback, and the ability to adjust timing, challenge, and stimulation levels. When considering therapy-centered game design, the needs of both therapists and patients should be considered. There is a necessary balance to consider in game design: They need to (a) be perceived as fun, (b) meet therapy goals, and (c) address therapists' needs (e.g., adjustability to address a range of patient abilities). Additionally, there is a need for a wide variety of available games to address novelty and personal preferences.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

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.

Clinical applications of MS-based protein quantification.

PubMed

Sabbagh, Bassel; Mindt, Sonani; Neumaier, Michael; Findeisen, Peter

2016-04-01

Mass spectrometry-based assays are increasingly important in clinical laboratory medicine and nowadays are already commonly used in several areas of routine diagnostics. These include therapeutic drug monitoring, toxicology, endocrinology, pediatrics, and microbiology. Accordingly, some of the most common analyses are therapeutic drug monitoring of immunosuppressants, vitamin D, steroids, newborn screening, and bacterial identification. However, MS-based quantification of peptides and proteins for routine diagnostic use is rather rare up to now despite excellent analytical specificity and good sensitivity. Here, we want to give an overview over current fit-for-purpose assays for MS-based protein quantification. Advantages as well as challenges of this approach will be discussed with focus on feasibility for routine diagnostic use. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Review for the generalist: evaluation of pediatric hip pain

PubMed Central

Houghton, Kristin M

2009-01-01

Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. Hip pain may also be referred from low back or pelvic pathology. Evaluation and management requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of hip and pelvic musculoskeletal pain in the pediatric population. PMID:19450281

Workplace diversity: a leadership challenge. Managing diversity is a social, financial, and moral imperative.

PubMed

Lappetito, J

1994-03-01

Fostering workplace diversity is about building an organizational culture that embraces personal differences and encourages heterogeneous persons to work together toward a common end. Setting in motion the transition to a more inclusive and productive workplace is an uncommon challenge and the primary responsibility of leaders, especially in Catholic healthcare. The origins of diversity can be found in creation itself. Not only are we united as a people of God and as members of the body of Christ, we are bound together through our shared humanity. Three values are especially relevant to promoting diversity in the workplace: respect for human dignity, the common good, and distributive justice as participation in the common good. Economic incentives strengthen the theological and moral motives for developing a diverse work force. Organizations' financial success will depend ultimately on how well diversity is integrated into the organizational culture. As a process, managing diversity enables healthcare leaders to discover new ways to develop the potential of all employees and at the same time improve performance and production. At the heart of managing diversity lies the reform of internal systems, structures, and processes. Managing diversity also requires the transformation of the organization's culture. Initiatives that are useful for setting a positive future course include conducting a cultural audit, establishing a cultural diversity task force, and putting in place a diversity "champion" who is accountable directly to the chief executive officer.

Common Origins of Diverse Misconceptions: Cognitive Principles and the Development of Biology Thinking

PubMed Central

Coley, John D.; Tanner, Kimberly D.

2012-01-01

Many ideas in the biological sciences seem especially difficult to understand, learn, and teach successfully. Our goal in this feature is to explore how these difficulties may stem not from the complexity or opacity of the concepts themselves, but from the fact that they may clash with informal, intuitive, and deeply held ways of understanding the world that have been studied for decades by psychologists. We give a brief overview of the field of developmental cognitive psychology. Then, in each of the following sections, we present a number of common challenges faced by students in the biological sciences. These may be in the form of misconceptions, biases, or simply concepts that are difficult to learn and teach, and they occur at all levels of biological analysis (molecular, cellular, organismal, population, and ecosystem). We then introduce the notion of a cognitive construal and discuss specific examples of how these cognitive principles may explain what makes some misconceptions so alluring and some biological concepts so challenging for undergraduates. We will argue that seemingly unrelated misconceptions may have common origins in a single underlying cognitive construal. These ideas emerge from our own ongoing cross-disciplinary conversation, and we think that expanding this conversation to include other biological scientists and educators, as well as other cognitive scientists, could have significant utility in improving biology teaching and learning. PMID:22949417

Common origins of diverse misconceptions: cognitive principles and the development of biology thinking.

PubMed

Coley, John D; Tanner, Kimberly D

2012-01-01

Many ideas in the biological sciences seem especially difficult to understand, learn, and teach successfully. Our goal in this feature is to explore how these difficulties may stem not from the complexity or opacity of the concepts themselves, but from the fact that they may clash with informal, intuitive, and deeply held ways of understanding the world that have been studied for decades by psychologists. We give a brief overview of the field of developmental cognitive psychology. Then, in each of the following sections, we present a number of common challenges faced by students in the biological sciences. These may be in the form of misconceptions, biases, or simply concepts that are difficult to learn and teach, and they occur at all levels of biological analysis (molecular, cellular, organismal, population, and ecosystem). We then introduce the notion of a cognitive construal and discuss specific examples of how these cognitive principles may explain what makes some misconceptions so alluring and some biological concepts so challenging for undergraduates. We will argue that seemingly unrelated misconceptions may have common origins in a single underlying cognitive construal. These ideas emerge from our own ongoing cross-disciplinary conversation, and we think that expanding this conversation to include other biological scientists and educators, as well as other cognitive scientists, could have significant utility in improving biology teaching and learning.

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

PubMed Central

Ridpath, Julia F.; Neill, John D.

2016-01-01

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

Human pluripotent stem cells: Prospects and challenges as a source of cardiomyocytes for in vitro modeling and cell-based cardiac repair.

PubMed

Hartman, Matthew E; Dai, Dao-Fu; Laflamme, Michael A

2016-01-15

Human pluripotent stem cells (PSCs) represent an attractive source of cardiomyocytes with potential applications including disease modeling, drug discovery and safety screening, and novel cell-based cardiac therapies. Insights from embryology have contributed to the development of efficient, reliable methods capable of generating large quantities of human PSC-cardiomyocytes with cardiac purities ranging up to 90%. However, for human PSCs to meet their full potential, the field must identify methods to generate cardiomyocyte populations that are uniform in subtype (e.g. homogeneous ventricular cardiomyocytes) and have more mature structural and functional properties. For in vivo applications, cardiomyocyte production must be highly scalable and clinical grade, and we will need to overcome challenges including graft cell death, immune rejection, arrhythmogenesis, and tumorigenic potential. Here we discuss the types of human PSCs, commonly used methods to guide their differentiation into cardiomyocytes, the phenotype of the resultant cardiomyocytes, and the remaining obstacles to their successful translation. Copyright © 2015 Elsevier B.V. All rights reserved.

Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda.

PubMed

Ashaba, Scholastic; Kaida, Angela; Coleman, Jessica N; Burns, Bridget F; Dunkley, Emma; O'Neil, Kasey; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Bangsberg, David R; Matthews, Lynn T; Psaros, Christina

2017-01-01

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community.

Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda

PubMed Central

Ashaba, Scholastic; Burns, Bridget F.; Dunkley, Emma; O’Neil, Kasey; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Bangsberg, David R.

2017-01-01

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28–35], a median of 3 living children [IQR: 2–5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community. PMID:28459866

Subarachnoid Hemorrhage

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

Family History

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

Aneurysm Complications

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

An architecture for consolidating multidimensional time-series data onto a common coordinate grid

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

Shippert, Tim; Gaustad, Krista

In this paper, consolidating measurement data for use by data models or in inter-comparison studies frequently requires transforming the data onto a common grid. Standard methods for interpolating multidimensional data are often not appropriate for data with non-homogenous dimensionality, and are hard to implement in a consistent manner for different datastreams. In addition, these challenges are increased when dealing with the automated procedures necessary for use with continuous, operational datastreams. In this paper we introduce a method of applying a series of one-dimensional transformations to merge data onto a common grid, examine the challenges of ensuring consistent application of datamore » consolidation methods, present a framework for addressing those challenges, and describe the implementation of such a framework for the Atmospheric Radiation Measurement (ARM) program.« less

An architecture for consolidating multidimensional time-series data onto a common coordinate grid

DOE PAGES

Shippert, Tim; Gaustad, Krista

2016-12-16

In this paper, consolidating measurement data for use by data models or in inter-comparison studies frequently requires transforming the data onto a common grid. Standard methods for interpolating multidimensional data are often not appropriate for data with non-homogenous dimensionality, and are hard to implement in a consistent manner for different datastreams. In addition, these challenges are increased when dealing with the automated procedures necessary for use with continuous, operational datastreams. In this paper we introduce a method of applying a series of one-dimensional transformations to merge data onto a common grid, examine the challenges of ensuring consistent application of datamore » consolidation methods, present a framework for addressing those challenges, and describe the implementation of such a framework for the Atmospheric Radiation Measurement (ARM) program.« less

Primary Care Clinic Re-Design for Prescription Opioid Management.

PubMed

Parchman, Michael L; Von Korff, Michael; Baldwin, Laura-Mae; Stephens, Mark; Ike, Brooke; Cromp, DeAnn; Hsu, Clarissa; Wagner, Ed H

The challenge of responding to prescription opioid overuse within the United States has fallen disproportionately on the primary care clinic setting. Here we describe a framework comprised of 6 Building Blocks to guide efforts within this setting to address the use of opioids for chronic pain. Investigators conducted site visits to thirty primary care clinics across the United States selected for their use of team-based workforce innovations. Site visits included interviews with leadership, clinic tours, observations of clinic processes and team meetings, and interviews with staff and clinicians. Data were reviewed to identify common attributes of clinic system changes around chronic opioid therapy (COT) management. These concepts were reviewed to develop narrative descriptions of key components of changes made to improve COT use. Twenty of the thirty sites had addressed improvements in COT prescribing. Across these sites a common set of 6 Building Blocks were identified: 1) providing leadership support; 2) revising and aligning clinic policies, patient agreements (contracts) and workflows; 3) implementing a registry tracking system; 4) conducting planned, patient-centered visits; 5) identifying resources for complex patients; and 6) measuring progress toward achieving clinic objectives. Common components of clinic policies, patient agreements and data tracked in registries to assess progress are described. In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing COT patients in primary care settings. © Copyright 2017 by the American Board of Family Medicine.

A Systematic Review of Wearable Patient Monitoring Systems - Current Challenges and Opportunities for Clinical Adoption.

PubMed

Baig, Mirza Mansoor; GholamHosseini, Hamid; Moqeem, Aasia A; Mirza, Farhaan; Lindén, Maria

2017-07-01

The aim of this review is to investigate barriers and challenges of wearable patient monitoring (WPM) solutions adopted by clinicians in acute, as well as in community, care settings. Currently, healthcare providers are coping with ever-growing healthcare challenges including an ageing population, chronic diseases, the cost of hospitalization, and the risk of medical errors. WPM systems are a potential solution for addressing some of these challenges by enabling advanced sensors, wearable technology, and secure and effective communication platforms between the clinicians and patients. A total of 791 articles were screened and 20 were selected for this review. The most common publication venue was conference proceedings (13, 54%). This review only considered recent studies published between 2015 and 2017. The identified studies involved chronic conditions (6, 30%), rehabilitation (7, 35%), cardiovascular diseases (4, 20%), falls (2, 10%) and mental health (1, 5%). Most studies focussed on the system aspects of WPM solutions including advanced sensors, wireless data collection, communication platform and clinical usability based on a specific area or disease. The current studies are progressing with localized sensor-software integration to solve a specific use-case/health area using non-scalable and 'silo' solutions. There is further work required regarding interoperability and clinical acceptance challenges. The advancement of wearable technology and possibilities of using machine learning and artificial intelligence in healthcare is a concept that has been investigated by many studies. We believe future patient monitoring and medical treatments will build upon efficient and affordable solutions of wearable technology.

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

PubMed

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

2016-11-01

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

Brain Aneurysm Foundation

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

Unruptured Brain Aneurysms

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

[Treatment of hip fractures in elderly patients].

PubMed

Hack, Juliana; Bliemel, Christopher; Ruchholtz, Steffen; Bücking, Benjamin

2015-04-01

Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program. © Georg Thieme Verlag Stuttgart · New York.

Photodynamic therapy in peri-implantitis

NASA Astrophysics Data System (ADS)

Leretter, Marius; Cândea, Adrian; Topala, Florin

2014-01-01

Peri-implantitis is like Damocles sword, threatening over our final results as is the most common cause of implant failure. It is, was and will be one of the most challenging tasks for the practitioner to deal with. The rough implant surface offers the ideal conditions for the pathogenic bacteria to stick and multiply. Even more, the growing mature biofilm is harder to eliminate. Mechanical cleaning and rinsing is not capable to destroy it entirely. Most treatment protocols include strong antibiotics, disregarding their side effects and interactions with other medications.

Management of osteoporosis: the Indian perspective.

PubMed

Handa, Rohini

2004-09-01

Osteoporosis is a common but neglected problem in India. The major challenges to management are lack of awareness and resource constraints. The management is also hampered by the non-availability of normative data for bone mineral density in Indians. Subclinical vitamin D deficiency is widespread. The drugs available in the country include calcium, vitamin D, hormone replacement therapy, raloxifene, alendronate, risedronate, calcitonin and teriparatide. Bisphosphonates (alendronate) constitute the mainstay of treatment in India. There is a need for evidence based, context specific and resource sensitive guidelines.

Memory management in genome-wide association studies

PubMed Central

2009-01-01

Genome-wide association is a powerful tool for the identification of genes that underlie common diseases. Genome-wide association studies generate billions of genotypes and pose significant computational challenges for most users including limited computer memory. We applied a recently developed memory management tool to two analyses of North American Rheumatoid Arthritis Consortium studies and measured the performance in terms of central processing unit and memory usage. We conclude that our memory management approach is simple, efficient, and effective for genome-wide association studies. PMID:20018047

Tinea cruris in children.

PubMed

Patel, Gopal A; Wiederkehr, Michael; Schwartz, Robert A

2009-09-01

Tinea cruris is an intensely pruritic fungal infection of the groin and adjacent skin. Also known as crotch rot and jock itch, it can be a troubling important entity that at times is a clinical, diagnostic, and therapeutic challenge. Predisposing factors include heat, humidity, and hyperhidrosis, common accompaniments of high school-aged athletes. Furthermore, obesity and diabetes mellitus, additional risk factors for tinea cruris, are reaching unprecedented levels in adolescents. Treatment options range from improving hygiene to topical antifungal agents and systemic antifungal agents, the latter with potentially dangerous side effects.

The marketing of dissolvable tobacco: social science and public policy research needs.

PubMed

Southwell, Brian G; Kim, Annice E; Tessman, Greta K; MacMonegle, Anna J; Choiniere, Conrad J; Evans, Sarah E; Johnson, Robin D

2012-01-01

The latest generation of smokeless tobacco products encompasses a wide range of offerings, including what is commonly referred to as dissolvable tobacco. Designed to deliver nicotine upon dissolving or disintegrating in a user's mouth, dissolvable tobacco products currently appear in various United States markets as strips, orbs, sticks, and lozenges. The emergence of these new products poses distinct opportunities and challenges for social and behavioral science and public health research and raises important public policy questions.

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

PubMed

Hartzell, Larry D; Kilpatrick, Lauren A

2014-10-01

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

Collaborative Orthopaedic Research Between and Within Institutions.

PubMed

Wolf, Brian R; Verma, Nikhil N; Spindler, Kurt P; Wright, Rick W

2017-02-15

Collaborative research is common in many medical disciplines; however, the field of orthopaedics has been relatively slow to adopt this type of research approach. Collaborative research efforts can occur between multiple institutions and, in some instances, may benefit from subspecialty society sponsorship. Collaborative research efforts between several research spheres within a single institution also can be advantageous. Collaborative research has many benefits, including a larger number of patients in studies, more power in the research, and better generalizability. In addition, collaborative research efforts allow resources to be pooled within and between institutions. The challenges of collaborative research include data management, funding, and the publication of manuscripts that have many authors.

The Blue Dot Workshop: Spectroscopic Search for Life on Extrasolar Planets

NASA Technical Reports Server (NTRS)

Des Marais, David J. (Editor)

1997-01-01

This workshop explored the key questions and challenges associated with detecting life on an extrasolar planet. The final product will be a NASA Conference Publication which includes the abstracts from 21 talks, summaries of key findings, and recommendations for future research. The workshop included sessions on three related topics: the biogeochemistry of biogenic gases in the atmosphere, the chemistry and spectroscopy of planetary atmospheres, and the remote sensing of planetary atmospheres and surfaces. With the observation that planetary formation is probably a common phenomenon, together with the advent of the technical capability to locate and describe extrasolar planets, this research area indeed has an exciting future.

[Evaluative designs in public health: methodological considerations].

PubMed

López, Ma José; Marí-Dell'Olmo, Marc; Pérez-Giménez, Anna; Nebot, Manel

2011-06-01

Evaluation of public health interventions poses numerous methodological challenges. Randomization of individuals is not always feasible and interventions are usually composed of multiple factors. To face these challenges, certain elements, such as the selection of the most appropriate design and the use of a statistical analysis that includes potential confounders, are essential. The objective of this article was to describe the most frequently used designs in the evaluation of public health interventions (policies, programs or campaigns). The characteristics, strengths and weaknesses of each of these evaluative designs are described. Additionally, a brief explanation of the most commonly used statistical analysis in each of these designs is provided. Copyright © 2011 Sociedad Española de Salud Pública y Administración Sanitaria. Published by Elsevier Espana. All rights reserved.

Engineering Ethics Education : Its Necessity, Objectives, Methods, Current State, and Challenges

NASA Astrophysics Data System (ADS)

Fudano, Jun

The importance of engineering ethics education has become widely recognized in the industrialized countries including Japan. This paper examines the background against which engineering ethics education is required, and reviews its objectives, methods, and challenges, as well as its current state. In pointing out important issues associated with the apparent acceptance and quantitative development of ethics education, especially after the establishment of the Japan Accreditation Board for Engineering Education in 1999, the author stresses that the most serious problem is the lack of common understanding on the objectives of engineering ethics education. As a strategy to improve the situation, the so-called “Ethics-across-the-Curriculum” approach is introduced. The author also claims that business/organization ethics which is consistent with engineering ethics should be promoted in Japan.

The Role of Medication in Supporting Emotional Wellbeing in Young People with Long-Term Needs

PubMed Central

Gray, Nicola J.; Wood, Damian M.

