Asia-Pacific Partnership for Human Development through TVET.

ERIC Educational Resources Information Center

Basu, C. K.

Despite their great geographic, economic, and demographic diversity, Asia-Pacific countries share many common challenges and pose many common issues that are fundamental to improving the quality and relevance of technical-vocational education and training (TVET) as a means of human resource development (HRD). Because of their great need for…

Standards, Assessment, and Readiness: Addressing Postsecondary Transition Issues across State Lines

ERIC Educational Resources Information Center

Michelau, Demarée K.

2015-01-01

This brief describes major challenges ahead for states, institutions, and most importantly, students as the standards and assessments from the Common Core Standards (CCSS) are implemented. It also offers recommendations to create a network structure that would assist K-12 and higher education leaders in addressing those challenges. To begin the…

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

PubMed

Wu, Yelena P; Steele, Ric G; Connelly, Mark A; Palermo, Tonya M; Ritterband, Lee M

2014-07-01

To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

Refugee Health: An Ongoing Commitment and Challenge

PubMed Central

Efird, Jimmy T.; Bith-Melander, Pollie

2018-01-01

Refugees represent a diverse group of displaced individuals with unique health issues and disease risks. The obstacles facing this population have their origins in war, violence, oppression, exploitation, and fear of persecution. Regardless of country of origin, a common bond exists, with refugees often confronting inadequate healthcare resources, xenophobia, discrimination, and a complex web of legal barriers in their new homelands. In many cases, the plight of refugees is multigenerational, manifesting as mental health issues, abuse, poverty, and family disruption. The health trajectory of refugees remains an ongoing commitment and challenge. PMID:29342831

Formulation and Stability of Solutions.

PubMed

Akers, Michael J

2016-01-01

Ready-to-use solutions are the most preferable and most common dosage forms for injectable and topical ophthalmic products. Drugs formulated as solution almost always have chemical and physical stability challenges as well as solubility limitations and the need to prevent inadvertent microbial contamination issues. The first in this series of articles took us through a discussion of optimizing the physical stability of solutions. This article concludes this series of articles with a discussion on foreign particles, protein aggregation, and immunogenicity; optimizing microbiological activity; and osmolality (tonicity) agents, and discusses how these challenges and issues are addressed.

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

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.

Challenges of Managing Animals in Disasters in the U.S.

PubMed Central

Heath, Sebastian E.; Linnabary, Robert D.

2015-01-01

Simple Summary This article describes common challenges to managing animals in disasters in the US, summarizes how some of these challenges are being met and makes recommendations on how to overcome others. Many predictable adverse situations affecting animals and their owners can be prevented when communities develop a comprehensive emergency management strategy that integrates animal care into planning, preparedness, mitigation, and recovery activities, as well as response. Abstract Common to many of the repeated issues surrounding animals in disasters in the U.S. is a pre-existing weak animal health infrastructure that is under constant pressure resulting from pet overpopulation. Unless this root cause is addressed, communities remain vulnerable to similar issues with animals they and others have faced in past disasters. In the US the plight of animals in disasters is frequently viewed primarily as a response issue and frequently handled by groups that are not integrated with the affected community’s emergency management. In contrast, animals, their owners, and communities would greatly benefit from integrating animal issues into an overall emergency management strategy for the community. There is no other factor contributing as much to human evacuation failure in disasters that is under the control of emergency management when a threat is imminent as pet ownership. Emergency managers can take advantage of the bond people have with their animals to instill appropriate behavior amongst pet owners in disasters. PMID:26479228

Setting the Bar for High-Ability Students

ERIC Educational Resources Information Center

Greene, Buck; Cross, Tracy L.

2013-01-01

Secondary school principals face no shortage of issues and challenges when it comes to ensuring that their teachers and students are ready for the Common Core State Standards. With so many issues competing for scarce time and resources, it is understandable that for many school leaders, the needs of high-ability and high-potential students are not…

Moving from Good Ideas in Educational Systems Change to Sustainable Program Implementation: Coming to Terms with Some of the Realities

ERIC Educational Resources Information Center

Noell, George H.; Gansle, Kristin A.

2009-01-01

Proponents of systemic changes in education commonly encounter ethical, theoretical, and pragmatic challenges in moving from possibility to implementation of their vision of change. Although ethical and theoretical issues are critically important to a successful change initiative, pragmatic issues relevant to assuring program implementation have…

Great Minds Don't Always Think Alike: The Challenges of Conducting Substance Abuse Prevention Research in Public Schools

ERIC Educational Resources Information Center

Renes, Susan L.; Ringwalt, Chris; Clark, Heddy Kovach; Hanley, Sean

2007-01-01

Prevention researchers and school personnel lack a common understanding concerning the opportunities and burdens of school-based drug prevention research. In this article, we review issues related to researching substance abuse prevention programs in school settings, and assess challenges related to recruitment, communication, research design,…

Fuels planning: science synthesis and integration; social issues fact sheet 11: Challenges to collaboration

Treesearch

Christine Esposito

2006-01-01

Bringing the right people into a collaborative process can be difficult. Potential collaborators must all feel they have something to gain to justify investing resources, sharing knowledge, and perhaps compromising on goals and actions. This fact sheet discusses some of the common challenges that individuals, communities, and institutions face in collaboration.

What Would Terri Want? On the Psychological Challenges of Surrogate Decision Making

ERIC Educational Resources Information Center

Ditto, Peter H

2006-01-01

The Terri Schiavo case was unique in the media attention it garnered, but the decision making challenges faced by Terri's family are common ones encountered by all families who must make choices about the use of life-sustaining medical treatment for an incapacitated loved one. This article highlights three key issues that were particularly…

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.

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.

Reducing restrictive practice in adult services: not only an issue for mental health professionals.

PubMed

Hext, Greg; Clark, Louise L; Xyrichis, Andreas

2018-05-10

Reducing 'restrictive practices' is an issue of national importance, pertinent to all NHS sectors, yet there is poor awareness of the issue in mainstream adult services. Such practices potentially restrict a person's rights to choice, self-determination, privacy and freedom. Challenging behaviour is often the result of unmet needs, communication difficulties or diagnostic overshadowing, but there is a common misconception that patients exhibit such behaviours because of their impaired intellectual abilities or mental health problems. This article seeks to raise awareness of restrictive practices and suggest the way forward. It highlights the importance of good de-escalation skills, which, if adopted early in therapeutic relationships, may help reduce the occurrence of challenging behaviours and situations. Behavioural support plans that adopt a biopsychopharmacosocial approach (BPPS) detail a range of interventions for managing challenging behaviours. Tailored support that follows a BPPS approach could reduce incidents of challenging behaviour, reduce costly observation, improve the patient experience and protect the patient's liberty.

Should Seat Belts Be Required on All School Buses?

ERIC Educational Resources Information Center

Mawdsley, Ralph D.

1996-01-01

Examines the limited case law involving seat belts for school buses and explores emerging legal issues surrounding use of common law causes of action to challenge school bus safety. (51 footnotes) (MLF)

What Causes COPD?

MedlinePlus

... please turn JavaScript on. Feature: The Challenge of COPD What Causes COPD? Past Issues / Fall 2014 Table of Contents Long- ... and the airways usually is the cause of COPD. In the United States, the most common irritant ...

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

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.

Working with Families Living with Autism: Potential Contributions of Marriage and Family Therapists

ERIC Educational Resources Information Center

Neely, Jason; Amatea, Ellen S.; Echevarria-Doan, Silvia; Tannen, Tina

2012-01-01

This article introduces marriage and family therapists (MFT) to some of the common issues faced by families that have a child with autism spectrum disorder (ASD). First, autism is defined and common myths surrounding it are discussed. Next, relational challenges are presented that families report experiencing during early childhood through the…

How To Avoid Crossfire and Seek Common Ground: A Journey for the Sake of Children.

ERIC Educational Resources Information Center

Ledell, Marjorie

A democracy must tolerate many points of view without becoming divided. Therefore, public educators and the communities they serve are challenged to help students understand political and religious issues without proselytizing. This handbook provides guidelines for beginning the journey toward common ground, for moving from a climate of antagonism…

Dignity, Health, and Membership: Who Counts as One of Us?

PubMed Central

Pilkington, Bryan C.

2016-01-01

This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy. The five articles in this issue address a range of topics from the human embryo and substantial change to conceptions of disability. They engage claims of moral status, defense of our humanity, and argue for an accurate and just classification of persons of different communities within a healthcare system. I argue in this essay that though their concerns are diverse, the authors in this issue help to answer a common question: “Who counts as one of us?” Reading these articles through the lens of membership and the themes of dignity illustrates this commonality and bears fruit for further reflection on many of the challenging issues addressed in the subsequent papers. PMID:26868673

A Values Base for the Norwegian Kindergarten: Common Ground across Cultural Affiliations?

ERIC Educational Resources Information Center

Hovdelien, Olav

2013-01-01

One of the major challenges facing modern-day secular states is the issue of social integration. The issue discussed in this article is how it is possible to arrive at unifying values in a multicultural society that is characterised by secularisation and disintegration of the Christian hegemony of former times on the one hand and by the emergence…

Common Themes, Challenges, Issues, and Aspirations of International Students Pursuing Doctoral Degrees in Education at a Midwestern University

ERIC Educational Resources Information Center

Mtika, Joe Mithi

2009-01-01

International students' studying abroad is a complicated phenomenon that has touched both the countries that send the students and those that receive them. The issues of international students have affected academic circles as well as public and private sectors. Participation of all stakeholders in higher education is crucial to the progress of…

Informal Statistics Help Desk

NASA Technical Reports Server (NTRS)

Ploutz-Snyder, R. J.; Feiveson, A. H.

2015-01-01

Back by popular demand, the JSC Biostatistics Lab is offering an opportunity for informal conversation about challenges you may have encountered with issues of experimental design, analysis, data visualization or related topics. Get answers to common questions about sample size, repeated measures, violation of distributional assumptions, missing data, multiple testing, time-to-event data, when to trust the results of your analyses (reproducibility issues) and more.

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.

Psychoactive Substance Dependence: A Dentist's Challenge.

PubMed

Millar, Lynsey

2015-05-01

Given the number of individuals who are dependent on alcohol and/or drugs, it is inevitable that they will present for dental treatment. They are at an increased risk of dental disease for multiple reasons. This paper aims to provide an overview for general dental practitioners (GDPs) of the challenges that can arise in treating such patients, alongside some suggestions for meeting these challenges. General issues are taken into consideration first, then a focus is made on each of the most common substances, together with their implications in dentistry.

Legal Challenges and Pitfalls for Start-up Companies - 48 Common Questions and Answers.

PubMed

Staehelin, Matthias

2014-12-01

Transforming a business idea into reality requires a legal implementation plan. The following 48 questions and answers address key issues that typically arise in start-up situations. Early planning can help avoid costly mistakes.

Defense.gov Special Report: Travels with Carter - March 2013

Science.gov Websites

Form. In this form, please indicate the nature of your accessibility issue/problem and your contact Common Security Challenges Deputy Defense Secretary Ash Carter is traveling to Asia to meet with U.S

Early career mentoring for translational researchers: mentee perspectives on challenges and issues.

PubMed

Keller, Thomas E; Collier, Peter J; Blakeslee, Jennifer E; Logan, Kay; McCracken, Karen; Morris, Cynthia

2014-01-01

The education and training of early career biomedical translational researchers often involves formal mentoring by more experienced colleagues. This study investigated the nature of these mentoring relationships from the perspective of mentees. The objective was to understand the challenges and issues encountered by mentees in forming and maintaining productive mentoring relationships. Three focus groups (n=14) were conducted with early career researchers who had mentored career development awards. Thematic analysis identified, categorized, and illustrated the challenges and issues reported by mentees. The range of mentee challenges was reflected in five major categories: (a) network--finding appropriate mentors to meet various needs; (b) access--structuring schedules and opportunities to receive mentoring; (c) expectations--negotiating the mechanics of the mentoring relationship and its purpose; (d) alignment--managing mentor-mentee mismatches regarding interests, priorities, and goals; and (e) skills and supports--developing the institutional supports to be successful. Mentoring relationships created for academic training and career development contend with tasks common to many other relationships, namely, recognizing compatibility, finding time, establishing patterns, agreeing to goals, and achieving aims. Identifying challenges faced by mentees can facilitate the development of appropriate trainings and supports to foster mentoring relationships in academic and career settings.

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

Learning through Making and Maker Education

ERIC Educational Resources Information Center

Hsu, Yu-Chang; Baldwin, Sally; Ching, Yu-Hui

2017-01-01

In this paper, we provide an overview of the current efforts in maker education, supported by a review of empirical studies. Our synthesis will inform the community about learning outcomes, potential and common issues, challenges, resources, and future research direction regarding maker education.

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

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.

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…

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, ...

Perspectives on diagnostic strategies for hyperglycemia in pregnancy - dealing with the barriers and challenges in China.

PubMed

Wei, Yumei; Yang, Huixia

2018-04-18

Hyperglycemia is one of the most common medical conditions women encounter during pregnancy. Hyperglycemia in pregnancy (HIP) is an issue of increasing concern to both obstetricians and administrators and it brings health issues for both mothers and offspring, not only early complications, but also long-term effects. HIP may either have been pre-gestational diabetes mellitus (pGDM), or gestational diabetes mellitus (GDM). After two-child policy fully carried out in China, the incidence of HIP would be increased further. There are many important issues such as the high prevalence of DM misdiagnosis, the diagnostic criteria of GDM, the strategies of GDM management in China need to deal with. We would focus on the barriers and challenges of diagnostic strategies for hyperglycemia in pregnancy in China. Copyright © 2018. Published by Elsevier B.V.

Ask the experts: the challenges and benefits of flow chemistry to optimize drug development.

PubMed

Anderson, Neal; Gernaey, Krist V; Jamison, Timothy F; Kircher, Manfred; Wiles, Charlotte; Leadbeater, Nicholas E; Sandford, Graham; Richardson, Paul

2012-09-01

Against a backdrop of a struggling economic and regulatory climate, pharmaceutical companies have recently been forced to develop new ways to provide more efficient technology to meet the demands of a competitive drug industry. This issue, coupled with an increase in patent legislation and a rising generics market, makes these themes common issues in the growth of drug development. As a consequence, the importance of process chemistry and scale-up has never been more under the spotlight. Future Medicinal Chemistry wishes to share the thoughts and opinions of a variety of experts from this field, discussing issues concerning the use of flow chemistry to optimize drug development, the potential regulatory and environmental challenges faced with this, and whether the academic and industrial sectors could benefit from a more harmonized system relevant to process chemistry.

Summary: achievements, critical issues, and thoughts on the future.

PubMed

Held, Kathryn D

2012-11-01

The number of individuals exposed to particle radiations in cancer treatment worldwide is increasing rapidly, and space agencies are developing plans for long duration, deep space missions in which humans could be exposed to significant levels of radiation from charged particles. Hence, the NCRP 47 th Annual Meeting on "Scientific and Policy Challenges of Particle Radiations in Medical Therapy and Space Missions" was a timely opportunity to showcase the current scientific knowledge regarding charged particles, enhance cross-fertilization between the oncology and space scientific communities, and identify common needs and challenges to both communities as well as ways to address those challenges. This issue of Health Physics contains papers from talks presented at that meeting and highlights provocative questions and the ample opportunities for synergism between space and particle-therapy research to further understanding of the biological impacts of particle radiations.

Lesbian Parenting: Issues, Strengths and Challenges.

ERIC Educational Resources Information Center

McNair, Ruth; Dempsey, Deborah; Wise, Sarah; Perlesz, Amaryll

2002-01-01

This study examined family relationships, conception methods, involvement of biological fathers in their children's lives, and the use of social and support networks by Australian lesbian and bisexual parents/prospective parents. Findings indicated that lesbians achieved parenthood most commonly within a heterosexual relationship or through self-…

Patchwork Plagiarism

ERIC Educational Resources Information Center

Cooper, Janice

2007-01-01

In this Information Age, students produce research projects by piecing together passages quoted verbatim and stitched together with a few introductory or transitional words. They assemble research as patchwork quilts rather than weaving a fabric of new knowledge. This common practice raises ethical issues and poses new challenges for library media…

Early Career Mentoring for Translational Researchers: Mentee Perspectives on Challenges and Issues

PubMed Central

Keller, Thomas E.; Collier, Peter J.; Blakeslee, Jennifer E.; Logan, Kay; McCracken, Karen; Morris, Cynthia

2014-01-01

Background and purposes The education and training of early career biomedical translational researchers often involves formal mentoring by more experienced colleagues. This study investigated the nature of these mentoring relationships from the perspective of mentees. The objective was to understand the challenges and issues encountered by mentees in forming and maintaining productive mentoring relationships. Method Three focus groups (n=14) were conducted with early career researchers who had mentored career development awards. Thematic analysis identified, categorized, and illustrated the challenges and issues reported by mentees. Results The range of mentee challenges was reflected in five major categories: 1) network—finding appropriate mentors to meet various needs; 2) access—structuring schedules and opportunities to receive mentoring; 3) expectations—negotiating the mechanics of the mentoring relationship and its purpose; 4) alignment—managing mentor-mentee mismatches regarding interests, priorities, and goals; and 5) skills and supports—developing the institutional supports to be successful. Conclusions Mentoring relationships created for academic training and career development contend with tasks common to many other relationships, namely recognizing compatibility, finding time, establishing patterns, agreeing to goals, and achieving aims. Identifying challenges faced by mentees can facilitate the development of appropriate trainings and supports to foster mentoring relationships in academic and career settings. PMID:25010230

Ethical Issues in Public Health Practice in Michigan

PubMed Central

Gollust, Sarah E.; Goold, Susan D.; Jacobson, Peter D.

2009-01-01

Objectives. We sought to ascertain the types of ethical challenges public health practitioners face in practice and to identify approaches used to resolve such challenges. Methods. We conducted 45 semistructured interviews with public health practitioners across a range of occupations (e.g., health officers, medical directors, sanitarians, nurses) at 13 health departments in Michigan. Results. Through qualitative analysis, we identified 5 broad categories of ethical issues common across occupations and locations: (1) determining appropriate use of public health authority, (2) making decisions related to resource allocation, (3) negotiating political interference in public health practice, (4) ensuring standards of quality of care, and (5) questioning the role or scope of public health. Participants cited a variety of values guiding their decision-making that did not coalesce around core values often associated with public health, such as social justice or utilitarianism. Public health practitioners relied on consultations with colleagues to resolve challenges, infrequently using frameworks for decision-making. Conclusions. Public health practitioners showed a nuanced understanding of ethical issues and navigated ethical challenges with minimal formal assistance. Decision-making guides that are empirically informed and tailored for practitioners might have some value. PMID:19059850

Psychosocial Issues in Geriatric Rehabilitation.

PubMed

Rodriguez, Ricardo M

2017-11-01

Geriatric patients present multiple age-related challenges and needs that must be taken into account during the rehabilitation process to achieve expected goals. This article examines the importance of identifying and managing psychosocial issues commonly observed in older adults and presents strategies to optimize their rehabilitation process. Depression, anxiety, fear of falling, adjustment issues, neurocognitive disorders, and caregiver support are discussed as a selection of factors that are relevant for geriatric patients undergoing rehabilitation. An argument is made for the importance of comprehensive geriatric assessment in older adults to identify salient issues that may impact rehabilitation and quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

78 FR 8353 - Rural Broadband Access Loans and Loan Guarantees

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

.... Other associated rural issues, such as environmental challenges or providing wireless service through... proposed regulations, the Food, Conservation, and Energy Act of 2008, more commonly known as the 2008 Farm... wireline and wireless technologies is in violation of the agency's ``technology neutral'' mandate and...

External Perceptions of Successful University Brands

ERIC Educational Resources Information Center

Chapleo, Chris

2008-01-01

Branding in universities has become an increasingly topical issue, with some institutions committing substantial financial resources to branding activities. The particular characteristics of the sector present challenges for those seeking to build brands, and it therefore seems to be timely and appropriate to investigate the common approaches of…

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…

Teacher Efficacy in Rural Zimbabwe

ERIC Educational Resources Information Center

Dunham, Judy K.; Song'ony, Daniel

2008-01-01

The need to address contextual variables, such as cultural bias and cultural norms, is a common challenge for researchers in international education. This article highlights societal conditions and cultural issues that could have impacted teacher efficacy data in Zimbabwe, a country known for its ongoing economic crisis, political repression, and…

Commentary: Implementing Interventions: Building a Shared Understanding of Why

ERIC Educational Resources Information Center

Grøver, Vibeke

2016-01-01

This commentary discusses how the articles that comprise this special issue conceptualize what is required for reading interventions to change instruction. Three challenges to successful implementation are addressed: identifying institutional barriers to change, identifying intervention components that are not commonly part of the teachers'…

"Cultural Responsiveness": A Framework for Re-Thinking Students' Interculturality through Study Abroad

ERIC Educational Resources Information Center

Giovanangeli, Angela; Oguro, Susan

2016-01-01

While intercultural competence is commonly a goal of university study abroad programmes, debates around criteria for assessing this competence have highlighted the challenges in appropriately identifying students' intercultural learning in relation to specific university programmes. To overcome these issues, this research moves beyond…

Using Consultation to Support English Learners: The Experiences of Bilingual School Psychologists

ERIC Educational Resources Information Center

O'Bryon, Elisabeth C.; Rogers, Margaret R.

2016-01-01

Through semi-structured interviews, this study explored 11 bilingual school psychologists' (BSPs) consultation experiences with teachers of English learners (EL) to determine referral concerns, recommendations made, challenges encountered, preparation experiences, and skills most needed. The most common referral issue concerned students' academic…

Scientific and Pragmatic Challenges for Bridging Education and Neuroscience

ERIC Educational Resources Information Center

Varma, Sashank; McCandliss, Bruce D.; Schwartz, Daniel L.

2008-01-01

Educational neuroscience is an emerging effort to integrate neuroscience methods, particularly functional neuroimaging, with behavioral methods to address issues of learning and instruction. This article consolidates common concerns about connecting education and neuroscience. One set of concerns is scientific: in-principle differences in methods,…

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.

Global trade and assisted reproductive technologies: regulatory challenges in international surrogacy.

PubMed

Nelson, Erin

2013-01-01

International surrogacy is an increasingly common phenomenon and an important global health challenge. Legal rules are a key consideration for the participants in international surrogacy arrangements. In some cases the law can help to resolve the complex issues that arise in this context, but it is important to consider the role played by law in contributing to the complex conflicts that such arrangements can generate. © 2013 American Society of Law, Medicine & Ethics, Inc.

Science Diplomacy in Large International Collaborations

NASA Astrophysics Data System (ADS)

Barish, Barry C.

2011-04-01

What opportunities and challenges does the rapidly growing internationalization of science, especially large scale science and technology projects, present for US science policy? On one hand, the interchange of scientists, the sharing of technology and facilities and the working together on common scientific goals promotes better understanding and better science. On the other hand, challenges are presented, because the science cannot be divorced from government policies, and solutions must be found for issues varying from visas to making reliable international commitments.

Artificial intelligence (AI) systems for interpreting complex medical datasets.

PubMed

Altman, R B

2017-05-01

Advances in machine intelligence have created powerful capabilities in algorithms that find hidden patterns in data, classify objects based on their measured characteristics, and associate similar patients/diseases/drugs based on common features. However, artificial intelligence (AI) applications in medical data have several technical challenges: complex and heterogeneous datasets, noisy medical datasets, and explaining their output to users. There are also social challenges related to intellectual property, data provenance, regulatory issues, economics, and liability. © 2017 ASCPT.

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.

Climate Change and Health in the Urban Context: The Experience of Barcelona.

PubMed

Villalbí, Joan R; Ventayol, Irma

2016-07-01

Climate change poses huge challenges for public health, and cities are at the forefront of this process. The purpose of this paper is to present the issues climate change poses for public health in the city of Barcelona, how they are being addressed, and what are the current major challenges, trying to contribute to the development of a baseline understanding of the status of adaptation in cities from a public health perspective. The major issues related to climate change faced by the city are common to other urban centers in a Mediterranean climate: heat waves, water availability and quality, air quality, and diseases transmitted by vectors, and all are reviewed in detail with empirical data. They are not a potential threat for the future, but have actually challenged the city services and infrastructure over the last years, requiring sustainable responses and rigorous planning. © The Author(s) 2016.

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

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.

76 FR 13769 - Rural Broadband Access Loans and Loan Guarantees

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-14

... reviewing public comments and revising the rule, the Food, Conservation, and Energy Act of 2008 (2008 Farm.... Other associated rural issues, such as environmental challenges or providing wireless service through..., Conservation, and Energy Act of 2008, more commonly known as the 2008 Farm Bill, was working its way through...

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…

"We're All Appalachian."

ERIC Educational Resources Information Center

Banker, Mark

2002-01-01

A teacher at a Knoxville college preparatory school challenges his students to analyze stereotypes about Appalachia and recognize that acceptance of their own Appalachian-ness is vital to their personal well-being and that of the region. Comparisons of Appalachians with Hispanics in northern New Mexico reveal common issues of land use, cultural…

Employment Counseling and Organizational Ethical Values

ERIC Educational Resources Information Center

Valentine, Sean

2004-01-01

Employment counseling is commonly used in companies to assist employees with various personal and professional challenges that are confronted in the workplace. Such guidance could affect the degree to which employees believe a company proactively supports an ethical orientation; the purpose of this study was to explore this issue. A self-report…

Multidimensional Measurement of Situational Interest in Physical Education: Application of Bifactor Exploratory Structural Equation Modeling

ERIC Educational Resources Information Center

Garn, Alex C.

2017-01-01

Multidimensional measurement is a common theme in motivation research because many constructs are conceptualized as having an overarching general factor (e.g., situational interest) and specific dimensions (e.g., attention demand, challenge, exploration intention, instant enjoyment, novelty). This review addresses current issues associated with…

The Impact of School Suspensions: A Student Wellbeing Issue

ERIC Educational Resources Information Center

Hemphill, Sheryl; Hargreaves, John

2009-01-01

School suspensions are commonly used in schools to address challenging student behaviours, often on the understanding that suspensions send a clear message to the school community about what is acceptable behaviour. However, there is a growing body of evidence that school suspensions have a range of unintended negative consequences including…

Sexual Victimization of Youth

ERIC Educational Resources Information Center

Small, Kevonne; Zweig, Janine M.

2007-01-01

An estimated 7.0% to 8.1% of American youth report being sexually victimized at some point in their life time. This article presents a background to youth sexual victimization, focusing on prevalence data, challenging issues when studying this problem, risk factors, and common characteristics of perpetrators. Additionally, a type of sexual…

Questions That Won't Go Away in Participatory Research

Treesearch

Jonathan W. Long; Heidi L. Ballard; Larry A. Fisher; Jill M. Belsky

2016-01-01

Ethical issues are intrinsic to conducting research regarding society and natural resources, but they often become poignant when engaging in Participatory Action Research. We compiled common and persistent challenges into a list of "Questions That Won't Go Away" or "QTWGAs" that are relevant to people interested in conducting participatory...

Engaging Faculty Senates in the Budget Planning Process

ERIC Educational Resources Information Center

Archibald, James G.; Conley, Valerie Martin

2011-01-01

Multiple rounds of budget cuts have created tensions on many campuses, prompting questions from faculty about whether institutions are using resources wisely and spending funds appropriately (Minor 2003). As institutions respond to fiscal challenges, it is important that administrators and faculty have a common understanding of budget issues and…

Improving Education in Confucian Countries through Analysis of Organizational Challenges, Leadership, and Responsibilities

ERIC Educational Resources Information Center

Schenck, Andrew D.

2015-01-01

While common philosophical foundations influence instruction and leadership in East Asian nations, variable historical factors also significantly impact education within these countries. The current study was designed to holistically examine educational systems in different Confucian contexts, so that contemporary issues and necessary reforms may…

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…

Facebook: The New Classroom Commons?

ERIC Educational Resources Information Center

Schwartz, Harriet L.

2010-01-01

There has been much discussion about the issue of boundaries on Facebook. Some suggest faculty members can resolve potential dilemmas in relation to students by making sensible decisions about what to post and by fine-tuning privacy settings. But the challenges and opportunities run deeper. For those who want to be appropriately accessible to…

Effects of varying levels of forest thinning on Tricholoma magnivelare (American matsutake)

Treesearch

Joyce L. Eberhart; Daniel L. Luoma

2013-01-01

Commercial matsutake mushroom (Tricholoma magnivelare) harvest in the Pacific Northwest is common in Lodgepole Pine (Pinus contorta) forests. Insuffi cient ecological knowledge of the mycorrhizae and mycelium has challenged monitoring of this resource. Among many management issues are concerns over logging practices, a lack of...

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.

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.

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.

Supervisory needs of research doctoral students in a university teaching hospital setting.

PubMed

Caldwell, Patrina Hy; Oldmeadow, Wendy; Jones, Cheryl A

2012-10-01

Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Users and uses of Landsat 8 satellite imagery—2014 survey results

USGS Publications Warehouse

Miller, Holly M.

2016-04-18

To explore the effect of the availability of Landsat 8 imagery on Landsat imagery use in general, established users (those who had consistently used Landsat imagery both before and after Landsat 8 imagery became available) using Landsat 8 imagery were asked about changes in the amount of Landsat imagery they used. The majority of established users using Landsat 8 imagery (60 percent) reported an average increase of 51 percent in the number of scenes obtained after Landsat 8 imagery became available. Landsat 8 users were asked if they had encountered challenges in using Landsat 8 whereas non-Landsat 8 users were asked if such challenges had played a role in why they were not using Landsat 8 imagery. Although many users did not encounter challenges when using or trying to use Landsat 8 data, slightly less than 30 percent did encounter issues with processing the data to a usable point. The most common issue reported was not being able to create or have access to a surface reflectance corrected product. Other challenges were related to the file sizes of images being too large to download, store, or analyze. There were no statistically significant differences between Landsat 8 and non-Landsat 8 users in terms of challenges encountered when using or trying to use the imagery, which indicates that users were not unduly discouraged by the challenges they may have encountered. When asked about potential consequences of not using Landsat 8, more than half of the non-Landsat 8 users did not report detrimental effects on their work from not using the imagery. Of those who did report detrimental effects, decreased quality of work, decreased scope of work, and increased time spent on work were the most common.   