2017-01-01

Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person’s emotional well-being. We use a series of case studies to illustrate the challenges for healthcare professionals supporting young people with medication use. The studies illustrate the efficacy and limitations of medication on improving emotional well-being by alleviating illness and distress, and how this efficacy must be balanced against both the adverse effects and the burden of treatment. There are specific challenges for medication management during adolescence including issues of adherence/concordance, facilitating autonomy and participation in decision making, and promoting independence. PMID:29099742

The relationship between creativity and mood disorders

PubMed Central

Andreasen, Nancy C.

2008-01-01

Research designed to examine the relationship between creativity and mental illnesses must confront multiple challenges. What is the optimal sample to study? How should creativity be defined? What is the most appropriate comparison group? Only a limited number of studies have examined highly creative individuals using personal interviews and a noncreative comparison group. The majority of these have examined writers. The preponderance of the evidence suggests that in these creative individuals the rate of mood disorder is high, and that both bipolar disorder and unipolar depression are quite common. Clinicians who treat creative individuals with mood disorders must also confronta variety of challenges, including the fear that treatment may diminish creativity, in the case of bipolar disorder, hovt/ever, it is likely that reducing severe manic episodes may actually enhance creativity in many individuals. PMID:18689294

Evaluation of Full Reynolds Stress Turbulence Models in FUN3D

NASA Technical Reports Server (NTRS)

Dudek, Julianne C.; Carlson, Jan-Renee

2017-01-01

Full seven-equation Reynolds stress turbulence models are promising tools for today’s aerospace technology challenges. This paper examines two such models for computing challenging turbulent flows including shock-wave boundary layer interactions, separation and mixing layers. The Wilcox and the SSG/LRR full second-moment Reynolds stress models have been implemented into the FUN3D (Fully Unstructured Navier-Stokes Three Dimensional) unstructured Navier-Stokes code and were evaluated for four problems: a transonic two-dimensional diffuser, a supersonic axisymmetric compression corner, a compressible planar shear layer, and a subsonic axisymmetric jet. Simulation results are compared with experimental data and results computed using the more commonly used Spalart-Allmaras (SA) one-equation and the Menter Shear Stress Transport (SST-V) two-equation turbulence models.

Evaluation of Full Reynolds Stress Turbulence Models in FUN3D

NASA Technical Reports Server (NTRS)

Dudek, Julianne C.; Carlson, Jan-Renee

2017-01-01

Full seven-equation Reynolds stress turbulence models are a relatively new and promising tool for todays aerospace technology challenges. This paper uses two stress-omega full Reynolds stress models to evaluate challenging flows including shock-wave boundary layer interactions, separation and mixing layers. The Wilcox and the SSG/LRR full second-moment Reynolds stress models have been implemented into the FUN3D (Fully Unstructured Navier-Stokes Three Dimensional) unstructured Navier-Stokes code and are evaluated for four problems: a transonic two-dimensional diffuser, a supersonic axisymmetric compression corner, a compressible planar shear layer, and a subsonic axisymmetric jet. Simulation results are compared with experimental data and results using the more commonly used Spalart-Allmaras (SA) one-equation and the Menter Shear Stress Transport (SST-V) two-equation turbulence models.

Breast cancer and neurofibromatosis type 1: a diagnostic challenge in patients with a high number of neurofibromas.

PubMed

Da Silva, André Vallejo; Rodrigues, Fabiana Resende; Pureza, Mônica; Lopes, Vania Gloria Silami; Cunha, Karin Soares

2015-03-26

Neurofibromatosis 1 is one of the most common genetic diseases in humans, presenting with multiple neurofibromas and an increased risk of various benign and malignant tumors, including breast cancer. In this paper we report a case of a woman with neurofibromatosis 1 and the challenge associated with detecting an advanced breast cancer because of numerous skin neurofibromas, which were responsible for a substantial delay in cancer diagnosis. Literature concerning the association of neurofibromatosis 1 and breast cancer is reviewed and discussed. Best practice guidelines for breast cancer detection are not sufficient for the screening of neurofibromatosis 1 carriers. A more intensive clinical and imaging approach should be used if the same early detection rate as in non-neurofibromatosis 1 women is to be achieved.

Educating patients: understanding barriers, learning styles, and teaching techniques.

PubMed

Beagley, Linda

2011-10-01

Health care delivery and education has become a challenge for providers. Nurses and other professionals are challenged daily to assure that the patient has the necessary information to make informed decisions. Patients and their families are given a multitude of information about their health and commonly must make important decisions from these facts. Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers. It is up to the nurse to assess and evaluate the patient's learning needs and readiness to learn because everyone learns differently. This article will examine how each of these barriers impact care delivery along with teaching and learning strategies will be examined. Copyright © 2011 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Systems biology solutions for biochemical production challenges.

PubMed

Hansen, Anne Sofie Lærke; Lennen, Rebecca M; Sonnenschein, Nikolaus; Herrgård, Markus J

2017-06-01

There is an urgent need to significantly accelerate the development of microbial cell factories to produce fuels and chemicals from renewable feedstocks in order to facilitate the transition to a biobased society. Methods commonly used within the field of systems biology including omics characterization, genome-scale metabolic modeling, and adaptive laboratory evolution can be readily deployed in metabolic engineering projects. However, high performance strains usually carry tens of genetic modifications and need to operate in challenging environmental conditions. This additional complexity compared to basic science research requires pushing systems biology strategies to their limits and often spurs innovative developments that benefit fields outside metabolic engineering. Here we survey recent advanced applications of systems biology methods in engineering microbial production strains for biofuels and -chemicals. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The sleepy teenager - diagnostic challenges.

PubMed

Landtblom, Anne-Marie; Engström, Maria

2014-01-01

The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character - and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area.

The Sleepy Teenager – Diagnostic Challenges

PubMed Central

Landtblom, Anne-Marie; Engström, Maria

2014-01-01

The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character – and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area. PMID:25136329

Modeling the Effects of Turbulence in Rotating Detonation Engines

NASA Astrophysics Data System (ADS)

Towery, Colin; Smith, Katherine; Hamlington, Peter; van Schoor, Marthinus; TESLa Team; Midé Team

2014-03-01

Propulsion systems based on detonation waves, such as rotating and pulsed detonation engines, have the potential to substantially improve the efficiency and power density of gas turbine engines. Numerous technical challenges remain to be solved in such systems, however, including obtaining more efficient injection and mixing of air and fuels, more reliable detonation initiation, and better understanding of the flow in the ejection nozzle. These challenges can be addressed using numerical simulations. Such simulations are enormously challenging, however, since accurate descriptions of highly unsteady turbulent flow fields are required in the presence of combustion, shock waves, fluid-structure interactions, and other complex physical processes. In this study, we performed high-fidelity three dimensional simulations of a rotating detonation engine and examined turbulent flow effects on the operation, performance, and efficiency of the engine. Along with experimental data, these simulations were used to test the accuracy of commonly-used Reynolds averaged and subgrid-scale turbulence models when applied to detonation engines. The authors gratefully acknowledge the support of the Defense Advanced Research Projects Agency (DARPA).

A comparative study of ethylene oxide gas, hydrogen peroxide gas plasma, and low-temperature steam formaldehyde sterilization.

PubMed

Kanemitsu, Keiji; Imasaka, Takayuki; Ishikawa, Shiho; Kunishima, Hiroyuki; Harigae, Hideo; Ueno, Kumi; Takemura, Hiromu; Hirayama, Yoshihiro; Kaku, Mitsuo

2005-05-01

To compare the efficacies of ethylene oxide gas (EOG), hydrogen peroxide gas plasma (PLASMA), and low-temperature steam formaldehyde (LTSF) sterilization methods. The efficacies of EOG, PLASMA, and LTSF sterilization were tested using metal and plastic plates, common medical instruments, and three process challenge devices with narrow lumens. All items were contaminated with Bacillus stearothermophilus spores or used a standard biological indicator. EOG and LTSF demonstrated effective killing of B. stearothermophilus spores, with or without serum, on plates, on instruments, and in process challenge devices. PLASMA failed to adequately sterilize materials on multiple trials in several experiments, including two of three plates, two of three instruments, and all process challenge devices. Our results suggest that PLASMA sterilization may be unsuccessful under certain conditions, particularly when used for items with complex shapes and narrow lumens. Alternatively, LTSF sterilization demonstrates excellent efficacy and is comparable to EOG sterilization. LTSF could potentially act as a substitute if EOG becomes unavailable due to environmental concerns.

Guide to Cybersecurity, Resilience, and Reliability for Small and Under-Resourced Utilities

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

Ingram, Michael; Martin, Maurice

Small electricity utilities -- those with less than 100 employees or 50,000 meters -- provide essential services to large parts of the United States while facing a number of challenges unique to their mission. For instance, they often serve areas that are sparsely populated, meaning that their per-customer cost to provide service is higher. At the same time, they often serve customers that have moderate or fixed incomes, meaning that they are under strong pressure to keep costs down. This pressure puts them on a strict budget and creates a need for innovative solutions to common problems. Further, their servicemore » areas may include extreme climates, making severe weather events more frequent and their aftermaths more expensive to address. This guide considers challenges that small utilities face while ensuring the reliability, resilience, and cybersecurity of their electric service; approaches to address those challenges using existing guidance documents; ways that the federal government could provide support in these areas.« less

Methodological Challenges in Research on Sexual Risk Behavior: I. Item Content, Scaling, and Data Analytical Options

PubMed Central

Schroder, Kerstin E. E.; Carey, Michael P.; Vanable, Peter A.

2008-01-01

Investigation of sexual behavior involves many challenges, including how to assess sexual behavior and how to analyze the resulting data. Sexual behavior can be assessed using absolute frequency measures (also known as “counts”) or with relative frequency measures (e.g., rating scales ranging from “never” to “always”). We discuss these two assessment approaches in the context of research on HIV risk behavior. We conclude that these two approaches yield non-redundant information and, more importantly, that only data yielding information about the absolute frequency of risk behavior have the potential to serve as valid indicators of HIV contraction risk. However, analyses of count data may be challenging due to non-normal distributions with many outliers. Therefore, we identify new and powerful data analytical solutions that have been developed recently to analyze count data, and discuss limitations of a commonly applied method (viz., ANCOVA using baseline scores as covariates). PMID:14534027

Small is challenging; distal femur fracture management in an elderly lady with achondroplastic dwarfism.

PubMed

Murphy, Colin G; Chrea, Bopha; Molloy, Alan P; Nicholson, Paul

2013-03-20

Achondroplasia is an autosomal dominant dwarfing condition that represents the most common form of skeletal dysplasia. The disease is caused by a mutation in the gene encoding fibroblast growth factor receptor 3 (FGFR3) found at the p16.3 locus on chromosome 4 which results in severe inhibition of subchondral bone growth. Anatomic variations, including articular and periarticular deformities classically seen with this condition, amplify the complexity of fracture fixation. Blood volume loss, age-related bone fragility, component selection and positioning pose serious orthopaedic challenges. Concomitant cardiovascular, respiratory and neurological comorbidities pose additional high-risk perioperative considerations. Despite an estimated prevalence of 1:25 000 in the general population, there is little literature concerning the operative and postoperative treatment challenges faced by orthopaedic surgeons dealing with fracture management on a patient with this condition. We present a case of an intercondylar femoral fracture in an elderly achondroplastic lady successfully treated with percutaneous screw fixation.

The Hidden Work of Exiting Homelessness: Challenges of Housing Service Use and Strategies of Service Recipients

PubMed Central

Mayberry, Lindsay S.

2015-01-01

This study explored the experiences of parents attempting to re-attain housing after a shelter stay. Eighty parents participated in semistructured face-to-face interviews approximately six months after being recruited from shelters in four states across the U.S. Qualitative analyses identified common challenges of service use, strategies of service recipients, and characteristics of positive and negative service experiences. Challenges of service use included “catch-22s” resulting from incongruity between service policies/procedures and participants’ contexts and/or requirements of other services, confusion and uncertainty resulting from absent or insufficient communication about services, and long waitlists. Participants demonstrated persistence and determination, networked with service providers, and activated formal resources. Positive service experiences were tailored to families’ needs and marked by clear and consistent communication between providers and with service recipients. Findings suggest effective health communication tactics should be applied to housing services. Providers should collaborate to ensure service attainment does not impede other pathways to stability. PMID:26997682

Improving acute patient flow and resolving emergency department overcrowding in New Zealand hospitals--the major challenges and the promising initiatives.

PubMed

Ardagh, Michael W; Tonkin, Gary; Possenniskie, Clare

2011-10-14

To determine the most common challenges to improving acute patient flow and resolving emergency department (ED) overcrowding in New Zealand hospitals, and to share some of the promising initiatives that have been implemented in response to them. To facilitate progress towards achievement of the Shorter Stays in Emergency Departments Health Target (the Target), the authors visited every District Health Board (DHB) in New Zealand. These visits followed a standardised visit format and subsequent to each visit a report was produced that noted the observed challenges, initiatives and successes in relation to the DHB's pursuit of the Target. Using these reports, the significant challenges and the promising initiatives across all of the DHBs were collated. Access to hospital beds, access to diagnostic tests and inpatient team delays were the most common challenges, followed by increased demand for ED services, ED facility deficiencies, ED staff deficiencies, delay to discharge of inpatients, difficulty engaging hospital clinical staff in changes, difficulty accessing aged care beds, and problems at nights and weekends. Promising initiatives were noted in relation to each of these. To improve acute care, resolve ED overcrowding and achieve the Target we need a comprehensive, whole of system approach and some significant changes to the way we use our physical and human resources. To address common challenges we need to share our experiences and expertise.

Brain Aneurysm: Treatment Options

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

Food-additive-induced urticaria: a survey of 838 patients with recurrent chronic idiopathic urticaria.

PubMed

Di Lorenzo, Gabriele; Pacor, Maria Luisa; Mansueto, Pasquale; Martinelli, Nicola; Esposito-Pellitteri, Maria; Lo Bianco, Claudia; Ditta, Vito; Leto-Barone, Maria Stefania; Napoli, Nicola; Di Fede, Gaetana; Rini, Giovambattista; Corrocher, Roberto

2005-11-01

Recurrent chronic idiopathic urticaria (RCIU) is a common skin condition that affects 0.1-3% of the population in the USA and Europe and accounts for nearly 75% of all 'ordinary' chronic urticaria (CU) cases. We studied 838 consecutive patients with RCIU referred to hospital between 1998 and 2003. Patients with known causes of CU were excluded. Clinical history, physical examination, and symptom diaries were evaluated during two periods, a diet-free period (1 week) and a food-additive-free diet (FAFD) period (4 weeks), respectively, and two double-blind placebo-controlled (DBPC) challenges of six food additives were administered. The first DBPC challenge included a mixture of the six food additives (DBPCmixed) given to all patients. The second DBPC challenge comprised the single food additives, administered at increasing doses (DBPCsingle) to patients with a positive DBPCmixed test and 105 patients with a negative DBPCmixed test, as a control. The DBPCmixed challenge was positive in 116 patients. None of the 105 control patients had a positive DBPCsingle test. Only 31 DBPCsingle tests were positive in patients with positive DBPCmixed challenge. Twenty-four of the 116 patients showing a positive DBPCmixed challenge also had a positive DBPCsingle result. Our results confirmed that food additive hypersensitivity reactions occurred in few RCIU patients using DBPCsingle challenge. The combination of the results of FAFD and DBPCmixed challenge seems to be of considerable practical interest for allergists, internists and dermatologists, rather than the data of clinical history and the results of DBPCsingle challenge, in patients with RCIU. Copyright (c) 2005 S. Karger AG, Basel.

Documenting Sociolinguistic Variation in Lesser-Studied Indigenous Communities: Challenges and Practical Solutions

ERIC Educational Resources Information Center

Mansfield, John; Stanford, James

2017-01-01

Documenting sociolinguistic variation in lesser-studied languages presents methodological challenges, but also offers important research opportunities. In this paper we examine three key methodological challenges commonly faced by researchers who are outsiders to the community. We then present practical solutions for successful variationist…

Overcoming Content-Associated Challenges Using Attention-Focused Methods

ERIC Educational Resources Information Center

Lebec, Michael T.; Kesteloot, Lauren

2015-01-01

A common challenge in higher education is teaching required content for which students traditionally have lower levels of interest. Physical therapist education programs experience this challenge when training entry-level students to document in the medical record. The authors compared learning outcomes among physical therapy students taught…

Brain Aneurysm Statistics and Facts

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

Brain Aneurysm Warning Signs/Symptoms

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

International Convergence on Geoscience Cyberinfrastructure

NASA Astrophysics Data System (ADS)

Allison, M. L.; Atkinson, R.; Arctur, D. K.; Cox, S.; Jackson, I.; Nativi, S.; Wyborn, L. A.

2012-04-01

There is growing international consensus on addressing the challenges to cyber(e)-infrastructure for the geosciences. These challenges include: Creating common standards and protocols; Engaging the vast number of distributed data resources; Establishing practices for recognition of and respect for intellectual property; Developing simple data and resource discovery and access systems; Building mechanisms to encourage development of web service tools and workflows for data analysis; Brokering the diverse disciplinary service buses; Creating sustainable business models for maintenance and evolution of information resources; Integrating the data management life-cycle into the practice of science. Efforts around the world are converging towards de facto creation of an integrated global digital data network for the geosciences based on common standards and protocols for data discovery and access, and a shared vision of distributed, web-based, open source interoperable data access and integration. Commonalities include use of Open Geospatial Consortium (OGC) and ISO specifications and standardized data interchange mechanisms. For multidisciplinarity, mediation, adaptation, and profiling services have been successfully introduced to leverage the geosciences standards which are commonly used by the different geoscience communities -introducing a brokering approach which extends the basic SOA archetype. Principal challenges are less technical than cultural, social, and organizational. Before we can make data interoperable, we must make people interoperable. These challenges are being met by increased coordination of development activities (technical, organizational, social) among leaders and practitioners in national and international efforts across the geosciences to foster commonalities across disparate networks. In doing so, we will 1) leverage and share resources, and developments, 2) facilitate and enhance emerging technical and structural advances, 3) promote interoperability across scientific domains, 4) support the promulgation and institutionalization of agreed-upon standards, protocols, and practice, and 5) enhance knowledge transfer not only across the community, but into the domain sciences, 6) lower existing entry barriers for users and data producers, 7) build on the existing disciplinary infrastructures leveraging their service buses. . All of these objectives are required for establishing a permanent and sustainable cyber(e)-infrastructure for the geosciences. The rationale for this approach is well articulated in the AuScope mission statement: "Many of these problems can only be solved on a national, if not global scale. No single researcher, research institution, discipline or jurisdiction can provide the solutions. We increasingly need to embrace e-Research techniques and use the internet not only to access nationally distributed datasets, instruments and compute infrastructure, but also to build online, 'virtual' communities of globally dispersed researchers." Multidisciplinary interoperability can be successfully pursued by adopting a "system of systems" or a "Network of Networks" philosophy. This approach aims to: (a) supplement but not supplant systems mandates and governance arrangements; (b) keep the existing capacities as autonomous as possible; (c) lower entry barriers; (d) Build incrementally on existing infrastructures (information systems); (e) incorporate heterogeneous resources by introducing distribution and mediation functionalities. This approach has been adopted by the European INSPIRE (Infrastructure for Spatial Information in the European Community) initiative and by the international GEOSS (Global Earth Observation System of Systems) programme.