Perceptions of the Importance and Utilization of Clinical Supervision among Certified Rural School Counselors

ERIC Educational Resources Information Center

Duncan, Kelly; Brown-Rice, Kathleen; Bardhoshi, Gerta

2014-01-01

This study explored rural school counselors' perceptions of clinical supervision. School counselors working in rural communities commonly encounter issues that challenge their ability to provide competent counseling services to the students they serve. School counselors serving in these areas are often the only rural mental health provider in…

Using Design Experiments to Understand Secondary Classroom Comprehension Practices

ERIC Educational Resources Information Center

Vaughn, Sharon; Simmons, Deborah; Wanzek, Jeanne

2013-01-01

Adolescents in the United States and their teachers face an enormous academic challenge with respect to reading comprehension. College and career readiness standards outlined in the Common Core (2012) place increased emphasis on preparing students to read increasingly complex text across a range of disciplinary content areas. At issue is how to…

Reforming the Higher Education System in Iraq: Internationalization via Decentralization

ERIC Educational Resources Information Center

Al-Janabi, Sufyan T. Faraj; Anderson, David

2011-01-01

In countries where higher education has largely been a state function, conservative bureaucracies are viewed as impediments to necessary development and change. Virtually everywhere, voices are raised to demand necessary reforms yet, in spite of these apparently common challenges, it remains true that policy-related education issues are framed by…

Sexual Orientation and School Discipline: New Evidence from a Population-Based Sample

ERIC Educational Resources Information Center

Mittleman, Joel

2018-01-01

Sexual minorities' risk for exclusionary discipline is a commonly cited indicator of the challenges that these students face. The current study addresses this issue by introducing a new data source for research on sexual minority students: the Fragile Families and Childhood Wellbeing Study. In this geographically diverse, population-based sample,…

Addressing Three Common Issues in Research on Youth Activities: An Integrative Approach for Operationalizing and Analyzing Involvement

ERIC Educational Resources Information Center

Busseri, Michael A.; Rose-Krasnor, Linda

2010-01-01

Youth activity involvement has been operationalized and analyzed using a wide range of approaches. Researchers face the challenges of distinguishing between the effects of involvement versus noninvolvement and intensity of involvement in a particular activity, accounting simultaneously for cumulative effects of involvement, and addressing multiple…

Effective Practices/Interventions for Students with Emotional and Behavioral Disorders

ERIC Educational Resources Information Center

Bock, Stacey Jones; Borders, Christy

2012-01-01

Students with emotional and behavioral disorders (E/BD) present unique challenges to the families and educators supporting them. Even though families and educators report that behavioral issues can be identified by age 3 (Walker, Ramsey, & Gresham, 2004), the commonly used wait-and-see approach to intervening results in children with E/BD not…

Improving Measurements of Self-Regulated Learning

ERIC Educational Resources Information Center

Winne, Philip H.

2010-01-01

Articles in this special issue present recent advances in using state-of-the-art software systems that gather data with which to examine and measure features of learning and particularly self-regulated learning (SRL). Despite important advances, there remain challenges. I examine key features of SRL and how they are measured using common tools. I…

Rivers Run Through It: Discovering the Interior Columbia River Basin.

ERIC Educational Resources Information Center

Davis, Shelley; Wojtanik, Brenda Lincoln; Rieben, Elizabeth

1998-01-01

Explores the Columbia River Basin, its ecosystems, and challenges faced by natural resource managers. By studying the basin's complexity, students can learn about common scientific concepts such as the power of water and effects of rain shadows. Students can also explore social-scientific issues such as conflicts between protecting salmon runs and…

How Is Cultural Diversity Positioned in Teacher Professional Standards? An International Analysis

ERIC Educational Resources Information Center

Santoro, Ninetta; Kennedy, Aileen

2016-01-01

Unprecedented levels of global mobility mean that culturally homogenous classrooms are now increasingly rare. This brings with it challenges for teachers and raises issues about what constitutes quality teaching and teachers. Professional standards are commonly seen as a key policy instrument through which teacher quality can be enhanced. This…

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

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

Joint ICMAN and IUPHAR natural products section meeting. Aberdeen UK 27-29th September 2017.

PubMed

Zhang, Yongxiang; Spedding, Michael; Wainwright, Cherry; Schini-Kerth, Valérie; Bermano, Giovanna

2017-09-01

This special issue of Biochemical Pharmacology contains proceedings of a joint conference sponsored by the Natural Products Section of the International Union of Basic and Clinical Pharmacology (IUPHAR) and the International Conference on the Mechanism of Action of Nutraceuticals (ICMAN), an organization dedicated to defining actions and clinical benefits of pharmaceuticals and nutraceuticals. Entitled "From Nutraceuticals to Pharmaceuticals: Common Challenges and Approaches", the conference was held in Aberdeen UK in September 2017. The aim of this gathering was to identify the challenges that must be overcome to identify and characterize novel therapeutics from natural products. Contained in this issue are reviews prepared by conference participants as well as abstracts describing oral and poster presentations. Copyright © 2017 Elsevier Inc. All rights reserved.

Need for Enhanced Environmental Representation in the Implementation of One Health.

PubMed

Barrett, Meredith A; Bouley, Timothy A

2015-06-01

Issues of global environmental change, global health, emerging disease, and sustainability present some of the most complex challenges of the twenty-first century. Individual disciplines cannot address these issues in isolation. Proactive, innovative, and trans-disciplinary solutions are required. Recognizing the inherent connectedness of humans, animals, plants, and their shared environment, One Health encourages the collaboration of many disciplines-including human and veterinary medicine, public health, social science, public policy, environmental science, and others-to address global and local health challenges. Despite great progress in this shift toward transdisciplinarity, the environmental component of the One Health paradigm remains underrepresented in One Health discourse. Human and animal health issues are commonly discussed under the umbrella of the One Health paradigm, while upstream environmental drivers and solutions are less prominent. We assessed the current integration of environmental issues in One Health publications and leadership. There is room for enhanced integration of environmental knowledge in the implementation of One Health approaches. We discuss the potential benefits from the collaboration between One Health and ecohealth, and explore strategies for increased environmental involvement.

Reviews on Security Issues and Challenges in Cloud Computing

NASA Astrophysics Data System (ADS)

An, Y. Z.; Zaaba, Z. F.; Samsudin, N. F.

2016-11-01

Cloud computing is an Internet-based computing service provided by the third party allowing share of resources and data among devices. It is widely used in many organizations nowadays and becoming more popular because it changes the way of how the Information Technology (IT) of an organization is organized and managed. It provides lots of benefits such as simplicity and lower costs, almost unlimited storage, least maintenance, easy utilization, backup and recovery, continuous availability, quality of service, automated software integration, scalability, flexibility and reliability, easy access to information, elasticity, quick deployment and lower barrier to entry. While there is increasing use of cloud computing service in this new era, the security issues of the cloud computing become a challenges. Cloud computing must be safe and secure enough to ensure the privacy of the users. This paper firstly lists out the architecture of the cloud computing, then discuss the most common security issues of using cloud and some solutions to the security issues since security is one of the most critical aspect in cloud computing due to the sensitivity of user's data.

Reflections on the challenges and possibilities of journal publication in science education

NASA Astrophysics Data System (ADS)

Milne, Catherine; Siry, Christina; Mueller, Michael

2015-12-01

In this editorial we reflect on the intersections between the review and publishing policies of Cultural Studies of Science Education (CSSE) and the challenges and possibilities in global science education publishing. In particular we discuss the tensions associated with open or closed review policies, the hegemony of English as a language of publication, and reflect on some of the common challenges experienced by editors and authors from different contexts. We draw on the paper set in this issue consisting of five papers focused on publishing in various contexts, and elaborate several central questions for the field of science education and the dissemination of knowledges.

Physician-entrepreneurship: a user's manual, part 1: critical questions for early-stage medical ventures.

PubMed

Lexa, Frank James; Lexa, Frank J

2005-07-01

The medical field is one of the most exciting in America for entrepreneurs. Radiologists and other medical practitioners are in a unique position to take advantage of opportunities to invent and create innovative products and services. Physicians have led many of the most important revolutionary and evolutionary changes that have occurred in the field in the past 100 years. However, many radiologists find the process of entrepreneurship a daunting one and are often deterred from acting on their ideas. This article addresses the key issues and challenges that entrepreneurs face when embarking on new enterprises. Although most of these issues face all entrepreneurs at this stage, this article focuses on medical innovation and its particular challenges. This article concentrates on the kinds of questions that physician-entrepreneurs need to ask before jumping in, the types of common pitfalls that await those who don't address these issues, and some answers to seek if you are to beat the odds and succeed.

Design and Development of Layered Security: Future Enhancements and Directions in Transmission

PubMed Central

Shahzad, Aamir; Lee, Malrey; Kim, Suntae; Kim, Kangmin; Choi, Jae-Young; Cho, Younghwa; Lee, Keun-Kwang

2016-01-01

Today, security is a prominent issue when any type of communication is being undertaken. Like traditional networks, supervisory control and data acquisition (SCADA) systems suffer from a number of vulnerabilities. Numerous end-to-end security mechanisms have been proposed for the resolution of SCADA-system security issues, but due to insecure real-time protocol use and the reliance upon open protocols during Internet-based communication, these SCADA systems can still be compromised by security challenges. This study reviews the security challenges and issues that are commonly raised during SCADA/protocol transmissions and proposes a secure distributed-network protocol version 3 (DNP3) design, and the implementation of the security solution using a cryptography mechanism. Due to the insecurities found within SCADA protocols, the new development consists of a DNP3 protocol that has been designed as a part of the SCADA system, and the cryptographically derived security is deployed within the application layer as a part of the DNP3 stack. PMID:26751443

Obesity Prevention for Individuals with Spina Bifida.

PubMed

Polfuss, Michele; Bandini, Linda G; Sawin, Kathleen J

2017-06-01

Obesity is a common comorbidity in individuals with spina bifida. Carrying excess weight exacerbates the inherent health challenges associated with spina bifida, impedes the individual's ability to self-manage their condition, and creates further challenges for family members and caregivers. This manuscript provides a narrative review of key issues for understanding and prevention of obesity in persons with spina bifida within the context of the social ecological model. Specific variables related to obesity and spina bifida include individual factors (i.e., body composition and measurement issues, energy needs, eating patterns, physical activity, and sedentary activity) family factors (i.e., parenting/family, peers), community factors (i.e., culture, built environment, healthcare and healthcare providers, and school), and societal factors (i.e., policy issues). Due to the complex etiology of obesity and its increased prevalence in individuals with spina bifida, it is critical to initiate prevention efforts early with a multifactorial approach for this at-risk population. Increased research is warranted to support these efforts.

Design and Development of Layered Security: Future Enhancements and Directions in Transmission.

PubMed

Shahzad, Aamir; Lee, Malrey; Kim, Suntae; Kim, Kangmin; Choi, Jae-Young; Cho, Younghwa; Lee, Keun-Kwang

2016-01-06

Today, security is a prominent issue when any type of communication is being undertaken. Like traditional networks, supervisory control and data acquisition (SCADA) systems suffer from a number of vulnerabilities. Numerous end-to-end security mechanisms have been proposed for the resolution of SCADA-system security issues, but due to insecure real-time protocol use and the reliance upon open protocols during Internet-based communication, these SCADA systems can still be compromised by security challenges. This study reviews the security challenges and issues that are commonly raised during SCADA/protocol transmissions and proposes a secure distributed-network protocol version 3 (DNP3) design, and the implementation of the security solution using a cryptography mechanism. Due to the insecurities found within SCADA protocols, the new development consists of a DNP3 protocol that has been designed as a part of the SCADA system, and the cryptographically derived security is deployed within the application layer as a part of the DNP3 stack.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program.

PubMed

Urgenson, Lauren S; Ryan, Clare M; Halpern, Charles B; Bakker, Jonathan D; Belote, R Travis; Franklin, Jerry F; Haugo, Ryan D; Nelson, Cara R; Waltz, Amy E M

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

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.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program

NASA Astrophysics Data System (ADS)

Urgenson, Lauren S.; Ryan, Clare M.; Halpern, Charles B.; Bakker, Jonathan D.; Belote, R. Travis; Franklin, Jerry F.; Haugo, Ryan D.; Nelson, Cara R.; Waltz, Amy E. M.

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

Best from the Best: Distinguished Principals Offer Nine Instructional Leadership Practices That Work

ERIC Educational Resources Information Center

Principal, 2012

2012-01-01

The term "best practice" is commonly used to describe "what works" in a specific situation or environment. When principals face a thorny challenge, they turn to their colleagues in the principalship for ideas about which strategies, activities, and approaches have proved to be effective and efficient in addressing the issue.…

Travelling Teens: A Parents' Guide to Family Relocation

ERIC Educational Resources Information Center

Linke, Pam

2005-01-01

Moving house is becoming a more common aspect of modern life; but this does not make it any easier to cope with the many issues that arise--from the everyday practicalities, to the social and emotional challenges involved. Families who are required to relocate face the potentially difficult task of settling each family member into the new…

What Do Trade Unions Think about Continuing Education for Teachers in Galicia?

ERIC Educational Resources Information Center

Ampudia, Baena; Tilve, Ana Ma. Fernandez; Dolores, Ma.

2016-01-01

The common ups and downs of school agendas coupled with the existence of new educational challenges have created a complicated scenario that places the issue of continuing education for teaching staff directly under the spotlight. As a consequence, the role of teachers' trade unions as with other requirements of continuing education is now put…

[Partnership around difficult teenagers in Brest].

PubMed

Saint-André, Stéphane; Botbol, Michel

2013-01-01

The issues surrounding difficult teenagers results in professionals formalising a partnership. Certain areas of focus are identified such as getting to know each other better in order to understand each other better, working in a "common language", understanding professional identities, or embracing long term partnership. Pressure to assess and rationalise spending, as well as political challenges, must be taken into consideration.

Measuring Principal Performance: How Rigorous Are Commonly Used Principal Performance Assessment Instruments? A Quality School Leadership Issue Brief. Revised

ERIC Educational Resources Information Center

Condon, Christopher; Clifford, Matthew

2012-01-01

Assessing school principal performance is both necessary and challenging. During the past five years, many states have begun using validated measures in summative assessments of novice principal competency as a basis for certification decisions. Although standardized tests are used for certification purposes, other types of assessments are being…

The Effect of Outsourcing on the Performance of Public Schools

ERIC Educational Resources Information Center

Rivera, Lonny J.

2009-01-01

Public education in the 21st century is faced with many difficult challenges. The first and probably most common issue is related to finance. As the economy continues to worsen, school districts are forced to find new revenue streams while at the same time reducing expenditures. In the current economic climate, it is becoming more difficult for…

Hit discovery and hit-to-lead approaches.

PubMed

Keseru, György M; Makara, Gergely M

2006-08-01

Hit discovery technologies range from traditional high-throughput screening to affinity selection of large libraries, fragment-based techniques and computer-aided de novo design, many of which have been extensively reviewed. Development of quality leads using hit confirmation and hit-to-lead approaches present their own challenges, depending on the hit discovery method used to identify the initial hits. In this paper, we summarize common industry practices adopted to tackle hit-to-lead challenges and review how the advantages and drawbacks of different hit discovery techniques could affect the various issues hit-to-lead groups face.

Ethics in the Legal and Business Practices of Radiation Oncology.

PubMed

Wall, Terry J

2017-10-01

Ethical issues arise when a professional endeavor such as medicine, which seeks to place the well-being of others over the self-interest of the practitioner, meets granular business and legal decisions involved in making a livelihood out of a professional calling. The use of restrictive covenants, involvement in self-referral patterns, and maintaining appropriate comity among physicians while engaged in the marketplace are common challenges in radiation oncology practice. A paradigm of analysis is presented to help navigate these management challenges. Copyright © 2017 Elsevier Inc. All rights reserved.

An investigation of how university sports team athletic therapists and physical therapists experience ethical issues.

PubMed

Riendeau, Catherine; Parent-Houle, Valérie; Lebel-Gabriel, Marie Eve; Gauvin, Patrick; Liu, Le Yu; Pearson, Isabelle; Hunt, Matthew R

2015-03-01

Qualitative study using interpretive description methodology. The purpose of this study was to better understand how ethical issues are experienced by university sports team athletic therapists and physical therapists. In clinical practice, sports teams are associated with a range of ethical issues. Issues commonly reported in the literature include confidentiality, return-to-play decisions, conflicts of interest, advertising, doping, and use of local anesthetic. To date, there has been limited examination of how athletic therapists and physical therapists involved with sports teams experience these ethical issues, and limited exploration of how these ethical issues, when encountered, are shaped by therapists' professional roles and responsibilities. Semi-structured interviews were conducted with 11 athletic or physical therapists working with sports teams in 5 Canadian provinces. The data were analyzed inductively, using a recursive approach and constant comparative techniques. Four key themes were developed relating to the participants' experiences of ethical issues: establishing and maintaining professional boundaries, striving for respectful and effective collaboration, seeking answers to ethical concerns, and living with the repercussions of challenging decisions. While many ethical issues reported by participants resemble those faced by sports medicine physicians, they are experienced in distinctive ways, due to differences in professional roles and identities. Issues concerning professional boundaries were also more prominent for the study participants than the literature has reported them to be for sports medicine physicians. Effective communication and enhanced collaboration appear to be key elements in managing these ethical challenges.

Identifying the challenges and facilitators of implementing a COPD care bundle

PubMed Central

Lennox, Laura; Green, Stuart; Howe, Cathy; Musgrave, Hannah; Bell, Derek; Elkin, Sarah

2014-01-01

Background 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. Methods 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. Results 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. Conclusions 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. PMID:25478183

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.

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.

The relationship between psychiatric symptomatology and motivation of challenging behaviour: a preliminary study.

PubMed

Holden, Børge; Gitlesen, Jens Petter

2008-01-01

In addition to explaining challenging behaviour by way of behaviour analytic, functional analyses, challenging behaviour is increasingly explained by way of psychiatric symptomatology. According to some researchers, the two approaches complement each other, as psychiatric symptomatology may form a motivational basis for the individual's response to more immediate environmental challenges, like deprivation and aversive conditions. The most common example may be that depressive mood may render task demands aversive. Consequently, the person may show escape-motivated challenging behaviour in the presence of demands. The question becomes whether, or to what extent, relationships between psychiatric symptomatologies and particular functions of challenging behaviour exist. In the present, preliminary study, PAS-ADD checklist, a psychiatric screening instrument, and motivation assessment scale (MAS) were employed in order to investigate this issue. The results show that symptomatologies are largely unrelated to particular behavioural functions. Practical implications are discussed.

Institutional Issues of International Power Grid Development in Northeast Asia

NASA Astrophysics Data System (ADS)

Korneev, Konstantin; Maksakova, Darya; Popov, Sergei

2018-01-01

With regard to the initiative of "International power interconnections in northeast Asia" here examines the challenges which may hinder the establishment of a common energy system in region. The analysis is based on the APERC methodology for international energy cooperation in the APEC region, and on historical approach to the development of pricing mechanisms and policy in the European common market of electricity trade and system services. Mechanisms for the prevention and overcoming of the revealed problems of regional cooperation in the power sector are proposed.

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.

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…

Yes, I May Become Ill and Someday I Will Die: Assessment and Treatment Considerations in the Case of Mrs. A.

ERIC Educational Resources Information Center

Asmundson, Gordon J. G.; Hadjistavrpolous, Heather D.

2004-01-01

Patients with health anxiety often present challenges to assessment and treatment planning. The case of Mrs. A. provides examples of several clinical issues common to these patients. Her symptoms cross several "DSM" diagnostic categories, with a primary presentation of hypochondriasis and secondary presentation of illness phobia. In this article,…

Challenges and Barriers in Primary School Education: The Experiences of Traveller Children and Young People in Northern Ireland

ERIC Educational Resources Information Center

Bloomer, Fiona; Hamilton, Jennifer; Potter, Michael

2014-01-01

Exclusion, discrimination and widespread disadvantage are issues common to the Traveller community. Children from the Traveller community are often seen as the most at risk within the education system in respect of attendance, attainment and bullying. In this article, we consider the views of Traveller children and parents with respect to primary…

Ethics, Engineering and the Challenge of Racial Reform in Education

ERIC Educational Resources Information Center

Tate, William F., IV

2005-01-01

The articles in this issue represent the growing body of literature in the field of education focused on problems of race. More specifically, these articles draw on the theoretical tenets of the New Race Group of Legal Studies or what is more commonly referred to as the critical race theory (CRT) movement. The author's goals in this article are…

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.

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

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.

Common management issues in pediatric patients with mild bleeding disorders.

PubMed

O'Brien, Sarah H

2012-10-01

Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cultural Diversity in Nursing Education: Perils, Pitfalls, and Pearls

PubMed Central

Bednarz, Hedi; Schim, Stephanie; Doorenbos, Ardith

2010-01-01

Increasing diversity in the classroom challenges nursing educators to identify issues that complicate teaching (perils), analyze barriers for themselves and their students (pitfalls), and select new strategies for working with nontraditional students (pearls). This article identifies concerns arising from attitudes and values within nursing and common approaches to diversity education, and then discusses key issues in nursing education that relate to human nature, culture, faculty workload, and student demographics. Finally, some strategies are proposed for increasing the effectiveness of professional preparation with diverse students through a focus on culturally congruent education and development of faculty cultural competence. PMID:20143759

Cultural diversity in nursing education: perils, pitfalls, and pearls.

PubMed

Bednarz, Hedi; Schim, Stephanie; Doorenbos, Ardith

2010-05-01

Increasing diversity in the classroom challenges nursing educators to identify issues that complicate teaching (perils), analyze barriers for themselves and their students (pitfalls), and select new strategies for working with nontraditional students (pearls). This article identifies concerns arising from attitudes and values within nursing and common approaches to diversity education, and then discusses key issues in nursing education that relate to human nature, culture, faculty workload, and student demographics. Finally, some strategies are proposed for increasing the effectiveness of professional preparation with diverse students through a focus on culturally congruent education and development of faculty cultural competence.

Branding the bio/biomedical engineering degree.

PubMed

Voigt, Herbert F

2011-01-01

The future challenges to medical and biological engineering, sometimes referred to as biomedical engineering or simply bioengineering, are many. Some of these are identifiable now and others will emerge from time to time as new technologies are introduced and harnessed. There is a fundamental issue regarding "Branding the bio/biomedical engineering degree" that requires a common understanding of what is meant by a B.S. degree in Biomedical Engineering, Bioengineering, or Biological Engineering. In this paper we address some of the issues involved in branding the Bio/Biomedical Engineering degree, with the aim of clarifying the Bio/Biomedical Engineering brand.

Dental care in children with developmental disabilities: attention deficit disorder, intellectual disabilities, and autism.

PubMed

Charles, Jane M

2010-01-01

The Federal government reports that 13% of Americans between birth and 18 years of old meet the definition of a child with special health care needs. These children and young adults present unique challenges for both pediatric and general dentists to provide access to the oral health care system--establishing a treatment plan for those with unique medical, behavioral and dental needs and maintaining oral health over the lifetime. The purpose of this article was to describe the characteristics of 3 common developmental disabilities and the challenges these issues present to the oral health care practitioner.

Aspirin and Nonsteroidal Antiinflammatory Drugs Hypersensitivity and Management.

PubMed

Modena, Brian; White, Andrew A; Woessner, Katharine M

2017-11-01

Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) are widely used in the United States and throughout the world for a variety of indications. Several unique hypersensitivity syndromes exist to this class of medications, making them one of the common reasons for consultation to the allergist. The lack of any laboratory-based diagnostic studies to assist in identifying the culprits in these reactions make evaluation of aspirin and NSAID hypersensitivity challenging. Identifying patients appropriate for oral challenge and/or desensitization protocols is the standard pragmatic approach to this issue when it arises. Copyright © 2017 Elsevier Inc. All rights reserved.

Ureilite Thin Section Preparation

NASA Technical Reports Server (NTRS)

Harrington, R.; Righter, K.

2014-01-01

Preparing thin and thick sections of ureilite type meteorites is a challenge that can confound even the most experienced section preparer. A common characteristic of these samples is the presence of carbon phases, particularly nanodiamonds, in the matrix along silicate grain boundaries, fractures, and cleavage plains [1]. The extreme hardness of the nanodiamonds presents a challenge to the section preparer in the form of high surface relief on the section. This hard material also causes considerable wear and tear on equipment and materials that are used for making the sections. These issues will be discussed and potentially helpful measures will be presented.

Health and Environment Linked for Information Exchange in Atlanta (HELIX-Atlanta): A Pilot Tracking System

NASA Technical Reports Server (NTRS)

Rickman, Doug; Shire, J.; Qualters, J.; Mitchell, K.; Pollard, S.; Rao, R.; Kajumba, N.; Quattrochi, D.; Estes, M., Jr.; Meyer, P.;

Challenges and solutions to pre- and post-randomization subgroup analyses.

PubMed

Desai, Manisha; Pieper, Karen S; Mahaffey, Ken

2014-01-01

Subgroup analyses are commonly performed in the clinical trial setting with the purpose of illustrating that the treatment effect was consistent across different patient characteristics or identifying characteristics that should be targeted for treatment. There are statistical issues involved in performing subgroup analyses, however. These have been given considerable attention in the literature for analyses where subgroups are defined by a pre-randomization feature. Although subgroup analyses are often performed with subgroups defined by a post-randomization feature--including analyses that estimate the treatment effect among compliers--discussion of these analyses has been neglected in the clinical literature. Such analyses pose a high risk of presenting biased descriptions of treatment effects. We summarize the challenges of doing all types of subgroup analyses described in the literature. In particular, we emphasize issues with post-randomization subgroup analyses. Finally, we provide guidelines on how to proceed across the spectrum of subgroup analyses.

SPSS and SAS programs for addressing interdependence and basic levels-of-analysis issues in psychological data.

PubMed

O'Connor, Brian P

2004-02-01

Levels-of-analysis issues arise whenever individual-level data are collected from more than one person from the same dyad, family, classroom, work group, or other interaction unit. Interdependence in data from individuals in the same interaction units also violates the independence-of-observations assumption that underlies commonly used statistical tests. This article describes the data analysis challenges that are presented by these issues and presents SPSS and SAS programs for conducting appropriate analyses. The programs conduct the within-and-between-analyses described by Dansereau, Alutto, and Yammarino (1984) and the dyad-level analyses described by Gonzalez and Griffin (1999) and Griffin and Gonzalez (1995). Contrasts with general multilevel modeling procedures are then discussed.

Making Scientific Data Usable and Useful

NASA Astrophysics Data System (ADS)

Satwicz, T.; Bharadwaj, A.; Evans, J.; Dirks, J.; Clark Cole, K.

2017-12-01

Transforming geological data into information that has broad scientific and societal impact is a process fraught with barriers. Data sets and tools are often reported to have poor user experiences (UX) that make scientific work more challenging than it needs be. While many other technical fields have benefited from ongoing improvements to the UX of their tools (e.g., healthcare and financial services) scientists are faced with using tools that are labor intensive and not intuitive. Our research team has been involved in a multi-year effort to understand and improve the UX of scientific tools and data sets. We use a User-Centered Design (UCD) process that involves naturalistic behavioral observation and other qualitative research methods adopted from Human-Computer Interaction (HCI) and related fields. Behavioral observation involves having users complete common tasks on data sets, tools, and websites to identify usability issues and understand the severity of the issues. We measure how successfully they complete tasks and diagnosis the cause of any failures. Behavioral observation is paired with in-depth interviews where users describe their process for generating results (from initial inquiry to final results). By asking detailed questions we unpack common patterns and challenges scientists experience while working with data. We've found that tools built using the UCD process can have a large impact on scientist work flows and greatly reduce the time it takes to process data before analysis. It is often challenging to understand the organization and nuances of data across scientific fields. By better understanding how scientists work we can create tools that make routine tasks less-labor intensive, data easier to find, and solve common issues with discovering new data sets and engaging in interdisciplinary research. There is a tremendous opportunity for advancing scientific knowledge and helping the public benefit from that work by creating intuitive, interactive, and powerful tools and resources for generating knowledge. The pathway to achieving that is through building a detailed understanding of users and their needs, then using this knowledge to inform the design of the data products, tools, and services scientists and non-scientists use to do their work.

Understanding compliance issues for daily self-injectable treatment in ambulatory care settings

PubMed Central

Brod, Meryl; Rousculp, Matthew; Cameron, Ann

2008-01-01

Background The challenge of understanding factors influencing compliance with injectable treatments is critical as injectable biologics/medications become more common. Objective Understanding compliance issues for long term self-injectable treatments, using a chronic condition (osteoporosis) as a model. Research design A qualitative study to generate hypotheses regarding compliance issues for self-injectable treatments. Semi-structured interview guides were developed and data collected from patients and clinical experts. Findings were analyzed for common themes and a conceptual model of the compliance impact of self-injectable treatments generated. Subjects Six physicians (Rheumatology, Internal Medicine, and Endocrinology) and 22 patients (14% never began treatment, 23% had filled at least one prescription but discontinued treatment, and 63% were currently on treatment) were interviewed. Results Physician and patient factors influenced the compliance process at four distinct time-points: pre-treatment, time treatment recommended, short-term, and long-term. Physician factors that influenced patients’ persistence were knowledge about treatment, patient-training resources, and clinical profile/efficacy evaluations. For patients, motivation level, physician message, and clinical profile were key. Logistical issues, minor side effects and injection site issues influenced adherence but not persistence. Conclusions Compliance is a multifactorial, dynamic process. Both physician and patient factors influence compliance at different points in the process. PMID:19920953

The business of pain medicine: the present mirrors antiquity.

PubMed

Kulich, Ronald; Loeser, John D

2011-07-01

The practice of pain medicine is often considered a fledgling field, as are the economic, business, and related ethical issues associated with providing these services. This article first traces the history of pain care and its relationships to industry and business, as well as the impact of government regulations over the ages. The authors challenge the view that the commonly discussed health care issues facing pain medicine are new by tracing the business and regulatory-related antecedents of pain care practice from the first through 21st century. The controversies associated with the practice of delivering pain-related health care services in an ethical manner are discussed with specific reference to the early work of clinicians, health care activists, and policy makers. The early activities of noteworthy individuals such as Pliny the Great, Hua T'o, John Locke, Benjamin Franklin, Oliver Wendell Holmes Sr., William Morton, Henry and William James, Heinrick Dresser, and other recent health care activists are reviewed. Issues of practitioner liability and regulatory restrictions on practice are also discussed in a historical context. The authors conclude that familiar ethical dilemmas commonly arose in past centuries, and history may be repeating itself with respect to the concerns now being discussed within our field. These arguments are reflected against the pain medicine Ethics Charters of the American Academy of Pain Medicine throughout the document. Finally, we outline the challenges for the present and future. With an understanding of these eight historical events as a backdrop, we may be at an opportune time to better address these issues in a manner that could provide the most effective pain care in our society. Wiley Periodicals, Inc.

Everyday Ethics: Ethical Issues and Stress in Nursing Practice

PubMed Central

Ulrich, Connie M.; Taylor, Carol; Soeken, Karen; O'Donnell, Patricia; Farrar, Adrienne; Danis, Marion; Grady, Christine

2010-01-01

Aim This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Background Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. Methods A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analyzed using descriptive statistics, cross-tabulations and Pearson correlations. Results A total of 422 questionnaires were used in the analysis. The five most frequently-occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Conclusion Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. PMID:20735502

Everyday ethics: ethical issues and stress in nursing practice.

PubMed

Ulrich, Connie M; Taylor, Carol; Soeken, Karen; O'Donnell, Patricia; Farrar, Adrienne; Danis, Marion; Grady, Christine

2010-11-01

This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analysed using descriptive statistics, cross-tabulations and Pearson correlations. A total of 422 questionnaires were used in the analysis. The five most frequently occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. © 2010 Blackwell Publishing Ltd.

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.

Mathematical Learning Disabilities in Special Populations: Phenotypic Variation and Cross-Disorder Comparisons

PubMed Central

Dennis, Maureen; Berch, Daniel B.; Mazzocco, Michèle M.M.

2011-01-01

What is mathematical learning disability (MLD)? The reviews in this special issue adopt different approaches to defining the construct of MLD. Collectively, they demonstrate the current status of efforts to establish a consensus definition and the challenges faced in this endeavor. In this commentary, we reflect upon the proposed pathways to mathematical learning difficulties and disabilities presented across the reviews. Specifically we consider how each of the reviews contributes to identifying the MLD phenotype by specifying the range of assets and deficits in mathematics, identifying sources of individual variation, and characterizing the natural progression of MLD over the life course. We show how principled comparisons across disorders address issues about the cognitive and behavioral co-morbidities of MLD, and whether commonalities in brain dysmorphology are associated with common mathematics performance profiles. We project the status of MLD research ten years hence with respect to theoretical gains, advances in methodology, and principled intervention studies. PMID:19213019

A world without Roe: how different would it be?