Useful global-change scenarios: current issues and challenges

NASA Astrophysics Data System (ADS)

Parson, E. A.

2008-10-01

Scenarios are increasingly used to inform global-change debates, but their connection to decisions has been weak and indirect. This reflects the greater number and variety of potential users and scenario needs, relative to other decision domains where scenario use is more established. Global-change scenario needs include common elements, e.g., model-generated projections of emissions and climate change, needed by many users but in different ways and with different assumptions. For these common elements, the limited ability to engage diverse global-change users in scenario development requires extreme transparency in communicating underlying reasoning and assumptions, including probability judgments. Other scenario needs are specific to users, requiring a decentralized network of scenario and assessment organizations to disseminate and interpret common elements and add elements requiring local context or expertise. Such an approach will make global-change scenarios more useful for decisions, but not less controversial. Despite predictable attacks, scenario-based reasoning is necessary for responsible global-change decisions because decision-relevant uncertainties cannot be specified scientifically. The purpose of scenarios is not to avoid speculation, but to make the required speculation more disciplined, more anchored in relevant scientific knowledge when available, and more transparent.

Lower extremity arthroplasty in patients with inflammatory arthritis: preoperative and perioperative management.

PubMed

Goodman, Susan M; Figgie, Mark

2013-06-01

Spondylarthritis, which includes conditions such as ankylosing spondylitis and psoriatic arthritis, and rheumatoid arthritis are the most common forms of inflammatory arthritis. Joint inflammation and damage may result in the need for arthroplasty, and the surgeon must be aware of the perioperative challenges associated with these systemic diseases. In patients with inflammatory arthritis who have polyarticular disease and spinal involvement at the time of presentation for lower extremity arthroplasty, preoperative evaluation must include careful evaluation of all joints, including the cervical spine. Preoperative assessment and perioperative management must be appropriate to minimize cardiac and pulmonary complications. Finally, the perioperative management of medications used to manage inflammatory arthritis is critical because these medications may increase the risk of infection and compromise wound healing.

Strategies and Challenges in Simultaneous Augmentation Mastopexy.

PubMed

Spring, Michelle A; Hartmann, Emily C; Stevens, W Grant

2015-10-01

Simultaneous breast augmentation and mastopexy is a common procedure often considered to be one of the most difficult cosmetic breast surgeries. One-stage augmentation mastopexy was initially described more than 50 years ago. The challenge lies in the fact that the surgery has multiple opposing goals: to increasing the volume of a breast, enhance the shape, and simultaneously decrease the skin envelope. Successful outcomes in augmentation can be expected with proper planning, technique, and patient education. This article focuses on common indications for simultaneous augmentation mastopexy, techniques for safe and effective combined procedures, challenges of the procedure, and potential complications. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving the asthma disparity gap with legal advocacy? A qualitative study of patient-identified challenges to improve social and environmental factors that contribute to poorly controlled asthma.

PubMed

Harris, Drew A; Mainardi, Anne; Iyamu, Osatohamwen; Rosenthal, Marjorie S; Bruce, R Douglas; Pisani, Margaret A; Redlich, Carrie A

2017-09-05

To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control. Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors. Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss. Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk.

Brain Aneurysm: Early Detection and Screening

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

Brain Aneurysm: Dealing with Emotional Distress

MedlinePlus

... Physical Challenge Emotional Challenges Potential Deficits Strategies For Short-Term Memory Loss Rehabilitation Kinds of Therapy What to Expect Common Questions How Long Until I Get Better? Why am I so ...

Challenges in conducting qualitative research in health: A conceptual paper.

PubMed

Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva

2015-01-01

Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

Restraint Procedures and Challenging Behaviours in Intellectual Disability: An Analysis of Causative Factors

ERIC Educational Resources Information Center

Matson, Johnny L.; Boisjoli, Jessica A.

2009-01-01

Background: Persons with intellectual disability often evince challenging behaviours. Efforts have been underway for some time to develop prosocial or positive skill acquisition treatments to address challenging behaviours. However, physical/mechanical and chemical restraint is still commonly used in many clinical and community settings. Such…

Understanding nutritional epidemiology and its role in policy.

PubMed

Satija, Ambika; Yu, Edward; Willett, Walter C; Hu, Frank B

2015-01-01

Nutritional epidemiology has recently been criticized on several fronts, including the inability to measure diet accurately, and for its reliance on observational studies to address etiologic questions. In addition, several recent meta-analyses with serious methodologic flaws have arrived at erroneous or misleading conclusions, reigniting controversy over formerly settled debates. All of this has raised questions regarding the ability of nutritional epidemiologic studies to inform policy. These criticisms, to a large degree, stem from a misunderstanding of the methodologic issues of the field and the inappropriate use of the drug trial paradigm in nutrition research. The exposure of interest in nutritional epidemiology is human diet, which is a complex system of interacting components that cumulatively affect health. Consequently, nutritional epidemiology constantly faces a unique set of challenges and continually develops specific methodologies to address these. Misunderstanding these issues can lead to the nonconstructive and sometimes naive criticisms we see today. This article aims to clarify common misunderstandings of nutritional epidemiology, address challenges to the field, and discuss the utility of nutritional science in guiding policy by focusing on 5 broad questions commonly asked of the field. © 2015 American Society for Nutrition.

Sensing in the collaborative Internet of Things.

PubMed

Borges Neto, João B; Silva, Thiago H; Assunção, Renato Martins; Mini, Raquel A F; Loureiro, Antonio A F

2015-03-19

We are entering a new era of computing technology, the era of Internet of Things (IoT). An important element for this popularization is the large use of off-the-shelf sensors. Most of those sensors will be deployed by different owners, generally common users, creating what we call the Collaborative IoT. This collaborative IoT helps to increase considerably the amount and availability of collected data for different purposes, creating new interesting opportunities, but also several challenges. For example, it is very challenging to search for and select a desired sensor or a group of sensors when there is no description about the provided sensed data or when it is imprecise. Given that, in this work we characterize the properties of the sensed data in the Internet of Things, mainly the sensed data contributed by several sources, including sensors from common users. We conclude that, in order to safely use data available in the IoT, we need a filtering process to increase the data reliability. In this direction, we propose a new simple and powerful approach that helps to select reliable sensors. We tested our method for different types of sensed data, and the results reveal the effectiveness in the correct selection of sensor data.

Assessment of anorexia nervosa: an overview of universal issues and contextual challenges

PubMed Central

2013-01-01

Aim Anorexia Nervosa (AN) is a complex and clinically challenging syndrome. Intended for specialist audiences, this narrative review aims to summarise the available literature related to assessment in the adult patient context, synthesising both research evidence and clinical consensus guidelines. Method We provide a review of the available literature on specialist assessment of AN focusing on common trajectories into assessment, obstacles accessing assessment, common presenting issues and barriers to the assessment process, the necessary scope of assessment, and tools and techniques. It describes the further step of synthesising assessment information in ways that can inform resultant care plans. Results In addition to assessment of core behaviours and diagnostic skills, considerations for the expert assessor include the functions of primary care, systemic and personal barriers, knowledge of current assessment tools and research pertaining to comorbid pathology in AN, assessing severity of illness, role of family at assessment, as well as medical, nutritional and compulsory elements of assessment. Conclusion Comprehensive assessment of AN in the current healthcare context still remains largely the remit of the specialist ED clinician. Assessment should remain an on-going process, paying particular attention to available empirical evidence, thereby reducing the gap between research and practice. PMID:24999408

Medical school 2.0: How we developed a student-generated question bank using small group learning.

PubMed

Gooi, Adrian C C; Sommerfeld, Connor S

2015-01-01

The multiple-choice question (MCQ) is one of the most common methods for formative and summative assessment in medical school. Common challenges with this format include (1) creating vetted questions and (2) involving students in higher-order learning activities. Involving medical students in the creation of MCQs may ameliorate both of these challenges. What we did: We used a small group learning structure to develop a student-generated question bank. Students created their own MCQ based on self-study materials, and then reviewed each other's questions within small groups. Selected questions were reviewed with the class as a whole. All questions were later vetted by the instructor and incorporated into a question bank that students could access for formative learning. Post-session survey indicated that 91% of the students felt that the class-created MCQ question bank was a valuable resource, and 86% of students would be interested in collaborating with the class for creating practice questions in future sessions. Developing a student-generated question bank can improve the depth and interactivity of student learning, increase session enjoyment and provide a potential resource for student assessment.

GEOSS: Addressing Big Data Challenges

NASA Astrophysics Data System (ADS)

Nativi, S.; Craglia, M.; Ochiai, O.

2014-12-01

In the sector of Earth Observation, the explosion of data is due to many factors including: new satellite constellations, the increased capabilities of sensor technologies, social media, crowdsourcing, and the need for multidisciplinary and collaborative research to face Global Changes. In this area, there are many expectations and concerns about Big Data. Vendors have attempted to use this term for their commercial purposes. It is necessary to understand whether Big Data is a radical shift or an incremental change for the existing digital infrastructures. This presentation tries to explore and discuss the impact of Big Data challenges and new capabilities on the Global Earth Observation System of Systems (GEOSS) and particularly on its common digital infrastructure called GCI. GEOSS is a global and flexible network of content providers allowing decision makers to access an extraordinary range of data and information at their desk. The impact of the Big Data dimensionalities (commonly known as 'V' axes: volume, variety, velocity, veracity, visualization) on GEOSS is discussed. The main solutions and experimentation developed by GEOSS along these axes are introduced and analyzed. GEOSS is a pioneering framework for global and multidisciplinary data sharing in the Earth Observation realm; its experience on Big Data is valuable for the many lessons learned.

Molecular commonality detection using an artificial enzyme membrane for in situ one-stop biosurveillance.

PubMed

Ikeno, Shinya; Asakawa, Hitoshi; Haruyama, Tetsuya

2007-08-01

Biodetection and biosensing have been developed based on the concept of sensitivity toward specific molecules. However, current demand may require more levelheaded or far-sighted methods, especially in the field of biological safety and security. In the fields of hygiene, public safety, and security including fighting bioterrorism, the detection of biological contaminants, e.g., microorganisms, spores, and viruses, is a constant challenge. However, there is as yet no sophisticated method of detecting such contaminants in situ without oversight. The authors focused their attention on diphosphoric acid anhydride, which is a structure common to all biological phosphoric substances. Interestingly, biological phosphoric substances are peculiar substances present in all living things and include many different substances, e.g., ATP, ADP, dNTP, pyrophosphate, and so forth, all of which have a diphosphoric acid anhydride structure. The authors took this common structure as the basis of their development of an artificial enzyme membrane with selectivity for the structure common to all biological phosphoric substances and studied the possibility of its application to in situ biosurveillance sensors. The artificial enzyme membrane-based amperometric biosensor developed by the authors can detect various biological phosphoric substances, because it has a comprehensive molecular selectivity for the structure of these biological phosphoric substances. This in situ detection method of the common diphosphoric acid anhydride structure brings a unique advantage to the fabrication of in situ biosurveillance sensors for monitoring biological contaminants, e.g., microorganism, spores, and viruses, without an oversight, even if they were transformed.

A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study).

PubMed

OʼToole, Robert V; Gary, Joshua L; Reider, Lisa; Bosse, Michael J; Gordon, Wade T; Hutson, James; Quinnan, Stephen M; Castillo, Renan C; Scharfstein, Daniel O; MacKenzie, Ellen J

2017-04-01

The treatment of high-energy open tibia fractures is challenging in both the military and civilian environments. Treatment with modern ring external fixation may reduce complications common in these patients. However, no study has rigorously compared outcomes of modern ring external fixation with commonly used internal fixation approaches. The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. Secondary outcomes include infection, fracture healing, limb function, and patient-reported outcomes including physical function and pain. One-year treatment costs and patient satisfaction will be compared between the 2 groups, and the percentage of Gustilo IIIB fractures that can be salvaged without soft tissue flap among patients receiving external fixation will be estimated.

The history of stress hyperglycaemia.

PubMed

Balasanthiran, A; Shotliff, K

2015-01-01

Stress hyperglycaemia, is a common phenomenon, frequently associated with adverse outcomes in a number of prevalent conditions including myocardial infarction and stroke. Knowledge on stress hyperglycaemia evolved in tandem with knowledge relating to homeostasis, stress and disease and involved some of the world's most eminent thinkers. Despite this, it still remains under-recognised. This paper illustrates significant points in the history of stress hyperglycaemia, from antiquity through to the present day, as well as the challenges faced in translating research into clinical benefit for patients. Profiles of significant protagonists including Claude Bernard, Walter Cannon and Hans Seyle are presented, as well their roles in the emergence of modern-day terminology and pathophysiological models. Major themes such as 'fight or flight' and homeostasis are central to this discussion. Closer to the present day, the role of stress hyperglycaemia in a number of common medical conditions is explored in more detail. Contention around evidence for treatment and the future risk of diabetes mellitus are also discussed.

The Allelic Landscape of Human Blood Cell Trait Variation and Links to Common Complex Disease.

PubMed

Astle, William J; Elding, Heather; Jiang, Tao; Allen, Dave; Ruklisa, Dace; Mann, Alice L; Mead, Daniel; Bouman, Heleen; Riveros-Mckay, Fernando; Kostadima, Myrto A; Lambourne, John J; Sivapalaratnam, Suthesh; Downes, Kate; Kundu, Kousik; Bomba, Lorenzo; Berentsen, Kim; Bradley, John R; Daugherty, Louise C; Delaneau, Olivier; Freson, Kathleen; Garner, Stephen F; Grassi, Luigi; Guerrero, Jose; Haimel, Matthias; Janssen-Megens, Eva M; Kaan, Anita; Kamat, Mihir; Kim, Bowon; Mandoli, Amit; Marchini, Jonathan; Martens, Joost H A; Meacham, Stuart; Megy, Karyn; O'Connell, Jared; Petersen, Romina; Sharifi, Nilofar; Sheard, Simon M; Staley, James R; Tuna, Salih; van der Ent, Martijn; Walter, Klaudia; Wang, Shuang-Yin; Wheeler, Eleanor; Wilder, Steven P; Iotchkova, Valentina; Moore, Carmel; Sambrook, Jennifer; Stunnenberg, Hendrik G; Di Angelantonio, Emanuele; Kaptoge, Stephen; Kuijpers, Taco W; Carrillo-de-Santa-Pau, Enrique; Juan, David; Rico, Daniel; Valencia, Alfonso; Chen, Lu; Ge, Bing; Vasquez, Louella; Kwan, Tony; Garrido-Martín, Diego; Watt, Stephen; Yang, Ying; Guigo, Roderic; Beck, Stephan; Paul, Dirk S; Pastinen, Tomi; Bujold, David; Bourque, Guillaume; Frontini, Mattia; Danesh, John; Roberts, David J; Ouwehand, Willem H; Butterworth, Adam S; Soranzo, Nicole

2016-11-17

Many common variants have been associated with hematological traits, but identification of causal genes and pathways has proven challenging. We performed a genome-wide association analysis in the UK Biobank and INTERVAL studies, testing 29.5 million genetic variants for association with 36 red cell, white cell, and platelet properties in 173,480 European-ancestry participants. This effort yielded hundreds of low frequency (<5%) and rare (<1%) variants with a strong impact on blood cell phenotypes. Our data highlight general properties of the allelic architecture of complex traits, including the proportion of the heritable component of each blood trait explained by the polygenic signal across different genome regulatory domains. Finally, through Mendelian randomization, we provide evidence of shared genetic pathways linking blood cell indices with complex pathologies, including autoimmune diseases, schizophrenia, and coronary heart disease and evidence suggesting previously reported population associations between blood cell indices and cardiovascular disease may be non-causal. Copyright © 2016 Elsevier Inc. All rights reserved.

Functions of intrinsic disorder in transmembrane proteins.

PubMed

Kjaergaard, Magnus; Kragelund, Birthe B

2017-09-01

Intrinsic disorder is common in integral membrane proteins, particularly in the intracellular domains. Despite this observation, these domains are not always recognized as being disordered. In this review, we will discuss the biological functions of intrinsically disordered regions of membrane proteins, and address why the flexibility afforded by disorder is mechanistically important. Intrinsically disordered regions are present in many common classes of membrane proteins including ion channels and transporters; G-protein coupled receptors (GPCRs), receptor tyrosine kinases and cytokine receptors. The functions of the disordered regions are many and varied. We will discuss selected examples including: (1) Organization of receptors, kinases, phosphatases and second messenger sources into signaling complexes. (2) Modulation of the membrane-embedded domain function by ball-and-chain like mechanisms. (3) Trafficking of membrane proteins. (4) Transient membrane associations. (5) Post-translational modifications most notably phosphorylation and (6) disorder-linked isoform dependent function. We finish the review by discussing the future challenges facing the membrane protein community regarding protein disorder.

Forensic issues in medical evaluation: competency and end-of-life issues.

PubMed

Soliman, Sherif; Hall, Ryan C W

2015-01-01

Decision-making capacity is a common reason for psychiatric consultation that is likely to become more common as the population ages. Capacity assessments are frequently compromised by misconceptions, such as the belief that incapacity is permanent or that patients with dementia categorically lack capacity. This chapter will review the conceptual framework of decision-making capacity and discuss its application to medical decision-making. We will review selected developments in capacity assessment and recommend an approach to assessing decision-making capacity. We will discuss the unique challenges posed by end-of-life care, including determining capacity, identifying surrogate decision-makers, and working with surrogate decision-makers. We will discuss clinical and legal approaches to incapacity, including advance directives, surrogate decision-makers, and guardians. We will discuss the legal standards based on which surrogates make medical decisions and outline options for resolving disagreements between clinical staff and surrogate decision-makers. We will offer recommendations for approaching decision-making capacity assessments. © 2015 S. Karger AG, Basel.

RNA-seq Data: Challenges in and Recommendations for Experimental Design and Analysis.

PubMed

Williams, Alexander G; Thomas, Sean; Wyman, Stacia K; Holloway, Alisha K

2014-10-01

RNA-seq is widely used to determine differential expression of genes or transcripts as well as identify novel transcripts, identify allele-specific expression, and precisely measure translation of transcripts. Thoughtful experimental design and choice of analysis tools are critical to ensure high-quality data and interpretable results. Important considerations for experimental design include number of replicates, whether to collect paired-end or single-end reads, sequence length, and sequencing depth. Common analysis steps in all RNA-seq experiments include quality control, read alignment, assigning reads to genes or transcripts, and estimating gene or transcript abundance. Our aims are two-fold: to make recommendations for common components of experimental design and assess tool capabilities for each of these steps. We also test tools designed to detect differential expression, since this is the most widespread application of RNA-seq. We hope that these analyses will help guide those who are new to RNA-seq and will generate discussion about remaining needs for tool improvement and development. Copyright © 2014 John Wiley & Sons, Inc.

Arthroscopic Triple Labral Repair in an Adolescent.

PubMed

Cotter, Eric J; Frank, Rachel M; Trenhaile, Scott W

2017-10-01

Traumatic glenohumeral dislocations often result in significant injury to the anterior-inferior labrum, most commonly leading to recurrent anterior instability. While in skeletally immature patients, shoulder trauma more commonly results in fracture versus a true dislocation, shoulder instability does occur and can be difficult to manage in the setting of open physes. In any event, the goal of treatment is to reduce the risk of recurrence and allow full participation in activities, including sports. Arthroscopic stabilization has been shown to be an effective treatment option for young patients, with good return to sport rates; however, the vast majority of literature on shoulder instability in the youth patient population focuses on anterior instability. Concomitant lesions of the anterior, posterior, and superior labrum have been rarely described in youth athletes and present a formidable clinical challenge, particularly in skeletally immature patients. In this Technical Note, we describe the authors' preferred technique for arthroscopic repair of a traumatic triple labral tear, including anterior, posterior, and type IV SLAP components, in adolescent patients.

Ultrasonic NDE Simulation for Composite Manufacturing Defects

NASA Technical Reports Server (NTRS)

Leckey, Cara A. C.; Juarez, Peter D.

2016-01-01

The increased use of composites in aerospace components is expected to continue into the future. The large scale use of composites in aerospace necessitates the development of composite-appropriate nondestructive evaluation (NDE) methods to quantitatively characterize defects in as-manufactured parts and damage incurred during or post manufacturing. Ultrasonic techniques are one of the most common approaches for defect/damage detection in composite materials. One key technical challenge area included in NASA's Advanced Composite's Project is to develop optimized rapid inspection methods for composite materials. Common manufacturing defects in carbon fiber reinforced polymer (CFRP) composites include fiber waviness (in-plane and out-of-plane), porosity, and disbonds; among others. This paper is an overview of ongoing work to develop ultrasonic wavefield based methods for characterizing manufacturing waviness defects. The paper describes the development and implementation of a custom ultrasound simulation tool that is used to model ultrasonic wave interaction with in-plane fiber waviness (also known as marcelling). Wavefield data processing methods are applied to the simulation data to explore possible routes for quantitative defect characterization.

KSC-06pd0462

NASA Image and Video Library

2006-03-10

KENNEDY SPACE CENTER, FLA. - Opening ceremonies of the 2006 FIRST Robotics Regional Competition held March 9-11 at the University of Central Florida in Orlando included Florida Governor Jeb Bush (center). At left is Sam Mallikarjunan from Rockledge High School, and at right is Stephanie Alphonso from Freedom High School in Orlando. The FIRST Robotics Competition challenges teams of young people and their mentors to solve a common problem in a six-week timeframe using a standard "kit of parts" and a common set of rules. Teams build robots from the parts and enter them in a series of competitions. FIRST, which is based on "For Inspiration and Recognition of Science and Technology," redefines winning for these students. Teams are rewarded for excellence in design, demonstrated team spirit, gracious professionalism and maturity, and ability to overcome obstacles. Scoring the most points is a secondary goal. Winning means building partnerships that last. NASA and the University of Central Florida are co-sponsors of the regional event, which this year included more than 50 teams. Photo credit: NASA/Kim Shiflett

Identifying the challenges and facilitators of implementing a COPD care bundle.

PubMed

Lennox, Laura; Green, Stuart; Howe, Cathy; Musgrave, Hannah; Bell, Derek; Elkin, Sarah

2014-01-01

Care bundles have been shown to improve outcomes, reduce hospital readmissions and reduce length of hospital stay; therefore increasing the speed of uptake and delivery of care bundles should be a priority in order to deliver more timely improvements and consistent high-quality care. Previous studies have detailed the difficulties of obtaining full compliance to bundle elements but few have described the underlying reasons for this. In order to improve future implementation this paper investigates the challenges encountered by clinical teams implementing a chronic obstructive pulmonary disease (COPD) care bundle and describes actions taken to overcome these challenges. An initial retrospective documentary analysis of data from seven clinical implementation teams was undertaken to review the challenges faced by the clinical teams. Three focus groups with healthcare professionals and managers explored solutions to these challenges developed during the project. Documentary analysis identified 28 challenges which directly impacted implementation of the COPD care bundle within five themes; staffing, infrastructure, process, use of improvement methodology and patient and public involvement. Focus groups revealed that the five most significant challenges for all groups were: staff too busy, staff shortages, lack of staff engagement, added workload of the bundle and patient coding issues. The participants shared facilitating factors used to overcome issues including: shifting perceptions to improve engagement, further education sessions to increase staff participation and gaining buy-in from managers through payment frameworks. Maximising the impact of a care bundle relies on its successful and timely implementation. Teams implementing the COPD care bundle encountered challenges that were common to all teams and sites. Understanding and learning from the challenges faced by previous endeavours and identifying the facilitators to overcoming these barriers provides an opportunity to mitigate issues that waste time and resources, and ensures that training can be tailored to the anticipated challenges.

Migration challenges among Zimbabwean refugees before, during and post arrival in South Africa

PubMed Central

Idemudia, Erhabor Sunday; Williams, John K.; Wyatt, Gail E.

2013-01-01

Abstract: Background: Zimbabweans are immigrating to South Africa with a commonly cited reason being economic opportunities. Prospects of finding employment may be a significant reason to leave behind family, friends, and community, sources that buffer and offer social support against life’s challenges. Currently, there is a dearth of research examining the motivators for Zimbabweans immigrating and the experiences encountered along the way and after arrival in South Africa. Such research is essential as large numbers of Zimbabweans may be at risk for emotional and physical trauma during this process. Methods: Two gender specific focus group discussions, each lasting 90-minutes and consisting of homeless Zimbabwean refugees, were conducted in the Limpopo Province of South Africa. A semi-structured interview assessed for experiences in and reasons for leaving Zimbabwe, as well as experiences en-route and within South Africa. Discussions were audio-recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method. Results: Three temporal themes were identified and included challenges and trauma experienced in Zimbabwe (pre-migration), during the immigration journey (mid-migration), and upon arrival in South Africa (post-migration). While there were some experiential differences, Zimbabwean men and women shared numerous traumatic commonalities. In addition to the themes, three subthemes contributing to reasons for leaving Zimbabwe, two subthemes of negative and traumatic experiences incurred mid-migration, and two post-migration subthemes of challenges were identified. Conclusions: Despite the difficulties encountered in their homeland, newly arrived Zimbabweans in South Africa may be exchanging old struggles for a new array of foreign and traumatic challenges. Reasons to immigrate and the psychological and physical toll of migration exacted at the individual and community levels are discussed. Recommendations advocating for culturally congruent mental health research, the training of culturally competent researchers and clinicians, and the development of policies that could influence the quality of life of Zimbabwean refugees are provided. PMID:22095004

Migration challenges among Zimbabwean refugees before, during and post arrival in South Africa.

PubMed

Idemudia, Erhabor Sunday; Williams, John K; Wyatt, Gail E

2013-01-01

Zimbabweans are immigrating to South Africa with a commonly cited reason being economic opportunities. Prospects of finding employment may be a significant reason to leave behind family, friends, and community, sources that buffer and offer social support against life's challenges. Currently, there is a dearth of research examining the motivators for Zimbabweans immigrating and the experiences encountered along the way and after arrival in South Africa. Such research is essential as large numbers of Zimbabweans may be at risk for emotional and physical trauma during this process. Two gender specific focus group discussions, each lasting 90-minutes and consisting of homeless Zimbabwean refugees, were conducted in the Limpopo Province of South Africa. A semi-structured interview assessed for experiences in and reasons for leaving Zimbabwe, as well as experiences en-route and within South Africa. Discussions were audio-recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method. Three temporal themes were identified and included challenges and trauma experienced in Zimbabwe (pre-migration), during the immigration journey (mid-migration), and upon arrival in South Africa (post-migration). While there were some experiential differences, Zimbabwean men and women shared numerous traumatic commonalities. In addition to the themes, three subthemes contributing to reasons for leaving Zimbabwe, two subthemes of negative and traumatic experiences incurred mid-migration, and two post-migration subthemes of challenges were identified. Despite the difficulties encountered in their homeland, newly arrived Zimbabweans in South Africa may be exchanging old struggles for a new array of foreign and traumatic challenges. Reasons to immigrate and the psychological and physical toll of migration exacted at the individual and community levels are discussed. Recommendations advocating for culturally congruent mental health research, the training of culturally competent researchers and clinicians, and the development of policies that could influence the quality of life of Zimbabwean refugees are provided.

Matching phenotypes to whole genomes: Lessons learned from four iterations of the personal genome project community challenges.

PubMed

Cai, Binghuang; Li, Biao; Kiga, Nikki; Thusberg, Janita; Bergquist, Timothy; Chen, Yun-Ching; Niknafs, Noushin; Carter, Hannah; Tokheim, Collin; Beleva-Guthrie, Violeta; Douville, Christopher; Bhattacharya, Rohit; Yeo, Hui Ting Grace; Fan, Jean; Sengupta, Sohini; Kim, Dewey; Cline, Melissa; Turner, Tychele; Diekhans, Mark; Zaucha, Jan; Pal, Lipika R; Cao, Chen; Yu, Chen-Hsin; Yin, Yizhou; Carraro, Marco; Giollo, Manuel; Ferrari, Carlo; Leonardi, Emanuela; Tosatto, Silvio C E; Bobe, Jason; Ball, Madeleine; Hoskins, Roger A; Repo, Susanna; Church, George; Brenner, Steven E; Moult, John; Gough, Julian; Stanke, Mario; Karchin, Rachel; Mooney, Sean D

2017-09-01

The advent of next-generation sequencing has dramatically decreased the cost for whole-genome sequencing and increased the viability for its application in research and clinical care. The Personal Genome Project (PGP) provides unrestricted access to genomes of individuals and their associated phenotypes. This resource enabled the Critical Assessment of Genome Interpretation (CAGI) to create a community challenge to assess the bioinformatics community's ability to predict traits from whole genomes. In the CAGI PGP challenge, researchers were asked to predict whether an individual had a particular trait or profile based on their whole genome. Several approaches were used to assess submissions, including ROC AUC (area under receiver operating characteristic curve), probability rankings, the number of correct predictions, and statistical significance simulations. Overall, we found that prediction of individual traits is difficult, relying on a strong knowledge of trait frequency within the general population, whereas matching genomes to trait profiles relies heavily upon a small number of common traits including ancestry, blood type, and eye color. When a rare genetic disorder is present, profiles can be matched when one or more pathogenic variants are identified. Prediction accuracy has improved substantially over the last 6 years due to improved methodology and a better understanding of features. © 2017 Wiley Periodicals, Inc.

New York State Public Health System Response to Hurricane Sandy: Lessons From the Field.

PubMed

Shipp Hilts, Asante; Mack, Stephanie; Eidson, Millicent; Nguyen, Trang; Birkhead, Guthrie S

2016-06-01

The aim of this study was to conduct interviews with public health staff who responded to Hurricane Sandy and to analyze their feedback to assess response strengths and challenges and recommend improvements for future disaster preparedness and response. Qualitative analysis was conducted of information from individual confidential interviews with 35 staff from 3 local health departments in New York State (NYS) impacted by Hurricane Sandy and the NYS Department of Health. Staff were asked about their experiences during Hurricane Sandy and their recommendations for improvements. Open coding was used to analyze interview transcripts for reoccurring themes, which were labeled as strengths, challenges, or recommendations and then categorized into public health preparedness capabilities. The most commonly cited strengths, challenges, and recommendations related to the Hurricane Sandy public health response in NYS were within the emergency operations coordination preparedness capability, which includes the abilities of health department staff to partner among government agencies, coordinate with emergency operation centers, conduct routine conference calls with partners, and manage resources. Health departments should ensure that emergency planning includes protocols to coordinate backup staffing, delineation of services that can be halted during disasters, clear guidelines to coordinate resources across agencies, and training for transitioning into unfamiliar disaster response roles. (Disaster Med Public Health Preparedness. 2016;10:443-453).

Moving oncolytic viruses into the clinic: clinical-grade production, purification, and characterization of diverse oncolytic viruses.

PubMed

Ungerechts, Guy; Bossow, Sascha; Leuchs, Barbara; Holm, Per S; Rommelaere, Jean; Coffey, Matt; Coffin, Rob; Bell, John; Nettelbeck, Dirk M

2016-01-01

Oncolytic viruses (OVs) are unique anticancer agents based on their pleotropic modes of action, which include, besides viral tumor cell lysis, activation of antitumor immunity. A panel of diverse viruses, often genetically engineered, has advanced to clinical investigation, including phase 3 studies. This diversity of virotherapeutics not only offers interesting opportunities for the implementation of different therapeutic regimens but also poses challenges for clinical translation. Thus, manufacturing processes and regulatory approval paths need to be established for each OV individually. This review provides an overview of clinical-grade manufacturing procedures for OVs using six virus families as examples, and key challenges are discussed individually. For example, different virus features with respect to particle size, presence/absence of an envelope, and host species imply specific requirements for measures to ensure sterility, for handling, and for determination of appropriate animal models for toxicity testing, respectively. On the other hand, optimization of serum-free culture conditions, increasing virus yields, development of scalable purification strategies, and formulations guaranteeing long-term stability are challenges common to several if not all OVs. In light of the recent marketing approval of the first OV in the Western world, strategies for further upscaling OV manufacturing and optimizing product characterization will receive increasing attention.

Moving oncolytic viruses into the clinic: clinical-grade production, purification, and characterization of diverse oncolytic viruses

PubMed Central

Ungerechts, Guy; Bossow, Sascha; Leuchs, Barbara; Holm, Per S; Rommelaere, Jean; Coffey, Matt; Coffin, Rob; Bell, John; Nettelbeck, Dirk M

2016-01-01

Oncolytic viruses (OVs) are unique anticancer agents based on their pleotropic modes of action, which include, besides viral tumor cell lysis, activation of antitumor immunity. A panel of diverse viruses, often genetically engineered, has advanced to clinical investigation, including phase 3 studies. This diversity of virotherapeutics not only offers interesting opportunities for the implementation of different therapeutic regimens but also poses challenges for clinical translation. Thus, manufacturing processes and regulatory approval paths need to be established for each OV individually. This review provides an overview of clinical-grade manufacturing procedures for OVs using six virus families as examples, and key challenges are discussed individually. For example, different virus features with respect to particle size, presence/absence of an envelope, and host species imply specific requirements for measures to ensure sterility, for handling, and for determination of appropriate animal models for toxicity testing, respectively. On the other hand, optimization of serum-free culture conditions, increasing virus yields, development of scalable purification strategies, and formulations guaranteeing long-term stability are challenges common to several if not all OVs. In light of the recent marketing approval of the first OV in the Western world, strategies for further upscaling OV manufacturing and optimizing product characterization will receive increasing attention. PMID:27088104

Using a participatory evaluation design to create an online data collection and monitoring system for New Mexico's Community Health Councils.

PubMed

Andrews, M L; Sánchez, V; Carrillo, C; Allen-Ananins, B; Cruz, Y B

2014-02-01

We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexico's health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicine's Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges. Copyright © 2013 Elsevier Ltd. All rights reserved.

Unmet medical needs in systemic lupus erythematosus

PubMed Central

2012-01-01

Systemic lupus erythematosus (SLE) is an autoimmune disease of diverse manifestations, with onset usually in young women in the third to fourth decade of life. The chronic nature of this relapsing remitting disease leads to organ damage accrual over time. Mortality and morbidity are increased in patients with SLE compared with the general population. Therapeutic advances over the last few decades have led to significant improvements in patient outcomes. Five-year survival has improved to over 90% from a low of 50% in the 1950s. However, multiple aspects of the management of SLE patients are still far from optimal. Early diagnosis remains a challenge; diagnostic delays leading to delay in definitive treatment are common. Monitoring treatment remains problematic due to the paucity of sensitive biomarkers. Current treatment regimens rely heavily on corticosteroids, even though corticosteroids are well known to cause organ damage. Treatment of refractory disease manifestations such as nephritis, recalcitrant cutaneous lesions and neurological involvement require new approaches with greater efficacy. Cognitive dysfunction is common in SLE patients, but early recognition and adequate treatment are yet to be established. Premature accelerated atherosclerosis remains a leading cause of morbidity and mortality. Fatigue is one of the most disabling symptoms, and contributes to the poor quality of life in patients with SLE. Ongoing research in SLE faces many challenges, including enrollment of homogeneous patient populations, use of reliable outcome measures and a standard control arm. The current review will highlight some of the outstanding unmet challenges in the management of this complex disease. PMID:23281889

Primary breast tuberculosis: diagnostic and therapeutic dilemmas.