PubMed

Glendon, M A

1989-01-01

In anticipation of the U.S. Supreme Court's decision in Webster v. Reproductive Health Services (3 Jul 1989), this issue of the Hastings Center Report includes articles by Glendon, M. Mahowald, and N. Rhoden under the unifying title "Abortion: searching for common ground." Each author acknowledges the polarization of public and political opinion after the Court's 1973 Roe v. Wade decision, and seeks to establish a common ground in the abortion debate upon which a regulatory structure could be built. Glendon, author of the monograph Abortion and Divorce in Western Law: American Failures, European Challenges (Harvard; 1987), describes Roe as the most permissive abortion law in the industrializled West. She suggests that the United States might look to European laws as models where experience has shown that political compromise is possible when regulating abortion in countries where public opinion on the issue is deeply divided.

Developing Q-methodology to explore staff views toward the use of technology in nurse education.

PubMed

Petit dit Dariel, Odessa; Wharrad, Heather; Windle, Richard

2010-01-01

Technology in education is moving quickly in terms of the hardware and software applications available, but also due to the expectations of an increasingly digitally competent student population. Academics have to rethink their pedagogy in relation to these changes. Nurse educators, in particular, must face the challenge of effectively integrating technology into what is essentially a hands-on, people-centred profession. To date, the factors most commonly cited as barriers to the adoption of e-learning by academics have focused on explicit and tangible ('hard') issues. Less frequently mentioned are the implicit and tacit ('soft') factors which are harder to identify. This article describes a pilot study using Q-methodology to explore the limitations of commonly used research methods in identifying how these hard and soft issues are prioritised by individuals, through the voices of nurse educators.

Reflections on Ethics and Humanity in Pediatric Neurology: the Value of Recognizing Ethical Issues in Common Clinical Practice.

PubMed

Ronen, Gabriel M; Rosenbaum, Peter L

2017-05-01

Our goals in this reflection are to (i) identify the ethical dimensions inherent in any clinical encounter and (ii) bring to the forefront of our pediatric neurology practice the myriad of opportunities to explore and learn from these ethical questions. We highlight specifically Beauchamp and Childress's principles of biomedical ethics. We use the terms ethics in common clinical practice and an ethical lens to remind people of the ubiquity of ethical situations and the usefulness of using existing ethical principles to analyze and resolve difficult situations in clinical practice. We start with a few common situations with which many of us tend to struggle. We describe what we understand as ethics and how and why developments in technology, novel potential interventions, policies, and societal perspectives challenge us to think about and debate ethical issues. Individual patients are not a singular population; each patient has their own unique life situations, culture, goals, and expectations that need to be considered with a good dose of humanity and humility. We believe that using an ethical lens-by which we mean making an explicit effort to identify and consider these issues openly-will help us to achieve this goal in practice, education, and research.

Current and Future Applications of Machine Learning for the US Army

DTIC Science & Technology

2018-04-13

designing from the unwieldy application of the first principles of flight controls, aerodynamics, blade propulsion, and so on, the designers turned...when the number of features runs into millions can become challenging. To overcome these issues, regularization techniques have been developed which...and compiled to run efficiently on either CPU or GPU architectures. 5) Keras63 is a library that contains numerous implementations of commonly used

Flipping the Script from Talking to Teens about "Celebrating Diversity" to Promoting Equity through Embracing Vulnerability and Enacting Courage

ERIC Educational Resources Information Center

Bettez, Silvia

2017-01-01

Diversity and inclusion are popular, yet often challenging, topics for youth in schools. A common approach to address the issues is to invite outside speakers to discuss ways to "celebrate diversity." After being invited to give such a talk, I created and enacted a presentation at an affluent high school on this topic that is grounded in…

Experiences of Agency for Healthcare Research and Quality-funded projects that implemented practices for safer patient care.

PubMed

Taylor, Stephanie L; Ridgely, M Susan; Greenberg, Michael D; Sorbero, Melony E S; Teleki, Stephanie S; Damberg, Cheryl L; Farley, Donna O

2009-04-01

To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices. Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS) grantees, from 2003 to 2006. Interviews with three grantee groups (n=60 total) implementing safe practice projects, with comparisons on factors influencing project implementation and sustainability. Semi-structured protocols contained open-ended questions on lessons learned and more structured questions on factors associated with project implementation and sustainability. The grantees shared common experiences, frequently identifying lessons learned regarding structural components needing to be in place before implementation, components of the implementation process, components of interventions' results needed for sustainability, changes in timelines or activities, unanticipated issues, and staff acceptance/adoption. Also, fewer Original grants had many of the factors related project to implementation/sustainability than the PIPS or Challenge grantees had. Although much of what was reported seemed like common sense, surprisingly few projects actually planned for or expected many of the barriers or facilitators they experienced during their project implementation. Others implementing practice improvements likely will share the experiences and issues identified by these implementation projects and can learn from their lessons.

Travellers accessing addiction services in Ireland (2007 to 2010): analysis of routine surveillance data.

PubMed

Carew, Anne Marie; Cafferty, Siobhán; Long, Jean; Bellerose, Delphine; Lyons, Suzi

2013-01-01

By accessing addiction treatment services recorded in routine national drug treatment data, the characteristics of Irish Travellers were analyzed to understand their needs and develop policies to tackle issues faced by this community. The number of Traveller cases accessing services increased by 163% between 2007 and 2010. Alcohol and opiates were the most common problem substances reported. Traveller women reported high rates of problem opiate use and risky injecting behaviors, contrary to the perception that problem substance use is a predominantly male issue. This presents a challenge to services to provide targeted, effective services to Travellers with problem substance use.

Issues and Design Drivers for Deep Space Habitats

NASA Technical Reports Server (NTRS)

Rucker, Michelle A.; Anderson, Molly

2012-01-01

A cross-disciplinary team of scientists and engineers applied expertise gained in Lunar Lander development to the conceptual design of a long-duration, deep space habitat for Near Earth Asteroid (NEA) missions. The design reference mission involved two launches to assemble 5-modules for a 380-day round trip mission carrying 4 crew members. The conceptual design process yielded a number of interesting debates, some of which could be significant design drivers in a detailed Deep Space Habitat (DSH) design. These issues included: Design to minimize crew radiation exposure, launch loads, communications challenges, docking system and hatch commonality, pointing and visibility, consumables, and design for contingency operations.

Sex and gender: the challenges for epidemiologists.

PubMed

Doyal, Lesley

2003-01-01

Gender issues are now receiving more attention on global and national health agendas. However, the evidence base for policy and practice in this area remains limited and conceptual confusion is still common. This article reviews the challenges facing epidemiologists and other researchers who aim to make their work more "gender sensitive." It begins by exploring the concepts of biological "sex" and social "gender" and assesses their implications for the health of both women and men. It then reviews a range of strategies for mainstreaming sex and gender into health research. The article concludes with brief comments on the links between gender equity and wider equality concerns.

How management teams can have a good fight.

PubMed

Eisenhardt, K M; Kahwajy, J L; Bourgeois, L J

1997-01-01

Top-level managers know that conflict over issues is natural and even necessary. Management teams that challenge one another's thinking develop a more complete understanding of their choices, create a richer range of options, and make better decisions. But the challenge--familiar to anyone who has ever been part of a management team--is to keep constructive conflict over issues from degenerating into interpersonal conflict. From their research on the interplay of conflict, politics, and speed in the decision--making process of management teams, the authors have distilled a set of six tactics characteristic of high-performing teams: They work with more, rather than less, information. They develop multiple alternatives to enrich debate. The establish common goals. They make an effort to inject humor into the workplace. They maintain a balanced corporate power structure. They resolve issues without forcing a consensus. These tactics work because they keep conflict focused on issues; foster collaborative, rather than competitive, relations among team members; and create a sense of fairness in the decision-making process. Without conflict, groups lose their effectiveness. Managers often become withdrawn and only superficially harmonious. The alternative to conflict is not usually agreement but rather apathy and disengagement, which open the doors to a primary cause of major corporate debacles: groupthink.

Ethical challenges in mental health research among internally displaced people: ethical theory and research implementation

PubMed Central

2013-01-01

Millions of people undergo displacement in the world. Internally displaced people (IDP) are especially vulnerable as they are not protected by special legislation in contrast to other migrants. Research conducted among IDPs must be correspondingly sensitive in dealing with ethical issues that may arise. Muslim IDPs in Puttalam district in the North-Western province of Sri Lanka were initially displaced from Northern Sri Lanka due to the conflict in 1991. In the backdrop of a study exploring the prevalence of common mental disorders among the IDPs, researchers encountered various ethical challenges. These included inter-related issues of autonomy, non-maleficence, beneficence, confidentiality and informed consent, and how these were tailored in a culture-specific way to a population that has increased vulnerability. This paper analyses how these ethical issues were perceived, detected and managed by the researchers, and the role of ethics review committees in mental health research concerning IDPs. The relevance of guidelines and methodologies in the context of an atypical study population and the benefit versus risk potential of research for IDPs are also discussed. The limitations that were encountered while dealing with ethical challenges during the study are discussed. The concept of post-research ethical conduct audit is suggested to be considered as a potential step to minimize the exploitation of vulnerable populations such as IDPs in mental health research. PMID:23497333

Ethical challenges in mental health research among internally displaced people: ethical theory and research implementation.

PubMed

Siriwardhana, Chesmal; Adikari, Anushka; Jayaweera, Kaushalya; Sumathipala, Athula

2013-03-12

Millions of people undergo displacement in the world. Internally displaced people (IDP) are especially vulnerable as they are not protected by special legislation in contrast to other migrants. Research conducted among IDPs must be correspondingly sensitive in dealing with ethical issues that may arise. Muslim IDPs in Puttalam district in the North-Western province of Sri Lanka were initially displaced from Northern Sri Lanka due to the conflict in 1991. In the backdrop of a study exploring the prevalence of common mental disorders among the IDPs, researchers encountered various ethical challenges. These included inter-related issues of autonomy, non-maleficence, beneficence, confidentiality and informed consent, and how these were tailored in a culture-specific way to a population that has increased vulnerability. This paper analyses how these ethical issues were perceived, detected and managed by the researchers, and the role of ethics review committees in mental health research concerning IDPs. The relevance of guidelines and methodologies in the context of an atypical study population and the benefit versus risk potential of research for IDPs are also discussed. The limitations that were encountered while dealing with ethical challenges during the study are discussed. The concept of post-research ethical conduct audit is suggested to be considered as a potential step to minimize the exploitation of vulnerable populations such as IDPs in mental health research.

Addressing Authorship Issues Prospectively: A Heuristic Approach.

PubMed

Roberts, Laura Weiss

2017-02-01

Collaborative writing in academic medicine gives rise to more richly informed scholarship, and yet challenging ethical issues surrounding authorship are commonly encountered. International guidelines on authorship help clarify whether individuals who have contributed to a completed scholarly work have been correctly included as authors, but these guidelines do not facilitate intentional and proactive authorship planning or decisions regarding authorship order.In this Commentary, the author presents a heuristic approach to help collaborators clarify, anticipate, and resolve practical and ethically important authorship issues as they engage in the process of developing manuscripts. As this approach illustrates, assignment of authorship should balance work effort and professional responsibility, reflecting the effort and intellectual contribution and the public accountability of the individuals who participate in the work. Using a heuristic approach for managing authorship issues prospectively can foster an ethical, collaborative writing process in which individuals are properly recognized for their contributions.

Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy.

PubMed

Poitras, Stéphane; Brosseau, Lucie

2008-01-01

The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

Methodological challenges in qualitative content analysis: A discussion paper.

PubMed

Graneheim, Ulla H; Lindgren, Britt-Marie; Lundman, Berit

2017-09-01

This discussion paper is aimed to map content analysis in the qualitative paradigm and explore common methodological challenges. We discuss phenomenological descriptions of manifest content and hermeneutical interpretations of latent content. We demonstrate inductive, deductive, and abductive approaches to qualitative content analysis, and elaborate on the level of abstraction and degree of interpretation used in constructing categories, descriptive themes, and themes of meaning. With increased abstraction and interpretation comes an increased challenge to demonstrate the credibility and authenticity of the analysis. A key issue is to show the logic in how categories and themes are abstracted, interpreted, and connected to the aim and to each other. Qualitative content analysis is an autonomous method and can be used at varying levels of abstraction and interpretation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Treatments for the challenging behaviours of adults with intellectual disabilities.

PubMed

Matson, Johnny L; Neal, Daniene; Kozlowski, Alison M

2012-10-01

To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs). Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies. Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs. One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.

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.

Assessing the Fragile X Syndrome Newborn Screening Landscape.

PubMed

Riley, Catharine; Wheeler, Anne

2017-06-01

Fragile X syndrome (FXS) is the most common known inherited form of intellectual disability. Early identification is an important step in linking FXS individuals with appropriate and timely medical and social services. Newborn screening (NBS) is 1 approach that has been used for other conditions to facilitate early identification. A literature review was conducted to identify issues, barriers, challenges, and approaches to addressing challenges related to NBS for FXS. Search terms included: fragile X syndrome, FMR1, newborn screening, screening, and genetic testing. To supplement the literature review, 9 key informant interviews were conducted. Information gathered through these interviews supplemented what was identified in the literature. Information from both the literature review and supplemental interviews was reviewed by 3 researchers who discussed and came to consensus on thematic areas and categorization of issues. The barriers and challenges related to NBS for FXS identified in the literature and by experts and stakeholders are categorized into 5 thematic areas: public health burden, treatment, timing, screening/testing methodologies, and translating results. Summaries of these issues and barriers are provided, along with potential approaches to addressing them. The issues and barriers described in this article highlight limited areas of knowledge that need be addressed to improve our understanding of FXS and the potential benefit of NBS. The landscape of NBS for FXS could be influenced by a series of research findings over time or a larger breakthrough that demonstrates an effective targeted treatment that has to be implemented early in life. Copyright © 2017 by the American Academy of Pediatrics.

Moral status, justice, and the common morality: challenges for the principlist account of moral change.

PubMed

Hodges, Kevin E; Sulmasy, Daniel P

2013-09-01

The theory of principlism elaborated by Beauchamp and Childress in Principles of Biomedical Ethics has become extremely influential in bioethics. The theory employs the idea of the common morality as a foundation for the principles of autonomy, beneficence, nonmaleficence, and justice. According to this account, the content of the common morality is universal and constant, while variability in morals is due to the fact that the issue of who is included within the scope of moral status evolves over time. This suggests that issues of moral status are not part of the common morality at all, and this presents a conundrum: questions of moral status seem central to any substantive account of justice, and any conception of the common morality that excludes moral status therefore seems inadequate for supporting a robust principle of justice. We argue that proponents of common morality theory are left with four options: (1) making moral status a part of the objective common morality and ignoring evidence that views about moral status do seem to vary over time and place; (2) excluding justice from the substantive content of the common morality; (3) taking common morality to be an imperfect approximation of an independently justified and universal foundationalist ethic against which the common morality is judged; or (4) weakening claims about the universality of common morality, thereby allowing the common morality to support a variety of principles of justice applicable only within particular communities that have specified the scope of moral status. We suspect that proponents of common morality theory will not view any of these options favorably, which raises questions about the ultimate contribution of that account.

Challenges in conducting psychiatry studies in India

PubMed Central

Kharawala, Saifuddin; Dalal, Jeroze

2011-01-01

A large number of psychiatry studies are conducted in India. Psychiatry studies are complex and present unique challenges in the Indian setting. Ethical issues pertaining to the risk of worsening of illness, use of placebo and validity of informed consents are commonly faced. Site selection can be difficult due to the relative paucity of ICH-GCP (International Conference on Harmonisation - Good Clinical Practice) trained psychiatry investigators in India. Recruitment can be challenging due to issues such as strict eligibility criteria, (lack of) availability of caregiver, illness-related considerations, etc. Assessment of the consent capacity of patients is not simple, while structured assessments are not commonly employed. As the illness fluctuates, the consent capacity may change, thus requiring continued assessment of consent capacity. Study patients run the risk of worsening of illness and suicide due to exposure to inactive treatments; this risk is counterbalanced by use of appropriate study designs, as well as the indirect psychotherapeutic support received. Psychiatry studies are associated with a high placebo response. This necessitates conduct of placebo-controlled studies despite the attendant difficulties. Also, the high placebo response is often the cause of failed trials. Rating scales are essential for assessment of drug response. Some rating instruments as well as some rater training procedures may not be suitable for the Indian setting. Technological advancements may increase the procedural complexity but improve the quality of ratings. Psychiatry studies present monitors and auditors with unique scenarios too. Utilization of psychiatry specific training and expertise is recommended to ensure successful conduct of these studies in India. PMID:21584176

Measure Guideline. Air Sealing Attics in Multifamily Buildings

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

Otis, Casey; Maxwell, Sean

2012-06-01

This Building America Measure Guideline is intended for owners, builders, contractors, homeowners, and other stakeholders in the multifamily building industry, and focuses on challenges found in existing buildings for a variety of housing types. It explains why air sealing is desirable, explores related health and safety issues, and identifies common air leakage points in multifamily building attics. In addition, it also gives an overview of materials and techniques typically used to perform air sealing work.

Measure Guideline: Air Sealing Attics in Multifamily Buildings

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

Otis, C.; Maxwell, S.

2012-06-01

This Building America Measure Guideline is intended for owners, builders, contractors, homeowners, and other stakeholders in the multifamily building industry, and focuses on challenges found in existing buildings for a variety of housing types. It explains why air sealing is desirable, explores related health and safety issues, and identifies common air leakage points in multifamily building attics. In addition, it also gives an overview of materials and techniques typically used to perform air sealing work.

Midwifery: "at the edge of history".

PubMed

Dahlen, H

2006-03-01

The paper focuses on possible future pathways in maternity care for midwives and nations to consider. The paper blends personal and professional experiences to outline priority areas facing midwives in the future. It begins by examining maternal mortality and morbidity in the developing world and considering the potential of the ten high priority action messages (1997) in helping to improve the plight of women and children in the future. The paper then examines major issues facing midwives in the developed world including: the way birth is viewed; the medical-midwifery divide; marketing midwifery; and finally the challenge of dealing with fear around birth. The third part of the paper examines a part of society where the two worlds meet and there are issues from both the developed and developing world to consider. The paper focuses on women from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander women and women birthing in remote and rural areas. By looking at these three worlds separately the paper examines different concerns facing midwives in the future but also draws on common issues that face us all as citizens of this planet and particularly as predominantly women. The paper challenges midwives to be politically active and dare to change the world.

Clinical Trials in Veterinary Medicine: A New Era Brings New Challenges.

PubMed

Oyama, M A; Ellenberg, S S; Shaw, P A

2017-07-01

Randomized clinical trials (RCTs) are among the most rigorous ways to determine the causal relationship between an intervention and important clinical outcome. Their use in veterinary medicine has become increasingly common, and as is often the case, with progress comes new challenges. Randomized clinical trials yield important answers, but results from these studies can be unhelpful or even misleading unless the study design and reporting are carried out with care. Herein, we offer some perspective on several emerging challenges associated with RCTs, including use of composite endpoints, the reporting of different forms of risk, analysis in the presence of missing data, and issues of reporting and safety assessment. These topics are explored in the context of previously reported veterinary internal medicine studies as well as through illustrative examples with hypothetical data sets. Moreover, many insights germane to RCTs in veterinary internal medicine can be drawn from the wealth of experience with RCTs in the human medical field. A better understanding of the issues presented here can help improve the design, interpretation, and reporting of veterinary RCTs. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Teamwork Reasoning and Multi-Satellite Missions

NASA Technical Reports Server (NTRS)

Marsella, Stacy C.; Plaunt, Christian (Technical Monitor)

2002-01-01

NASA is rapidly moving towards the use of spatially distributed multiple satellites operating in near Earth orbit and Deep Space. Effective operation of such multi-satellite constellations raises many key research issues. In particular, the satellites will be required to cooperate with each other as a team that must achieve common objectives with a high degree of autonomy from ground based operations. The multi-agent research community has made considerable progress in investigating the challenges of realizing such teamwork. In this report, we discuss some of the teamwork issues that will be faced by multi-satellite operations. The basis of the discussion is a particular proposed mission, the Magnetospheric MultiScale mission to explore Earth's magnetosphere. We describe this mission and then consider how multi-agent technologies might be applied in the design and operation of these missions. We consider the potential benefits of these technologies as well as the research challenges that will be raised in applying them to NASA multi-satellite missions. We conclude with some recommendations for future work.

Logistical Challenges and Opportunities for Conducting Peer Nomination Research in Schools.

PubMed

Mayeux, Lara; Kraft, Caroline

2017-09-01

Although conducting psychological research within schools has always required effort, persistence, and the careful navigation of various interests, there is a consensus among child and adolescent researchers that, over the past 2 decades, it has become increasingly difficult to collect data within schools. In this chapter, we lay out common and consistent difficulties, frustrations, and obstacles that researchers face when attempting to conduct peer nomination research in schools. Many of these difficulties are faced not only by researchers conducting peer nominations but by any investigator attempting to do school-based research, and we discuss these issues more broadly. We also focus on the specific challenges associated with sociometric methods. We present suggestions and solutions for overcoming these issues and consider ways that researchers can give back to schools and establish long-term partnerships that benefit the students, teachers, and administrators of participating schools, as well as the researchers themselves. Such partnerships have the potential to make data collection easier and to open doors to new research opportunities. © 2017 Wiley Periodicals, Inc.

Global health issues and challenges.

PubMed

Dickenson-Hazard, Nancy

2004-01-01

To describe issues, challenges and potential strategies in achieving nursing's global preferred future, focused on promoting healthy communities worldwide. Three sets of Arista conferences, a total of 7 conferences, were sponsored by Sigma Theta Tau International Honor Society of Nursing. Arista2 and Arista3--the focus of this report--were held in different world regions. A total of 109 invited multi-disciplinary participants identified conditions that affect nursing and health care, strategic actions to address those conditions, and recommendations for the nursing profession. Reports from each conference are synthesized in this executive summary. Both common and unique themes were identified in various world regions. Key components of the preferred future were professional restructuring and the delivery of holistic, human, and culturally appropriate care. Participants in all regional conferences recommended strategic actions regarding: student-centered educational systems, environments in which nurses practice, the way nurses lead, the knowledge nurses need, the settings in which nurses work, the conditions under which the profession operates, the influence of nurses, and the ways nurses learn.

Policy needs and options for a common transatlantic approach towards measuring adoption, usage and benefits of eHealth.

PubMed

Stroetmann, Karl A; Middleton, Blackford

2011-01-01

The European Union (EU) sponsored ARGOS project analysed current eHealth policy thinking in both the EU and the USA, compared strategic challenges and outcomes in selected fields, and drafted roadmaps towards developing advanced global approaches for these issues. This policy brief focuses on better understanding the benefits and costs of eHealth investments, assessing their overall socio-economic impact, identifying challenges and success factors, as well as measuring and globally benchmarking the concrete usage of eHealth solutions. These are by now key policy priorities not only of national governments and the European Commission, but also of international institutions like WHO or OECD. There is a strong felt transatlantic need for stocktaking, identifying lessons learned, sharing of experience, and working together to advance these issues for the benefit of health systems. A growing number of national and international activities can be taken advantage of. Recommendations on how to proceed with such transatlantic activities are proposed.

Non-dairy probiotic food products: An emerging group of functional foods.

PubMed

Min, Min; Bunt, Craig R; Mason, Susan L; Hussain, Malik A

2018-04-09

The functional food sector has shown tremendous growth in recent years with the application of probiotic bacteria as "food additives". The utilization of probiotic bacteria in food presents many challenges related to their growth, survival, viability, stability and functionality in food processing, storage and consumption as well as changes of sensory characteristics of probiotic foods. Although dairy foods are currently the most common food carrier to deliver probiotics, an increasing number of non-dairy food matrices exhibit potential for delivery of probiotics. This review provides more recent insight into the emergence of non-dairy probiotics products, the interactions between probiotics and different food matrices and the challenges in developing such products. Some of the technical issues are also reviewed and discussed. These issues include the efficacy of probiotic bacteria in non-chilled, low pH or high water activity foods; the potential loss of bacterial viability, additionally unwanted fermentation and changes of the sensory characteristics of food products which may result in poor microbiological quality and low acceptability to consumers.

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.

The Concept of Ecologically Oriented Progress and Natural Resource Preservation

NASA Astrophysics Data System (ADS)

Gasanov, M. A.; Kolotov, K. A.; Demidenko, K. A.; Podgornaya, E. A.; Kadnikova, O. V.

2017-01-01

The most important issue of scientific and technological progress is considering the environment challenges of industrial development. It means that the progress must be ecologically oriented and environmentally friendly. The most adequate concept for the approach to the issue of “man - society - nature” relations is the ontology of the noosphere - the idea of a common space for human beings and nature. It presents an ideal example of an optimistic attitude towards the coordination between accelerating the scientific and technological development and natural resource saving. However, to maintain the balance between human needs and environmental processes determined by this concept, it is essential to include the lean production training into technological development of society.

The ethical practice of psychotherapy: easily within our reach.

PubMed

Barnett, Jeffrey E

2008-05-01

Psychotherapists confront a myriad of ethical dilemmas as they endeavor to provide effective services. This issue of the Journal of Clinical Psychology: In Session on Ethics in Psychotherapy provides psychotherapists with thoughtful reviews, case examples, and practical guidance in the major areas of ethics. Following this brief introduction, the subsequent seven articles cover Informed consent; confidentiality, privilege, and their limits; treatment of minors and their families; business matters of practice (e.g., money, fees, bartering, advertising); clinical competence and scope of practice; boundaries and nonsexual multiple relationships; and termination and abandonment. This issue is designed to promote ethical practice, to provide guidance on common ethical dilemmas, and to prevent ethical challenges before they occur.

Secrecy vs. the need for ecological information: challenges to environmental activism in Russia.

PubMed

Jandl, T

1998-01-01

This article identifies the lessons learned from the Nikitin case study in Russia. The Nikitin case involves the analysis of sources of radioactive contamination in several Russian counties and in the Russian Northern Fleet. Norway was interested in the issue due to proximity to the storage sites. The issue involved national security and environmental protection. It was learned that mixing national security issues with environmental issues offers dangerous and multiple challenges. Environmental groups must build relationships with a wide audience. International security policy must include the issues of globalization of trade and the spread of environmental problems into the global commons (oceans and atmosphere). The risk of an environmentally dangerous accident as a consequence of Cold War activities is greater than the risk of nuclear war. Secrecy in military affairs is not justified when there is inadequate storage of nuclear weapons and contaminated materials. In Russia, the concern is great due to their economic transition and shortages of funds for even the most basic needs, which excludes nuclear waste clean up. The Bellona Foundation studied the extent of nuclear pollution from military nuclear reactors in the Kola peninsula of northwest Russia, in 1994 and 1996. Russian security police arrested one of the report authors for alleged national security violations. A valuable lesson learned was that local Russian environmental groups needed international support. The military nuclear complex poses an enormous hazard. Limiting inspections is an unacceptable national security risk. The new Russian law on state secrets is too broad.

Common Technologies for Environmental Research Infrastructures in ENVRIplus

NASA Astrophysics Data System (ADS)

Paris, Jean-Daniel

2016-04-01

Environmental and geoscientific research infrastructures (RIs) are dedicated to distinct aspects of the ocean, atmosphere, ecosystems, or solid Earth research, yet there is significant commonality in the way they conceive, develop, operate and upgrade their observation systems and platforms. Many environmental Ris are distributed network of observatories (be it drifting buoys, geophysical observatories, ocean-bottom stations, atmospheric measurements sites) with needs for remote operations. Most RIs have to deal with calibration and standardization issues. RIs use a variety of measurements technologies, but this variety is based on a small, common set of physical principles. All RIs have set their own research and development priorities, and developed their solution to their problems - however many problems are common across RIs. Finally, RIs may overlap in terms of scientific perimeter. In ENVRIplus we aim, for the first time, to identify common opportunities for innovation, to support common research and development across RIs on promising issues, and more generally to create a forum to spread state of the art techniques among participants. ENVRIplus activities include 1) measurement technologies: where are the common types of measurement for which we can share expertise or common development? 2) Metrology : how do we tackle together the diversified challenge of quality assurance and standardization? 3) Remote operations: can we address collectively the need for autonomy, robustness and distributed data handling? And 4) joint operations for research: are we able to demonstrate that together, RIs are able to provide relevant information to support excellent research. In this process we need to nurture an ecosystem of key players. Can we involve all the key technologists of the European RIs for a greater mutual benefit? Can we pave the way to a growing common market for innovative European SMEs, with a common programmatic approach conducive to targeted R&D? Can we develop a common metrological language adapted to the observation of our environment? We aim at creating a space for exchange on the "hardware" issues of our networks of observatories, a forum that allows fast transmission across RIs of best practices and state of the art technology, a laboratory for joint research and co-development, where research infrastructures and their communities join efforts on well-identified objectives.

A guide to wound managment in palliative care.

PubMed

Naylor, Wayne A

2005-11-01

Wound management in palliative patients is often a very challenging area of care. There are many unique issues that can combine to produce complicated wound management scenarios, including the types of wounds and wound symptoms most commonly affecting palliative care patients, as well as the presence of concurrent disease and associated treatment. Problems exist with the availability of suitable dressings and balancing life expectancy with the goals of wound care. A significant, and possibly under-recognized, issue is the emotional and social distress experienced by these patients, which can be directly attributed to their wound. These problems must all be recognized and addressed in order to manage wounds effectively in this patient population. This article aims to explore these issues and offer advice on the management of wound-related symptoms, with the ultimate goal of improving patients' quality of life.

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

Not Available

The increasing scale-up of fast pyrolysis in North America and Europe, as well as the exploration and expansion of markets for the energy use of biocrude oils that now needs to take place, suggested that it was timely to convene an international meeting on the properties and combustion behavior of these oils. A common understanding of the state-of-the-art and technical and other challenges which need to be met during the commercialization of biocrude fuel use, can be achieved. The technical issues and understanding of combustion of these oils are rapidly being advanced through R&D in the United States, Canada, Europemore » and Scandinavia. It is obvious that for the maximum economic impact of biocrude, it will be necessary to have a common set of specifications so that oils can be used interchangeably with engines and combustors which require minimal modification to use these renewable fuels. Fundamental and applied studies being pursued in several countries are brought together in this workshop so that we can arrive at common strategies. In this way, both the science and the commercialization are advanced to the benefit of all, without detracting from the competitive development of both the technology and its applications. This United States-Canada-Finland collaboration has led to the two and one half day specialists meeting at which the technical basis for advances in biocrude development is discussed. The goal is to arrive at a common agenda on issues that cross national boundaries in this area. Examples of agenda items are combustion phenomena, the behavior of trace components . of the oil (N, alkali metals), the formation of NO{sub x}, in combustion, the need for common standards and environmental safety and health issues in the handling, storage and transportation of biocrudes.« less

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

Milne, T.