PubMed

Hiremath, Bharati V; Subramaniam, Narayana

2015-01-01

To review the diagnostic and therapeutic challenges associated with treating isolated primary breast tuberculosis through discussion of our series of seven cases. Although breast is an uncommon site of occurrence of tuberculosis and isolated primary breast tuberculosis is an even rarer entity, its importance lies in distinguishing it from more common pathologies like abscesses or malignancy and avoiding unnecessary erroneous surgical intervention. The spectrum and presentation is wide and varied and we present our experience in managing seven such cases. A retrospective analysis of all the cases of histopathologically proven primary breast tuberculosis in the last three years at M.S. Ramaiah Hospital (2012-2014) was done. Analysis was in terms of mode of presentation, clinical features, diagnostic modalities used for evaluation and confirmation of the diagnosis, medical treatment and surgical intervention, if any. Special emphasis was placed on dilemmas in diagnosis and difficulties encountered during treatment. All cases were followed up till cure. Patients most commonly presented with a breast abscess, painful breast lumps and recurrent abscesses. Other foci of tuberculosis were ruled out in all of these patients. Majority were treated exclusively with anti-tubercular therapy (although regimens varied), but those with abscesses underwent incision and drainage. All cases were treated and followed up till cure. The challenges associated with primary breast tuberculosis are multiple, including which anti-tubercular therapy regimen to use, when to surgically intervene (as the breast is a cosmetically important area) and treating atypical mycobacteria. We provide a detailed discussion of the challenges we faced and review of literature.

IS-ENES project management - lessons learnt

NASA Astrophysics Data System (ADS)

Parinet, Marie; Guglielmo, Francesca; Joussaume, Sylvie

2017-04-01

IS-ENES is the distributed e-infrastructure of models, model data and metadata of the European Network for Earth System Modelling (ENES). It has benefitted from two EC FP7 grants and aims towards further European and national funding to achieve sustainability. We highlight here several challenges related to project management that have risen in the course of these two project-phases spanning 8 years. Some challenges are related to the heterogeneity of the activities within IS-ENES, with different groups working on very diverse activities, not necessarily strictly interdependent. An immediate consequence is the need of implementing and setting up in early phases of the project efficient collection and circulation of information to preserve and reinforce the systemic view of the infrastructure as a whole and the pursuit of common goals, including coordinated provision of services. Toward and beyond such common goals, managing IS-ENES, covering both scientific and more strictly management-related aspects, implies a double-paced approach: besides setting up efficient project workflow, there is the need of setting up longer term objectives. This implies, within the project lifetime, to elaborate and implement a coherent organizational (consistent with scientific goals, funding schemes, research and technology landscape) strategy to pursue these goals beyond the project itself. Furthermore, a series of more generic project management challenges will also be listed and can be gathered around 3 main objectives: ease the internal processes in order to optimize the work, anticipate delays and budget issues, and motivate the project teams by ensuring an efficient internal and external communication.

Preparation, Imaging, and Quantification of Bacterial Surface Motility Assays

PubMed Central

Morales-Soto, Nydia; Anyan, Morgen E.; Mattingly, Anne E.; Madukoma, Chinedu S.; Harvey, Cameron W.; Alber, Mark; Déziel, Eric; Kearns, Daniel B.; Shrout, Joshua D.

2015-01-01

Bacterial surface motility, such as swarming, is commonly examined in the laboratory using plate assays that necessitate specific concentrations of agar and sometimes inclusion of specific nutrients in the growth medium. The preparation of such explicit media and surface growth conditions serves to provide the favorable conditions that allow not just bacterial growth but coordinated motility of bacteria over these surfaces within thin liquid films. Reproducibility of swarm plate and other surface motility plate assays can be a major challenge. Especially for more “temperate swarmers” that exhibit motility only within agar ranges of 0.4%-0.8% (wt/vol), minor changes in protocol or laboratory environment can greatly influence swarm assay results. “Wettability”, or water content at the liquid-solid-air interface of these plate assays, is often a key variable to be controlled. An additional challenge in assessing swarming is how to quantify observed differences between any two (or more) experiments. Here we detail a versatile two-phase protocol to prepare and image swarm assays. We include guidelines to circumvent the challenges commonly associated with swarm assay media preparation and quantification of data from these assays. We specifically demonstrate our method using bacteria that express fluorescent or bioluminescent genetic reporters like green fluorescent protein (GFP), luciferase (lux operon), or cellular stains to enable time-lapse optical imaging. We further demonstrate the ability of our method to track competing swarming species in the same experiment. PMID:25938934

The Electronic Data Methods (EDM) forum for comparative effectiveness research (CER).

PubMed

Holve, Erin; Segal, Courtney; Lopez, Marianne Hamilton; Rein, Alison; Johnson, Beth H

2012-07-01

AcademyHealth convened the Electronic Data Methods (EDM) Forum to collect, synthesize, and share lessons from eleven projects that are building infrastructure and using electronic clinical data for comparative effectiveness research (CER) and patient-centered outcomes research (PCOR). This paper provides a brief review of participating projects and provides a framework of common challenges. EDM Forum staff conducted a text review of relevant grant programs' funding opportunity announcements; projects' research plans; and available information on projects' websites. Additional information was obtained from presentations provided by each project; phone calls with project principal investigators, affiliated partners, and staff from the Agency for Healthcare Research and Quality (AHRQ); and six site visits. Projects participating in the EDM Forum are building infrastructure and developing innovative strategies to address a set of methodological, and data and informatics challenges, here identified in a common framework. The eleven networks represent more than 20 states and include a range of partnership models. Projects vary substantially in size, from 11,000 to more than 7.5 million individuals. Nearly all of the AHRQ priority populations and conditions are addressed. In partnership with the projects, the EDM Forum is focused on identifying and sharing lessons learned to advance the national dialogue on the use of electronic clinical data to conduct CER and PCOR. These efforts have the shared goal of addressing challenges in traditional research studies and data sources, and aim to build infrastructure and generate evidence to support a learning health care system that can improve patient outcomes.

Ethical Challenges and Solutions Regarding Delirium Studies in Palliative Care

PubMed Central

Sweet, Lisa; Adamis, Dimitrios; Meagher, David; Davis, Daniel; Currow, David; Bush, Shirley H.; Barnes, Christopher; Hartwick, Michael; Agar, Meera; Simon, Jessica; Breitbart, William; MacDonald, Neil; Lawlor, Peter G.

2014-01-01

Context Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. Objectives Based on deliberations at the Studies to Understand Delirium in Palliative Care Settings (SUNDIPS) meeting and an associated literature review, this article discusses ethical issues central to the conduct of research on delirious PC patients. Methods Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. We also reviewed statements of relevance to delirium research in major national and international ethics guidelines. Results Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Proposed solutions include designing informed consent statements that are clear, concise, and free of complex phraseology; use of concise, yet accurate, capacity assessment instruments with a minimally burdensome schedule; and use of PC friendly consent models, such as facilitated, deferred, experienced, advance, and proxy models. Conclusion Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC. PMID:24388124

Common functional targets of adaptive micro- and macro-evolutionary divergence in killifish.

PubMed

Whitehead, Andrew; Zhang, Shujun; Roach, Jennifer L; Galvez, Fernando

2013-07-01

Environmental salinity presents a key barrier to dispersal for most aquatic organisms, and adaptation to alternate osmotic environments likely enables species diversification. Little is known of the functional basis for derived tolerance to environmental salinity. We integrate comparative physiology and functional genomics to explore the mechanistic underpinnings of evolved variation in osmotic plasticity within and among two species of killifish; Fundulus majalis harbours the ancestral mainly salt-tolerant phenotype, whereas Fundulus heteroclitus harbours a derived physiology that retains extreme salt tolerance but with expanded osmotic plasticity towards the freshwater end of the osmotic continuum. Common-garden comparative hypo-osmotic challenge experiments show that F. heteroclitus is capable of remodelling gill epithelia more quickly and at more extreme osmotic challenge than F. majalis. We detect an unusual pattern of baseline transcriptome divergence, where neutral evolutionary processes appear to govern expression divergence within species, but patterns of divergence for these genes between species do not follow neutral expectations. During acclimation, genome expression profiling identifies mechanisms of acclimation-associated response that are conserved within the genus including regulation of paracellular permeability. In contrast, several responses vary among species including those putatively associated with cell volume regulation, and these same mechanisms are targets for adaptive physiological divergence along osmotic gradients within F. heteroclitus. As such, the genomic and physiological mechanisms that are associated with adaptive fine-tuning within species also contribute to macro-evolutionary divergence as species diversify across osmotic niches. © 2013 John Wiley & Sons Ltd.

Presidential Green Chemistry Challenge: 1997 Greener Synthetic Pathways Award

EPA Pesticide Factsheets

Presidential Green Chemistry Challenge 1997 award winner, BHC Company, developed a highly atom-efficient method to make ibuprofen, a common painkiller, using three catalytic steps instead of six stoichiometric ones.

Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges?

PubMed

Huter, Kai; Dubas-Jakóbczyk, Katarzyna; Kocot, Ewa; Kissimova-Skarbek, Katarzyna; Rothgang, Heinz

2018-01-01

In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.

Efficient heuristics for maximum common substructure search.

PubMed

Englert, Péter; Kovács, Péter

2015-05-26

Maximum common substructure search is a computationally hard optimization problem with diverse applications in the field of cheminformatics, including similarity search, lead optimization, molecule alignment, and clustering. Most of these applications have strict constraints on running time, so heuristic methods are often preferred. However, the development of an algorithm that is both fast enough and accurate enough for most practical purposes is still a challenge. Moreover, in some applications, the quality of a common substructure depends not only on its size but also on various topological features of the one-to-one atom correspondence it defines. Two state-of-the-art heuristic algorithms for finding maximum common substructures have been implemented at ChemAxon Ltd., and effective heuristics have been developed to improve both their efficiency and the relevance of the atom mappings they provide. The implementations have been thoroughly evaluated and compared with existing solutions (KCOMBU and Indigo). The heuristics have been found to greatly improve the performance and applicability of the algorithms. The purpose of this paper is to introduce the applied methods and present the experimental results.

May nasal hyperreactivity be a sequela of recurrent common cold?

PubMed

Cassano, M; Cassano, P; Ciprandi, G

2011-01-01

Respiratory viral infections may worsen bronchial hyperreactivity. However, there is no data on the possible role of recurrent infectious rhinitis in nose hyperreactivity. This study was therefore designed to investigate whether subjects suffering from recurrent common cold have nasal hyperreactivity, assessed by histamine nasal challenge. This study included a group of 40 patients (19 males, mean age 34.1 years) with history of at least five episodes of common cold in the previous year, but without documented allergy, and twenty healthy subjects (8 males, mean age 32.3 years) were enrolled as control group, all of whom were non-allergic. Nasal provocation test with histamine was performed in all subjects. Nasal provocation test with histamine induced a 200% increase in nasal resistance after provocation in 24 (60%) patients suffering from recurrent viral rhinitis. No normal subject had an increase >180% in nasal resistance. There was a significant difference between the patient group and the control group (p<0.05). In conclusion, this study shows that nasal hyperreactivity might be a sequela of recurrent common cold. Further studies should be conducted to confirm this preliminary finding.

The Impact of Living with Klinefelter Syndrome: A Qualitative Exploration of Adolescents and Adults.

PubMed

Turriff, Amy; Macnamara, Ellen; Levy, Howard P; Biesecker, Barbara

2017-08-01

Klinefelter syndrome (XXY) is a common yet significantly underdiagnosed condition with considerable medical, psychological and social implications. Many health care providers lack familiarity with XXY, resulting in medical management challenges and a limited understanding of the personal impact of the condition. Genetic counselors benefit from understanding the challenges adolescents and men with XXY face to effectively address their medical and psychosocial needs. The purpose of this study was to understand the impact of living with XXY as an adolescent or an adult. Individuals aged 14 to 75 years with self-reported XXY were recruited from online support networks to complete a web-based survey that included open-ended questions. Open-ended responses were coded and analyzed thematically (n = 169 to 210 for each open-ended question). Over half of respondents to the open-ended questions reported challenges in finding health care providers who are knowledgeable about XXY, with many describing an extensive diagnostic odyssey and relief when receiving a diagnosis. Individuals sought support coping with the challenges they face and acknowledgement of the positive aspects of XXY. Recommendations are made for how genetic counseling can enhance quality of life for individuals living with XXY.

Expanding Access to Malaria Diagnosis through Retail Shops in Western Kenya: What Do Shop Workers Think?

PubMed

Rusk, Andria; Goodman, Catherine; Naanyu, Violet; Koech, Beatrice; Obala, Andrew; O'Meara, Wendy Prudhomme

2013-01-01

Background. The common symptoms of malaria reduce the specificity of clinical diagnosis. Presumptive treatment is conventional but can lead to overdiagnosis of malaria, delay of appropriate treatment, overprescription of antimalarials, and drug resistance. Routine use of diagnostic tests can address many of these concerns. Though treatment is often procured from retailers, there is low availability of rapid diagnostic tests for malaria (MRDTs), a simple, inexpensive, and accurate diagnostic solution. We know little about the challenges to expanding access to diagnostics through these outlets. Methods. To understand the perceptions of the benefits and challenges to selling rapid diagnostic tests for malaria, we conducted focus group discussions with antimalarial retailers who serve the residents of the Webuye Health and Demographic Surveillance Site in western Kenya. Results. Medicine retailers perceived MRDTs to be beneficial to their customers and businesses but also included cost, fear of the tests, risks of self-treatment, and regulatory concerns among the challenges to using and selling MRDTs. Conclusion. MRDTs represent a viable approach to increase access to malaria diagnostic testing. Medicine retailers are eager for MRDTs to be made available to them. However, certain challenges remain to implementation in retail outlets and should be addressed in advance.

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.

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

Brotz, Jay Kristoffer; Hymel, Ross W; Punnoose, Ratish J.

One of the greatest challenges facing designers of equipment to be used in a nuclear arms control treaty is how to convince the other party in the treaty to trust its results and functionality. Whether the host provides equipment meant to prove treaty obligations and the inspector needs to gain that trust (commonly referred to as authentication), or the inspector provides this equipment and the host needs to gain this trust (commonly considered to be included in certification), one party generally has higher confidence in the equipment at the start of a treaty regime and the other party needs tomore » gain that confidence prior to use. While we focus on authentication in this document—that is, the inspector gaining confidence in host-provided equipment—our conclusions will likely apply to host certification of inspector-provided equipment.« less

Sign changes as a universal concept in first-passage-time calculations

NASA Astrophysics Data System (ADS)

Braun, Wilhelm; Thul, Rüdiger

2017-01-01

First-passage-time problems are ubiquitous across many fields of study, including transport processes in semiconductors and biological synapses, evolutionary game theory and percolation. Despite their prominence, first-passage-time calculations have proven to be particularly challenging. Analytical results to date have often been obtained under strong conditions, leaving most of the exploration of first-passage-time problems to direct numerical computations. Here we present an analytical approach that allows the derivation of first-passage-time distributions for the wide class of nondifferentiable Gaussian processes. We demonstrate that the concept of sign changes naturally generalizes the common practice of counting crossings to determine first-passage events. Our method works across a wide range of time-dependent boundaries and noise strengths, thus alleviating common hurdles in first-passage-time calculations.

Child Disaster Mental Health Interventions: Therapy Components

PubMed Central

Pfefferbaum, Betty; Sweeton, Jennifer L.; Nitiéma, Pascal; Noffsinger, Mary A.; Varma, Vandana; Nelson, Summer D.; Newman, Elana

2015-01-01

Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention. PMID:25225954

Food and Nutrition Board update: What do SNAP allotments, physical fitness, and obesity prevention have in common?

PubMed

Meyers, Linda D; Murphy, Suzanne P; Yaktine, Ann L

2013-09-01

The Institute of Medicine's Food and Nutrition Board had a productive year, with important expert committee reports on the Supplemental Food Assistance Program, physical fitness, and accelerating obesity prevention efforts that provided grounding for dietary guidance and nutrition policies and programs. This summary describes Food and Nutrition Board activities, including current thinking on dietary reference intakes. The summary also highlights consensus reports on defining and measuring Supplemental Food Assistance Program benefit adequacy and on physical fitness and health outcomes in youth. In addition, current and new activities related to obesity prevention and care are addressed. What do these activities have in common? All adhere to the Institute of Medicine report model by filling gaps and by being analytical, evidence-based, and challenging.

Implementing CITES regulations for timber.

PubMed

Blundell, Arthur G

2007-03-01

Foresters are currently confronted with a new challenge. For the first time a commonly traded timber species has been listed on the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). At the 12th Conference of the Parties in November 2002, countries voted 68 to 30 to place the premier timber species of Latin America, big-leaf mahogany (Swietenia macrophylla King [Meliaceae]), on CITES Appendix II. Under Appendix II regulations, trade in mahogany requires that exporting countries verify that each shipment was legally obtained and that its harvest was non-detrimental to the survival of the species. Unfortunately, implementation has been weak, in part because countries have yet to develop a common, pragmatic, cost-effective system to make the legal and non-detriment findings. This paper recommends what such a system might include.

Fluvial reservoir architecture in the Malay Basin: Opportunities and challenges

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

Elias, M.R.; Dharmarajan, K.

1994-07-01

Miocene fluvial sandstones are significant hydrocarbon-bearing reservoirs in the Malay Basin. These include high energy, braided stream deposits of group K, associated with late development of extensional half grabens and relatively lower energy, meandering, and anastomosing channel deposits of group I formed during the subsequent basin sag phase. Group K reservoirs are typically massive, commonly tens of meters thick, and cover an extensive part of the Malay Basin. These reservoirs have good porosity and permeability at shallow burial depths. However, reservoir quality deteriorates rapidly with increasing depth. Lateral and vertical reservoir continuity is generally good within a field, commonly formingmore » a single system. Good water drive enhances recovery. Seismic modeling to determine fluid type and the extent of interfluvial shales is possible due to reservoir homogeneity.« less

Common Primary and Secondary Causes of Headache in the Elderly.

PubMed

Sharma, Tara L

2018-03-01

Headache in the elderly, defined as individuals aged 65 and older, although less prevalent than younger individuals, can present as a diagnostic challenge, given the increase in potentially fatal diseases within this population. These individuals require a complete history, neurological examination, and assessment of potential secondary causes of headaches. Secondary causes include temporal or giant cell arteritis, subdural hematomas, central nervous system (CNS) tumors, strokes, and CNS infections. Once secondary conditions are ruled out, then primary causes of headache are considered such as tension-type headache, migraine, cluster headache, or hypnic headache. This article reviews the distinguishing characteristics of the most common types of headache in patients over the age of 65 years old, along with potential diagnostic tests and treatment. © 2018 American Headache Society.

Building successful coalitions for promoting advance care planning.

PubMed

Marchand, Lucille; Fowler, Kathryn J; Kokanovic, Obrad

2006-01-01

Advance care planning (ACP) has had few successful initiatives. This qualitative study explores the challenges and successes of an advance care planning coalition in Wisconsin called Life Planning 2000 using key informant interviews (n = 24) and grounded theory. Major themes included: commitment (the need for leadership, recruitment of key members, and funding); cohesiveness (disparate groups collaborating toward a common purpose), and outcomes (shift in paradigm from signing documents to process of advanced care planning, new-found collaborative relationships, and educational tool development). Coalitions need to define short-, intermediate-, and long-term goals that result in measurable outcomes and an evaluation process. Resources must be commensurate with goals. Strong leadership, paid staff adequate funding, and the collaboration of diverse groups working toward common goals are the basic requirements of a successful coalition.

Data collection challenges in community settings: Insights from two field studies of patients with chronic disease

PubMed Central

Holden, Richard J.; McDougald Scott, Amanda M.; Hoonakker, Peter L.T.; Hundt, Ann S.; Carayon, Pascale

2014-01-01

Purpose Collecting information about health and disease directly from patients can be fruitfully accomplished using contextual approaches, ones that combine more and less structured methods in home and community settings. This paper's purpose is to describe and illustrate a framework of the challenges of contextual data collection. Methods A framework is presented based on prior work in community-based participatory research and organizational science, comprised of ten types of challenges across four broader categories. Illustrations of challenges and suggestions for addressing them are drawn from two mixed-method, contextual studies of patients with chronic disease in two regions of the US. Results The first major category of challenges was concerned with the researcher-participant partnership, for example, the initial lack of mutual trust and understanding between researchers, patients, and family members. The second category concerned patient characteristics such as cognitive limitations and a busy personal schedule that created barriers to successful data collection. The third concerned research logistics and procedures such as recruitment, travel distances, and compensation. The fourth concerned scientific quality and interpretation, including issues of validity, reliability, and combining data from multiple sources. The two illustrative studies faced both common and diverse research challenges and used many different strategies to address them. Conclusion Collecting less structured data from patients and others in the community is potentially very productive but requires the anticipation, avoidance, or negotiation of various challenges. Future work is necessary to better understand these challenges across different methods and settings, as well as to test and identify strategies to address them. PMID:25154464

Ongoing ostomy self-care challenges of long-term rectal cancer survivors.

PubMed

Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C; Krouse, Robert S

2018-05-29

Surgical treatment for rectal cancer (RC) can result in an intestinal ostomy that requires lifelong adaptation and investment of physical, cognitive, and financial resources. However, little is known about the extent of ongoing challenges related to ostomy self-care among long-term RC survivors. We analyzed the prevalence of self-reported ostomy self-care challenges and the physical and environmental factors that can support or undermine ostomy self-care. We mailed surveys to long-term (≥ 5 years post-diagnosis) RC survivors, including 177 adults with ostomies who were members of integrated health systems in northern California, Oregon, and Washington State. Potential participants were identified through tumor registries. Data were also extracted from electronic health records. The response rate was 65%. The majority of respondents were male (67%), and the mean age was 75 years. Sixty-three percent of respondents reported at least one ostomy self-care challenge. The most common challenges were leakage or skin problems around the ostomy and needing to change the pouching system too frequently. Twenty-two percent reported difficulty caring for their ostomy. Younger age and higher BMI were consistently related to ostomy self-care challenges. The majority of RC survivors reported ostomy-related self-care challenges, and 31% experienced problems across multiple domains of ostomy self-care. In addition, most survivors reported significant physical challenges that could lead to ostomy-related disability. Although the participants surveyed had access to ostomy care nurses, the care gaps we found suggest that additional work is needed to understand barriers to ostomy care, reduce unmet needs, and improve well-being among this group.

An open access database for the evaluation of heart sound algorithms.

PubMed

Liu, Chengyu; Springer, David; Li, Qiao; Moody, Benjamin; Juan, Ricardo Abad; Chorro, Francisco J; Castells, Francisco; Roig, José Millet; Silva, Ikaro; Johnson, Alistair E W; Syed, Zeeshan; Schmidt, Samuel E; Papadaniil, Chrysa D; Hadjileontiadis, Leontios; Naseri, Hosein; Moukadem, Ali; Dieterlen, Alain; Brandt, Christian; Tang, Hong; Samieinasab, Maryam; Samieinasab, Mohammad Reza; Sameni, Reza; Mark, Roger G; Clifford, Gari D

2016-12-01

In the past few decades, analysis of heart sound signals (i.e. the phonocardiogram or PCG), especially for automated heart sound segmentation and classification, has been widely studied and has been reported to have the potential value to detect pathology accurately in clinical applications. However, comparative analyses of algorithms in the literature have been hindered by the lack of high-quality, rigorously validated, and standardized open databases of heart sound recordings. This paper describes a public heart sound database, assembled for an international competition, the PhysioNet/Computing in Cardiology (CinC) Challenge 2016. The archive comprises nine different heart sound databases sourced from multiple research groups around the world. It includes 2435 heart sound recordings in total collected from 1297 healthy subjects and patients with a variety of conditions, including heart valve disease and coronary artery disease. The recordings were collected from a variety of clinical or nonclinical (such as in-home visits) environments and equipment. The length of recording varied from several seconds to several minutes. This article reports detailed information about the subjects/patients including demographics (number, age, gender), recordings (number, location, state and time length), associated synchronously recorded signals, sampling frequency and sensor type used. We also provide a brief summary of the commonly used heart sound segmentation and classification methods, including open source code provided concurrently for the Challenge. A description of the PhysioNet/CinC Challenge 2016, including the main aims, the training and test sets, the hand corrected annotations for different heart sound states, the scoring mechanism, and associated open source code are provided. In addition, several potential benefits from the public heart sound database are discussed.

Rhabdomyosarcoma: Current Challenges and Their Implications for Developing Therapies

PubMed Central

Hettmer, Simone; Li, Zhizhong; Billin, Andrew N.; Barr, Frederic G.; Cornelison, D.D.W.; Ehrlich, Alan R.; Guttridge, Denis C.; Hayes-Jordan, Andrea; Helman, Lee J.; Houghton, Peter J.; Khan, Javed; Langenau, David M.; Linardic, Corinne M.; Pal, Ranadip; Partridge, Terence A.; Pavlath, Grace K.; Rota, Rossella; Schäfer, Beat W.; Shipley, Janet; Stillman, Bruce; Wexler, Leonard H.; Wagers, Amy J.; Keller, Charles

2014-01-01

Rhabdomyosarcoma (RMS) represents a rare, heterogeneous group of mesodermal malignancies with skeletal muscle differentiation. One major subgroup of RMS tumors (so-called “fusion-positive” tumors) carries exclusive chromosomal translocations that join the DNA-binding domain of the PAX3 or PAX7 gene to the transactivation domain of the FOXO1 (previously known as FKHR) gene. Fusion-negative RMS represents a heterogeneous spectrum of tumors with frequent RAS pathway activation. Overtly metastatic disease at diagnosis is more frequently found in individuals with fusion-positive than in those with fusion-negative tumors. RMS is the most common pediatric soft-tissue sarcoma, and approximately 60% of all children and adolescents diagnosed with RMS are cured by currently available multimodal therapies. However, a curative outcome is achieved in <30% of high-risk individuals with RMS, including all those diagnosed as adults, those diagnosed with fusion-positive tumors during childhood (including metastatic and nonmetastatic tumors), and those diagnosed with metastatic disease during childhood (including fusion-positive and fusion-negative tumors). This white paper outlines current challenges in RMS research and their implications for developing more effective therapies. Urgent clinical problems include local control, systemic disease, need for improved risk stratification, and characterization of differences in disease course in children and adults. Biological challenges include definition of the cellular functions of PAX-FOXO1 fusion proteins, clarification of disease heterogeneity, elucidation of the cellular origins of RMS, delineation of the tumor microenvironment, and identification of means for rational selection and testing of new combination therapies. To streamline future therapeutic developments, it will be critical to improve access to fresh tumor tissue for research purposes, consider alternative trial designs to optimize early clinical testing of candidate drugs, coalesce advocacy efforts to garner public and industry support, and facilitate collaborative efforts between academia and industry. PMID:25368019

Presidential Green Chemistry Challenge: 1998 Greener Synthetic Pathways Award

EPA Pesticide Factsheets

Presidential Green Chemistry Challenge 1998 award winner, Flexsys America, developed nucleophilic aromatic substitution for hydrogen to eliminate waste from a common reaction and to produce 4-ADPA, a high-volume chemical.

Report on the Third Workshop on Sustainable Software for Science: Practice and Experiences (WSSSPE3)

NASA Astrophysics Data System (ADS)

Katz, Daniel S.; Choi, Sou-Cheng T.; Niemeyer, Kyle E.; Hetherington, James; Löffler, Frank; Gunter, Dan; Idaszak, Ray; Brandt, Steven R.; Miller, Mark A.; Gesing, Sandra; Jones, Nick D.; Weber, Nic; Marru, Suresh; Allen, Gabrielle; Penzenstadler, Birgit; Venters, Colin C.; Davis, Ethan; Hwang, Lorraine; Todorov, Ilian; Patra, Abani; de Val-Borro, Miguel

2016-02-01

This report records and discusses the Third Workshop on Sustainable Software for Science: Practice and Experiences (WSSSPE3). The report includes a description of the keynote presentation of the workshop, which served as an overview of sustainable scientific software. It also summarizes a set of lightning talks in which speakers highlighted to-the-point lessons and challenges pertaining to sustaining scientific software. The final and main contribution of the report is a summary of the discussions, future steps, and future organization for a set of self-organized working groups on topics including developing pathways to funding scientific software; constructing useful common metrics for crediting software stakeholders; identifying principles for sustainable software engineering design; reaching out to research software organizations around the world; and building communities for software sustainability. For each group, we include a point of contact and a landing page that can be used by those who want to join that group's future activities. The main challenge left by the workshop is to see if the groups will execute these activities that they have scheduled, and how the WSSSPE community can encourage this to happen.

Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations

PubMed Central

Schaefbauer, Chris L; Campbell, Terrance R; Senteio, Charles; Siek, Katie A; Bakken, Suzanne; Veinot, Tiffany C

2016-01-01

Objective We compare 5 health informatics research projects that applied community-based participatory research (CBPR) approaches with the goal of extending existing CBPR principles to address issues specific to health informatics research. Materials and methods We conducted a cross-case analysis of 5 diverse case studies with 1 common element: integration of CBPR approaches into health informatics research. After reviewing publications and other case-related materials, all coauthors engaged in collaborative discussions focused on CBPR. Researchers mapped each case to an existing CBPR framework, examined each case individually for success factors and barriers, and identified common patterns across cases. Results Benefits of applying CBPR approaches to health informatics research across the cases included the following: developing more relevant research with wider impact, greater engagement with diverse populations, improved internal validity, more rapid translation of research into action, and the development of people. Challenges of applying CBPR to health informatics research included requirements to develop strong, sustainable academic-community partnerships and mismatches related to cultural and temporal factors. Several technology-related challenges, including needs to define ownership of technology outputs and to build technical capacity with community partners, also emerged from our analysis. Finally, we created several principles that extended an existing CBPR framework to specifically address health informatics research requirements. Conclusions Our cross-case analysis yielded valuable insights regarding CBPR implementation in health informatics research and identified valuable lessons useful for future CBPR-based research. The benefits of applying CBPR approaches can be significant, particularly in engaging populations that are typically underserved by health care and in designing patient-facing technology. PMID:26228766

Testing flow diversion in animal models: a systematic review.

PubMed

Fahed, Robert; Raymond, Jean; Ducroux, Célina; Gentric, Jean-Christophe; Salazkin, Igor; Ziegler, Daniela; Gevry, Guylaine; Darsaut, Tim E

2016-04-01

Flow diversion (FD) is increasingly used to treat intracranial aneurysms. We sought to systematically review published studies to assess the quality of reporting and summarize the results of FD in various animal models. Databases were searched to retrieve all animal studies on FD from 2000 to 2015. Extracted data included species and aneurysm models, aneurysm and neck dimensions, type of flow diverter, occlusion rates, and complications. Articles were evaluated using a checklist derived from the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. Forty-two articles reporting the results of FD in nine different aneurysm models were included. The rabbit elastase-induced aneurysm model was the most commonly used, with 3-month occlusion rates of 73.5%, (95%CI [61.9-82.6%]). FD of surgical sidewall aneurysms, constructed in rabbits or canines, resulted in high occlusion rates (100% [65.5-100%]). FD resulted in modest occlusion rates (15.4% [8.9-25.1%]) when tested in six complex canine aneurysm models designed to reproduce more difficult clinical contexts (large necks, bifurcation, or fusiform aneurysms). Adverse events, including branch occlusion, were rarely reported. There were no hemorrhagic complications. Articles complied with 20.8 ± 3.9 of 41 ARRIVE items; only a small number used randomization (3/42 articles [7.1%]) or a control group (13/42 articles [30.9%]). Preclinical studies on FD have shown various results. Occlusion of elastase-induced aneurysms was common after FD. The model is not challenging but standardized in many laboratories. Failures of FD can be reproduced in less standardized but more challenging surgical canine constructions. The quality of reporting could be improved.

Translating the Science of Measuring Ecosystems at a National Scale: Developing NEON's Online Learning Portal

NASA Astrophysics Data System (ADS)

Wasser, L. A.; Gram, W.; Goehring, L.

2014-12-01

"Big Data" are becoming increasingly common in many fields. The National Ecological Observatory Network (NEON) will be collecting data over the 30 years, using consistent, standardized methods across the United States. These freely available new data provide an opportunity for increased understanding of continental- and global scale processes such as changes in vegetation structure and condition, biodiversity and landuse. However, while "big data" are becoming more accessible and available, integrating big data into the university courses is challenging. New and potentially unfamiliar data types and associated processing methods, required to work with a growing diversity of available data, may warrant time and resources that present a barrier to classroom integration. Analysis of these big datasets may further present a challenge given large file sizes, and uncertainty regarding best methods to properly statistically summarize and analyze results. Finally, teaching resources, in the form of demonstrative illustrations, and other supporting media that might help teach key data concepts, take time to find and more time to develop. Available resources are often spread widely across multi-online spaces. This presentation will overview the development of NEON's collaborative University-focused online education portal. Portal content will include 1) videos and supporting graphics that explain key concepts related to NEON data products including collection methods, key metadata to consider and consideration of potential error and uncertainty surrounding data analysis; and 2) packaged "lab" activities that include supporting data to be used in an ecology, biology or earth science classroom. To facilitate broad use in classrooms, lab activities will take advantage of freely and commonly available processing tools, techniques and scripts. All NEON materials are being developed in collaboration with existing labs and organizations.

Magnetic resonance imaging of the fetal brain.

PubMed

Tee, L Mf; Kan, E Yl; Cheung, J Cy; Leung, W C

2016-06-01

This review covers the recent literature on fetal brain magnetic resonance imaging, with emphasis on techniques, advances, common indications, and safety. We conducted a search of MEDLINE for articles published after 2010. The search terms used were "(fetal OR foetal OR fetus OR foetus) AND (MR OR MRI OR [magnetic resonance]) AND (brain OR cerebral)". Consensus statements from major authorities were also included. As a result, 44 relevant articles were included and formed the basis of this review. One major challenge is fetal motion that is largely overcome by ultra-fast sequences. Currently, single-shot fast spin-echo T2-weighted imaging remains the mainstay for motion resistance and anatomical delineation. Recently, a snap-shot inversion recovery sequence has enabled robust T1-weighted images to be obtained, which is previously a challenge for standard gradient-echo acquisitions. Fetal diffusion-weighted imaging, diffusion tensor imaging, and magnetic resonance spectroscopy are also being developed. With multiplanar capabilities, superior contrast resolution and field of view, magnetic resonance imaging does not have the limitations of sonography, and can provide additional important information. Common indications include ventriculomegaly, callosum and posterior fossa abnormalities, and twin complications. There are safety concerns about magnetic resonance-induced heating and acoustic damage but current literature showed no conclusive evidence of deleterious fetal effects. The American College of Radiology guideline states that pregnant patients can be accepted to undergo magnetic resonance imaging at any stage of pregnancy if risk-benefit ratio to patients warrants that the study be performed. Magnetic resonance imaging of the fetal brain is a safe and powerful adjunct to sonography in prenatal diagnosis. It can provide additional information that aids clinical management, prognostication, and counselling.

Showing Your Students You Care: Seeing the Individual Trees in the Classroom Forest

ERIC Educational Resources Information Center

Philipp, Randolph A.; Thanheiser, Eva

2010-01-01

Teaching is a complex profession, and although every context is unique, teachers face common challenges. The authors have identified two challenges that nearly every teacher encounters: (1) managing a classroom of students; and (2) addressing the needs of individual students. Although these are not teachers' only challenges, the authors highlight…

Responding to Hostility: Evidence-Based Guidance for Communication during Planned Organizational Change

ERIC Educational Resources Information Center

Campbell, Kim Sydow; Carmichael, Pierson; Naidoo, Jefrey S.