The increasing scale-up of fast pyrolysis in North America and Europe, as well as the exploration and expansion of markets for the energy use of biocrude oils that now needs to take place, suggested that it was timely to convene an international meeting on the properties and combustion behavior of these oils. A common understanding of the state-of-the-art and technical and other challenges which need to be met during the commercialization of biocrude fuel use, can be achieved. The technical issues and understanding of combustion of these oils are rapidly being advanced through R&D in the United States. Canada, Europemore » and Scandinavia. It is obvious that for the maximum economic impact of biocrude, it will be necessary to have a common set of specifications so that oils can be used interchangeably with engines and combustors which require minimal modification to use these renewable fuels. Fundamental and applied studies being pursued in several countries are brought together in this workshop so that we can arrive at common strategies. In this way, both the science and the commercialization are advanced to the benefit of all, without detracting from the competitive development of both the technology and its applications. This United States-Canada-Finland collaboration has led to the two and one half day specialists meeting at which the technical basis for advances in biocrude development is discussed. The goal is to arrive at a common agenda on issues that cross national boundaries in this area. Examples of agenda items are combustion phenomena, the behavior of trace components of the oil (N, alkali metals), the formation of NOx in combustion, the need for common standards and environmental safety and health issues in the handling, storage and transportation of biocrudes.« less

The Application of Radio Frequency Identification Technology to Overcome Three Common Aerial Port Challenges: A Concept

DTIC Science & Technology

2004-06-01

better record keeping (d’Hont, 2004). Unilever , the 25th largest company in the world and manufacturer of toothpaste and shampoo, uses RFID...January 2004b. -----. “’Smart Pallet System’ at Unilever .” Excerpt from article from Texas Instruments company website, issue 16, 1996. n. pag...valuable background and perspective for this paper. Thank you Arlene for your patience during those long nights and several weekends when I needed to

Management of adolescents with congenital adrenal hyperplasia

PubMed Central

Merke, Deborah P; Poppas, Dix P

2014-01-01

The management of congenital adrenal hyperplasia involves suppression of adrenal androgen production, in addition to treatment of adrenal insufficiency. Management of adolescents with congenital adrenal hyperplasia is especially challenging because changes in the hormonal milieu during puberty can lead to inadequate suppression of adrenal androgens, psychosocial issues often affect adherence to medical therapy, and sexual function plays a major part in adolescence and young adulthood. For these reasons, treatment regimen reassessment is indicated during adolescence. Patients with non-classic congenital adrenal hyperplasia require reassessment regarding the need for glucocorticoid drug treatment. No clinical trials have compared various regimens for classic congenital adrenal hyperplasia in adults, thus therapy is individualised and based on the prevention of adverse outcomes. Extensive patient education is key during transition from paediatric care to adult care and should include education of females with classic congenital adrenal hyperplasia regarding their genital anatomy and surgical history. Common issues for these patients include urinary incontinence, vaginal stenosis, clitoral pain, and cosmetic concerns; for males with classic congenital adrenal hyperplasia, common issues include testicular adrenal rest tumours. Transition from paediatric to adult care is most successful when phased over many years. Education of health-care providers on how to successfully transition patients is greatly needed. PMID:24622419

A synthesis of convergent reflections, tensions and silences in linking gender and global environmental change research.

PubMed

Iniesta-Arandia, Irene; Ravera, Federica; Buechler, Stephanie; Díaz-Reviriego, Isabel; Fernández-Giménez, María E; Reed, Maureen G; Thompson-Hall, Mary; Wilmer, Hailey; Aregu, Lemlem; Cohen, Philippa; Djoudi, Houria; Lawless, Sarah; Martín-López, Berta; Smucker, Thomas; Villamor, Grace B; Wangui, Elizabeth Edna

2016-12-01

This synthesis article joins the authors of the special issue "Gender perspectives in resilience, vulnerability and adaptation to global environmental change" in a common reflective dialogue about the main contributions of their papers. In sum, here we reflect on links between gender and feminist approaches to research in adaptation and resilience in global environmental change (GEC). The main theoretical contributions of this special issue are threefold: emphasizing the relevance of power relations in feminist political ecology, bringing the livelihood and intersectionality approaches into GEC, and linking resilience theories and critical feminist research. Empirical insights on key debates in GEC studies are also highlighted from the nine cases analysed, from Europe, the Americas, Asia, Africa and the Pacific. Further, the special issue also contributes to broaden the gender approach in adaptation to GEC by incorporating research sites in the Global North alongside sites from the Global South. This paper examines and compares the main approaches adopted (e.g. qualitative or mixed methods) and the methodological challenges that derive from intersectional perspectives. Finally, key messages for policy agendas and further research are drawn from the common reflection.

Psychotropic medication management in persons with co-occurring psychiatric and substance use disorders.

PubMed

Sowers, W; Golden, S

1999-01-01

Persons presenting with concurrent psychiatric and substance problems present unique challenges for diagnosis and for effective and rational treatment planning. This is especially true for psychiatrists attempting to prescribe pharmacologic interventions which will promote recovery from both disorders and improve function. In order to be effective in this endeavor it is important to have a clear understanding of the dynamics of addiction as well as the particular issues and struggles related to mental illness which will affect an individual's attitude toward and use of medication. This article discusses some of the common problems related to diagnostic decision making and initiation of medication in persons with co-occurring disorders. An algorithm for guiding these decisions is presented. Common misconceptions held by these individuals regarding medication, as distinguished from "drugs," are considered. Unique psychodynamic issues that may lead these persons to actively seek medication as a solution to their problems, or which may, conversely, lead them to an outright rejection of medication as a part of their recovery, are discussed. Countertransferential issues influencing the physician's approach to prescribing for this population are also considered. The article concludes with recommendations for pharmacologic approaches to address specific psychiatric syndromes which may present in this population.

The age of anxiety: role of animal models of anxiolytic action in drug discovery

PubMed Central

Cryan, John F; Sweeney, Fabian F

2011-01-01

Anxiety disorders are common, serious and a growing health problem worldwide. However, the causative factors, aetiology and underlying mechanisms of anxiety disorders, as for most psychiatric disorders, remain relatively poorly understood. Animal models are an important aid in giving insight into the aetiology, neurobiology and, ultimately, the therapy of human anxiety disorders. The approach, however, is challenged with a number of complexities. In particular, the heterogeneous nature of anxiety disorders in humans coupled with the associated multifaceted and descriptive diagnostic criteria, creates challenges in both animal modelling and in clinical research. In this paper, we describe some of the more widely used approaches for assessing the anxiolytic activity of known and potential therapeutic agents. These include ethological, conflict-based, hyponeophagia, vocalization-based, physiological and cognitive-based paradigms. Developments in the characterization of translational models are also summarized, as are the challenges facing researchers in their drug discovery efforts in developing new anxiolytic drugs, not least the ever-shifting clinical conceptualization of anxiety disorders. In conclusion, to date, although animal models of anxiety have relatively good validity, anxiolytic drugs with novel mechanisms have been slow to emerge. It is clear that a better alignment of the interactions between basic and clinical scientists is needed if this is to change. LINKED ARTICLES This article is part of a themed issue on Translational Neuropharmacology. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2011.164.issue-4 PMID:21545412

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

PubMed

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

2011-09-01

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

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.

Moral experience and ethical challenges in an emergency department in Pakistan: emergency physicians' perspectives.

PubMed

Zafar, Waleed

2015-04-01

Emergency departments (ED) are often stressful environments posing unique ethical challenges-issues that primarily raise moral rather than clinical concerns-in patient care. Despite this, there are very few reports of what emergency physicians find ethically challenging in their everyday work. Emergency medicine (EM) is a relatively young but rapidly growing specialty that is gaining acceptance worldwide. The aim of this study was to explore the perspectives of EM residents and physicians regarding the common ethical challenges they face during patient care in one of only two academic EM departments in Pakistan. These challenges could then be addressed in residents' training and departmental practice guidelines. A qualitative research design was employed and in-depth interviews were conducted with ED physicians. Participants were encouraged to think of specific examples from their work, to highlight the particular ethical concerns raised and to describe in detail the process by which those concerns were addressed or left unresolved. Transcripts were analysed using grounded theory methods. Thirteen participants were interviewed and they described four key challenges: how to provide highest quality care with limited resources; how to be truthful to patients; what to do when it is not possible to provide or continue treatment to patients; and when (and when not) to offer life-sustaining treatments. Participants' accounts provided important insights into how physicians tried to resolve these challenges in the 'local moral world' of an ED in Pakistan. The study highlights the need for developing systematic and contextually appropriate mechanisms for resolving common ethical challenges in the EDs and for training residents in moral problem solving. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Issues Related to Screening and Caring for Newborns With Hearing Impairments].

PubMed

Liou, Mei-Show; Tsao, Ying

2016-12-01

The critical period for auditory development in humans begins at around the 20th gestational week and continues until 3 years of age. Both genetic and environmental factors are known to cause impaired hearing. Without early identification and intervention, hearing-impaired children face a high risk of experiencing significant difficulties with speech and language development, social behavior, and emotional functioning. Two types of commonly used hearing screening technologies include transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (aABR). aABR is considered to have high sensitivity and specificity, to have a relatively low referral rate, and to generate a relatively low rate of false-positive results in identifying newborn hearing impairment. The present paper outlines the psychosocial issues that are commonly experienced by parents of hearing-impaired children. Parents and other family members may benefit from medical, financial, social, and education supports in order to facilitate their adjustment to this challenging situation. The relevant literature is reviewed and recommendations for improving care for this population are provided.

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.

The middle manager role in energy company environmental efforts

NASA Astrophysics Data System (ADS)

Fischhoff, Maya E.

2005-12-01

This research examines the internal organizational processes determining corporate environmental action. Corporations have a tremendous environmental impact, yet relatively little is known about how employees within them view and work on these issues. The research focused on middle managers, a level of the company whose value is often questioned. Interviews were conducted with 70 middle managers at two energy companies (comprising utilities and unregulated businesses). Interviews examined the shape and significance of middle manager involvement in environmental issues, looking specifically at what issues middle managers deal with, what goals they pursue, and what approaches they use. The research finds middle managers' roles with respect to environmental issues to be far-reaching and complex. Much of their effort is focused on meeting regulatory requirements ("complying"). They are committed to compliance, in part for ethical reasons, but often find regulations frustrating and costly. Compliance is more challenging than commonly thought; it demands time, knowledge, and substantial creativity. In pursuing it, interviewees work with employees throughout the organization. This research shows middle managers interacting with those hierarchically above and below them in ways that greatly modify earlier portrayals of middle managers. Earlier portrayals often emphasized struggles for power within the organization. Here, middle managers work in ways best characterized as collaborative and supportive. Middle managers also have extensive involvement laterally within the company and with groups outside the company. These links have received modest attention in literature, yet are found to be terribly important. Middle managers' lateral efforts inside the company, often on teams, allow diverse expertise (e.g., from people in different functions) to be applied to environmental issues. Documenting middle managers' involvement externally, with governmental officials and sectors of the public, illuminates areas of very visible corporate impact. External interactions are also settings in which middle managers encounter alternative views about environmental issues. The study reveals the importance of middle managers in the challenge of environmental compliance. It provides knowledge that can be used by external entities seeking to connect with companies, and by companies seeking to address environmental issues better. It thus aids understanding of a critical societal challenge and opportunity.

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.

Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review.

PubMed

Thomas, Beena Elizabeth; Shanmugam, Poonguzhali; Malaisamy, Muniyandi; Ovung, Senthanro; Suresh, Chandra; Subbaraman, Ramnath; Adinarayanan, Srividya; Nagarajan, Karikalan

2016-01-01

Limited treatment options, long duration of treatment and associated toxicity adversely impact the physical and mental well-being of multidrug-resistant tuberculosis (MDR-TB) patients. Despite research advances in the microbiological and clinical aspects of MDR-TB, research on the psychosocial context of MDR-TB is limited and less understood. We searched the databases of PubMed, MEDLINE, Embase and Google Scholar to retrieve all published articles. The final manuscripts included in the review were those with a primary focus on psychosocial issues of MDR-TB patients. These were assessed and the information was thematically extracted on the study objective, methodology used, key findings, and their implications. Intervention studies were evaluated using components of the methodological and quality rating scale. Due to the limited number of studies and the multiple methodologies employed in the observational studies, we summarized these studies using a narrative approach, rather than conducting a formal meta-analysis. We used 'thematic synthesis' method for extracting qualitative evidences and systematically organised to broader descriptive themes. A total of 282 published articles were retrieved, of which 15 articles were chosen for full text review based on the inclusion criteria. Six were qualitative studies; one was a mixed methods study; and eight were quantitative studies. The included studies were divided into the following issues affecting MDR-TB patients: a) psychological issues b) social issues and economic issues c) psychosocial interventions. It was found that all studies have documented range of psychosocial and economic challenges experienced by MDR-TB patients. Depression, stigma, discrimination, side effects of the drugs causing psychological distress, and the financial constraints due to MDR-TB were some of the common issues reported in the studies. There were few intervention studies which addressed these psychosocial issues most of which were small pilot studies. There is dearth of large scale randomized psychosocial intervention studies that can be scaled up to strengthen management of MDR-TB patients which is crucial for the TB control programme. This review has captured the psychosocial and economic issues challenging MDR patients. However there is urgent need for feasible, innovative psychosocial and economic intervention studies that help to equip MDR-TB patients cope with their illness, improve treatment adherence, treatment outcomes and the overall quality of life of MDR-TB patients.

Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review

PubMed Central

Thomas, Beena Elizabeth; Shanmugam, Poonguzhali; Malaisamy, Muniyandi; Ovung, Senthanro; Suresh, Chandra; Subbaraman, Ramnath; Adinarayanan, Srividya; Nagarajan, Karikalan

2016-01-01

Background Limited treatment options, long duration of treatment and associated toxicity adversely impact the physical and mental well-being of multidrug-resistant tuberculosis (MDR-TB) patients. Despite research advances in the microbiological and clinical aspects of MDR-TB, research on the psychosocial context of MDR-TB is limited and less understood. Methodology We searched the databases of PubMed, MEDLINE, Embase and Google Scholar to retrieve all published articles. The final manuscripts included in the review were those with a primary focus on psychosocial issues of MDR-TB patients. These were assessed and the information was thematically extracted on the study objective, methodology used, key findings, and their implications. Intervention studies were evaluated using components of the methodological and quality rating scale. Due to the limited number of studies and the multiple methodologies employed in the observational studies, we summarized these studies using a narrative approach, rather than conducting a formal meta-analysis. We used ‘thematic synthesis’ method for extracting qualitative evidences and systematically organised to broader descriptive themes. Results A total of 282 published articles were retrieved, of which 15 articles were chosen for full text review based on the inclusion criteria. Six were qualitative studies; one was a mixed methods study; and eight were quantitative studies. The included studies were divided into the following issues affecting MDR-TB patients: a) psychological issues b) social issues and economic issues c) psychosocial interventions. It was found that all studies have documented range of psychosocial and economic challenges experienced by MDR-TB patients. Depression, stigma, discrimination, side effects of the drugs causing psychological distress, and the financial constraints due to MDR-TB were some of the common issues reported in the studies. There were few intervention studies which addressed these psychosocial issues most of which were small pilot studies. There is dearth of large scale randomized psychosocial intervention studies that can be scaled up to strengthen management of MDR-TB patients which is crucial for the TB control programme. Conclusion This review has captured the psychosocial and economic issues challenging MDR patients. However there is urgent need for feasible, innovative psychosocial and economic intervention studies that help to equip MDR-TB patients cope with their illness, improve treatment adherence, treatment outcomes and the overall quality of life of MDR-TB patients. PMID:26807933

Obese patients and radiography literature: what do we know about a big issue?

PubMed Central

Le, Nhat Tan Thanh; Robinson, John; Lewis, Sarah J

2015-01-01

Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for. PMID:26229678

Obese patients and radiography literature: what do we know about a big issue?

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

Le, Nhat Tan Thanh; Robinson, John; Lewis, Sarah J, E-mail: sarah.lewis@sydney.edu.au

Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposuremore » through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for.« less

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.

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

Neumann, Scott; Britton, Jay; Devos, Arnold N.

There are many uses for the Common Information Model (CIM), an ontology that is being standardized through Technical Committee 57 of the International Electrotechnical Commission (IEC TC57). The most common uses to date have included application modeling, information exchanges, information management and systems integration. As one should expect, there are many issues that become apparent when the CIM ontology is applied to any one use. Some of these issues are shortcomings within the current draft of the CIM, and others are a consequence of the different ways in which the CIM can be applied using different technologies. As the CIMmore » ontology will and should evolve, there are several dangers that need to be recognized. One is overall consistency and impact upon applications when extending the CIM for a specific need. Another is that a tight coupling of the CIM to specific technologies could limit the value of the CIM in the longer term as an ontology, which becomes a larger issue over time as new technologies emerge. The integration of systems is one specific area of interest for application of the CIM ontology. This is an area dominated by the use of XML for the definition of messages. While this is certainly true when using Enterprise Application Integration (EAI) products, it is even more true with the movement towards the use of Web Services (WS), Service-Oriented Architectures (SOA) and Enterprise Service Buses (ESB) for integration. This general IT industry trend is consistent with trends seen within the IEC TC57 scope of power system management and associated information exchange. The challenge for TC57 is how to best leverage the CIM ontology using the various XML technologies and standards for integration. This paper will provide examples of how the CIM ontology is used and describe some specific issues that should be addressed within the CIM in order to increase its usefulness as an ontology. It will also describe some of the issues and challenges that will be faced as the CIM ontology is leveraged for integration purposes by IEC TC57 standards.« less

What people with Down Syndrome can teach us about cardiopulmonary disease.

PubMed

Colvin, Kelley L; Yeager, Michael E

2017-01-01

Down syndrome is the most common chromosomal abnormality among live-born infants. Through full or partial trisomy of chromosome 21, Down syndrome is associated with cognitive impairment, congenital malformations (particularly cardiovascular) and dysmorphic features. Immune disturbances in Down syndrome account for an enormous disease burden ranging from quality-of-life issues (autoimmune alopecia) to more serious health issues (autoimmune thyroiditis) and life-threatening issues (leukaemia, respiratory tract infections and pulmonary hypertension). Cardiovascular and pulmonary diseases account for ∼75% of the mortality seen in persons with Down syndrome. This review summarises the cardiovascular, respiratory and immune challenges faced by individuals with Down syndrome, and the genetic underpinnings of their pathobiology. We strongly advocate increased comparative studies of cardiopulmonary disease in persons with and without Down syndrome, as we believe these will lead to new strategies to prevent and treat diseases affecting millions of people worldwide. Copyright ©ERS 2017.

[ETHICS, MORALS AND SOCIETY IN PERSONALIZED MEDICINE].

PubMed

Flugelman, Anath

2015-09-01

Following the completion of the human genome project, genomic medicine including personalized medicine, widely based on pharmacogenetics and pharmacogenomics, is rapidly developing. This breakthrough should benefit humankind thanks to tailoring the most appropriate prevention, interventions and therapies to each individual, minimizing adverse side effects, based on inter-personal genetic variety and polymorphism. Yet wide spectrum ethical, legal and social issues carry significant implications regarding individuals, families, society and public health. The main issues concern genomic information and autonomy, justice and equity, resources allocation and solidarity, challenging the traditional role of medicine and dealing with unlimited boundaries of knowledge. Those issues are not new nor exceptional to genomic medicine, yet their wide unlimited scope and implications on many aspects of life renders them crucial. These aspects will be discussed in light of Beauchamp and Childress' four principles: non-maleficence, beneficence, autonomy and justice, and main moral philosophies, Kant's autonomy, Utilitarianism which promotes the common good, and Rawls' Theory of Justice.

Myelodysplastic syndromes: more prevalent than we know.

PubMed

Sandhu, Satinderpal K; Sekeres, Mikkael A

2008-11-01

Myelodysplastic syndromes (MDS), a hematopoietic disorder for which formal tracking began as recently as 2001, is rapidly gaining recognition as a cause of anemia. The incidence of MDS increases with age and is considered the most common hematologic cancer in the elderly. The disease can follow an indolent course or rapidly progress to acute myelogenous leukemia (AML). Comorbidities and functional issues make this disease challenging to diagnose and treat in geriatric patients. This article reviews the epidemiology, classification, and treatment options for MDS.

GLIMMPSE Lite: Calculating Power and Sample Size on Smartphone Devices

PubMed Central

Munjal, Aarti; Sakhadeo, Uttara R.; Muller, Keith E.; Glueck, Deborah H.; Kreidler, Sarah M.

2014-01-01

Researchers seeking to develop complex statistical applications for mobile devices face a common set of difficult implementation issues. In this work, we discuss general solutions to the design challenges. We demonstrate the utility of the solutions for a free mobile application designed to provide power and sample size calculations for univariate, one-way analysis of variance (ANOVA), GLIMMPSE Lite. Our design decisions provide a guide for other scientists seeking to produce statistical software for mobile platforms. PMID:25541688

Atmospheric Flux Computations in Complex Terrain

NASA Technical Reports Server (NTRS)

Smith, Paul L.; Kopp, Fred J.; Orville, Harold D.

2000-01-01

The greatest challenges in applying atmospheric water budget expressions are in determining the divergence and evapotranspiration terms. The evapotranspiration problem is ubiquitous, and critical issues of spatial and temporal resolution commonly arise in establishing the divergence term. In complex terrain, further difficulties crop up in using typical data on atmospheric profiles of water vapor and wind to estimate the divergence term. Those difficulties are the subject of this paper; considerations related to topographic variations both along and normal to the flow direction are treated.

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.

Informal Statistics Help Desk

NASA Technical Reports Server (NTRS)

Young, M.; Koslovsky, M.; Schaefer, Caroline M.; Feiveson, A. H.

2017-01-01

Back by popular demand, the JSC Biostatistics Laboratory and LSAH statisticians are offering an opportunity to discuss your statistical challenges and needs. Take the opportunity to meet the individuals offering expert statistical support to the JSC community. Join us for an informal conversation about any questions you may have encountered with issues of experimental design, analysis, or data visualization. Get answers to common questions about sample size, repeated measures, statistical assumptions, missing data, multiple testing, time-to-event data, and when to trust the results of your analyses.

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.

Assessing organizational change in multisector community health alliances.

PubMed

Alexander, Jeffrey A; Hearld, Larry R; Shi, Yunfeng

2015-02-01

The purpose of this article was to identify some common organizational features of multisector health care alliances (MHCAs) and the analytic challenges presented by those characteristics in assessing organizational change. Two rounds of an Internet-based survey of participants in 14 MHCAs. We highlight three analytic challenges that can arise when quantitatively studying the organizational characteristics of MHCAs-assessing change in MHCA organization, assessment of construct reliability, and aggregation of individual responses to reflect organizational characteristics. We illustrate these issues using a leadership effectiveness scale (12 items) validated in previous research and data from 14 MHCAs participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program. High levels of instability and turnover in MHCA membership create challenges in using survey data to study changes in key organizational characteristics of MHCAs. We offer several recommendations to diagnose the source and extent of these problems. © Health Research and Educational Trust.

Discriminative Ocular Artifact Correction for Feature Learning in EEG Analysis.

PubMed

Xinyang Li; Cuntai Guan; Haihong Zhang; Kai Keng Ang

2017-08-01

Electrooculogram (EOG) artifact contamination is a common critical issue in general electroencephalogram (EEG) studies as well as in brain-computer interface (BCI) research. It is especially challenging when dedicated EOG channels are unavailable or when there are very few EEG channels available for independent component analysis based ocular artifact removal. It is even more challenging to avoid loss of the signal of interest during the artifact correction process, where the signal of interest can be multiple magnitudes weaker than the artifact. To address these issues, we propose a novel discriminative ocular artifact correction approach for feature learning in EEG analysis. Without extra ocular movement measurements, the artifact is extracted from raw EEG data, which is totally automatic and requires no visual inspection of artifacts. Then, artifact correction is optimized jointly with feature extraction by maximizing oscillatory correlations between trials from the same class and minimizing them between trials from different classes. We evaluate this approach on a real-world EEG dataset comprising 68 subjects performing cognitive tasks. The results showed that the approach is capable of not only suppressing the artifact components but also improving the discriminative power of a classifier with statistical significance. We also demonstrate that the proposed method addresses the confounding issues induced by ocular movements in cognitive EEG study.

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.

Health of adolescent refugees resettling in high-income countries.

PubMed

Hirani, Kajal; Payne, Donald; Mutch, Raewyn; Cherian, Sarah

2016-07-01

Adolescent refugees are a vulnerable population with complex healthcare needs that are distinct from younger and older age groups. Physical health problems are common in this cohort with communicable diseases being the focus of attention followed by an emphasis on nutritional deficiencies and other chronic disorders. Adolescent refugees have also often experienced multiple traumatic stressors and are at a heightened risk of developing mental health problems. Navigating these problems at the time of pubertal development adds further challenges and can exacerbate or lead to the emergence of health risk behaviours. Educational difficulties and acculturation issues further compound these issues. Adolescents who have had experiences in detention or are unaccompanied by parents are particularly at risk. Despite a constantly growing number of adolescent refugees resettling in high-income countries, knowledge regarding their specific healthcare needs is limited. Research data are largely extrapolated from studies conducted within paediatric and adult cohorts. Holistic management of the medical and psychological issues faced by this group is challenging and requires an awareness of the socioeconomic factors that can have an impact on effective healthcare delivery. Legal and ethical issues can further complicate their management and addressing these in a culturally appropriate manner is essential. Early identification and management of the healthcare issues faced by adolescent refugees resettling in high-income countries are key to improving long-term health outcomes and future healthcare burden. This review article aims to increase knowledge and awareness of these issues among paediatricians and other health professionals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

On the Adaptive Protection of Microgrids: A Review on How to Mitigate Cyber Attacks and Communication Failures

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

Habib, Hany F; Lashway, Christopher R; Mohammed, Osama A

One main challenge in the practical implementation of a microgrid is the design of an adequate protection scheme in both grid connected and islanded modes. Conventional overcurrent protection schemes face selectivity and sensitivity issues during grid and microgrid faults since the fault current level is different in both cases for the same relay. Various approaches have been implemented in the past to deal with this problem, yet the most promising ones are the implementation of adaptive protection techniques abiding by the IEC 61850 communication standard. This paper presents a critical review of existing adaptive protection schemes, the technical challenges formore » the use of classical protection techniques and the need for an adaptive, smart protection system. However, the risk of communication link failures and cyber security threats still remain a challenge in implementing a reliable adaptive protection scheme. A contingency is needed where a communication issue prevents the relay from adjusting to a lower current level during islanded mode. An adaptive protection scheme is proposed that utilizes energy storage (ES) and hybrid ES (HESS) already available in the network as a mechanism to source the higher fault current. Four common grid ES and HESS are reviewed for their suitability in feeding the fault while some solutions are proposed.« less

Challenges of transitioning from a faculty to an administrative role: part 2, moving from individual contributor to group leader.

PubMed

Thompson, Cesarina M

2011-01-01

Many new nursing leaders assuming deanships, assistant, or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, Jana L. Pressler, PhD, RN, and Carole A. Kenner, PhD, RNC-NIC, FAAN, the editors of this department, address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. In this article, the editors asked guest author, Dr Cesarina Thompson, to discuss the transition process from faculty to administrative role.

Perspectives on Technology-Assisted Relaxation Approaches to Support Mind-Body Skills Practice in Children and Teens: Clinical Experience and Commentary.

PubMed

Culbert, Timothy

2017-04-04

It has been well-established that a variety of mind-body (MB) techniques, including yoga, mental imagery, hypnosis, biofeedback, and meditation, are effective at addressing symptoms such as pain, anxiety, nausea, and insomnia, as well as helping with a wide variety of medical, emotional, and behavioral issues in pediatric populations. In addition, MB skills can also be health promoting in the long-term, and with regular practice, could potentially contribute to longer attention spans, social skills, emotional regulation, and enhanced immune system functioning. Importantly, the benefits accrued from MB skills are largely dose dependent, meaning that individuals who practice with some consistency tend to benefit the most, both in the short- and long-term. However, clinical experience suggests that for busy patients, the regular practice of MB skills can be challenging and treatment adherence commonly becomes an issue. This commentary reviews the concept of technology assisted relaxation as an engaging and effective option to enhance treatment adherence (i.e., daily practice) for pediatric patients, for whom MB skills have been recommended to address physical and mental health challenges.

Overcoming barriers to a research-ready national commercial claims database.

PubMed

Newman, David; Herrera, Carolina-Nicole; Parente, Stephen T

2014-11-01

Billions of dollars have been spent on the goal of making healthcare data available to clinicians and researchers in the hopes of improving healthcare and lowering costs. However, the problems of data governance, distribution, and accessibility remain challenges for the healthcare system to overcome. In this study, we discuss some of the issues around holding, reporting, and distributing data, including the newest "big data" challenge: making the data accessible to researchers and policy makers. This article presents a case study in "big healthcare data" involving the Health Care Cost Institute (HCCI). HCCI is a nonprofit, nonpartisan, independent research institute that serves as a voluntary repository of national commercial healthcare claims data. Governance of large healthcare databases is complicated by the data-holding model and further complicated by issues related to distribution to research teams. For multi-payer healthcare claims databases, the 2 most common models of data holding (mandatory and voluntary) have different data security requirements. Furthermore, data transport and accessibility may require technological investment. HCCI's efforts offer insights from which other data managers and healthcare leaders may benefit when contemplating a data collaborative.

Ethical challenges faced by healthcare professionals who care for suicidal patients: a scoping review.

PubMed

Saigle, Victoria; Racine, Eric

2018-04-17

For each one of the approximately 800,000 people who die from suicide every year, an additional twenty people attempt suicide. Many of these attempts result in hospitalization or in contact with other healthcare services. However, many personal, educational, and institutional barriers make it difficult for healthcare professionals to care for suicidal individuals. We reviewed literature that discusses suicidal patients in healthcare settings in order to highlight common ethical issues and to identify knowledge gaps. A sample was generated via PubMed using keywords "[(ethics OR *ethic*) AND suicid*] AND [English (Language) OR French (Language)]" (final N = 52), ethics content was extracted according to scoping review methodology, and categorized thematically. We identified three main areas posing ethical challenges for health professionals caring for suicidal individuals and their families. These were: (1) making clinical decisions for patients in acute care or when presented with specific circumstances; (2) issues arising from therapeutic relationships in chronic care, and (3) organizational factors. There is considerable uncertainty about how to resolve ethical issues when caring for someone who is suicidal. The stigma associated with suicide and mental illness, problems associated with risk-benefit assessments, and the fear of being held liable for malpractice should a patient die by suicide were overarching themes present across these three categories. Caring for suicidal patients is clinically and ethically challenging. The current literature highlights the complexity and range of decisions that need to be made. More attention should be paid to the difficulties faced by healthcare professionals and the development of solutions.

Medical big data: promise and challenges.