2015-01-01

Hostile challenges to planned organization change are common and challenging to deal with effectively. Little research has explained successful responses to such stakeholder hostility. To address this gap, we use the concept of readiness to characterize the content of hostile challenges. We also use rhetorical strategies based on speech act theory…

Vocational and Technical Education in Lebanon: Strategic Issues and Challenges

ERIC Educational Resources Information Center

Karam, Gebran

2006-01-01

The current status of the Lebanese vocational and technical education (VTE) system is assessed and the strategic issues and challenges facing it are identified. In addition to the economic and social challenges that are common to many developing countries, the Lebanese system suffers from idiosyncratic problems, which may require innovative and…

Frameworks for Understanding Challenging Behaviour in Out-of-Home Care

ERIC Educational Resources Information Center

McLean, Sara; Kettler, Lisa; Delfabbro, Paul; Riggs, Damien

2012-01-01

Background: Challenging and disruptive behaviour is commonly reported among children placed in the out-of-home care sector. Little is known about how stakeholders in this sector understand or manage challenging behaviour. Method: Ninety-two stakeholders in the South Australian out-of-home care sector were interviewed about their approach to…

A component analysis of positive behaviour support plans.

PubMed

McClean, Brian; Grey, Ian

2012-09-01

Positive behaviour support (PBS) emphasises multi-component interventions by natural intervention agents to help people overcome challenging behaviours. This paper investigates which components are most effective and which factors might mediate effectiveness. Sixty-one staff working with individuals with intellectual disability and challenging behaviours completed longitudinal competency-based training in PBS. Each staff participant conducted a functional assessment and developed and implemented a PBS plan for one prioritised individual. A total of 1,272 interventions were available for analysis. Measures of challenging behaviour were taken at baseline, after 6 months, and at an average of 26 months follow-up. There was a significant reduction in the frequency, management difficulty, and episodic severity of challenging behaviour over the duration of the study. Escape was identified by staff as the most common function, accounting for 77% of challenging behaviours. The most commonly implemented components of intervention were setting event changes and quality-of-life-based interventions. Only treatment acceptability was found to be related to decreases in behavioural frequency. No single intervention component was found to have a greater association with reductions in challenging behaviour.

Safe prescribing: a titanic challenge

PubMed Central

Routledge, Philip A

2012-01-01

The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

NASA's Earth Observing Data and Information System - Near-Term Challenges

NASA Technical Reports Server (NTRS)

Behnke, Jeanne; Mitchell, Andrew; Ramapriyan, Hampapuram

2018-01-01

NASA's Earth Observing System Data and Information System (EOSDIS) has been a central component of the NASA Earth observation program since the 1990's. EOSDIS manages data covering a wide range of Earth science disciplines including cryosphere, land cover change, polar processes, field campaigns, ocean surface, digital elevation, atmosphere dynamics and composition, and inter-disciplinary research, and many others. One of the key components of EOSDIS is a set of twelve discipline-based Distributed Active Archive Centers (DAACs) distributed across the United States. Managed by NASA's Earth Science Data and Information System (ESDIS) Project at Goddard Space Flight Center, these DAACs serve over 3 million users globally. The ESDIS Project provides the infrastructure support for EOSDIS, which includes other components such as the Science Investigator-led Processing systems (SIPS), common metadata and metrics management systems, specialized network systems, standards management, and centralized support for use of commercial cloud capabilities. Given the long-term requirements, and the rapid pace of information technology and changing expectations of the user community, EOSDIS has evolved continually over the past three decades. However, many challenges remain. Challenges addressed in this paper include: growing volume and variety, achieving consistency across a diverse set of data producers, managing information about a large number of datasets, migration to a cloud computing environment, optimizing data discovery and access, incorporating user feedback from a diverse community, keeping metadata updated as data collections grow and age, and ensuring that all the content needed for understanding datasets by future users is identified and preserved.

Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations

PubMed Central

Lam, Eugene; McCarthy, Amanda; Brennan, Muireann

2015-01-01

Humanitarian emergencies may result in breakdown of regular health services including routine vaccination programs. Displaced populations including refugees and internally displaced persons are particularly susceptible to outbreaks of communicable diseases such as vaccine-preventable diseases (VPDs). Common VPDs encountered in humanitarian emergencies include measles, polio, and depending on geographical location, meningococcal meningitis, yellow fever, hepatitis A, and cholera. We conducted a review of 50 published articles from 2000 to 2015 concerning VPDs in humanitarian emergencies. This article provides an update on the available literature regarding vaccinations among this highly vulnerable population and describes the unique challenges of VPDs during humanitarian emergencies. Humanitarian emergencies place affected populations at risk for elevated morbidity and mortality from VPDs due to creation or exacerbation of factors associated with disease transmission such as mass population movements, overcrowding, malnutrition, and poor water and sanitation conditions. Vaccination is one of the most basic and critical health interventions for protecting vulnerable populations during emergencies. Growing insecurity, as seen in the increasing number of targeted attacks on health workers in recent years, as well as destruction of cold chain and infrastructure for transportation of supplies, are creating new challenges in provision of life saving vaccines in conflict settings. Population displacement can also threaten global VPD eradication and elimination efforts. While highly effective vaccines and guidelines to combat VPDs are available, the trend of increasing number of humanitarian emergencies globally poses new and emerging challenges in providing vaccination among displaced populations. PMID:26406333

Common Chemicals as Precursors of Improvised Explosive Devices: The Challenges of Controlling Domestic Terrorism

DTIC Science & Technology

2005-09-01

utilizing common household products that contain precursor chemicals which, when combined, become explosive. B. IMPORTANCE Improvised Explosive...legislation removing acetone or other common household products from the market. Consumer convenience is a powerful lobbying factor and law makers...as IEDs rather than common household products . 23 Oklahoma City National Memorial website, http

Beyond the Core: Peer Observation Brings Common Core to Vocational and Electives Classes

ERIC Educational Resources Information Center

Thurber Rasmussen, Harriette

2014-01-01

This article describes how a Washington State School District increased professional learning around the Common Core State Standards. The challenge was how to establish a way for career and technical education and electives teachers to learn and apply Common Core in their classes. Weaving Common Core literacy standards into vocational and…

Emerging infections: a perpetual challenge

PubMed Central

Morens, David M; Folkers, Gregory K; Fauci, Anthony S

2008-01-01

Emerging and re-emerging infectious diseases, and their determinants, have recently attracted substantial scientific and popular attention. HIV/AIDS, severe acute respiratory syndrome, H5N1 avian influenza, and many other emerging diseases have either proved fatal or caused international alarm. Common and interactive co-determinants of disease emergence, including population growth, travel, and environmental disruption, have been increasingly documented and studied. Are emerging infections a new phenomenon related to modern life, or do more basic determinants, transcending time, place, and human progress, govern disease generation? By examining a number of historically notable epidemics, we suggest that emerging diseases, similar in their novelty, impact, and elicitation of control responses, have occurred throughout recorded history. Fundamental determinants, typically acting in concert, seem to underlie their emergence, and infections such as these are likely to continue to remain challenges to human survival. PMID:18992407

Building a Road from Light to Energy

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

Li, Anton; Bilby, David; Barito, Adam

Representing the Center for Solar and Thermal Energy Conversion (CSTEC), this document is one of the entries in the Ten Hundred and One Word Challenge. As part of the challenge, the 46 Energy Frontier Research Centers were invited to represent their science in images, cartoons, photos, words and original paintings, but any descriptions or words could only use the 1000 most commonly used words in the English language, with the addition of one word important to each of the EFRCs and the mission of DOE energy. The mission of the Center for Solar and Thermal Energy Conversion (CSTEC) is tomore » design and to synthesize new materials for high efficiency photovoltaic (PV) and thermoelectric (TE) devices, predicated on new fundamental insights into equilibrium and non-equilibrium processes, including quantum phenomena, that occur in materials over various spatial and temporal scales.« less

FutureTox: building the road for 21st century toxicology and risk assessment practices.

PubMed

Rowlands, J Craig; Sander, Miriam; Bus, James S

2014-02-01

This article reports on the outcome of FutureTox, a Society of Toxicology (SOT) Contemporary Concepts in Toxicology (CCT) workshop, whose goal was to address the challenges and opportunities associated with implementing 21st century technologies for toxicity testing, hazard identification, and risk assessment. One goal of the workshop was to facilitate an interactive multisector and discipline dialog. To this end, workshop invitees and participants included stakeholders from governmental and regulatory agencies, research institutes, academia, and the chemical and pharmaceutical industry in Europe and the United States. The workshop agenda was constructed to collectively review and discuss the state-of-the-science in these fields, better define the problems and challenges, outline their collective goals for the future, and identify areas of common agreement key to advancing these technologies into practice.

FutureTox: Building the Road for 21st Century Toxicology and Risk Assessment Practices

PubMed Central

Rowlands, J. Craig; Bus, James S.

2014-01-01

This article reports on the outcome of FutureTox, a Society of Toxicology (SOT) Contemporary Concepts in Toxicology (CCT) workshop, whose goal was to address the challenges and opportunities associated with implementing 21st century technologies for toxicity testing, hazard identification, and risk assessment. One goal of the workshop was to facilitate an interactive multisector and discipline dialog. To this end, workshop invitees and participants included stakeholders from governmental and regulatory agencies, research institutes, academia, and the chemical and pharmaceutical industry in Europe and the United States. The workshop agenda was constructed to collectively review and discuss the state-of-the-science in these fields, better define the problems and challenges, outline their collective goals for the future, and identify areas of common agreement key to advancing these technologies into practice. PMID:24204016

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

PubMed

Gaebel, Ashley; Keiser, Megan

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

Psychological Flexibility as a Framework for Understanding and Improving Family Reintegration Following Military Deployment.

PubMed

Sandoz, Emily K; Moyer, Danielle N; Armelie, Aaron P

2015-10-01

Postdeployment reintegration may present an exceptional challenge to service members and their families; yet, overcoming this challenge seems to strengthen family relationships through a shared sense of purpose. Navigating family reintegration may be an important determinant of long-term psychological well-being. If the needs of military families are to be answered effectively, it is of critical importance to identify the skills that facilitate positive reintegration following deployment. This article proposes psychological flexibility as a group of interrelated skills that could be directly intervened on to facilitate not only resilience but also positive growth and development. This paper focuses on the conceptualization of family reintegration in terms of psychological flexibility, including common deficits observed in this population and potential goals of treatment. Video Abstract. © 2014 American Association for Marriage and Family Therapy.

Issues and challenges of information fusion in contested environments: panel results

NASA Astrophysics Data System (ADS)

Blasch, Erik; Kadar, Ivan; Chong, Chee; Jones, Eric K.; Tierno, Jorge E.; Fenstermacher, Laurie; Gorman, John D.; Levchuk, Georgiy

2015-05-01

With the plethora of information, there are many aspects to contested environments such as the protection of information, network privacy, and restricted observational and entry access. In this paper, we review and contrast the perspectives of challenges and opportunities for future developments in contested environments. The ability to operate in a contested environment would aid societal operations for highly congested areas with limited bandwidth such as transportation, the lack of communication and observations after a natural disaster, or planning for situations in which freedom of movement is restricted. Different perspectives were presented, but common themes included (1) Domain: targets and sensors, (2) network: communications, control, and social networks, and (3) user: human interaction and analytics. The paper serves as a summary and organization of the panel discussion as towards future concerns for research needs in contested environments.

Dilemmas and challenges for the shelter sector: lessons learned from the Sphere revision process.

PubMed

Saunders, Graham

2004-06-01

Key dilemmas and challenges for those involved in the shelter sector are described, based on issues that emerged from the extensive global consultative process undertaken to inform the revision of the Sphere handbook. The range of perspectives on the major themes is presented, with suggestions as to how these issues could be progressed. Themes include the poor definition of the sector and the lack of a consistent approach among the leading shelter actors; the absence of a common terminology; the conflict between "temporary" versus "durable" solutions; the disconnect between technical advisers and the field; the need for greater recognition of local coping strategies and the local context; the involvement of recipients and host governments in policy development; the need for better "how-to" guidance; and the limited incorporation of the emerging themes of livelihoods etc. to date.

Cleaner Energy for Cars

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

Cropley, Cecelia

Representing the Center for Catalytic Hydrocarbon Functionalization (CCHF), this document is one of the entries in the Ten Hundred and One Word Challenge. As part of the challenge, the 46 Energy Frontier Research Centers were invited to represent their science in images, cartoons, photos, words and original paintings, but any descriptions or words could only use the 1000 most commonly used words in the English language, with the addition of one word important to each of the EFRCs and the mission of DOE: energy. The mission of CCHF is to develop, validate, and optimize new methods to rearrange the bondsmore » of hydrocarbons, implement enzymatic strategies into synthetic systems, and design optimal environments for catalysts that can be used to reversibly functionalize hydrocarbons, especially for more efficient use of natural gas including low temperature conversion to liquid fuels.« less

Enrolling African-American and Latino patients with asthma in comparative effectiveness research: Lessons learned from 8 patient-centered studies.

PubMed

Kramer, C Bradley; LeRoy, Lisa; Donahue, Sara; Apter, Andrea J; Bryant-Stephens, Tyra; Elder, John P; Hamilton, Winifred J; Krishnan, Jerry A; Shelef, Deborah Q; Stout, James W; Sumino, Kaharu; Teach, Stephen J; Federman, Alex D

2016-12-01

African-American and Latino patients are often difficult to recruit for asthma studies. This challenge is a barrier to improving asthma care and outcomes for these populations. We sought to examine the recruitment experiences of 8 asthma comparative effectiveness studies that specifically targeted African-American and Latino patients, and identify the solutions they developed to improve recruitment. Case report methodology was used to gather and evaluate information on study design, recruitment procedures and outcomes from study protocols and annual reports, and in-depth interviews with each research team. Data were analyzed for themes, commonalities, and differences. There were 4 domains of recruitment challenges: individual participant, institutional, research team, and study intervention. Participants had competing demands for time and some did not believe they had asthma. Institutional challenges included organizational policies governing monetary incentives and staff hiring. Research team challenges included ongoing training needs of recruitment staff, and intervention designs often were unappealing to participants because of inconveniences. Teams identified a host of strategies to address these challenges, most importantly engagement of patients and other stakeholders in study design and troubleshooting, and flexibility in data collection and intervention application to meet the varied needs of patients. Asthma researchers may have greater success with recruitment by addressing uncertainty among patients about asthma diagnosis, engaging stakeholders in all aspects of study design and implementation, and maximizing flexibility of study and intervention protocols. However, even with such efforts, engagement of African-American and Latino patients in asthma research may remain low. Greater investment in research on engaging these populations in asthma research may ultimately be needed to improve their asthma care and outcomes. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Healthcare provider education to support integration of pharmacogenomics in practice: the eMERGE Network experience

PubMed Central

Rohrer Vitek, Carolyn R; Abul-Husn, Noura S; Connolly, John J; Hartzler, Andrea L; Kitchner, Terrie; Peterson, Josh F; Rasmussen, Luke V; Smith, Maureen E; Stallings, Sarah; Williams, Marc S; Wolf, Wendy A; Prows, Cynthia A

2017-01-01

Ten organizations within the Electronic Medical Records and Genomics Network developed programs to implement pharmacogenomic sequencing and clinical decision support into clinical settings. Recognizing the importance of informed prescribers, a variety of strategies were used to incorporate provider education to support implementation. Education experiences with pharmacogenomics are described within the context of each organization's prior involvement, including the scope and scale of implementation specific to their Electronic Medical Records and Genomics projects. We describe common and distinct education strategies, provide exemplars and share challenges. Lessons learned inform future perspectives. Future pharmacogenomics clinical implementation initiatives need to include funding toward implementing provider education and evaluating outcomes. PMID:28639489

Rare Earth Fluorescent Nanomaterials for Enhanced Development of Latent Fingerprints.

PubMed

Wang, Meng; Li, Ming; Yu, Aoyang; Wu, Jian; Mao, Chuanbin

2015-12-30

The most commonly found fingerprints at crime scenes are latent and, thus, an efficient method for detecting latent fingerprints is very important. However, traditional developing techniques have drawbacks such as low developing sensitivity, high background interference, complicated operation, and high toxicity. To tackle this challenge, we have synthesized two kinds of rare earth fluorescent nanomaterials, including the fluoresce red-emitting YVO4:Eu nanocrystals and green-emitting LaPO4:Ce,Tb nanobelts, and then used them as fluorescent labels for the development of latent fingerprints with high sensitivity, high contrast, high selectivity, high efficiency, and low background interference, on various substrates including noninfiltrating materials, semi-infiltrating materials, and infiltrating materials.

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

PubMed

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

2016-01-01

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

Science and religion in dialogue over the global commons

NASA Astrophysics Data System (ADS)

Edenhofer, Ottmar; Flachsland, Christian; Knopf, Brigitte

2015-10-01

The Pope's encyclical makes unprecedented progress in developing scientific dialogue with religion by drawing on research, and encouraging further discussion about the ethical challenge of governing the global commons.

The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update.

PubMed

Bobo, William V

2017-10-01

Bipolar disorders, including bipolar I disorder (BP-I) and bipolar II disorder (BP-II), are common, potentially disabling, and, in some cases, life-threatening conditions. Bipolar disorders are characterized by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. Bipolar disorders present many diagnostic and therapeutic challenges for busy clinicians. Adequate management of bipolar disorders requires pharmacotherapy and psychosocial interventions targeted to the specific phases of illness. Effective treatments are available for each illness phase, but mood episode relapses and incomplete responses to treatment are common, especially for the depressive phase. Mood symptoms, psychosocial functioning, and suicide risk must, therefore, be continually reevaluated, and, when necessary, the plan of care must be adjusted during long-term treatment. Many patients will require additional treatment of comorbid psychiatric and substance use disorders and management of a variety of commonly co-occurring chronic general medical conditions. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts.