PubMed

Lee, Choong Ho; Yoon, Hyung-Jin

2017-03-01

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

Medical big data: promise and challenges

PubMed Central

Lee, Choong Ho; Yoon, Hyung-Jin

2017-01-01

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

Comparison of the Performance and Capabilities of Femtocell versus Wi-Fi Networks

DTIC Science & Technology

2012-09-01

6  II.  FEMTOCELL HISTORY, ISSUES, AND CHALLENGES ...................................9  A.  A BRIEF HISTORY OF FEMTOCELLS...9  B.  FEMTOCELL ISSUES AND CHALLENGES ...........................................10  1.  Quality of... Challenges .........................................................................12  5.  Regulatory Challenges

Common benefit from a perspective of "Non-traditional Partners": A proposed agenda to address the status quo in Global Space Governance

NASA Astrophysics Data System (ADS)

Aganaba-Jeanty, Timiebi

2015-12-01

It is presupposed that there is a dominant position in interpreting the freedom of Outer Space which has not given much real significance to the idea of common benefit. The reason that this causes difficulty is that there is an ambiguity to common benefit. This dominant position however sees the issue of benefit sharing in the context of the perceived tension between established space faring nations and emerging and aspirant States and the idea that freedom could take on a different meaning depending on where one is on the scale of development. It fails to recognize that solutions to contemporary and historical governance challenges have been much less oriented towards the interests of less developed States or new entrants, making the accrual and sharing of benefits dependent on the free will of those States able to carry out a variety of space activities independently. As a result of this, the debate around common benefit is exploited to seek individual benefit derived for a State as opposed to what our effort to use space collectively can generate. In recent times, the issue has not received much attention. This is because it is believed to be partly resolved through normative frameworks such as Article 1 of the Outer Space Treaty and the Space Benefits Declaration. While an attempt to re-address historical contentious issues, asserted to be resolved, may appear illusory or futile; such analysis can be useful depending on the account that the reader believes should be given to the normative character of human nature. To this end, the writings of legal, political and social theorists and methodologies from Critical Legal Schools may prove insightful for a deeper contextualization of the historical debate, the current understanding of the freedoms of Outer Space as well as unearth future perspectives to aid in addressing the current pressing space related issue of our time: Sustainability of Space Activities. This article proposes three main issue areas to investigate to find solutions to some of the perceived tensions prevalent in space governance:

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

Controversies in oncologist-patient communication: a nuanced approach to autonomy, culture, and paternalism.

PubMed

Cherny, Nathan I

2012-01-01

Difficult dialogues with patients facing life-changing decisions are an intrinsic part of oncologic practice and a major source of stress. Having a sophisticated approach to the concepts of autonomy, paternalism, and culture can help in addressing difficult dilemmas that arise around the issues of disclosure and decision making. This article addresses some of the most common major challenges in oncologist-patient communication with a nuanced approach to the concepts of autonomy, paternalism, and culture. It introduces the new concept of"voluntary diminished autonomy" and describes the implications this concept has for the consent process. It also attempts to bring clarity to common problems and misconceptions relating to culture, paternalism, and therapeutic privilege as these pertain to the communication practices of oncologists.

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

Meeting the Challenge of Crohn's Disease

MedlinePlus

... page please turn JavaScript on. Feature: Crohn's Disease Meeting the Challenge of Crohn's Disease Past Issues / Winter ... Living with Crohn's Disease / What Is Crohn's Disease / Meeting the Challenge of Crohn's Disease Winter 2016 Issue: ...

Big data and clinicians: a review on the state of the science.

PubMed

Wang, Weiqi; Krishnan, Eswar

2014-01-17

In the past few decades, medically related data collection saw a huge increase, referred to as big data. These huge datasets bring challenges in storage, processing, and analysis. In clinical medicine, big data is expected to play an important role in identifying causality of patient symptoms, in predicting hazards of disease incidence or reoccurrence, and in improving primary-care quality. The objective of this review was to provide an overview of the features of clinical big data, describe a few commonly employed computational algorithms, statistical methods, and software toolkits for data manipulation and analysis, and discuss the challenges and limitations in this realm. We conducted a literature review to identify studies on big data in medicine, especially clinical medicine. We used different combinations of keywords to search PubMed, Science Direct, Web of Knowledge, and Google Scholar for literature of interest from the past 10 years. This paper reviewed studies that analyzed clinical big data and discussed issues related to storage and analysis of this type of data. Big data is becoming a common feature of biological and clinical studies. Researchers who use clinical big data face multiple challenges, and the data itself has limitations. It is imperative that methodologies for data analysis keep pace with our ability to collect and store data.

4 Gbps Scalable Low-Voltage Signaling (SLVS) transceiver for pixel radiation detectors

NASA Astrophysics Data System (ADS)

Kadlubowski, Lukasz A.; Kmon, Piotr

2017-08-01

We report on the design of 4 Gbps Scalable Low-Voltage Signaling (SLVS) transceiver in 40nm CMOS technology for application-specific integrated circuits (ASICs) dedicated to pixel radiation detectors. Serial data are transmitted with +/-200mV differential swing around 200mV nominal common-mode level. The common-mode interference minimization is crucial in such a design, due to EMC requirements. For multi-gigabit-per-second speeds, the influence of power supply path becomes one of the most challenging design issues. Accurate modeling of supply pads at each step of the design is necessary. Our analysis shows that the utilization of multiple bond wires as well as separate power supply pads for bulk terminals connection of the transistors is essential to ensure proper operation of the transceiver. The design is a result of various trade-offs between speed, required operating conditions, common-mode interference as well as power and area consumption.

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.

Counseling Psychology Research on Sexual (Orientation) Minority Issues: Conceptual and Methodological Challenges and Opportunities

ERIC Educational Resources Information Center

Moradi, Bonnie; Mohr, Jonathan J.; Worthington, Roger L.; Fassinger, Ruth E.

2009-01-01

This lead article of the special issue discusses conceptual and methodological considerations in studying sexual minority issues, particularly in research conducted by counseling psychologists (including the work represented in this special issue). First, the overarching challenge of conceptualizing and defining sexual minority populations is…

32 CFR 1907.13 - Identification of material at issue.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Identification of material at issue. 1907.13... ORDER 12958 Filing of Challenges § 1907.13 Identification of material at issue. Authorized holders shall append the documents at issue and clearly mark those portions subject to the challenge. If information...

32 CFR 1802.13 - Identification of material at issue.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Identification of material at issue. 1802.13... EXECUTIVE ORDER 12958 Filing Of Challenges § 1802.13 Identification of material at issue. Authorized holders shall append the documents at issue and clearly mark those portions subject to the challenge. If...

Community Colleges--Prevention Challenges. Issues in Prevention

ERIC Educational Resources Information Center

Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention, 2012

2012-01-01

This issue of "Issues in Prevention" focuses on prevention challenges facing community colleges. This issue contains the following articles: (1) Prevention at Community Colleges; (2) Q&A With William Auvenshine; (3) Chancellor's Initiative at the University of Wisconsin-Stout; (4) Alcohol Marketing in the Digital Age; and (5) Higher Education…

The ethics of human reproductive cloning: when world views collide.

PubMed

Cohen, Cynthia B

2004-01-01

Two camps in bioethics with seemingly opposing world views have staked out conflicting positions regarding the ethics of human reproductive cloning. These camps do not appear to share common concepts or ways of reasoning through which to exchange views and come to a meeting of minds about uses of this technology. Yet analysis of their respective approaches to several issues surrounding reproductive cloning, such as where the ethical limits of individual reproductive choice lie, whether the use of this technology would violate human dignity, whether it would create risks to the resulting fetuses and children that would make its use intolerable, and whether it would challenge certain core social values, reveals that they are not wholly opposed to one another. Indeed, it displays that they hold certain beliefs, values, and concerns in common. Moreover, it indicates that the different world views that they each presuppose, while flawed in certain respects, do not collide in every respect, but can be reconciled in significant ways that provide fertile ground for agreement about several issues related to human reproductive cloning.

Current methods of laboratory diagnosis of Chlamydia trachomatis infections.

PubMed Central

Black, C M

1997-01-01

Infections caused by Chlamydia trachomatis are probably the most common sexually transmitted diseases in the United States. Commonly unrecognized and often inadequately treated, chlamydial infections can ascend the reproductive tract and cause pelvic inflammatory disease, which often results in the devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. C. trachomatis infections are also known to increase the risk for human immunodeficiency virus infection. The obligate intracellular life cycle of C. trachomatis has traditionally required laboratory diagnostic tests that are technically demanding, labor-intensive, expensive, and difficult to access. In spite of these historical challenges, however, laboratory diagnosis of C. trachomatis has been a rapidly advancing area in which there is presently a wide array of commercial diagnostic technologies, costs, manufacturers. This review describes and compares the diagnostic methods for C. trachomatis infection that are currently approved for use in the United States, including the newest DNA amplification technologies which are yet to be licensed for commercial use. Issues to consider in selecting a test for purposes of screening versus diagnosis based on prevalence, performance, legal, social, and cost issues are also discussed. PMID:8993862

Childhood discipline: challenges for clinicians and parents.

PubMed

Banks, J Burton

2002-10-15

Although childhood discipline is an important issue for parents, this topic is seldom emphasized by family physicians during well-child examinations. Behavior problems are relatively common but frequently under-recognized by physicians. Opportunities to counsel parents about safe, effective methods of discipline are therefore missed. Discipline should be instructive and age-appropriate and should include positive reinforcement for good behavior. Punishment is only one aspect of discipline and, in order to be effective, it must be prompt, consistent, and fair. Time-out is frequently used to correct younger children, but because it is often enforced improperly, it loses its effectiveness. Corporal punishment is a controversial but common form of discipline that is less effective than some other types of punishment. Its use is linked to child and spouse abuse, as well as to future substance use, violent crime, poor self-esteem, and depression. Despite the possible negative effects of corporal punishment, it is still widely accepted in our society. Since discipline plays an important role in the social and emotional development of children, physicians should be trained to discuss this issue with parents during routine well-child examinations.

Summary of human social, cultural, behavioral (HSCB) modeling for information fusion panel discussion

NASA Astrophysics Data System (ADS)

Blasch, Erik; Salerno, John; Kadar, Ivan; Yang, Shanchieh J.; Fenstermacher, Laurie; Endsley, Mica; Grewe, Lynne

2013-05-01

During the SPIE 2012 conference, panelists convened to discuss "Real world issues and challenges in Human Social/Cultural/Behavioral modeling with Applications to Information Fusion." Each panelist presented their current trends and issues. The panel had agreement on advanced situation modeling, working with users for situation awareness and sense-making, and HSCB context modeling in focusing research activities. Each panelist added different perspectives based on the domain of interest such as physical, cyber, and social attacks from which estimates and projections can be forecasted. Also, additional techniques were addressed such as interest graphs, network modeling, and variable length Markov Models. This paper summarizes the panelists discussions to highlight the common themes and the related contrasting approaches to the domains in which HSCB applies to information fusion applications.

Polymer Energy Rechargeable System (PERS) Development Program

NASA Technical Reports Server (NTRS)

Baldwin, Richard S.; Manzo, Michelle A.; Dalton, Penni J.; Marsh, Richard A.; Surampudi, Rao

2001-01-01

The National Aeronautics and Space Administration (NASA) and the Air Force Research Laboratory (AFRL) have recently established a collaborative effort to support the development of polymer-based, lithium-based cell chemistries and battery technologies to address the next generation of aerospace applications and mission needs. The overall objective of this development program, which is referred to as PERS, Polymer Energy Rechargeable System, is to establish a world-class technology capability and U.S. leadership in polymer-based battery technology for aerospace applications. Programmatically, the PERS initiative will exploit both interagency collaborations to address common technology and engineering issues and the active participation of academia and private industry. The initial program phases will focus on R&D activities to address the critical technical issues and challenges at the cell level.

Health, human rights, and the conduct of clinical research within oppressed populations

PubMed Central

Mills, Edward J; Singh, Sonal

2007-01-01

Background Clinical trials evaluating interventions for infectious diseases require enrolling participants that are vulnerable to infection. As clinical trials are conducted in increasingly vulnerable populations, issues of protection of these populations become challenging. In settings where populations are forseeably oppressed, the conduct of research requires considerations that go beyond common ethical concerns and into issues of international human rights law. Discussion Using examples of HIV prevention trials in Thailand, hepatitis-E prevention trials in Nepal and malaria therapeutic trials in Burma (Myanmar), we address the inadequacies of current ethical guidelines when conducting research within oppressed populations. We review existing legislature in the United States and United Kingdom that may be used against foreign investigators if trial hardships exist. We conclude by making considerations for research conducted within oppressed populations. PMID:17996056

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

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

Challenging oral contraception after weight loss by bariatric surgery.

PubMed

Merhi, Zaher O

2007-01-01

As surgical weight loss becomes more commonly performed in fertile women, adequate contraception is more frequently becoming an issue. The purpose of this article is to appraise the literature to ascertain whether the use of oral contraception is effective and adequate after bariatric surgery. The literature search revealed that the combination of lower oral contraception dosages and surgical gastrointestinal disturbances might place patients at higher risks of unintended pregnancy. Until clinical trials show its efficacy, physicians should use oral contraception with prudence after bariatric surgery. 2007 S. Karger AG, Basel

The first international workshop on the role and impact of mathematics in medicine: A collective account

PubMed Central

Artzrouni, Marc; Begg, Colin; Chabiniok, Radomir; Clairambault, Jean; Foss, AJE; Hargrove, John; Lee, Eva K; Siggers, Jennifer H; Tindall, Marcus

2011-01-01

The First International Workshop on The Role and Impact of Mathematics in Medicine (RIMM) convened in Paris in June 2010. A broad range of researchers discussed the difficulties, challenges and opportunities faced by those wishing to see mathematical methods contribute to improved medical outcomes. Finding mechanisms for interdisciplinary meetings, developing a common language, staying focused on the medical problem at hand, deriving realistic mathematical solutions, obtaining high quality data and seeing things through “by the bedside” are some of the issues discussed by the participants.

Considerations for the design, analysis and presentation of in vivo studies.

PubMed

Ranstam, J; Cook, J A

2017-03-01

To describe, explain and give practical suggestions regarding important principles and key methodological challenges in the study design, statistical analysis, and reporting of results from in vivo studies. Pre-specifying endpoints and analysis, recognizing the common underlying assumption of statistically independent observations, performing sample size calculations, and addressing multiplicity issues are important parts of an in vivo study. A clear reporting of results and informative graphical presentations of data are other important parts. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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.

Ethical issues in ocular genetics.

PubMed

Mezer, Eedy; Wygnanski-Jaffe, Tamara

2009-09-01

To review some of the major issues in ophthalmic genetics ethics: predictive testing, prenatal testing and abortion, gene therapy, confidentiality, payment for genetic testing, the duty to recontact patients and convey new information. Patients and families may perceive benefits even though genetic testing may be associated with adverse psychosocial outcomes. Most patients were in favor of prenatal diagnosis but opposed abortion. Patient selection as candidates for gene therapy should be based on the different clinical characteristics of each hereditary disease. The balance between the right of the patient for confidentiality and the best interest of family members or society is an ethical challenge. Most insurance companies will pay for genetic testing if the condition is hereditary. The duty to recontact patients when new medical information becomes available is still ethically controversial. The field of ocular genetics is ever growing involving complex medical, technical, financial and social issues. As a result, ethical issues are expected to become more common. Properly prepared medical professionals as well as unique counseling for participants and families may enable improved decision-making taking into consideration the needs of each individual.

Ethical issues in microbicide clinical trials for HIV prevention.

PubMed

Gangestad, Angelina K; Salata, Robert A

2012-01-01

Women account for half of new infections with HIV annually. Heterosexual transmission is the most common route of infection in resource limited settings (RLS). An effective microbicide would help decrease transmission of HIV and potentially enable women to have more control in sexual relationships. Research into microbicides is done predominantly in RLS. In addition, there will be different issues and challenges to consider with respect to rectal microbicide use in men. There exist several ethical issues around microbicide development and clinical research which we explore in this review. Respect for persons, including autonomy and protection of vulnerable populations, beneficence, and justice are explored as they relate to microbicide research. Improving standards of care in RLS, trial design, and informed consent are discussed in more detail. Special populations including pregnant women, adolescents, and men who have sex with men are considered in more detail. A multipronged approach to HIV prevention will be necessary to have an impact on HIV prevention. A continued discussion around ethical issues in regard to study design, interpretation of results and implementation of compounds brought to market will remain critically important.

Collaborative innovations with rural and regional secondary teachers: enhancing student learning in mathematics

NASA Astrophysics Data System (ADS)

Pegg, John; Panizzon, Debra

2011-06-01

When questioned, secondary mathematics teachers in rural and regional schools in Australia refer to their limited opportunities to engage and share experiences with peers in other schools as an under-utilised and cost-effective mechanism to support their professional learning and enhance their students' learning. The paper reports on the creation and evaluation of a network of learning communities of rural secondary mathematics teachers around a common purpose—enhancement and increased engagement of student learning in mathematics. To achieve this goal, teams of teachers from six rural schools identified an issue hindering improved student learning of mathematics in their school. Working collaboratively with support from university personnel with expertise in curriculum, assessment and quality pedagogy, teachers developed and implemented strategies to address an identified issue in ways that were relevant to their teaching contexts. The research study identifies issues in mathematics of major concern to rural teachers of mathematics, the successes and challenges the teachers faced in working in learning communities on the issue they identified, and the efficacy of the professional learning model.

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.

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

ERIC Educational Resources Information Center

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

2010-01-01

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

Legal Aspects of Sleep Medicine in the 21st Century.

PubMed

Venkateshiah, Saiprakash B; Hoque, Romy; Collop, Nancy A

2018-05-08

Multiple manifestations of sleep disorders may interact with the law making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable due to the actions of sleepy employees. Hence awareness of causes of excessive sleepiness such as sleep deprivation and OSA is increasing among trucking, railroad, and other safety sensitive occupations. Interestingly, litigation related to perioperative complications due to Obstructive Sleep Apnea (OSA) is more frequent than non-operative issues such as a failure to diagnose OSA. Parasomnia associated sleep-related violence (SRV) represents a challenge to clinicians, as they may be asked to consider parasomnia as a possible contributing, mitigating, or exculpatory factor in criminal proceedings. Clinicians should also familiarize with the legal and regulatory aspects of running an independent sleep laboratory. Sleep telemedicine practice using 21 st century technology has opened novel and unique challenges to existing laws. In this review, we shall cover the most common interactions between sleep disorders and the law including the challenges of excessive sleepiness and driving; other legal issues involving patients with obstructive sleep apnea (OSA); and the liabilities associated with parasomnia disorder. We shall also cover some practical legal aspects involving independent sleep laboratories and the field of sleep telemedicine. Published by Elsevier Inc.

More than a thousand words: Helping science speak for itself (Invited)

NASA Astrophysics Data System (ADS)

Hassol, S. J.; Somerville, R. C.; Hussin, D. R.

2013-12-01

Our community has awakened to the complex challenges of communicating about climate change when much more than the science is at issue. Our awareness now includes cultural and psychological issues, and it is critical to continue this focus. At the same time, most people still say they need more information about the science, and so we are challenged to deliver that information in more accessible and effective ways. We are experimenting with some new strategies and techniques at our website, climatecommunication.org. We recently created ten narrated, animated videos that visualize important aspects of climate science. These range from explaining the iconic Keeling Curve to addressing how we know the recent warming is human-induced, to an overview of actions that can stabilize climate affordably. These videos provide a kind of 'guided tour' through what can otherwise be difficult-to-understand scientific graphs. Through other video resources on our site, including answers to common questions and biographical videos of our science advisors, we illuminate the fascinating process of science and portray scientists as the interesting, multi-faceted people they are. This can help challenge the stereotype of scientists, and enhance trust by revealing that scientists share many values and concerns with their fellow citizens. In this talk, we explore the resources available on climatecommunication.org, and discuss our ideas for combining accurate science with effective techniques for communicating with the public.

Structural materials for Gen-IV nuclear reactors: Challenges and opportunities

NASA Astrophysics Data System (ADS)

Murty, K. L.; Charit, I.

2008-12-01

Generation-IV reactor design concepts envisioned thus far cater toward a common goal of providing safer, longer lasting, proliferation-resistant and economically viable nuclear power plants. The foremost consideration in the successful development and deployment of Gen-IV reactor systems is the performance and reliability issues involving structural materials for both in-core and out-of-core applications. The structural materials need to endure much higher temperatures, higher neutron doses and extremely corrosive environment, which are beyond the experience of the current nuclear power plants. Materials under active consideration for use in different reactor components include various ferritic/martensitic steels, austenitic stainless steels, nickel-base superalloys, ceramics, composites, etc. This paper presents a summary of various Gen-IV reactor concepts, with emphasis on the structural materials issues depending on the specific application areas. This paper also discusses the challenges involved in using the existing materials under both service and off-normal conditions. Tasks become increasingly complex due to the operation of various fundamental phenomena like radiation-induced segregation, radiation-enhanced diffusion, precipitation, interactions between impurity elements and radiation-produced defects, swelling, helium generation and so forth. Further, high temperature capability (e.g. creep properties) of these materials is a critical, performance-limiting factor. It is demonstrated that novel alloy and microstructural design approaches coupled with new materials processing and fabrication techniques may mitigate the challenges, and the optimum system performance may be achieved under much demanding conditions.

Chikungunya in the region of the Americas. A challenge for rheumatologists and health care systems.

PubMed

Pineda, Carlos; Muñoz-Louis, Roberto; Caballero-Uribe, Carlo V; Viasus, Diego

2016-10-01

At the end of 2013, the Pan American Health Organization issued an epidemiological alert due to the detection of the first local cases of Chikungunya in the Americas. By August 2015, autochthonous transmissions were detected in 33 countries and territories of the Americas. Latin America has reported nearly one million cases; only Colombia has issued a report of >200,000 cases during the first 4 months of 2015. In some Latin American and Caribbean countries, Chikungunya becomes a major public health problem. The disease commonly exhibits a self-limited course of arthritis, usually lasting for a few days or that may be prolonged to weeks; however, in 10-60 % of cases, joint pain may become chronic and persist for up to 3-5 years. Human-caused environmental changes, such as climate change, the globalization of international exchange, and disordered urban growth, are some factors that aid in its emergence and dissemination. Outbreaks of Chikungunya comprise a challenge for health care systems and rheumatologists because of the high attack rate on the population and the anticipated development of post-Chikungunya chronic rheumatism. This review emphasizes the rheumatologic clinical manifestations reported in the American continent and highlights the challenges that health care systems face in the absence of an effective vaccine and specific treatment to fight Chikungunya.

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

Cognitive impairment and driving safety.

PubMed

Eby, David W; Molnar, Lisa J

2012-11-01

As the populations of many countries continue to age, cognitive impairment will likely become more common. Individuals with cognitive impairment pose special challenges for families, health professionals, driving safety professionals, and the larger community, particularly if these older adults depend on driving as their primary means of community mobility. It is vital that we continue to extend our knowledge about the driving behavior of individuals' with cognitive impairment, as well as try to develop effective means of screening and assessing these individuals for fitness to drive and help facilitate their transition to non-driving when appropriate. This special issue is intended to provide researchers and practitioners an opportunity to present the most recent research findings on driving-related issues among older adults with cognitive impairment. The issue contains 11 original contributions from seven countries. The topics covered by these papers are: crash risks; screening, assessment, and fitness to drive; driving performance using a driving simulator; and driving behaviors and driving-related decisions of people with cognitive impairments. Copyright © 2012. Published by Elsevier Ltd.

Service provider perceptions of transitioning from audio to video capability in a telehealth system: a qualitative evaluation.

PubMed

Clay-Williams, Robyn; Baysari, Melissa; Taylor, Natalie; Zalitis, Dianne; Georgiou, Andrew; Robinson, Maureen; Braithwaite, Jeffrey; Westbrook, Johanna

2017-08-14

Telephone consultation and triage services are increasingly being used to deliver health advice. Availability of high speed internet services in remote areas allows healthcare providers to move from telephone to video telehealth services. Current approaches for assessing video services have limitations. This study aimed to identify the challenges for service providers associated with transitioning from audio to video technology. Using a mixed-method, qualitative approach, we observed training of service providers who were required to switch from telephone to video, and conducted pre- and post-training interviews with 15 service providers and their trainers on the challenges associated with transitioning to video. Two full days of simulation training were observed. Data were transcribed and analysed using an inductive approach; a modified constant comparative method was employed to identify common themes. We found three broad categories of issues likely to affect implementation of the video service: social, professional, and technical. Within these categories, eight sub-themes were identified; they were: enhanced delivery of the health service, improved health advice for people living in remote areas, safety concerns, professional risks, poor uptake of video service, system design issues, use of simulation for system testing, and use of simulation for system training. This study identified a number of unexpected potential barriers to successful transition from telephone to the video system. Most prominent were technical and training issues, and personal safety concerns about transitioning from telephone to video media. Addressing identified issues prior to implementation of a new video telehealth system is likely to improve effectiveness and uptake.

Barriers and facilitators to implementing cancer survivorship care plans.

PubMed

Dulko, Dorothy; Pace, Claire M; Dittus, Kim L; Sprague, Brian L; Pollack, Lori A; Hawkins, Nikki A; Geller, Berta M

2013-11-01

To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs. Descriptive pilot study. Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center. 17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey. Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit. SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit. Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis. Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation. Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative. Accessing complete medical records is an obstacle for completing SCPs. A 3-6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care.

Managing the Mission: The Primary Challenge to Campus Child Care.

ERIC Educational Resources Information Center

Townley, Kim F.; Zeece, Pauline Davey

1991-01-01

Examines complex issues and challenges faced by a comprehensive child care system in its efforts to meet its teaching, research, and service missions. These issues and challenges are examined in terms of an expanded, integrated model for comprehensive child care. (SH)

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

The challenges and rewards of engaging a skeptical public

PubMed Central

2013-01-01

Findings published in this issue suggest that a substantial subset of the Israeli public generally trusts government, yet is determined to make their own judgments about the need for precautionary action in certain types of public health emergencies. This reflective approach, which may be common in other countries as well, poses a substantial challenge to achieving desired levels of compliance, particularly when the threat requires swift and concerted action. The aim of this commentary is to discuss both the challenges and the rewards of engaging a public that wants to weigh evidence prior to taking action in an emergency, rather than defer to expert judgment. While engaging a skeptical public can be difficult, a reflective public acknowledges that preparedness is a shared responsibility of government and individuals and may be receptive to messages about the need for household and community self-sufficiency in a disaster. This is a commentary on the article “Analysis of Public Responses to Preparedness Policies” by Velan and colleagues. PMID:23537194

Quality of life in epilepsy (QOLIE): insights about epilepsy and support groups from people with epilepsy (San Francisco Bay Area, USA).

PubMed

Chung, Kenny; Liu, Yuan; Ivey, Susan L; Huang, Debbie; Chung, Corina; Guo, Wenting; Tseng, Winston; Ma, Daveena

2012-06-01

This study evaluated quality of life (QOL) in people with epilepsy (PWE) in the San Francisco Bay Area. This was a qualitative study examining QOL through the use of focus groups and of the QOLIE-31-P survey instrument. Six focus groups were conducted to examine self-reported challenges due to epilepsy. Focus groups were conducted for individuals who did and did not attend support groups. Individuals with epilepsy reported substantial difficulties with finances, physical and psychosocial functioning. Also, limited knowledge about services and relatively negative feelings toward self were common among newly diagnosed participants. Many of the issues surrounding QOL and challenges were shared across groups. Epilepsy-related social services appeared to be useful in helping PWE cope and in increasing PWE's awareness of key enabling services. Although many individuals with epilepsy reported poor QOL and other challenges, epilepsy-related services may be under-utilized due to a lack of awareness. Copyright © 2012 Elsevier Inc. All rights reserved.

Taking stock of infections and antibiotic resistance in the elderly and long-term care facilities: A survey of existing and upcoming challenges.

PubMed

Augustine, S; Bonomo, R A

2011-09-01

Treating elderly patients with infections represents one of the greatest challenges to health-care providers. Older adults are the largest growing sector of the population and suffer excessively from infectious diseases such as pneumonia, urinary tract infections (UTIs), and skin and soft-tissue infections. Often because of disabilities, the elderly require treatment of infectious diseases in long-term care facilities (LTCFs). As a result of antibiotic use, LTCFs have become "reservoirs of resistance" and multi-drug resistant (MDR) pathogens are frequently recovered. Clinicians also need to be aware of the impairment of immune function and other emerging chronic infections (HIV, HCV) that are now present in the elderly. Despite vigilance regarding this issue, delays in diagnosis and initiation of therapy are common. This article reviews the changing landscape of infections in the elderly and the challenge these syndromes present in the context of an increasing older population that requires dedicated resources.

Instructional Vignettes in Publication and Journalism Ethics in Radiology Research: Assessment via a Survey of Radiology Trainees.

PubMed

Rosenkrantz, Andrew B; Ginocchio, Luke A

2016-07-01

The aim of the present study was to assess the potential usefulness of written instructional vignettes relating to publication and journalism ethics in radiology via a survey of radiology trainees. A literature review was conducted to guide the development of vignettes, each describing a scenario relating to an ethical issue in research and publication, with subsequent commentary on the underlying ethical issue and potential approaches to its handling. Radiology trainees at a single institution were surveyed regarding the vignettes' perceived usefulness. A total of 21 vignettes were prepared, addressing institutional review board and human subjects protection, authorship issues, usage of previous work, manuscript review, and other miscellaneous topics. Of the solicited trainees, 24.7% (16/65) completed the survey. On average among the vignettes, 94.0% of the participants found the vignette helpful; 19.9 received prior formal instruction on the issue during medical training; 40.0% received prior informal guidance from a research mentor; and 42.0% indicated that the issue had arisen in their own or a peer's prior research experience. The most common previously experienced specific issue was authorship order (93.8%). Free-text responses were largely favorable regarding the value of the vignettes, although also indicated numerous challenges in properly handling the ethical issues: impact of hierarchy, pressure to publish, internal politics, reluctance to conduct sensitive conversations with colleagues, and variability in journal and professional society policies. Radiology trainees overall found the vignettes helpful, addressing commonly encountered topics for which formal and informal guidance were otherwise lacking. The vignettes are publicly available through the Association of University Radiologists (AUR) website and may foster greater insights by investigators into ethical aspects of the publication and journalism process, thus contributing to higher quality radiology research. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Stakeholders' perspective on issues and challenges associated with care and treatment of aging-related cognitive impairment disorders in Singapore.

PubMed

Setia, Monika; Islam, Amina M; Thompson, James P; Matchar, David B

2011-11-01

An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has concomitant implications for social and health systems. The objective of this study is to understand the perspectives of prominent stakeholders about current and future issues and challenges associated with CI/dementia among the elderly in Singapore. Using indepth interviews, this qualitative study obtained the views of multiple stakeholders on issues and challenges associated with CI/dementia in Singapore. The 30 individuals interviewed as part of the study included clinicians, policy-makers, researchers, community workers, administrators, and caregivers. Using a framework approach, interview texts were indexed into domains and issues by utilizing NVivo 9.0 software. The stakeholders expressed concerns related to multiple domains of the CI/dementia care system: attitude and awareness, economics, education, family caregiving, inputs to care system, living arrangements, prevention, screening and diagnosis, and treatment and management of care. Within each domain, multiple issues and challenges were identified by respondents. The study identifies a complex set of inter-related issues and challenges that are associated with the care and treatment of people with CI/dementia. The results suggest that CI and dementia profoundly affect patients, families, and communities and that the issues related to the two disorders are truly system-wide. These findings lay the foundation for utilization of a systems approach to studying CI/dementia and provide an analytic framework for future research on complex health care issues.

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.

Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints.

PubMed

Harrison, Reema; Walton, Merrilyn; Healy, Judith; Smith-Merry, Jennifer; Hobbs, Coletta

2016-04-01

To explore the applicability of a patient complaint taxonomy to data on serious complaint cases. Qualitative descriptive study. Complaints made to the New South Wales (NSW) Health Care Complaints Commission, Australia between 2005 and 2010. All 138 cases of serious complaints by patients about public hospitals and other health facilities investigated in the 5-year period. A thematic analysis of the complaints was conducted to identify particular complaint issues and the Reader et al. (Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;23:678-89.) patient complaint taxonomy was then used to classify these issues into categories and sub-categories. The 138 investigated cases revealed 223 complaint issues. Complaint issues were distributed into the three domains of the patient complaint taxonomy: clinical, management and relationships. Complaint issue most commonly related to delayed diagnosis, misdiagnosis, medication errors, inadequate examinations, inadequate/nil treatment and quality of care including nursing care. The types of complaints from patients about their healthcare investigated by the NSW Commission were similar to those received by other patient complaint entities in Australia and worldwide. The application of a standard taxonomy to large numbers of complaints cases from different sources would enable the creation of aggregated data. Such data would have better statistical capacity to identify common safety and quality healthcare problems and so point to important areas for improvement. Some conceptual challenges in devising and using a taxonomy must be addressed, such as inherent problems in ensuring coding consistency, and giving greater weight to patient concerns about their treatment. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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.

Ethical challenges and solutions regarding delirium studies in palliative care.

PubMed

Sweet, Lisa; Adamis, Dimitrios; Meagher, David J; Davis, Daniel; Currow, David C; Bush, Shirley H; Barnes, Christopher; Hartwick, Michael; Agar, Meera; Simon, Jessica; Breitbart, William; MacDonald, Neil; Lawlor, Peter G

2014-08-01

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. 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. 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. 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. 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. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Health information exchange: national and international approaches.

PubMed

Vest, Joshua R

2012-01-01

Health information exchange (HIE), the process of electronically moving patient-level information between different organizations, is viewed as a solution to the fragmentation of data in health care. This review provides a description of the current state of HIE in seven nations, as well was three international HIE efforts, with a particular focus on the relation of exchange efforts to national health care systems, common challenges, and the implications of cross-border information sharing. National and international efforts highlighted in English language informatics journals, professional associations, and government reports are described. Fully functioning HIE is not yet a common phenomenon worldwide. However, multiple nations see the potential benefits of HIE and that has led to national and international efforts of varying scope, scale, and purview. National efforts continue to work to overcome the challenges of interoperability, record linking, insufficient infrastructures, governance, and interorganizational relationships, but have created architectural strategies, oversight agencies, and incentives to foster exchange. The three international HIE efforts reviewed represent very different approaches to the same problem of ensuring the availability of health information across borders. The potential of HIE to address many cost and quality issues will ensure HIE remains on many national agendas. In many instances, health care executives and leaders have opportunities to work within national programs to help shape local exchange governance and decide technology partners. Furthermore, HIE raises policy questions concerning the role of centralized planning, national identifiers, standards, and types of information exchanged, each of which are vital issues to individual health organizations and worthy of their attention.

Clinical decision support alert malfunctions: analysis and empirically derived taxonomy.

PubMed

Wright, Adam; Ai, Angela; Ash, Joan; Wiesen, Jane F; Hickman, Thu-Trang T; Aaron, Skye; McEvoy, Dustin; Borkowsky, Shane; Dissanayake, Pavithra I; Embi, Peter; Galanter, William; Harper, Jeremy; Kassakian, Steve Z; Ramoni, Rachel; Schreiber, Richard; Sirajuddin, Anwar; Bates, David W; Sittig, Dean F

2018-05-01

To develop an empirically derived taxonomy of clinical decision support (CDS) alert malfunctions. We identified CDS alert malfunctions using a mix of qualitative and quantitative methods: (1) site visits with interviews of chief medical informatics officers, CDS developers, clinical leaders, and CDS end users; (2) surveys of chief medical informatics officers; (3) analysis of CDS firing rates; and (4) analysis of CDS overrides. We used a multi-round, manual, iterative card sort to develop a multi-axial, empirically derived taxonomy of CDS malfunctions. We analyzed 68 CDS alert malfunction cases from 14 sites across the United States with diverse electronic health record systems. Four primary axes emerged: the cause of the malfunction, its mode of discovery, when it began, and how it affected rule firing. Build errors, conceptualization errors, and the introduction of new concepts or terms were the most frequent causes. User reports were the predominant mode of discovery. Many malfunctions within our database caused rules to fire for patients for whom they should not have (false positives), but the reverse (false negatives) was also common. Across organizations and electronic health record systems, similar malfunction patterns recurred. Challenges included updates to code sets and values, software issues at the time of system upgrades, difficulties with migration of CDS content between computing environments, and the challenge of correctly conceptualizing and building CDS. CDS alert malfunctions are frequent. The empirically derived taxonomy formalizes the common recurring issues that cause these malfunctions, helping CDS developers anticipate and prevent CDS malfunctions before they occur or detect and resolve them expediently.

Every Child. Volume 13, Number 2, 2007

ERIC Educational Resources Information Center

Elliott, Alison, Ed.

2007-01-01

The theme of this issue of "Every Child" is "Challenging Practice and Challenging Practices." It covers a range of issues challenging the images of a "traditional" children's service. Contents include an editorial by Alison Elliott, "Wise Vision, Workable Solutions and Early Childhood Action," a guest…

Conservation of native Pacific trout diversity in western North America

USGS Publications Warehouse

Penaluna, Brooke E.; Abadía-Cardoso, Alicia; Dunham, Jason B.; García de León, Francisco J; Gresswell, Robert E.; Luna, Arturo Ruiz; Taylor, Eric B.; Shepard, Bradley B.; Al-Chokhachy, Robert K.; Muhlfeld, Clint C.; Bestgen, Kevin R.; Rogers, Kevin H.; Escalante, Marco A; Keeley, Ernest R; Temple, Gabriel; Williams, Jack E.; Matthews, Kathleen; Pierce, Ron; Mayden, Richard L.; Kovach, Ryan; Garza, John Carlos; Fausch, Kurt D.

2016-01-01

Pacific trout Oncorhynchus spp. in western North America are strongly valued in ecological, socioeconomic, and cultural views, and have been the subject of substantial research and conservation efforts. Despite this, the understanding of their evolutionary histories, overall diversity, and challenges to their conservation is incomplete. We review the state of knowledge on these important issues, focusing on Pacific trout in the genus Oncorhynchus. Although most research on salmonid fishes emphasizes Pacific salmon, we focus on Pacific trout because they share a common evolutionary history, and many taxa in western North America have not been formally described, particularly in the southern extent of their ranges. Research in recent decades has led to the revision of many hypotheses concerning the origin and diversification of Pacific trout throughout their range. Although there has been significant success at addressing past threats to Pacific trout, contemporary and future threats represented by nonnative species, land and water use activities, and climate change pose challenges and uncertainties. Ultimately, conservation of Pacific trout depends on how well these issues are understood and addressed, and on solutions that allow these species to coexist with a growing scope of human influences.

Ethical challenges in cluster randomized controlled trials: experiences from public health interventions in Africa and Asia

PubMed Central

Azad, Kishwar; Fernandez, Armida; Manandhar, Dharma S; Mwansambo, Charles W; Tripathy, Prasanta; Costello, Anthony M

2009-01-01

Abstract Public health interventions usually operate at the level of groups rather than individuals, and cluster randomized controlled trials (RCTs) are one means of evaluating their effectiveness. Using examples from six such trials in Bangladesh, India, Malawi and Nepal, we discuss our experience of the ethical issues that arise in their conduct. We set cluster RCTs in the broader context of public health research, highlighting debates about the need to reconcile individual autonomy with the common good and about the ethics of public health research in low-income settings in general. After a brief introduction to cluster RCTs, we discuss particular challenges we have faced. These include the nature of – and responsibility for – group consent, and the need for consent by individuals within groups to intervention and data collection. We discuss the timing of consent in relation to the implementation of public health strategies, and the problem of securing ethical review and approval in a complex domain. Finally, we consider the debate about benefits to control groups and the standard of care that they should receive, and the issue of post-trial adoption of the intervention under test. PMID:19876544

Perspectives on Technology-Assisted Relaxation Approaches to Support Mind-Body Skills Practice in Children and Teens: Clinical Experience and Commentary

PubMed Central

Culbert, Timothy

2017-01-01

It has been well-established that a variety of mind-body (MB) techniques, including yoga, mental imagery, hypnosis, biofeedback, and meditation, are effective at addressing symptoms such as pain, anxiety, nausea, and insomnia, as well as helping with a wide variety of medical, emotional, and behavioral issues in pediatric populations. In addition, MB skills can also be health-promoting in the long-term, and with regular practice, could potentially contribute to longer attention spans, social skills, emotional regulation, and enhanced immune system functioning. Importantly, the benefits accrued from MB skills are largely dose-dependent, meaning that individuals who practice with some consistency tend to benefit the most, both in the short- and long-term. However, clinical experience suggests that for busy patients, the regular practice of MB skills can be challenging and treatment adherence commonly becomes an issue. This commentary reviews the concept of technology-assisted relaxation as an engaging and effective option to enhance treatment adherence (i.e., daily practice) for pediatric patients, for whom MB skills have been recommended to address physical and mental health challenges. PMID:28375179

Impact of parental acquired brain injury on children: Review of the literature and conceptual model.

PubMed

Tiar, Anna Maria Vitale; Dumas, Jean E

2015-01-01

Data on children's adjustment following parental acquired brain injury (ABI) are disparate and spare, and appear inconclusive. Nonetheless, they suggest that children's well-being is at risk, but often neglected. Indeed, lack of a unifying conceptual model makes it difficult to integrate available evidence, in order to circumscribe relevant factors and understand how these may influence children's outcomes in more or less favourable ways. The present review proposes the coping competence model as a theoretical framework apt to clarify these issues and organize the available evidence. In brief, the model states that impact of parental ABI on children reflects the extent of the challenges children face and their preponderant ways of coping with them, i.e. pro-socially, anti-socially or asocially. Evidence shows that children deal with some common socioaffective as well as achievement challenges. Further, it is consistent with the three main coping modalities supported by the model. Overall, children's outcomes appear variable, but clearly at risk and in need of special attention. This review summarizes these outcomes, raises conceptual as well as methodological questions to be addressed in future research and eventually presents relevant issues for support and clinical services.

Science Teachers Taking their First Steps toward Teaching Socioscientific Issues through Collaborative Action Research

NASA Astrophysics Data System (ADS)

Lee, Hyunju; Yang, Jung-eun

2017-06-01

This study presents two science teachers, Catherine and Jennifer, who took their first steps toward teaching socioscientific issues through collaborative action research. The teachers participated in the collaborative action research project because they wanted to address socioscientific issues but had limited experience in teaching them. The research questions included what kinds of challenges the teachers encountered when implementing socioscientific issues and to what extent they resolved the challenging issues as participating in collaborative action research. The primary data source consisted of audiotapes of regular group meetings containing information on the process of constructing and implementing lesson plans and reflecting on their teaching of socioscientific issues. We also collected classroom videotapes of the teachers' instruction and audiotapes of students' small group discussions and their worksheets. The findings indicated that when addressing socioscientific issues in the classes, the teachers encountered several challenging issues. We categorized them into four: (1) restructuring classroom dynamics and culture, (2) scaffolding students' engagement in socioscientific issues, (3) dealing with values, and (4) finding their niche in schools. However, this study showed that collaborative action research could be a framework for helping the teachers to overcome such challenges and have successful experiences of teaching socioscientific issues. These experiences became good motivation, to gradually develop their understanding of teaching socioscientific issues and instructional strategies for integrating the knowledge and skills that they had accumulated over the years.

6 Common Cancers - Skin Cancer

MedlinePlus

... Bar Home Current Issue Past Issues 6 Common Cancers - Skin Cancer Past Issues / Spring 2007 Table of Contents For ... AP Photo/Herald-Mail, Kevin G. Gilbert Skin Cancer Skin cancer is the most common form of ...

Managing the culturally diverse medical practice team: twenty-five strategies.

PubMed

Hills, Laura

2014-01-01

A common misconception is that the phrase workplace diversity means meeting certain quotas in employee race or gender categories. In fact, diversity is much more than that. This article explores the unique benefits and challenges of managing a culturally diverse medical practice team and offers practice managers 25 practical strategies. It describes the two types of diversity training that are beneficial to practice managers and the kinds of policies, practices, and procedures that foster and promote diversity. This article also explores ethnocentrism, racism, ageism, sexism, stereotyping, and other potentially divisive issues among a diverse medical practice team. It provides an assessment instrument practice managers can use to evaluate their own diversity management skills. Finally, this article defines specifically what is meant by the term diversity and explores the top 10 diversity issues in workplaces today.

A study of influences of the workers' compensation and injury management regulations on aviation safety at a workplace.

PubMed

Yadav, Devinder K; Nikraz, Hamid; Chen, Yongqing

2016-01-01

As the aviation industries developed, so too did the recognition that there must be an effective regulatory framework to address issues related to the workers' compensation and rehabilitation. All employees would like to work and return home safely from their workplace. Therefore, the efficient management of workplace injury and disease reduces the cost of aviation operations and improves flight safety. Workers' compensation and injury management laws regulate a majority of rehabilitation and compensation issues, but achieving an injury-free workplace remains a major challenge for the regulators. This paper examines the clauses of the workers' compensation and injury management laws of Western Australia related to workplace safety, compensation, and rehabilitations of the injured workers. It also discusses various provisions of common law under the relevant workers' health injury management legislations.

Modeling Count Outcomes from HIV Risk Reduction Interventions: A Comparison of Competing Statistical Models for Count Responses

PubMed Central

Xia, Yinglin; Morrison-Beedy, Dianne; Ma, Jingming; Feng, Changyong; Cross, Wendi; Tu, Xin

2012-01-01

Modeling count data from sexual behavioral outcomes involves many challenges, especially when the data exhibit a preponderance of zeros and overdispersion. In particular, the popular Poisson log-linear model is not appropriate for modeling such outcomes. Although alternatives exist for addressing both issues, they are not widely and effectively used in sex health research, especially in HIV prevention intervention and related studies. In this paper, we discuss how to analyze count outcomes distributed with excess of zeros and overdispersion and introduce appropriate model-fit indices for comparing the performance of competing models, using data from a real study on HIV prevention intervention. The in-depth look at these common issues arising from studies involving behavioral outcomes will promote sound statistical analyses and facilitate research in this and other related areas. PMID:22536496

Hyperpigmentation therapy: a review.

PubMed

Desai, Seemal R

2014-08-01

With an increasing number of multicultural patients and those of different backgrounds presenting in dermatology clinics, issues facing patients with higher Fitzpatrick skin classifications, often referred to as skin of color patients, are on the rise. Knowledge of the diagnostic dilemmas, cutting edge treatment options, and latest clinical research in the diagnosis and management of cutaneous anomalies in skin of color patients is of paramount importance. Of the most common complaints in patients with skin of color is hyperpigmentation. Despite the availability of multiple treatments for the condition, hyperpigmentation continues to present clinical management challenges for dermatologists. Difficulty may be traced to physician or patient reluctance to use certain agents or interventions, failure to identify and avoid contributing factors, and insufficient attention paid to the psychosocial aspects of the disease. This review addresses a variety of issues including the diagnosis and management of hyperpigmentation.

Health and safety strategies in a changing Europe.

PubMed

Walters, D

1998-01-01

This article presents a synthesis of some of the more significant findings from two recent surveys on working conditions and national strategies for their improvement in the European Union in the 1990s. As patterns and organization of employment have changed in the past decade, the consequences for health and safety present new challenges for legislators, the social partners, the regulatory agencies, and the specialists. These challenges are only partially met in most European member states. Because of the continued deregulation of employment, reduced public expenditure, and reduced trade union presence, the operation of strategies to implement a common framework of E.U. legislation is limited and often incomplete. This issue must be confronted if systems for promoting the well-being of people at work in Europe are to keep up with the rapidly changing nature of the risks that they face.

Bio-geomorphology and resilience thinking: Common ground and challenges

NASA Astrophysics Data System (ADS)

Thoms, Martin C.; Meitzen, Kimberly M.; Julian, Jason P.; Butler, David R.

2018-03-01

Geomorphology plays a fundamental role in shaping and maintaining landscapes, as well as influencing the social and ecological systems that occupy and utilize these landscapes. In turn, social-ecological systems can have a profound influence on geomorphic forms and processes. These interactions highlight the tightly coupled nature of geomorphic systems. Over the past decade, there has been a proliferation of research at the interface of geomorphology and resilience thinking, and the 2017 Binghamton Symposium brought together leading researchers from both communities to address mutual concerns and challenges of these two disciplines. This paper reviews some of the key intersections between the disciplines of bio-geomorphology and resilience thinking, and the papers presented at the symposium. The papers in this volume illustrate the current status of the disciplines, the difficulties in bridging the disciplines, and the issues that are emerging as research priorities.

Bioethics and Moral Agency: On Autonomy and Moral Responsibility.

PubMed

Skalko, John; Cherry, Mark J

2016-10-01

Two clusters of essays in this issue of The Journal of Medicine and Philosophy provide a critical gaze through which to explore central moral, phenomenological, ontological, and political concerns regarding human moral agency and personal responsibility. The first cluster challenges common assumptions in bioethics regarding the voluntariness of human actions. The second set turns the debate towards morally responsible choice within the requirements of distributive justice. The force of their collective analysis leaves us with a well-founded basis critically to approach any account of bioethics or health policy that is insufficiently attentive to the central challenges of human freedom and responsible free choice. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

Technical challenges for the future of high energy lasers

NASA Astrophysics Data System (ADS)

LaFortune, K. N.; Hurd, R. L.; Fochs, S. N.; Rotter, M. D.; Pax, P. H.; Combs, R. L.; Olivier, S. S.; Brase, J. M.; Yamamoto, R. M.

2007-02-01

The Solid-State, Heat-Capacity Laser (SSHCL) program at Lawrence Livermore National Laboratory is a multi-generation laser development effort scalable to the megawatt power levels with current performance approaching 100 kilowatts. This program is one of many designed to harness the power of lasers for use as directed energy weapons. There are many hurdles common to all of these programs that must be overcome to make the technology viable. There will be a in-depth discussion of the general issues facing state-of-the-art high energy lasers and paths to their resolution. Despite the relative simplicity of the SSHCL design, many challenges have been uncovered in the implementation of this particular system. An overview of these and their resolution are discussed. The overall system design of the SSHCL, technological strengths and weaknesses, and most recent experimental results will be presented.

The Health Consequences of Obesity in Young Adulthood.

PubMed

Cheng, Hoi Lun; Medlow, Sharon; Steinbeck, Katharine

2016-03-01

Young adults are gaining weight faster than any age group. This weight gain and the appearance of obesity-related comorbidities often commence in adolescence. Psychosocial distress and mental health issues are common and debilitating, and treatment approaches are likely to be similar to those for adolescents. At the same time, young adults may have physical morbidities which will continue and worsen throughout adulthood, such as hypertension, diabetes and polycystic ovarian syndrome. Health consequences of obesity are challenging to manage in young adults as their symptoms may be minimal, they are less likely to engage with healthcare due to other life priorities and their neurocognitive developmental stage makes therapy adherence difficult. Clinicians who manage young adults with obesity need to be aware of these age-specific challenges, as well as the sexual and reproductive health concerns that are present in this age group.

Using Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice.

PubMed

Gillen, Jacob R; Ramirez, Adriana G; Farineau, Diane W; Hoke, Tracey R; Schirmer, Bruce D; Williams, Michael D; Lau, Christine L

Meaningful education of residents in systems-based practice is notoriously challenging, despite its recognition as 1 of the 6 Accreditation Council for Graduate Medical Education core competencies. To address this challenge, surgery residents and other members of the health care team were organized into interdisciplinary workgroups that were tasked with developing solutions to "systems issues" confronted on a daily basis. The project's goals included providing more meaningful, hands-on educational experience for residents in system-based practice, while also generating practical solutions to workflow issues through interprofessional collaboration. Project participants included all surgery residents at the University of Virginia in Charlottesville, VA, as well as surgical health care professionals across all disciplines. Participants were organized into workgroups. Over the course of 3 sessions, each of 1-hour, each workgroup identified commonly encountered systems issues, chose 1 issue to address, and determined an implementable solution for this issue. In total, 140 participants were divided among 13 workgroups. Workgroup topics ranged from improving paging etiquette to standardizing interdisciplinary communication. In total, 9 of the 13 proposals have been piloted or fully implemented as standard practice at our institution, either within a single unit or over the entire health system. This project demonstrates an innovative approach toward resident education in system-based practice, providing residents with a hands-on experience in problem solving from a systems perspective. These interdisciplinary workgroups generated effective solutions to issues that were meaningful to frontline health care providers. Interdisciplinary collaboration within the workgroups served as a valuable team-building exercise to improve relations between the disciplines. This project can serve as a model for other institutions desiring meaningful education in the Accreditation Council for Graduate Medical Education competency of systems-based practice. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

Big Data and Clinicians: A Review on the State of the Science

PubMed Central

Wang, Weiqi

2014-01-01

Background In the past few decades, medically related data collection saw a huge increase, referred to as big data. These huge datasets bring challenges in storage, processing, and analysis. In clinical medicine, big data is expected to play an important role in identifying causality of patient symptoms, in predicting hazards of disease incidence or reoccurrence, and in improving primary-care quality. Objective The objective of this review was to provide an overview of the features of clinical big data, describe a few commonly employed computational algorithms, statistical methods, and software toolkits for data manipulation and analysis, and discuss the challenges and limitations in this realm. Methods We conducted a literature review to identify studies on big data in medicine, especially clinical medicine. We used different combinations of keywords to search PubMed, Science Direct, Web of Knowledge, and Google Scholar for literature of interest from the past 10 years. Results This paper reviewed studies that analyzed clinical big data and discussed issues related to storage and analysis of this type of data. Conclusions Big data is becoming a common feature of biological and clinical studies. Researchers who use clinical big data face multiple challenges, and the data itself has limitations. It is imperative that methodologies for data analysis keep pace with our ability to collect and store data. PMID:25600256

Supporting Middle School Students Whose Parents Are Deployed: Challenges and Strategies for Schools

ERIC Educational Resources Information Center

Williams, Brenda

2013-01-01

Middle school students from military families face unique challenges, especially when their parents are deployed. Among the challenges they experience are frequent relocations; issues that affect academic achievement; uncertainty; and changes in roles, responsibilities, and relationships at home. Reunification involves issues of the returning…

Considering the Challenges of Counselling Practice in Schools

ERIC Educational Resources Information Center

Low, Poi Kee

2009-01-01

School counselling is developing rapidly in many countries around the World. As with any practice in a secondary setting, challenges and special issues are often identified, discussed, and managed. These can be categorized into four distinct domains: 1) Internal challenges, which include issues related to clientele groups, teachers' attitudes…

Have the Answers to Common Legal Questions Concerning Nutrition Support Changed Over the Past Decade? 10 Questions for 10 Years.

PubMed

Barrocas, Albert; Cohen, Michael L

2016-06-01

Clinical nutrition specialists (CNSs) are often confronted with technological, ethical, and legal questions, that is, what can be done technologically, what should be done ethically, and what must be done legally, which conflict at times. The conflict represents a "troubling trichotomy" as discussed in the lead article of this issue of Nutrition in Clinical Practice (NCP). During Clinical Nutrition Week in 2006, a symposium covering these 3 topics was presented, and later that year, an article covering the same topic was published in NCP In this article, we revisit several legal questions/issues that were raised 10 years ago and discuss current answers and approaches. Some of the answers remain unchanged. Other answers have been modified by additional legislation, court decisions, or regulations. In addition, new questions/issues have arisen. Some of the most common questions regarding nutrition support involve the following: liability, informed consent, medical decisional incapacity vs legal competence, advance directive specificity, surrogate decision making, physician orders for life-sustaining treatment and electronic medical orders for life-sustaining treatment, legal definition of death, patient vs family decision making, the noncompliant patient, and elder abuse obligations. In the current healthcare environment, these questions and issues are best addressed via a transdisciplinary team that focuses on function rather than form. The CNS can play a pivotal role in dealing with these challenges by applying the acronym ACT: being Accountable and Communicating with all stakeholders while actively participating as an integral part of the transdisciplinary Team. © 2016 American Society for Parenteral and Enteral Nutrition.

[Big Data- challenges and risks].

PubMed

Krauß, Manuela; Tóth, Tamás; Hanika, Heinrich; Kozlovszky, Miklós; Dinya, Elek

2015-12-06

The term "Big Data" is commonly used to describe the growing mass of information being created recently. New conclusions can be drawn and new services can be developed by the connection, processing and analysis of these information. This affects all aspects of life, including health and medicine. The authors review the application areas of Big Data, and present examples from health and other areas. However, there are several preconditions of the effective use of the opportunities: proper infrastructure, well defined regulatory environment with particular emphasis on data protection and privacy. These issues and the current actions for solution are also presented.

Use of outsourced nurses in long-term acute care hospitals: outcomes and leadership preferences.

PubMed

Alvarez, M Raymond; Kerr, Bernard J; Burtner, Joan; Ledlow, Gerald; Fulton, Larry V

2011-02-01

When staffing effectiveness is not maintained over time, the likelihood of negative outcomes increases. This challenge is particularly problematic in long-term acute care hospitals (LTACHs) where use of outsourced temporary nurses is common when providing safe, sufficient care to medically complex patients who require longer hospital stays than normally would occur. To assess this issue, the authors discuss the outcomes of their survey of LTACH chief nursing officers that demonstrated LTACH quality indicators and overall patient satisfaction were within nationally accepted benchmarks even with higher levels of outsourced nurses used in this post-acute care setting.

Beyond specific pathogen-free: biology and effect of common viruses in macaques.

PubMed

Lerche, Nicholas W; Simmons, Joe H

2008-02-01

Macaque models have contributed to key advances in our basic knowledge of behavior, anatomy, and physiology as well as to our understanding of a wide variety of human diseases. This issue of Comparative Medicine focuses on several of the viral agents (members of Retroviridae, Herpesviridae and 2 small DNA viruses) that can infect both nonhuman primates and humans as well as confound research studies. Featured articles also address the challenges of developing colonies of macaques and other nonhuman primates that are truly specific pathogen-free for these and other adventitious infectious agents.

Applying computation biology and "big data" to develop multiplex diagnostics for complex chronic diseases such as osteoarthritis.

PubMed

Ren, Guomin; Krawetz, Roman

2015-01-01

The data explosion in the last decade is revolutionizing diagnostics research and the healthcare industry, offering both opportunities and challenges. These high-throughput "omics" techniques have generated more scientific data in the last few years than in the entire history of mankind. Here we present a brief summary of how "big data" have influenced early diagnosis of complex diseases. We will also review some of the most commonly used "omics" techniques and their applications in diagnostics. Finally, we will discuss the issues brought by these new techniques when translating laboratory discoveries to clinical practice.

Beyond Specific Pathogen-Free: Biology and Effect of Common Viruses in Macaques

PubMed Central

Lerche, Nicholas W; Simmons, Joe H

2008-01-01

Macaque models have contributed to key advances in our basic knowledge of behavior, anatomy, and physiology as well as to our understanding of a wide variety of human diseases. This issue of Comparative Medicine focuses on several of the viral agents (members of Retroviridae, Herpesviridae and 2 small DNA viruses) that can infect both nonhuman primates and humans as well as confound research studies. Featured articles also address the challenges of developing colonies of macaques and other nonhuman primates that are truly specific pathogen-free for these and other adventitious infectious agents. PMID:19793451

Discharge lamp technologies

NASA Technical Reports Server (NTRS)

Dakin, James

1994-01-01

This talk is an overview of discharge lamp technology commonly employed in general lighting, with emphasis on issues pertinent to lighting for plant growth. Since the audience is primarily from the plant growth community, and this begins the light source part of the program, we will start with a brief description of the discharge lamps. Challenges of economics and of thermal management make lamp efficiency a prime concern in controlled environment agriculture, so we will emphasize science considerations relating to discharge lamp efficiency. We will then look at the spectra and ratings of some representative lighting products, and conclude with a discussion of technological advances.

Hiring an associate dean of academic affairs.

PubMed

Pressler, Jana L; Kenner, Carole A

2009-01-01

Many new nursing leaders assuming deanships, assistant deanships, or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Effecting change in striving to achieve capacity.

PubMed

Pressler, Jana L; Kenner, Carole

2007-01-01

Many new nursing leaders assuming deanships and assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Embracing new directions in curricula and teaching.

PubMed

Pressler, Jana L; Kenner, Carole

2009-01-01

Many new nursing leaders assuming deanships or assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Addressing the underperformance of faculty and staff.

PubMed

Kenner, Carole; Pressler, Jana L

2006-01-01

Many new nursing leaders assuming work as deans, assistant deans, or interim deans have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, both deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

When does outsourcing become a right source for academic excellence?

PubMed

Kenner, Carole; Pressler, Jana L

2006-01-01

Many new nursing leaders assuming deanships, assistant deanships, or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Capitalizing on joint ventures to economize in nursing.

PubMed

Pressler, Jana L; Kenner, Carole A

2010-01-01

Many new nursing leaders assuming deanships, assistant, or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Starting small and early for research funding.

PubMed

Pressler, Jana L; Kenner, Carole A

2009-01-01

Many new nursing leaders assuming deanships or assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

The ripple effect: advancing faculty research?

PubMed

Kenner, Carole; Pressler, Jana L

2008-01-01

Many new nursing leaders assuming deanships or assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Performance evaluations and literacy.

PubMed

Pressler, Jana L; Kenner, Carole A

2009-01-01

Many new nursing leaders assuming deanships or assistant or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, 2 deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Press coverage of the new psychology by the New York Times during the progressive era.

PubMed

Dennis, Paul M

2011-05-01

Press coverage of psychology by the New York Times was examined for the Progressive Era. Following a period in which psychology was associated with spiritualism, psychoanalysis, and the Emmanuel movement, the Times gave editorial preference to reports about psychology's applications. Reaching an audience that was both affluent and influential, the topics emphasized by the Times included the lie detector, psychological applications in the work place, mental tests, and child psychology. These areas reflected issues of social concern to Progressives, publicized the rise of the psychologist as expert, and aided psychology in its challenge to common sense.

Clinical Trial Design in Neuroendocrine Tumors.

PubMed

Halperin, Daniel M; Yao, James C

2016-02-01

Neuroendocrine tumors (NETs) present tremendous opportunities for productive clinical investigation, but substantial challenges as well. Investigators must be aware of common pitfalls in study design, informed by an understanding of the history of trials in the field, to make the best use of available data and our patient volunteers. We believe the salient issues in clinical trial design and interpretation in the NET field are patient homogeneity, standardized response assessment, and rigorous design and execution. Whether designing or interpreting a study in patients with NET, these principles should drive assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis article: accuracy of the DIDGET glucose meter in children and young adults with diabetes.

PubMed

Kim, Sarah

2011-09-01

Diabetes is one of the most common chronic diseases among American children. Although studies show that intensive management, including frequent glucose testing, improves diabetes control, this is difficult to accomplish. Bayer's DIDGET® glucose meter system pairs with a popular handheld video game system and couples good blood glucose testing habits with video-game-based rewards. In this issue, Deeb and colleagues performed a study demonstrating the accuracy of the DIDGET meter, a critical asset to this novel product designed to alleviate some of the challenges of managing pediatric diabetes. © 2011 Diabetes Technology Society.

Return on investment: an essential economics measure in higher education.

PubMed

Pressler, Jana L; Kenner, Carole A

2014-01-01

Many new nursing leaders assuming deanships, assistant deanships, or interim deanships have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Responding to Policy Challenges with Research Evidence: Introduction to Special Issue

ERIC Educational Resources Information Center

Aydarova, Elena; Berliner, David C.