PubMed

Zielinski, Ruth; Searing, Kimberly; Deibel, Megan

2015-01-01

Gastrointestinal discomforts are a very common complaint in pregnancy. In fact, most pregnant women will experience at least one discomfort. This article focuses on 5 common conditions that occur in pregnancy: gastroesophageal reflux disease, diarrhea, constipation, hemorrhoids, and pica. While these conditions do occur in men and nonpregnant women, they occur more frequently in pregnancy because of the anatomic and physiologic changes associated with gestation. The type and severity of symptoms can vary from individual to individual, making treatment a challenge for healthcare providers, particularly when caring for pregnant women because the effects of medications and other treatments on the developing fetus are often not extensively studied. While these discomforts are rarely life-threatening, they can cause significant distress and impair quality of life. The goal of this article was to provide a summary of the anatomic and physiological changes during pregnancy that contribute to the increasing incidence of these discomforts and to provide information about each condition including prevalence, symptoms, and treatment modalities.

Insight into Jordanian thinking about HIV: knowledge of Jordanian men and women about HIV prevention.

PubMed

Alkhasawneh, Esra; McFarland, Willi; Mandel, Jeffery; Seshan, Vidya

2014-01-01

Research on HIV prevention programs for countries with large Muslim populations is scarce. HIV knowledge, attitudes, and beliefs were assessed in a convenience sample of 128 women and 88 men at two universities in Jordan with the goal of gaining insight into how to approach HIV risk behaviors. In general terms, 97% of participants had heard of AIDS and the majority understood the common methods of transmission. Misconceptions were common; most participants did not recognize condoms as an HIV prevention method. A sense of fatalism regarding the acquisition of HIV was common. In Jordan, challenges to HIV-prevention interventions includes misconceptions about HIV transmission, gender-related differences in the willingness to discuss sexual issues, and fatalism regarding the acquisition of HIV. Silence about sexual activity, particularly among women, was pervasive. Culturally tailored interventions are needed to decrease stigma and address gender inequalities that may contribute to increased risks of HIV in Jordan. Copyright © 2014 Association of Nurses in AIDS Care. All rights reserved.

Analysis Commons, A Team Approach to Discovery in a Big-Data Environment for Genetic Epidemiology

PubMed Central

Brody, Jennifer A.; Morrison, Alanna C.; Bis, Joshua C.; O'Connell, Jeffrey R.; Brown, Michael R.; Huffman, Jennifer E.; Ames, Darren C.; Carroll, Andrew; Conomos, Matthew P.; Gabriel, Stacey; Gibbs, Richard A.; Gogarten, Stephanie M.; Gupta, Namrata; Jaquish, Cashell E.; Johnson, Andrew D.; Lewis, Joshua P.; Liu, Xiaoming; Manning, Alisa K.; Papanicolaou, George J.; Pitsillides, Achilleas N.; Rice, Kenneth M.; Salerno, William; Sitlani, Colleen M.; Smith, Nicholas L.; Heckbert, Susan R.; Laurie, Cathy C.; Mitchell, Braxton D.; Vasan, Ramachandran S.; Rich, Stephen S.; Rotter, Jerome I.; Wilson, James G.; Boerwinkle, Eric; Psaty, Bruce M.; Cupples, L. Adrienne

2017-01-01

Summary paragraph The exploding volume of whole-genome sequence (WGS) and multi-omics data requires new approaches for analysis. As one solution, we have created a cloud-based Analysis Commons, which brings together genotype and phenotype data from multiple studies in a setting that is accessible by multiple investigators. This framework addresses many of the challenges of multi-center WGS analyses, including data sharing mechanisms, phenotype harmonization, integrated multi-omics analyses, annotation, and computational flexibility. In this setting, the computational pipeline facilitates a sequence-to-discovery analysis workflow illustrated here by an analysis of plasma fibrinogen levels in 3996 individuals from the National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) WGS program. The Analysis Commons represents a novel model for transforming WGS resources from a massive quantity of phenotypic and genomic data into knowledge of the determinants of health and disease risk in diverse human populations. PMID:29074945

The application of systems thinking in health: why use systems thinking?

PubMed

Peters, David H

2014-08-26

This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. A common thread is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. They each address problems of complexity, which is a frequent challenge in global health. The different methods and tools are suited to different types of inquiry and involve both qualitative and quantitative techniques. The paper concludes by emphasizing that explicit models used in systems thinking provide new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to improve people's health.

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

African Security Challenges: Now and Over the Horizon Improving African Security Through the Use of Non/Less-Than -Lethal Force: Challenges , Issues and Approaches

DTIC Science & Technology

2010-05-01

donor funding is no longer available. For instance, Brazil and Colombia were unable to sustain their CP programs when funding from donors to establish...forces. Other more advanced forms of non/less-than-lethal weapons which are common in the West, such as Tasers , are far less common on the continent...31 As part of this discussion, several experts discussed Tasers , in particular, though one expert also mentioned

Brain-Computer Interfaces: A Neuroscience Paradigm of Social Interaction? A Matter of Perspective

PubMed Central

Mattout, Jérémie

2012-01-01

A number of recent studies have put human subjects in true social interactions, with the aim of better identifying the psychophysiological processes underlying social cognition. Interestingly, this emerging Neuroscience of Social Interactions (NSI) field brings up challenges which resemble important ones in the field of Brain-Computer Interfaces (BCI). Importantly, these challenges go beyond common objectives such as the eventual use of BCI and NSI protocols in the clinical domain or common interests pertaining to the use of online neurophysiological techniques and algorithms. Common fundamental challenges are now apparent and one can argue that a crucial one is to develop computational models of brain processes relevant to human interactions with an adaptive agent, whether human or artificial. Coupled with neuroimaging data, such models have proved promising in revealing the neural basis and mental processes behind social interactions. Similar models could help BCI to move from well-performing but offline static machines to reliable online adaptive agents. This emphasizes a social perspective to BCI, which is not limited to a computational challenge but extends to all questions that arise when studying the brain in interaction with its environment. PMID:22675291

Bounded agency in humanitarian settings: a qualitative study of adherence to antiretroviral therapy among refugees situated in Kenya and Malaysia.

PubMed

Mendelsohn, Joshua B; Rhodes, Tim; Spiegel, Paul; Schilperoord, Marian; Burton, John Wagacha; Balasundaram, Susheela; Wong, Chunting; Ross, David A

2014-11-01

HIV-positive refugees confront a variety of challenges in accessing and adhering to antiretroviral therapy (ART) and attaining durable viral suppression; however, there is little understanding of what these challenges are, how they are navigated, or how they may differ across humanitarian settings. We sought to document and examine accounts of the threats, barriers and facilitators experienced in relation to HIV treatment and care and to conduct comparisons across settings. We conducted semi-structured interviews among a purposive sample of 14 refugees attending a public, urban HIV clinic in Kuala Lumpur, Malaysia (July-September 2010), and 12 refugees attending a camp-based HIV clinic in Kakuma, Kenya (February-March 2011). We used framework methods and between-case comparison to analyze and interpret the data, identifying social and environmental factors that influenced adherence. The multiple issues that threatened adherence to antiretroviral therapy or precipitated actual adherence lapses clustered into three themes: "migration", "insecurity", and "resilience". The migration theme included issues related to crossing borders and integrating into treatment systems upon arrival in a host country. Challenges related to crossing borders were reported in both settings, but threats pertaining to integration into, and navigation of, a new health system were exclusive to the Malaysian setting. The insecurity theme included food insecurity, which was most commonly reported in the Kenyan setting; health systems insecurity, reported in both settings; and emotional insecurity, which was most common in the Kenyan setting. Resilient processes were reported in both settings. We drew on the concept of "bounded agency" to argue that, despite evidence of personal and community resilience, these processes were sometimes insufficient for overcoming social and environmental barriers to adherence. In general, interventions might aim to bolster individuals' range of action with targeted support that bolsters resilient processes. Specific interventions are needed to address locally-based food and health system insecurities. Copyright © 2014 Elsevier Ltd. All rights reserved.

Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension.

PubMed

Chisholm, Peter; Anpalahan, Mahesan

2017-04-01

Both hypertension and orthostatic hypotension (OH) are strongly age-associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well-established treatments. Not infrequently, they both coexist, further compounding the management. This review provides comprehensive information on OH, including pathophysiology, diagnostic workup and treatment, with a view to provide a practical guide to its management. Special references are made to patients with supine hypertension and postprandial hypotension and older hypertensive patients. © 2016 Royal Australasian College of Physicians.

Comparative Effectiveness Research in Gynecologic Oncology

PubMed Central

Patankar, Sonali; Tergas, Ana I.

2015-01-01

The field of gynecologic oncology is faced with a number of challenges including how to incorporate new drugs and procedures into practice, how to balance therapeutic efficacy and toxicity of treatment, how to individualize therapy to particular patients or groups of patients, and how to contain the rapidly rising costs associated with oncologic care. In this chapter we examine three common and highly debated clinical scenarios in gynecologic oncology: the initial management of ovarian cancer, the role of lymphadenectomy in the treatment of endometrial cancer, and the choice of adjuvant therapy for ovarian cancer. PMID:25677027

Ethical issues in neonatal and pediatric clinical trials.

PubMed

Laventhal, Naomi; Tarini, Beth A; Lantos, John

2012-10-01

Children have been identified as uniquely vulnerable clinical research subjects since the early 1970s. This article reviews the historical underpinnings of this designation, the current regulatory framework for pediatric and neonatal research, and common problems in pediatric research oversight. It also presents 3 areas of pediatric and neonatal research (genomic screening, healthy children donating stem cells, and therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy) that highlight contemporary challenges in pediatric research ethics, including balancing risk and benefit, informed consent and assent, and clinical equipoise. Copyright © 2012 Elsevier Inc. All rights reserved.

Low cost venom extractor based on Arduino(®) board for electrical venom extraction from arthropods and other small animals.

PubMed

Besson, Thomas; Debayle, Delphine; Diochot, Sylvie; Salinas, Miguel; Lingueglia, Eric

2016-08-01

Extracting venom from small species is usually challenging. We describe here an affordable and versatile electrical venom extractor based on the Arduino(®) Mega 2560 Board, which is designed to extract venom from arthropods and other small animals. The device includes fine tuning of stimulation time and voltage. It was used to collect venom without apparent deleterious effects, and characterized for the first time the venom of Zoropsis spinimana, a common spider in French Mediterranean regions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Genetic causes of amyotrophic lateral sclerosis: new genetic analysis methodologies entailing new opportunities and challenges

PubMed Central

Marangi, Giuseppe; Traynor, Bryan J.

2018-01-01

The genetic architecture of amyotrophic lateral sclerosis (ALS) is being increasingly understood. In this far-reaching review, we examine what is currently known about ALS genetics and how these genes were initially identified. We also discuss the various types of mutations that might underlie this fatal neurodegenerative condition and outline some of the strategies that might be useful in untangling them. These include expansions of short repeat sequences, common and low-frequency genetic variations, de novo mutations, epigenetic changes, somatic mutations, epistasis, oligogenic and polygenic hypotheses. PMID:25316630

Splenic injuries in athletes: a review.

PubMed

Gannon, Elizabeth H; Howard, Thomas

2010-01-01

Splenic injuries can be challenging to the sports medicine physician. While these injuries are not common among athletes, they can have serious, potentially fatal consequences if not properly diagnosed and managed in a prompt and timely fashion. Currently, there are no evidence-based guidelines on returning athletes to previous levels of activity after sustaining a splenic injury. In addition, there is no consensus on follow-up imaging after injury. This article discusses the evaluation of athletes with blunt abdominal trauma for splenic injury, including the imaging, management, and current return-to-play guidelines.

Framework for Architecture Trade Study Using MBSE and Performance Simulation

NASA Technical Reports Server (NTRS)

Ryan, Jessica; Sarkani, Shahram; Mazzuchim, Thomas

2012-01-01

Increasing complexity in modern systems as well as cost and schedule constraints require a new paradigm of system engineering to fulfill stakeholder needs. Challenges facing efficient trade studies include poor tool interoperability, lack of simulation coordination (design parameters) and requirements flowdown. A recent trend toward Model Based System Engineering (MBSE) includes flexible architecture definition, program documentation, requirements traceability and system engineering reuse. As a new domain MBSE still lacks governing standards and commonly accepted frameworks. This paper proposes a framework for efficient architecture definition using MBSE in conjunction with Domain Specific simulation to evaluate trade studies. A general framework is provided followed with a specific example including a method for designing a trade study, defining candidate architectures, planning simulations to fulfill requirements and finally a weighted decision analysis to optimize system objectives.

"Staying with the Trouble" in Child-Insect-Educator Common Worlds

ERIC Educational Resources Information Center

Nxumalo, Fikile; Pacini-Ketchabaw, Veronica

2017-01-01

Classroom pet programs have become extremely popular in urban North American early childhood classrooms. This article challenges anthropocentric child-pet pedagogies by proposing common world pedagogies of "staying with the trouble." Drawing from a common world multispecies ethnography in one early childhood centre, the authors engage…

Rural Asthma: Current Understanding of Prevalence, Patterns, and Interventions for Children and Adolescents.

PubMed

Estrada, Robin Dawson; Ownby, Dennis R

2017-06-01

Asthma is the most common chronic illness of children and adolescents in the USA. While asthma has been understood to disproportionately affect urban dwellers, recent investigations have revealed rural pediatric asthma prevalence to be very similar to urban and to be more closely correlated with socioeconomic and environmental factors than geographic location or population density. Rural children experience factors unique to location that impact asthma development and outcomes, including housing quality, cigarette smoke exposure, and small/large-scale farming. Additionally, there are challenging barriers to appropriate asthma care that frequently are more severe for those living in rural areas, including insurance status, lack of primary care providers and pulmonary specialists, knowledge deficits (both patient and provider), and a lack of culturally tailored asthma interventions. Interventions designed to address rural pediatric asthma disparities are more likely to be successful when targeted to specific challenges, such as the use of school-based services or telemedicine to mitigate asthma care access issues. Continued research on understanding the complex interaction of specific rural environmental factors with host factors can inform future interventions designed to mitigate asthma disparities.

Challenges with Operating a Water Recovery System (WRS) in the Microgravity Environment of the International Space Station (ISS)

NASA Technical Reports Server (NTRS)

Carter, Donald Layne

2017-01-01

The ISS WRS produces potable water from crew urine, crew latent, and Sabatier product water. This system has been operational on ISS since November 2008, producing over 30,000 L of water during that time. The WRS includes a Urine Processor Assembly (UPA) to produce a distillate from the crew urine. This distillate is combined with the crew latent and Sabatier product water and further processed by the Water Processor Assembly (WPA) to the potable water. The UPA and WPA use technologies commonly used on ISS for water purification, including filtration, distillation, adsorption, ion exchange, and catalytic oxidation. The primary challenge with the design and operation of the WRS has been with implementing these technologies in microgravity. The absence of gravity has created unique issues that impact the constituency of the waste streams, alter two-phase fluid dynamics, and increases the impact of particulates on system performance. NASA personnel continue to pursue upgrades to the existing design to improve reliability while also addressing their viability for missions beyond ISS.

Decision Neuroscience: Neuroeconomics

PubMed Central

Smith, David V.; Huettel, Scott A.

2012-01-01

Few aspects of human cognition are more personal than the choices we make. Our decisions – from the mundane to the impossibly complex – continually shape the courses of our lives. In recent years, researchers have applied the tools of neuroscience to understand the mechanisms that underlie decision making, as part of the new discipline of decision neuroscience. A primary goal of this emerging field has been to identify the processes that underlie specific decision variables, including the value of rewards, the uncertainty associated with particular outcomes, and the consequences of social interactions. Recent work suggests potential neural substrates that integrate these variables, potentially reflecting a common neural currency for value, to facilitate value comparisons. Despite the successes of decision neuroscience research for elucidating brain mechanisms, significant challenges remain. These include building new conceptual frameworks for decision making, integrating research findings across disparate techniques and species, and extending results from neuroscience to shape economic theory. To overcome these challenges, future research will likely focus on interpersonal variability in decision making, with the eventual goal of creating biologically plausible models for individual choice. PMID:22754602

The challenge of diagnosing focal hand dystonia in musicians

PubMed Central

Rosset-Llobet, J.; Candia, V.; Molas, S. Fàbregas i; Dolors Rosinés i Cubells, D.; Pascual-Leone, A.

2012-01-01

Background and purpose To most clinicians, medical problems in musicians, particularly those concerning focal hand dystonia, constitute an unfamiliar domain difficult to manage. The latter can importantly influence diagnostics and the course of treatment. The purpose of this study was to enlighten the issue and to identify possible problems in diagnosing musicians’ cramp within the Spanish medical community. Methods We used a brief questions’ catalog and clinical histories of 665 musicians seen at our clinic for performing artists. We analyzed patients’ diagnosis records in 87 cases of focal hand dystonia (13.1%). In so doing, we surveyed previous diagnoses and diverse treatments prescriptions prior to referral to our clinic. Results Referrals came primarily from orthopaedists and neurologists. The 52.9% arrived at our clinic without a diagnosis or a suspicion of suffering from focal dystonia. The most frequently attempted diagnoses other than musicians’ dystonia included nerve compression, tendonitis and trigger fingers. Commonly prescribed treatments included rest, various surgical procedures, physiotherapy and oral anti-inflammatory medication. Conclusions This data depicts the diagnostic challenges of medical professionals may encounter when confronted with musician’s focal dystonia. PMID:19473363

Overcoming Challenges to Care in the Juvenile Justice System: A Case Study and Commentary.

PubMed

Savage, Rebekah J; Reese, Jasmine M; Wallace, Stephenie; Wang, Timothy; Jester, Traci; Lowe, Robert; Hyndman, LaKeshia; Durant, Nefertiti

2017-01-01

Youth in the criminal justice system commonly suffer from multiple medical and psychological health problems. Because they likely live in lower socioeconomic environments, the medical care they receive through the justice system might be their only recent medical care and can result in the discovery of health problems or chronic illnesses that must be managed while in the system and beyond. We describe the case of an adolescent diagnosed with a serious chronic disease during his time in an urban detention center to illustrate how health workers and justice staff must use a team approach in caring for this vulnerable population of children. Barriers to appropriate care, including social and systems-level challenges, are discussed. The lessons learned in this case can be applied more broadly to other vulnerable youth populations, including those in foster care and impoverished communities where the primary care pediatrician (or other assigned pediatric specialist) is both the leader of the medical team and an advocate for quality care. © American Academy of Pediatrics, 2017. All rights reserved.