2018-01-01

In a policy climate where various actors claim to have solutions for the enduring challenges of teacher education, policy deliberations sideline certain voices and omit important perspectives. This special issue brings together scholars who attend to the voices, perspectives, and issues overlooked by teacher education policy debates dominated by…

Extending New Paradigm Childhood Research: Meeting the Challenges of Including Younger Children

ERIC Educational Resources Information Center

Darbyshire, Philip; Schiller, Wendy; MacDougall, Colin

2005-01-01

This special issue of "Early Child Development and Care" focuses on the issues involved in researching the views and experiences of young children. Challenging issues need to be addressed. For example, what constitutes ethical questioning of children? What are young children's rights as research respondents? What is meaningful 'informed consent'…

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

ERIC Educational Resources Information Center

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

2015-01-01

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

Cough: an unmet clinical need

PubMed Central

Dicpinigaitis, Peter V

2011-01-01

Cough is among the most common complaints for which patients worldwide seek medical attention. Thus, the evaluation and treatment of cough result in tremendous financial expenditure and consumption of health care resources. Yet, despite the clinical significance of cough, research efforts aimed at improving diagnostic capabilities and developing more effective therapeutic agents have been, to date, disappointing in their limited scope and outcomes. Acute cough due to the common cold represents the most common type of cough. Currently, available medications for the symptomatic management of acute cough are inadequate due to lack of proven efficacy and/or their association with undesirable or intolerable side effects at anti-tussive doses. Subacute cough, often representing a prolonged post-viral response, is typically refractory to standard anti-tussive therapy. Few clinical trials have evaluated therapeutic options for subacute cough. Diagnostic challenges facing the clinician in the management of chronic cough include the determination of whether symptoms of upper airway cough syndrome (formerly, postnasal drip syndrome) or gastro-oesophageal reflux disease are indeed the underlying cause of cough. Chronic, refractory unexplained (formerly, idiopathic) cough must be distinguished from cough that has not been fully evaluated and treated according to current guideline recommendations. Eagerly awaited are new safe and effective anti-tussive agents for use when cough suppression is desired, regardless of underlying aetiology of cough, as well as practical, validated ambulatory cough counters to aid clinical assessment and future research in the field of cough. LINKED ARTICLES This article is part of a themed issue on Respiratory Pharmacology. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2011.163.issue-1 PMID:21198555

Strategic Challenges during Changing Times: A Prioritized Research Program, 1994

DTIC Science & Technology

1994-04-01

and planning. 14, SUBJECT T[RMS 15 NUMBER OF PAGES strategic assessments; domestic and global issues and 5 trends; peace operations; political...1994 or which, for a variety of reasons, will riot be published. 3 SECTION I TRANSREGIONAL SECURITY CONCERNS Regional Challenges, Global Issues . When...but global issues . Global security issues derive from three forms of connectivity. The first is economic. Today, there is truly a world economy. Markets

[Merging different biobanks under one roof : Benefits and constraints on the way to a centralized biobank using the example of the BMBH].

PubMed

Schmitt, S; Döllinger, C; Maier, A; Herpel, E; Schirmacher, P; Kirsten, R

2018-05-23

Founded in 1386, Heidelberg University is Germany's oldest and one of Europe's most reputable universities. As a scientific hub in Germany, Heidelberg is home to several internationally renowned medical research facilities that have an enormous demand for biomaterial samples and data-especially in the field of translational and cancer research.The main objective of the BMBF-funded project "BioMaterialBank Heidelberg" (BMBH) was the harmonization of local biobanking under the same administrative roof through the implementation of common and standardized project, data, and quality management procedures.In the very beginning, existing structures and processes of the participating biobanks in Heidelberg were identified and a common administrative structure with central representatives for IT and quality management (QM) was established to coordinate all BMBH activities.Over time, implementation of consented structures and processes took place, also revealing organizational challenges that had to be solved concerning, for example, differences in sample handling and the definition of consistent access regulations.We will discuss below these challenges as well as the opportunities of building a centralized biobank and show how issues can be resolved using the example of the BMBH.

Transition of Care from Childhood to Adulthood: Congenital Hypogonadotropic Hypogonadism.

PubMed

Dwyer, Andrew A; Pitteloud, Nelly

2018-01-01

Passage from childhood to adult life involves biological changes culminating in full reproductive capacity as well as psychosocial development. For patients with congenital hypogonadotropic hypogonadism (CHH), this can be an emotionally challenging time as their pubertal failure results in striking physical differences from their peers. CHH is difficult to differentiate from common disorders of puberty such as constitutional delay of growth and puberty. As such, delays in diagnosis are frequent, and it is a common source of stress and frustration for these adolescents. While effective treatments are available for inducing puberty and attaining fertility is possible in most cases, patients may find it difficult to cope with living with CHH. A critical issue for adolescents with CHH is the risk for being lost to follow-up during the transition from pediatric-centered care to adult care. This article will review the state of the art in diagnosis and treatment of patients with CHH with a particular focus on supporting an effective transition from pediatric-centered care to adult-oriented endocrine services. A synthesis of best practices is offered to help guide clinicians in supporting patients and families during this challenging period of care. © 2018 S. Karger AG, Basel.

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.

The MUSOS (MUsic SOftware System) Toolkit: A computer-based, open source application for testing memory for melodies.

PubMed

Rainsford, M; Palmer, M A; Paine, G

2018-04-01

Despite numerous innovative studies, rates of replication in the field of music psychology are extremely low (Frieler et al., 2013). Two key methodological challenges affecting researchers wishing to administer and reproduce studies in music cognition are the difficulty of measuring musical responses, particularly when conducting free-recall studies, and access to a reliable set of novel stimuli unrestricted by copyright or licensing issues. In this article, we propose a solution for these challenges in computer-based administration. We present a computer-based application for testing memory for melodies. Created using the software Max/MSP (Cycling '74, 2014a), the MUSOS (Music Software System) Toolkit uses a simple modular framework configurable for testing common paradigms such as recall, old-new recognition, and stem completion. The program is accompanied by a stimulus set of 156 novel, copyright-free melodies, in audio and Max/MSP file formats. Two pilot tests were conducted to establish the properties of the accompanying stimulus set that are relevant to music cognition and general memory research. By using this software, a researcher without specialist musical training may administer and accurately measure responses from common paradigms used in the study of memory for music.

Rural Matters: The Rural Challenge News, 1997-2000.

ERIC Educational Resources Information Center

Rural Matters: The Rural Challenge News, 2000

2000-01-01

This document contains the 10 quarterly issues of "Rural Matters: The Rural Challenge News," published from Fall 1997 to Winter 2000 (the final issue). This newsletter focused on projects funded by the Annenberg Rural Challenge, as well as research summaries and opinion pieces on the benefits of small schools, place-based education, and…

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that might not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A 2-day consensus meeting was held on November 18-19, 2008 in Chicago, IL, to achieve the objective. Before the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock production specialists, journal editors, assistant editors, and associate editors. Before the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items would need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional subitem was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

Convergent ethical issues in HIV/AIDS, tuberculosis and malaria vaccine trials in Africa: Report from the WHO/UNAIDS African AIDS Vaccine Programme's Ethics, Law and Human Rights Collaborating Centre consultation, 10-11 February 2009, Durban, South Africa.

PubMed

Mamotte, Nicole; Wassenaar, Douglas; Koen, Jennifer; Essack, Zaynab

2010-03-09

Africa continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges. In order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009. Key cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing. The consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields.

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.

Primary Care Providers Report Challenges to Cirrhosis Management and Specialty Care Coordination.

PubMed

Beste, Lauren A; Harp, Bonnie K; Blais, Rebecca K; Evans, Ginger A; Zickmund, Susan L

2015-09-01

Two-thirds of patients with cirrhosis do not receive guideline-concordant liver care. Cirrhosis patients are less likely to receive recommended care when followed exclusively by primary care providers (PCPs), as opposed to specialty co-management. Little is known about how to optimize cirrhosis care delivered by PCPs. We conducted a qualitative analysis to explore PCPs' attitudes and self-reported roles in caring for patients with cirrhosis. We recruited PCPs from seven Veterans Affairs facilities in the Pacific Northwest via in-service trainings and direct email from March to October 2012 (n = 24). Trained staff administered structured telephone interviews covering: (1) general attitudes; (2) roles and practices; and (3) barriers and facilitators to cirrhosis management. Two trained, independent coders reviewed each interview transcript and thematically coded responses. Three overarching themes emerged in PCPs' perceptions of cirrhosis patients: the often overwhelming complexity of comorbid medical, psychiatric, and substance issues; the importance of patient self-management; and challenges surrounding specialty care involvement and co-management of cirrhosis. While PCPs felt they brought important skills to bear, such as empathy and care coordination, they strongly preferred to defer major cirrhosis management decisions to specialists. The most commonly reported barriers to care included patient behaviors, access issues, and conflicts with specialists. PCPs perceive Veterans with cirrhosis as having significant medical and psychosocial challenges. PCPs tend not to see their role as directing cirrhosis-related management decisions. Educational efforts directed at PCPs must foster PCP empowerment and improve comfort with managing cirrhosis.

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

Germain, Shawn

Nuclear Power Plant (NPP) refueling outages create some of the most challenging activities the utilities face in both tracking and coordinating thousands of activities in a short period of time. Other challenges, including nuclear safety concerns arising from atypical system configurations and resource allocation issues, can create delays and schedule overruns, driving up outage costs. Today the majority of the outage communication is done using processes that do not take advantage of advances in modern technologies that enable enhanced communication, collaboration and information sharing. Some of the common practices include: runners that deliver paper-based requests for approval, radios, telephones, desktopmore » computers, daily schedule printouts, and static whiteboards that are used to display information. Many gains have been made to reduce the challenges facing outage coordinators; however; new opportunities can be realized by utilizing modern technological advancements in communication and information tools that can enhance the collective situational awareness of plant personnel leading to improved decision-making. Ongoing research as part of the Light Water Reactor Sustainability Program (LWRS) has been targeting NPP outage improvement. As part of this research, various applications of collaborative software have been demonstrated through pilot project utility partnerships. Collaboration software can be utilized as part of the larger concept of Computer-Supported Cooperative Work (CSCW). Collaborative software can be used for emergent issue resolution, Outage Control Center (OCC) displays, and schedule monitoring. Use of collaboration software enables outage staff and subject matter experts (SMEs) to view and update critical outage information from any location on site or off.« less

The National Trauma Institute: Lessons learned in the funding and conduct of 16 trauma research studies.

PubMed

Price, Michelle A; Beilman, Gregory J; Fabian, Timothy C; Hoyt, David B; Jurkovich, Gregory J; Knudson, M Margaret; MacKenzie, Ellen J; Marshall, Vivienne S; Overton, Kimberly E; Peitzman, Andrew B; Phillips, Monica J; Pruitt, Basil A; Smith, Sharon L; Stewart, Ronald M; Jenkins, Donald H

2016-09-01

To increase trauma-related research and elevate trauma on the national research agenda, the National Trauma Institute (NTI) issued calls for proposals, selected funding recipients, and coordinated 16 federally funded (Department of Defense) trauma research awards over a 4-year period. We sought to collect and describe the lessons learned from this activity to inform future researchers of barriers and facilitators. Fifteen principal investigators participated in semistructured interviews focused on study management issues such as securing institutional approvals, screening and enrollment, multisite trials management, project funding, staffing, and institutional support. NTI Science Committee meeting minutes and study management data were included in the analysis. Simple descriptive statistics were generated and textual data were analyzed for common themes. Principal investigators reported challenges in obtaining institutional approvals, delays in study initiation, screening and enrollment, multisite management, and study funding. Most were able to successfully resolve challenges and have been productive in terms of scholarly publications, securing additional research funding, and training future trauma investigators. Lessons learned in the conduct of the first two funding rounds managed by NTI are instructive in four key areas: regulatory processes, multisite coordination, adequate funding, and the importance of an established research infrastructure to ensure study success. Recommendations for addressing institution-related and investigator-related challenges are discussed along with ongoing advocacy efforts to secure sustained federal funding of a national trauma research program commensurate with the burden of injury.

Factor for felons: how can we provide haemophilia care to the incarcerated?

PubMed

Lambing, A; Kachalsky, E; Mueller, L M; Kuriakose, P

2015-11-01

In 2011, 6.98-million offenders were documented in the adult correctional system, with state operating costs designated 12% towards medical care ($11.97 day per inmate) for the general population. Common co-existing health problems identified are: arthritis (13%), hypertension (11%), asthma (10%) and heart problems (6%). Less than 5% of inmates have health issues related to cancer, diabetes, liver or renal problems and communicable diseases. The leading cause of death is suicide (33.2%), followed by heart disease (26.1%). Despite these statistics quality is lacking. Given these statistics, one would expect that a small proportion of patients from Hemophilia Treatment Center (HTC) will spend some time within the justice system. Currently there are no data addressing haemophilia care needs while incarcerated. This article will review the current health care issues in the adult correctional system. Additionally, six case reports of incarcerated haemophiliacs will be highlighted exploring the successes and challenges with maintaining haemophilia care addressing the priority of meeting the haemophilia care needs verses the penal system regulations. It can be expected that at some point, the HTC will experience a patient incarcerated for some period of time. The HTC will continue to advocate for their patient within this system, despite the many challenges faced. Despite the challenges outlined, ongoing communication and education with the correctional system, education of the medical personnel and prison personnel remains the priority as we advocate for our patients. Continued strategies in these areas are paramount. © 2015 John Wiley & Sons Ltd.

Ethics of research for patients in pain.

PubMed

Waisel, David B

2017-04-01

This review describes advances in rising and continuing ethical issues in research in patients in pain. Although some of the issues focus directly on pain research, such as research in neonatal pain management, others focus on widespread ethical issues that are relevant to pain research, such as scientific misconduct, deception, placebo use and genomics. Scientific misconduct is more widespread than realized and requires greater awareness of the markers of misconduct like irreproducibility. More education about what qualifies as misconduct, such as consent violations, plagiarism and inappropriate patient recruitment along with data falsification needs to be implemented. Wayward researchers may attend a rehabilitation conference to improve their practices. Studies in neonatal pain management do not require comparing an intervention with the inadequate analgesia of a placebo; comparing with a standard approach is sufficient. Deception of research patients may be acceptable under narrow circumstances. The legitimacy of using broad informed consent for biobanking and genomic studies are being challenged as changes to the Common Rule are being considered. Increasing complexity and the desire to further medical knowledge complicates research methods and informed consent. The ethical issues surrounding these and offshoot areas will continue to develop.

The informal curriculum - general practitioner perceptions of ethics in clinical practice.

PubMed

Sturman, Nancy J; Parker, Malcolm; van Driel, Mieke L

2012-12-01

Australian medical students should graduate with an understanding of the principles of medical law and ethics, and their application to clinical settings. Although student perspectives have been studied previously, the teacher experience of ethical issues also needs to be understood, particularly in the general practice setting. Interviews were conducted with a convenience sample of 13 general practitioner teachers. They were asked to reflect on common and/or important ethical issues in their day-to-day practice. An inductive thematic analysis of the data was performed by two investigators, who reached a consensus on major themes using an iterative, dialogic process. Participants reported negotiating ethical issues frequently. Major themes included patient-doctor relationships, professional differences, truth-telling, ethically 'grey' areas and the personal demands of ethical decision making. General practitioners in this study describe sometimes needing to apply judgement and compromise in situations involving legal or ethical issues, in order to act in the best interests of patients and to successfully negotiate the patient-doctor relationship. Students learning in this clinical context may perceive mixed messages and ethical lapses in these challenging 'grey' areas. The ethical acumen and emotional resilience of both students and clinical teachers may be enhanced by ongoing reflective discussion with colleagues.

The United States and Japan pursue a common agenda.

PubMed

Westley, S B

1996-10-01

In July 1993, the US and Japan formed the "Common Agenda for Cooperation in Global Perspective," an economic alliance to promote health and human development, respond to challenges to global stability, protect the global environment, advance science and technology, and foster exchanges for mutual understanding. A Global Issues Initiative (GII) has been created within this framework to support family planning, HIV and sexually transmitted disease prevention and control efforts, maternal and child health, primary health care, and women's empowerment. Participation in the GII has led Japan to more than double the technical assistance it provides and to broaden its geographic focus from Asia to the entire developing world. The US continues to fund population and health programs in more than 50 countries. The Common Agenda grew out of a US-Japan development assistance policy consultation dialogue known as the "Honolulu process," which sought ways to promote mutual understanding among US and Japanese development assistance personnel (through international internships) and nongovernmental organizations and to identify specific areas for joint or parallel development projects. Cooperative activities are underway in the Philippines, Indonesia, Bangladesh, India, Ghana, Peru, Guatemala, Mexico, and Jamaica. Joint project evaluations have also taken place in Zambia and Ghana. The Common Agenda's Children's Health Initiative has supported such initiatives as achieving child immunization in the Newly Independent States and joint efforts to eradicate polio and micronutrient disorders. The Women in Development initiative enhances girls' education and assists women engaged in small-scale enterprises. After initial difficulties in agreeing on joint strategies, the Common Agenda has been an "overwhelmingly positive" experience with the potential to meet critical challenges, because Japan and the US account for 40% of all development assistance worldwide.

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.

Key statistical and analytical issues for evaluating treatment effects in periodontal research.

PubMed

Tu, Yu-Kang; Gilthorpe, Mark S

2012-06-01

Statistics is an indispensible tool for evaluating treatment effects in clinical research. Due to the complexities of periodontal disease progression and data collection, statistical analyses for periodontal research have been a great challenge for both clinicians and statisticians. The aim of this article is to provide an overview of several basic, but important, statistical issues related to the evaluation of treatment effects and to clarify some common statistical misconceptions. Some of these issues are general, concerning many disciplines, and some are unique to periodontal research. We first discuss several statistical concepts that have sometimes been overlooked or misunderstood by periodontal researchers. For instance, decisions about whether to use the t-test or analysis of covariance, or whether to use parametric tests such as the t-test or its non-parametric counterpart, the Mann-Whitney U-test, have perplexed many periodontal researchers. We also describe more advanced methodological issues that have sometimes been overlooked by researchers. For instance, the phenomenon of regression to the mean is a fundamental issue to be considered when evaluating treatment effects, and collinearity amongst covariates is a conundrum that must be resolved when explaining and predicting treatment effects. Quick and easy solutions to these methodological and analytical issues are not always available in the literature, and careful statistical thinking is paramount when conducting useful and meaningful research. © 2012 John Wiley & Sons A/S.

The Management, Storage, Utilization of Astronomical Data in the 21st Century Version 1.00

NASA Astrophysics Data System (ADS)

Hanisch, Bob; Quinn, Peter; Lawrence, Andy; Hanisch, Bob

2004-03-01

The costs and resources associated with the development of forefront astronomical research capabilities often greatly exceed the funding capacities of individual universities, research organizations, and nations (e.g., Atacama Large Millimeter Array [ALMA], The Square Kilometre Array [SKA], and Extremely Large (optical) Telescopes in the 30m-100m class [ELTs]). Collaborative alliances of organizations and nations are therefore being formed to build new, facility-class astronomical observatories across the globe. This expansion and globalization of the astronomical research effort raises a number of major issues that need to be confronted and solved by astronomers, research funding bodies, and governments. Some of these issues are being met by other sciences and some are unique to the research diversity inherent in exploring the Universe through multiple, complementary wavelength windows. In all cases, the challenges of managing, maximally utilizing, and collaboratively sharing the huge volume of digital information flowing from these new observatories is focusing and leading the discussion of critical issues for success. This discussion paper seeks to identify a number of these major issues, to highlight a new vision for a common research infrastructure that will enable some of these issues to be addressed, and further, to identify some of the practical and policy issues associated with long term solutions and the maximal return on a global research investments.

The UNESCO Bioethics Programme: a review.

PubMed

Langlois, Adéle

2014-01-01

UNESCO's Bioethics Programme was established in 1993. In twenty years it has adopted three international declarations, on the human genome (1997), human genetic data (2003) and bioethics (2005); produced reports on a wide range of bioethics issues; and developed capacity building and public education programmes in bioethics. Yet UNESCO has sometimes struggled to assert its authority in the wider bioethics world. Some bioethicists have criticized the 2005 declaration and suggested that the World Health Organization might be better placed to advance bioethics. In 2011, after four years of debate, UNESCO decided not to draft a convention on human reproductive cloning, because consensus on the issue proved impossible. This article reviews the standard setting and capacity building activities of the UNESCO Bioethics Programme. While the Programme faces challenges common to most intergovernmental organizations, its achievements in expanding international law and building bioethics capacity should not be underestimated.

Surgical ethics: surgical virtue and more.

PubMed

Vercler, Christian J

2015-01-01

The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

Improving cold chain systems: Challenges and solutions.

PubMed

Ashok, Ashvin; Brison, Michael; LeTallec, Yann

2017-04-19

While a number of new vaccines have been rolled out across the developing world (with more vaccines in the pipeline), cold chain systems are struggling to efficiently support national immunization programs in ensuring the availability of safe and potent vaccines. This article reflects on the Clinton Health Access Initiative, Inc. (CHAI) experience working since 2010 with national immunization programs and partners to improve vaccines cold chains in 10 countries-Ethiopia, Nigeria, Kenya, Malawi, Tanzania, Uganda, Cameroon, Mozambique, Lesotho and India - to identify the root causes and solutions for three common issues limiting cold chain performance. Key recommendations include: Collectively, the solutions detailed in this article chart a path to substantially improving the performance of the cold chain. Combined with an enabling global and in-country environment, it is possible to eliminate cold chain issues as a substantial barrier to effective and full immunization coverage over the next few years. Copyright © 2017. Published by Elsevier Ltd.

An overview of chronic kidney disease management and CAPD in the home.

PubMed

Jain, Neerja; Simoyi, Pat

2008-05-01

Chronic kidney disease (CKD) is a common, harmful, but treatable long term condition. An overview of CKD is provided in this article. Kidney Research UK, www.kidneyresearchuk.org a national charity dedicated to research, has developed the A Better Life through Education and empowerment (ABLE) programme which seeks to research and raise awareness o the issues among 'at risk' groups as well as among relevant health professionals. Part Two of the renal NSF suggests many actions that can be taken in primary care to prevent CKD. In the event of Established Renal Failure (ERF), there are a number of treatment options available including continuous ambulatory peritoneal dialysis (CAPD), described here. Kidney Research UK's Patient DVD module two (complimentary copy attached to this issue) provides more detail using case studies. The DVD offers practical help, support and guidance on how to overcome some of the challenges.

Business Architecture Development at Public Administration - Insights from Government EA Method Engineering Project in Finland

NASA Astrophysics Data System (ADS)

Valtonen, Katariina; Leppänen, Mauri

Governments worldwide are concerned for efficient production of services to customers. To improve quality of services and to make service production more efficient, information and communication technology (ICT) is largely exploited in public administration (PA). Succeeding in this exploitation calls for large-scale planning which embraces issues from strategic to technological level. In this planning the notion of enterprise architecture (EA) is commonly applied. One of the sub-architectures of EA is business architecture (BA). BA planning is challenging in PA due to a large number of stakeholders, a wide set of customers, and solid and hierarchical structures of organizations. To support EA planning in Finland, a project to engineer a government EA (GEA) method was launched. In this chapter, we analyze the discussions and outputs of the project workshops and reflect emerged issues on current e-government literature. We bring forth insights into and suggestions for government BA and its development.

Combinatorial biomatrix/cell-based therapies for restoration of host tissue architecture and function

PubMed Central

Cantu, David Antonio; Kao, W. John

2014-01-01

This Progress Report reviews recent advances in the utility of extracellular matrix (ECM)-mimic biomaterials in presenting and delivering therapeutic cells to promote tissue healing. This overview gives a brief introduction of different cell types being used in regenerative medicine and tissue engineering while addressing critical issues that must be overcome before cell-based approaches can be routinely employed in the clinic. A selection of 5 commonly used cell-associated, biomaterial platforms (collagen, hyaluronic acid, fibrin, alginate, and poly(ethylene glycol)) are reviewed for treatment of a number of acute injury or diseases with emphasis on animal models and clinical trials. This article concludes with current challenges and future perspectives regarding foreign body host response to biomaterials and immunological reactions to allogeneic or xenogeneic cells, vascularization and angiogenesis, matching mechanical strength and anisotropy of native tissues, as well as other non-technical issues regarding the clinical translation of biomatrix/cell-based therapies. PMID:23828863

Breaking barriers in the genomics and pharmacogenetics of drug addiction

PubMed Central

Ho, MK; Goldman, D; Heinz, A; Kaprio, J; Kreek, MJ; Li, MD; Munafò, MR; Tyndale, RF

2013-01-01

Drug addictions remain a substantial health issue, with limited treatment options currently available. Despite considerable advances in the understanding of our genetic architecture, the genetic underpinning of complex disorders remains elusive. Numerous candidate genes have been implicated in the etiology and response to treatment for different addictions based on our current understanding of the neurobiology. Genome-wide association studies have also provided novel targets. However, replication of these studies is often lacking which complicates interpretation; this will improve as issues such as phenotypic characterization, the apparent “missing heritability”, the identification of functional variants, and possible gene-environment interactions are addressed. In addition, there is growing evidence that genetic information can be useful for refining the choice of addiction treatment. As genetic testing becomes more common in the practice of medicine, a variety of ethical and practical challenges, some of which are unique to drug addiction, will also need to be considered. PMID:20981002

Evolutionary perspectives on wildlife disease: concepts and applications

PubMed Central

Vander Wal, Eric; Garant, Dany; Pelletier, Fanie

2014-01-01

Wildlife disease has the potential to cause significant ecological, socioeconomic, and health impacts. As a result, all tools available need to be employed when host–pathogen dynamics merit conservation or management interventions. Evolutionary principles, such as evolutionary history, phenotypic and genetic variation, and selection, have the potential to unravel many of the complex ecological realities of infectious disease in the wild. Despite this, their application to wildlife disease ecology and management remains in its infancy. In this article, we outline the impetus behind applying evolutionary principles to disease ecology and management issues in the wild. We then introduce articles from this special issue on Evolutionary Perspectives on Wildlife Disease: Concepts and Applications, outlining how each is exemplar of a practical wildlife disease challenge that can be enlightened by applied evolution. Ultimately, we aim to bring new insights to wildlife disease ecology and its management using tools and techniques commonly employed in evolutionary ecology. PMID:25469154

Grid Generation for Multidisciplinary Design and Optimization of an Aerospace Vehicle: Issues and Challenges

NASA Technical Reports Server (NTRS)

Samareh, Jamshid A.

2000-01-01

The purpose of this paper is to discuss grid generation issues and to challenge the grid generation community to develop tools suitable for automated multidisciplinary analysis and design optimization of aerospace vehicles. Special attention is given to the grid generation issues of computational fluid dynamics and computational structural mechanics disciplines.

Challenges and Opportunities for Education about Dual Use Issues in the Life Sciences

ERIC Educational Resources Information Center

National Academies Press, 2011

2011-01-01

The Challenges and Opportunities for Education About Dual Use Issues in the Life Sciences workshop was held to engage the life sciences community on the particular security issues related to research with dual use potential. More than 60 participants from almost 30 countries took part and included practicing life scientists, bioethics and…

Technology Transfer Challenges for High-Assurance Software Engineering Tools

NASA Technical Reports Server (NTRS)

Koga, Dennis (Technical Monitor); Penix, John; Markosian, Lawrence Z.

2003-01-01

In this paper, we describe our experience with the challenges thar we are currently facing in our effort to develop advanced software verification and validation tools. We categorize these challenges into several areas: cost benefits modeling, tool usability, customer application domain, and organizational issues. We provide examples of challenges in each area and identrfj, open research issues in areas which limit our ability to transfer high-assurance software engineering tools into practice.

Is There Any Evidence for Rapid, Genetically-Based, Climatic Niche Expansion in the Invasive Common Ragweed?

PubMed

Gallien, Laure; Thuiller, Wilfried; Fort, Noémie; Boleda, Marti; Alberto, Florian J; Rioux, Delphine; Lainé, Juliette; Lavergne, Sébastien

2016-01-01

Climatic niche shifts have been documented in a number of invasive species by comparing the native and adventive climatic ranges in which they occur. However, these shifts likely represent changes in the realized climatic niches of invasive species, and may not necessarily be driven by genetic changes in climatic affinities. Until now the role of rapid niche evolution in the spread of invasive species remains a challenging issue with conflicting results. Here, we document a likely genetically-based climatic niche expansion of an annual plant invader, the common ragweed (Ambrosia artemisiifolia L.), a highly allergenic invasive species causing substantial public health issues. To do so, we looked for recent evolutionary change at the upward migration front of its adventive range in the French Alps. Based on species climatic niche models estimated at both global and regional scales we stratified our sampling design to adequately capture the species niche, and localized populations suspected of niche expansion. Using a combination of species niche modeling, landscape genetics models and common garden measurements, we then related the species genetic structure and its phenotypic architecture across the climatic niche. Our results strongly suggest that the common ragweed is rapidly adapting to local climatic conditions at its invasion front and that it currently expands its niche toward colder and formerly unsuitable climates in the French Alps (i.e. in sites where niche models would not predict its occurrence). Such results, showing that species climatic niches can evolve on very short time scales, have important implications for predictive models of biological invasions that do not account for evolutionary processes.

Quality of life outcomes in 599 cancer and non-cancer patients with colostomies.

PubMed

Krouse, Robert; Grant, Marcia; Ferrell, Betty; Dean, Grace; Nelson, Rebecca; Chu, David

2007-03-01

A colostomy is known to impact negatively on a patient's quality of life (QOL). Concerns include incontinence, rectal discharge, gas, difficulties in returning to work, decreased sexual activity, and travel and leisure challenges. Reports have described QOL outcomes in cancer patients with colostomies and inflammatory bowel syndrome with colostomies, but little has been written regarding a comparison of cancer and non-cancer populations. The purpose of this study was to describe QOL issues of colostomy patients and compare these issues in cancer and non-cancer participants. A QOL-ostomy questionnaire was mailed to 2455 California members of the United Ostomy Association. Of the 1457 respondents (59%), 599 had a colostomy. Most were results from cancer (517/599), with colorectal cancer being the most common diagnosis. The most common benign diagnoses were inflammatory bowel disease and diverticulitis. Demographics were similar, except for more females in the non-cancer group (76%), and increased length of time with colostomy from the cancer group (mean 135.9 versus 106.4 months, P = 0.03). Common QOL problems included sexual problems, gas, constipation, travel difficulties, and dissatisfaction with appearance. Overall, cancer patients had less difficulty adjusting to their colostomies. Results confirmed the negative impact of a colostomy on QOL. While patients with cancer had a better overall QOL than those with benign processes, concerns were common to all colostomy patients. These results provide health care practitioners with information useful in discussing QOL concerns during pre-operation treatment decisions and post operative teaching and follow-up care.

Knowledge Is Power: The Issue of Censorship in Middle Grades Literacy Instruction

ERIC Educational Resources Information Center

Whitney, Jennifer D.

2007-01-01

Book challenges have become more and more frequent in recent years. In particular, those books that address issues most relevant to preteens and teenagers seem to be the object of many challenges. Many of the hundreds of challenged works represent literary classics and high-quality writing for young audiences. Teachers, administrators and other…

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.

A New Gilded Age, and What It Means for Global Health Comment on "Global Health Governance Challenges 2016 - Are We Ready?"

PubMed

Schrecker, Ted

2016-08-17

New contours of global inequality present new challenges for global health, and require that we consider new kinds of health issues as global. I provide a number of illustrations, arguing the need for a political science of health that goes beyond conventional preoccupations with formal institutional and inter-state interactions and takes into account how globalization has affected the health policy landscape and restructured the distribution of economic and political power not only among countries, but also within them. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

GiveMe Shelter: a people-centred design process for promoting independent inquiry-led learning in engineering

NASA Astrophysics Data System (ADS)

Dyer, Mark; Grey, Thomas; Kinnane, Oliver

2017-11-01

It has become increasingly common for tasks traditionally carried out by engineers to be undertaken by technicians and technologist with access to sophisticated computers and software that can often perform complex calculations that were previously the responsibility of engineers. Not surprisingly, this development raises serious questions about the future role of engineers and the education needed to address these changes in technology as well as emerging priorities from societal to environmental challenges. In response to these challenges, a new design module was created for undergraduate engineering students to design and build temporary shelters for a wide variety of end users from refugees, to the homeless and children. Even though the module provided guidance on principles of design thinking and methods for observing users needs through field studies, the students found it difficult to respond to needs of specific end users but instead focused more on purely technical issues.

Controversies and challenges in fibromyalgia: a review and a proposal

PubMed Central

Cohen, Helen

2017-01-01

Fibromyalgia (FM) is the most commonly encountered chronic widespread pain (CWP) condition in rheumatology. In comparison to inflammatory arthritis (IA), it can seem ill defined with no clear understanding of the pathology and therefore no specific targeted treatment. This inevitably raises controversies and challenges. However, this is an outdated view perpetuated by poor teaching of pain at undergraduate and postgraduate levels, and the perennial problem of advances in relevant cross-speciality knowledge penetrating speciality silos. Research has provided a better understanding of the aetiopathology and FM is now regarded as a centralized pain state. Effective treatment is possible utilizing a multidisciplinary approach combining nonpharmacologic and pharmacologic treatments rooted in a biopsychosocial model. This article will provide a review of the mechanisms, diagnosis and treatment of FM, focus on some ongoing contentious issues and propose a change to the diagnostic terminology. PMID:28458723

Earthquake forecasting during the complex Amatrice-Norcia seismic sequence

PubMed Central

Marzocchi, Warner; Taroni, Matteo; Falcone, Giuseppe

2017-01-01

Earthquake forecasting is the ultimate challenge for seismologists, because it condenses the scientific knowledge about the earthquake occurrence process, and it is an essential component of any sound risk mitigation planning. It is commonly assumed that, in the short term, trustworthy earthquake forecasts are possible only for typical aftershock sequences, where the largest shock is followed by many smaller earthquakes that decay with time according to the Omori power law. We show that the current Italian operational earthquake forecasting system issued statistically reliable and skillful space-time-magnitude forecasts of the largest earthquakes during the complex 2016–2017 Amatrice-Norcia sequence, which is characterized by several bursts of seismicity and a significant deviation from the Omori law. This capability to deliver statistically reliable forecasts is an essential component of any program to assist public decision-makers and citizens in the challenging risk management of complex seismic sequences. PMID:28924610

Earthquake forecasting during the complex Amatrice-Norcia seismic sequence.

PubMed

Marzocchi, Warner; Taroni, Matteo; Falcone, Giuseppe

2017-09-01

Earthquake forecasting is the ultimate challenge for seismologists, because it condenses the scientific knowledge about the earthquake occurrence process, and it is an essential component of any sound risk mitigation planning. It is commonly assumed that, in the short term, trustworthy earthquake forecasts are possible only for typical aftershock sequences, where the largest shock is followed by many smaller earthquakes that decay with time according to the Omori power law. We show that the current Italian operational earthquake forecasting system issued statistically reliable and skillful space-time-magnitude forecasts of the largest earthquakes during the complex 2016-2017 Amatrice-Norcia sequence, which is characterized by several bursts of seismicity and a significant deviation from the Omori law. This capability to deliver statistically reliable forecasts is an essential component of any program to assist public decision-makers and citizens in the challenging risk management of complex seismic sequences.

Conceptual Challenges of the Systemic Approach in Understanding Cell Differentiation.

PubMed

Paldi, Andras

2018-01-01

The cells of a multicellular organism are derived from a single zygote and genetically identical. Yet, they are phenotypically very different. This difference is the result of a process commonly called cell differentiation. How the phenotypic diversity emerges during ontogenesis or regeneration is a central and intensely studied but still unresolved issue in biology. Cell biology is facing conceptual challenges that are frequently confused with methodological difficulties. How to define a cell type? What stability or change means in the context of cell differentiation and how to deal with the ubiquitous molecular variations seen in the living cells? What are the driving forces of the change? We propose to reframe the problem of cell differentiation in a systemic way by incorporating different theoretical approaches. The new conceptual framework is able to capture the insights made at different levels of cellular organization and considered previously as contradictory. It also provides a formal strategy for further experimental studies.

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.

Ethical challenges in Emergency Medical Services: controversies and recommendations.

PubMed

Becker, Torben K; Gausche-Hill, Marianne; Aswegan, Andrew L; Baker, Eileen F; Bookman, Kelly J; Bradley, Richard N; De Lorenzo, Robert A; Schoenwetter, David J

2013-10-01

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

CE: Epilepsy Update, Part 1: Refining Our Understanding of a Complex Disease.

PubMed

Smith, Gigi; Wagner, Janelle L; Edwards, Jonathan C

2015-05-01

Epilepsy is a serious, common neurologic disease that affects people of all ages. As underscored in the 2012 Institute of Medicine report Epilepsy Across the Spectrum: Promoting Health and Understanding, the millions of people living with epilepsy in the United States face the challenges of seeking out high-quality, coordinated health care and community services; overcoming epilepsy misinformation and stigma; and finding understanding and support in their communities. This article, the first in a two-part series, discusses new research that has increased our understanding of epilepsy's etiology and pathophysiology, new definitions that are changing the ways we evaluate and treat this disease, conditions that frequently present with epilepsy, and psychosocial challenges faced by people with epilepsy. Part 2, which will appear in next month's issue, reviews comprehensive nursing care and evidence-based treatment for epilepsy and presents resources for people with epilepsy and their families.

Future challenges for vection research: definitions, functional significance, measures, and neural bases

PubMed Central

Palmisano, Stephen; Allison, Robert S.; Schira, Mark M.; Barry, Robert J.

2015-01-01

This paper discusses four major challenges facing modern vection research. Challenge 1 (Defining Vection) outlines the different ways that vection has been defined in the literature and discusses their theoretical and experimental ramifications. The term vection is most often used to refer to visual illusions of self-motion induced in stationary observers (by moving, or simulating the motion of, the surrounding environment). However, vection is increasingly being used to also refer to non-visual illusions of self-motion, visually mediated self-motion perceptions, and even general subjective experiences (i.e., “feelings”) of self-motion. The common thread in all of these definitions is the conscious subjective experience of self-motion. Thus, Challenge 2 (Significance of Vection) tackles the crucial issue of whether such conscious experiences actually serve functional roles during self-motion (e.g., in terms of controlling or guiding the self-motion). After more than 100 years of vection research there has been surprisingly little investigation into its functional significance. Challenge 3 (Vection Measures) discusses the difficulties with existing subjective self-report measures of vection (particularly in the context of contemporary research), and proposes several more objective measures of vection based on recent empirical findings. Finally, Challenge 4 (Neural Basis) reviews the recent neuroimaging literature examining the neural basis of vection and discusses the hurdles still facing these investigations. PMID:25774143

Airway Problems in Neonates—A Review of the Current Investigation and Management Strategies

PubMed Central

Mok, Quen

2017-01-01

Airway problems in the neonatal population are often life threatening and raise challenging issues in diagnosis and management. The airway problems can result from congenital or acquired lesions and can be broadly classified into those causing obstruction or those due to an abnormal “communication” in the airway. Many different investigations are now available to identify the diagnosis and quantify the severity of the problem, and these tests can be simple or invasive. Bronchography and bronchoscopy are essential to determine the extent and severity of the airway problem and to plan treatment strategy. Further imaging techniques help to delineate other commonly associated abnormalities. Echocardiography is also important to confirm any associated cardiac abnormality. In this review, the merits and disadvantages of the various investigations now available to the clinician will be discussed. The current therapeutic strategies are discussed, and the review will focus on the most challenging conditions that cause the biggest management conundrums, specifically laryngotracheal cleft, congenital tracheal stenosis, and tracheobronchomalacia. Management of acquired stenosis secondary to airway injury from endotracheal intubation will also be discussed as this is a common problem. Slide tracheoplasty is the preferred surgical option for long-segment tracheal stenosis, and results have improved significantly. Stents are occasionally required for residual or recurrent stenosis following surgical repair. There is sufficient evidence that a multidisciplinary team approach for managing complex airway issues provides the best results for the patient. There is ongoing progress in the field with newer diagnostic tools as well as development of innovative management techniques, such as biodegradable stents and stem cell-based tracheal transplants, leading to a much better prognosis for these children in the future. PMID:28424763

Sustainable Sourcing of Global Agricultural Raw Materials: Assessing Gaps in Key Impact and Vulnerability Issues and Indicators

PubMed Central

Springer, Nathaniel P.; Garbach, Kelly; Guillozet, Kathleen; Haden, Van R.; Hedao, Prashant; Hollander, Allan D.; Huber, Patrick R.; Ingersoll, Christina; Langner, Megan; Lipari, Genevieve; Mohammadi, Yaser; Musker, Ruthie; Piatto, Marina; Riggle, Courtney; Schweisguth, Melissa; Sin, Emily; Snider, Sara; Vidic, Nataša; White, Aubrey; Brodt, Sonja; Quinn, James F.; Tomich, Thomas P.

2015-01-01

Understanding how to source agricultural raw materials sustainably is challenging in today’s globalized food system given the variety of issues to be considered and the multitude of suggested indicators for representing these issues. Furthermore, stakeholders in the global food system both impact these issues and are themselves vulnerable to these issues, an important duality that is often implied but not explicitly described. The attention given to these issues and conceptual frameworks varies greatly—depending largely on the stakeholder perspective—as does the set of indicators developed to measure them. To better structure these complex relationships and assess any gaps, we collate a comprehensive list of sustainability issues and a database of sustainability indicators to represent them. To assure a breadth of inclusion, the issues are pulled from the following three perspectives: major global sustainability assessments, sustainability communications from global food companies, and conceptual frameworks of sustainable livelihoods from academic publications. These terms are integrated across perspectives using a common vocabulary, classified by their relevance to impacts and vulnerabilities, and categorized into groups by economic, environmental, physical, human, social, and political characteristics. These issues are then associated with over 2,000 sustainability indicators gathered from existing sources. A gap analysis is then performed to determine if particular issues and issue groups are over or underrepresented. This process results in 44 “integrated” issues—24 impact issues and 36 vulnerability issues —that are composed of 318 “component” issues. The gap analysis shows that although every integrated issue is mentioned at least 40% of the time across perspectives, no issue is mentioned more than 70% of the time. A few issues infrequently mentioned across perspectives also have relatively few indicators available to fully represent them. Issues in the impact framework generally have fewer gaps than those in the vulnerability framework. PMID:26065899

How should the completeness and quality of curated nanomaterial data be evaluated?

NASA Astrophysics Data System (ADS)

Marchese Robinson, Richard L.; Lynch, Iseult; Peijnenburg, Willie; Rumble, John; Klaessig, Fred; Marquardt, Clarissa; Rauscher, Hubert; Puzyn, Tomasz; Purian, Ronit; Åberg, Christoffer; Karcher, Sandra; Vriens, Hanne; Hoet, Peter; Hoover, Mark D.; Hendren, Christine Ogilvie; Harper, Stacey L.

2016-05-01

Nanotechnology is of increasing significance. Curation of nanomaterial data into electronic databases offers opportunities to better understand and predict nanomaterials' behaviour. This supports innovation in, and regulation of, nanotechnology. It is commonly understood that curated data need to be sufficiently complete and of sufficient quality to serve their intended purpose. However, assessing data completeness and quality is non-trivial in general and is arguably especially difficult in the nanoscience area, given its highly multidisciplinary nature. The current article, part of the Nanomaterial Data Curation Initiative series, addresses how to assess the completeness and quality of (curated) nanomaterial data. In order to address this key challenge, a variety of related issues are discussed: the meaning and importance of data completeness and quality, existing approaches to their assessment and the key challenges associated with evaluating the completeness and quality of curated nanomaterial data. Considerations which are specific to the nanoscience area and lessons which can be learned from other relevant scientific disciplines are considered. Hence, the scope of this discussion ranges from physicochemical characterisation requirements for nanomaterials and interference of nanomaterials with nanotoxicology assays to broader issues such as minimum information checklists, toxicology data quality schemes and computational approaches that facilitate evaluation of the completeness and quality of (curated) data. This discussion is informed by a literature review and a survey of key nanomaterial data curation stakeholders. Finally, drawing upon this discussion, recommendations are presented concerning the central question: how should the completeness and quality of curated nanomaterial data be evaluated?Nanotechnology is of increasing significance. Curation of nanomaterial data into electronic databases offers opportunities to better understand and predict nanomaterials' behaviour. This supports innovation in, and regulation of, nanotechnology. It is commonly understood that curated data need to be sufficiently complete and of sufficient quality to serve their intended purpose. However, assessing data completeness and quality is non-trivial in general and is arguably especially difficult in the nanoscience area, given its highly multidisciplinary nature. The current article, part of the Nanomaterial Data Curation Initiative series, addresses how to assess the completeness and quality of (curated) nanomaterial data. In order to address this key challenge, a variety of related issues are discussed: the meaning and importance of data completeness and quality, existing approaches to their assessment and the key challenges associated with evaluating the completeness and quality of curated nanomaterial data. Considerations which are specific to the nanoscience area and lessons which can be learned from other relevant scientific disciplines are considered. Hence, the scope of this discussion ranges from physicochemical characterisation requirements for nanomaterials and interference of nanomaterials with nanotoxicology assays to broader issues such as minimum information checklists, toxicology data quality schemes and computational approaches that facilitate evaluation of the completeness and quality of (curated) data. This discussion is informed by a literature review and a survey of key nanomaterial data curation stakeholders. Finally, drawing upon this discussion, recommendations are presented concerning the central question: how should the completeness and quality of curated nanomaterial data be evaluated? Electronic supplementary information (ESI) available: (1) Detailed information regarding issues raised in the main text; (2) original survey responses. See DOI: 10.1039/c5nr08944a

Evolving issues in the management of reflux disease?

PubMed

Yuan, Yuhong; Hunt, Richard H

2009-07-01

Gastroesophageal reflux disease (GERD) is a common chronic disorder often successfully treated, although there are several evolving issues in management. We reviewed the issues related to unmet needs over the past 12 months. A substantial number of patients fail to respond adequately to once or even twice daily proton pump inhibitor (PPI). There is no standard definition of PPI failure in GERD; a universally accepted definition for treatment success is also not available. Differentiation between erosive esophagitis and nonerosive reflux disease can be made but requires endoscopy; but studies still confuse functional heartburn and nonerosive reflux disease, which impacts management. Acid reflux plays an important role in GERD pathogenesis and the precise role of acid requires more studies of differences between erosive esophagitis and nonerosive reflux disease symptom generation and the implication of nocturnal acidification. Several possible mechanisms may explain GERD refractory to PPIs. Management of PPI nonresponders remains a challenge. Objective and precise evaluation of symptoms and treatment response requires study in high-quality trials. New therapeutic approaches are under investigation to answer unmet needs and improve erosive esophagitis healing rates and symptom control.

The e-MapScholar project—an example of interoperability in GIScience education

NASA Astrophysics Data System (ADS)

Purves, R. S.; Medyckyj-Scott, D. J.; Mackaness, W. A.

2005-03-01

The proliferation of the use of digital spatial data in learning and teaching provides a set of opportunities and challenges for the development of e-learning materials suitable for use by a broad spectrum of disciplines in Higher Education. Effective e-learning materials must both provide engaging materials with which the learner can interact and be relevant to the learners' disciplinary and background knowledge. Interoperability aims to allow sharing of data and materials through the use of common agreements and specifications. Shared learning materials can take advantage of interoperable components to provide customisable components, and must consider issues in sharing data across institutional borders. The e-MapScholar project delivers teaching materials related to spatial data, which are customisable with respect to both context and location. Issues in the provision of such interoperable materials are discussed, including suitable levels of granularity of materials, the provision of tools to facilitate customisation and mechanisms to deliver multiple data sets and the metadata issues related to such materials. The examples shown make extensive use of the OpenGIS consortium specifications in the delivery of spatial data.

Topic Modeling of NASA Space System Problem Reports: Research in Practice

NASA Technical Reports Server (NTRS)

Layman, Lucas; Nikora, Allen P.; Meek, Joshua; Menzies, Tim

2016-01-01

Problem reports at NASA are similar to bug reports: they capture defects found during test, post-launch operational anomalies, and document the investigation and corrective action of the issue. These artifacts are a rich source of lessons learned for NASA, but are expensive to analyze since problem reports are comprised primarily of natural language text. We apply topic modeling to a corpus of NASA problem reports to extract trends in testing and operational failures. We collected 16,669 problem reports from six NASA space flight missions and applied Latent Dirichlet Allocation topic modeling to the document corpus. We analyze the most popular topics within and across missions, and how popular topics changed over the lifetime of a mission. We find that hardware material and flight software issues are common during the integration and testing phase, while ground station software and equipment issues are more common during the operations phase. We identify a number of challenges in topic modeling for trend analysis: 1) that the process of selecting the topic modeling parameters lacks definitive guidance, 2) defining semantically-meaningful topic labels requires nontrivial effort and domain expertise, 3) topic models derived from the combined corpus of the six missions were biased toward the larger missions, and 4) topics must be semantically distinct as well as cohesive to be useful. Nonetheless,topic modeling can identify problem themes within missions and across mission lifetimes, providing useful feedback to engineers and project managers.

Diagnostic challenges of childhood asthma.

PubMed

Bakirtas, Arzu

2017-01-01

Diagnosis of asthma in childhood is challenging. Both underdiagnosis and overdiagnosis of asthma are important issues. The present review gives information about challenging factors for an accurate diagnosis of childhood asthma. Although underdiagnosis of asthma in childhood has always been the most important diagnostic problem, overdiagnosis of asthma has also been increasingly recognized. This is probably due to diagnosis of asthma based on symptoms and signs alone. Demonstration of variable airflow obstruction by lung function tests is the most common asthma diagnostic tests used in practice and is therefore strongly recommended in children who can cooperate. Recently, an asthma guideline combining the clinical and economic evidences with sensitivity and specificity of diagnostic procedures was developed to improve accuracy of diagnosis and to avoid overdiagnosis. This guideline provided an algorithmic clinical and cost-effective approach and included fractional exhaled nitric oxide measurement as one of the diagnostic tests in addition to lung function. Diagnosis of asthma in children should be made by combining relevant history with at least two confirmatory diagnostic tests whenever possible. Diagnosis based on short-period treatment trials should be limited to young children who are unable to cooperate with these tests.

Dress codes and appearance policies: challenges under federal legislation, part 2: title VII of the civil rights act and gender.

PubMed

Mitchell, Michael S; Koen, Clifford M; Darden, Stephen M

2014-01-01

As more and more individuals express themselves with tattoos and body piercings and push the envelope on what is deemed appropriate in the workplace, employers have an increased need for creation and enforcement of reasonable dress codes and appearance policies. As with any employment policy or practice, an appearance policy must be implemented and enforced without regard to an individual's race, color, gender, national origin, religion, disability, age, or other protected status. A policy governing dress and appearance based on the business needs of an employer that is applied fairly and consistently and does not have a disproportionate effect on any protected class will generally be upheld if challenged in court. By examining some of the more common legal challenges to dress codes and how courts have resolved the disputes, health care managers can avoid many potential problems. This article, the second part of a 3-part examination of dress codes and appearance policies, focuses on the issue of gender under the Civil Rights Act of 1964. Pertinent court cases that provide guidance for employers are addressed.

Dress codes and appearance policies: challenges under federal legislation, part 1: title VII of the civil rights act and religion.

PubMed

Mitchell, Michael S; Koen, Clifford M; Moore, Thomas W

2013-01-01

As more and more individuals choose to express themselves and their religious beliefs with headwear, jewelry, dress, tattoos, and body piercings and push the envelope on what is deemed appropriate in the workplace, employers have an increased need for creation and enforcement of reasonable dress codes and appearance policies. As with any employment policy or practice, an appearance policy must be implemented and enforced without regard to an individual's race, color, sex, national origin, religion, disability, age, or any other protected status. A policy governing dress and appearance based on the business needs of an employer that is applied fairly and consistently and does not have a disproportionate effect on any protected class will generally be upheld if challenged in court. By examining some of the more common legal challenges to dress codes and how courts have resolved the disputes, health care managers can avoid many potential problems. This article addresses the issue of religious discrimination focusing on dress and appearance and some of the court cases that provide guidance for employers.

How common are challenging behaviours amongst individuals with Fragile X Syndrome? A systematic review.

PubMed

Hardiman, Rebecca Lyndsey; McGill, Peter

2018-05-01

Fragile X Syndrome (FXS) appears to be associated with an increased risk for engaging in challenging behaviour, particularly self-injury, relative to those with mixed aetiology learning disabilities. Such behavioural issues are reported to be of high concern for those providing support. As such, this systematic review aimed to gain further epidemiological data regarding challenging behaviours in individuals with FXS, including: self-injurious behaviour (SIB), hand-biting as a specific topography of SIB, aggression and property destruction. Twenty eight manuscripts were identified which reported the prevalence of a relevant topography of behaviour, with widely varying prevalence estimates. Weighted averages of the prevalence of behaviours were calculated across studies. Comparison of proportions revealed significant gender differences and differences in the prevalence of types of behaviour. It is hoped that this comprehensive overview of data on this clinically significant topic will help to inform and drive future investigation to understand and provide effective intervention for the benefit of those with FXS. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Research and development of smart wearable health applications: the challenge ahead.

PubMed

Lymberis, Andreas

2004-01-01

Continuous monitoring of physiological and physical parameters is necessary for the assessment and management of personal health status. It can significantly contribute to the reduction of healthcare cost by avoiding unnecessary hospitalisations and ensuring that those who need urgent care get it sooner. In conjunction with cost-effective telemedicine platforms, ubiquitous health monitoring can significantly contribute to the enhancement of disease prevention and early diagnosis, disease management, treatment and home rehabilitation. Latest developments in the area of micro and nanotechnologies, information processing and wireless communication offer, today, the possibility for minimally (or non) invasive biomedical measurement but also wearable sensing, processing and data communication. Although the systems are being developed to satisfy specific user needs, a number of common critical issues have to be tackled to achieve reliable and acceptable smart health wearable applications e.g. biomedical sensors, user interface, clinical validation, data security and confidentiality, scenarios of use, decision support, user acceptance and business models. Major technological achievements have been realised the last few years. Cutting edge development combining functional clothing and integrated electronics open a new research area and possibilities for body sensing and communicating health parameters. This paper reviews the current status of research and development on smart wearable health systems and applications and discusses the outstanding issues and future challenges.

Why invest in an educational fellowship program?

PubMed

Searle, Nancy S; Hatem, Charles J; Perkowski, Linda; Wilkerson, LuAnn

2006-11-01

Expanding and refining the repertoire of medical school teaching faculty is required by the many current and changing demands of medical education. To meet this challenge academic medical institutions have begun to establish programs--including educational fellowship programs--to improve the teaching toolboxes of faculty and to empower them to assume leadership roles within both institutional and educational arenas. In this article, the authors (1) provide historical background on educational fellowship programs; (2) describe the prevalence and focus of these programs in North American medical schools, based on data from a recent (2005) survey; and (3) give a brief overview of the nine fellowship programs that are discussed fully in other articles in this issue of Academic Medicine. These articles describe very different types of educational fellowships that, nevertheless, share common features: a cohort of faculty members who are selected to participate in a longitudinal set of faculty development activities to improve participants' teaching skills and to build a cadre of educational leaders for the institution. Evaluation of educational fellowships remains a challenging issue, but the authors contend that one way to evaluate the programs' effectiveness is to look at the educational improvements that have been instigated by program graduates. The authors hope that the various program descriptions will help readers to improve their existing programs and/or to initiate new programs.

The art of co-production of knowledge in environmental sciences and management: lessons from international practice

NASA Astrophysics Data System (ADS)

Djenontin, Ida Nadia S.; Meadow, Alison M.

2018-06-01

This review paper addresses the challenging question of "how to" design and implement co-production of knowledge in climate science and other environmental and agricultural sciences. Based on a grounded theory review of nine (9) published case studies of transdisciplinary and collaborative research projects, the paper offers a set of common themes regarding specific components and processes for the design, implementation, and achievement of co-production of knowledge work, which represent the "Modus Operandi" of knowledge co-production. The analysis focuses on practical methodological guidance based on lessons from how different research teams have approached the challenges of complex collaborative research. We begin by identifying broad factors or actions that inhibit or facilitate the process, then highlight specific practices associated with co-production of knowledge and necessary competencies for undertaking co-production. We provide insights on issues such as the integration of social and professional cultures, gender and social equity, and power dynamics, and illustrate the different ways in which researchers have addressed these issues. By exploring the specific practices involved in knowledge co-production, this paper provides guidance to researchers on how to navigate different possibilities of the process of conducting transdisciplinary and co-production of knowledge research projects that best fit their research context, stakeholder needs, and research team capacities.

The art of co-production of knowledge in environmental sciences and management: lessons from international practice.

PubMed

Djenontin, Ida Nadia S; Meadow, Alison M

2018-06-01

This review paper addresses the challenging question of "how to" design and implement co-production of knowledge in climate science and other environmental and agricultural sciences. Based on a grounded theory review of nine (9) published case studies of transdisciplinary and collaborative research projects, the paper offers a set of common themes regarding specific components and processes for the design, implementation, and achievement of co-production of knowledge work, which represent the "Modus Operandi" of knowledge co-production. The analysis focuses on practical methodological guidance based on lessons from how different research teams have approached the challenges of complex collaborative research. We begin by identifying broad factors or actions that inhibit or facilitate the process, then highlight specific practices associated with co-production of knowledge and necessary competencies for undertaking co-production. We provide insights on issues such as the integration of social and professional cultures, gender and social equity, and power dynamics, and illustrate the different ways in which researchers have addressed these issues. By exploring the specific practices involved in knowledge co-production, this paper provides guidance to researchers on how to navigate different possibilities of the process of conducting transdisciplinary and co-production of knowledge research projects that best fit their research context, stakeholder needs, and research team capacities.

Existential challenges in young people living with a cancer diagnosis.

PubMed

Odh, Ida; Löfving, Martina; Klaeson, Kicki

2016-10-01

In Sweden, approximately 500 people between the ages of 15 and 39 are diagnosed with cancer each year. When someone is diagnosed with a life-threatening disease, existential issues are easily triggered. Young adults are in a developmental phase of life and are exposed to an extra amount of pressure. The Internet and social media are a daily part of the life of young adults and the use of blogs is common. The aim of this study was to elucidate the theoretical framework of Yalom and his four 'givens' expressed in blogs written by young adults living with various cancer diagnoses in Sweden. This study used a qualitative method in which written stories from six public blogs were analysed using qualitative content analysis. The findings offer valuable in-depth knowledge about the existential issues in this population. The results can be described as a journey with several existential challenges and with death as an impending threat. The bloggers' awareness of their mortality was described as creating a sense of loss and existential loneliness. This study shows that young adults are empowered by the writing of blogs and that blogs can play an important part in increasing wellbeing and a sense of coherence within this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

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

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

PubMed

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

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

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

DOE PAGES

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

2015-08-07

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

Captive care and welfare considerations for beavers.

PubMed

Campbell-Palmer, Róisín; Rosell, Frank

2015-01-01

Beavers (Castor spp.) tend not to be a commonly held species and little published material exists relating to their captive care. We review published material and discuss husbandry issues taking into account the requirements of wild beavers. As social mammals with complex chemical communication systems and with such an ability to modify their environments, studies of wild counterparts suggest the captive requirements of beavers may actually be more sophisticated than generally perceived. Common field techniques may have practical application in the captive setting. Their widespread utilisation in conservation, including reintroductions, translocations and habitat management, also requires components of captive care. As welfare science advances there is increasing pressure on captive collections to improve standards and justify the keeping of animals. Conservation science is increasingly challenged to address individual welfare standards. Further research focusing on the captive care of beavers is required. © 2015 Wiley Periodicals, Inc.

Eco-analytical Methodology in Environmental Problems Monitoring

NASA Astrophysics Data System (ADS)

Agienko, M. I.; Bondareva, E. P.; Chistyakova, G. V.; Zhironkina, O. V.; Kalinina, O. I.

2017-01-01

Among the problems common to all mankind, which solutions influence the prospects of civilization, the problem of ecological situation monitoring takes very important place. Solution of this problem requires specific methodology based on eco-analytical comprehension of global issues. Eco-analytical methodology should help searching for the optimum balance between environmental problems and accelerating scientific and technical progress. The fact that Governments, corporations, scientists and nations focus on the production and consumption of material goods cause great damage to environment. As a result, the activity of environmentalists is developing quite spontaneously, as a complement to productive activities. Therefore, the challenge posed by the environmental problems for the science is the formation of geo-analytical reasoning and the monitoring of global problems common for the whole humanity. So it is expected to find the optimal trajectory of industrial development to prevent irreversible problems in the biosphere that could stop progress of civilization.

The challenge of improvised explosives

DOE PAGES

Maienschein, Jon L.

2012-06-14

Energetic materials have been developed for decades, and indeed centuries, with a common set of goals in mind. Performance (as a detonating explosive, a propellant, or a pyrotechnic) has always been key, equally important have been the attributes of safety, stability, and reproducibility. Research and development with those goals has led to the set of energetic materials commonly used today. In the past few decades, the adoption and use of improvised explosives in attacks by terrorists or third-world parties has led to many questions about these materials, e.g., how they may be made, what threat they pose to the intendedmore » target, how to handle them safely, and how to detect them. The unfortunate advent of improvised explosives has opened the door for research into these materials, and there are active programs in many countries. I will discuss issues and opportunities facing research into improvised explosives.« less

Internationalizing forensic assessments of criminal responsibility.

PubMed

Meynen, Gerben; Oei, Karel

2011-12-01

One of the important characteristics of current medicine is that it is an international endeavor. The fact that medicine is a global undertaking might even be one of its core strengths. However, the universal nature of medicine can be compromised when local issues become significant factors in medical practice. In this paper we identify criminal law as a relevant factor complicating the process of internationalizing a particular medical practice: the assessment of a defendant within the context of the question of criminal responsibility. Since criminal law--especially the laws relevant to assessments of criminal responsibility--may differ from country to country, or rather from jurisdiction to jurisdiction, forensic psychiatrists face the challenge of finding common ground and a common framework to advance these forensic psychiatric assessments. We describe the current situation and argue for internationalizing the discussion about this assessment, pointing to the example provided by assessments of competence.

Multispectral Photogrammetric Data Acquisition and Processing Forwall Paintings Studies

NASA Astrophysics Data System (ADS)

Pamart, A.; Guillon, O.; Faraci, S.; Gattet, E.; Genevois, M.; Vallet, J. M.; De Luca, L.

2017-02-01

In the field of wall paintings studies different imaging techniques are commonly used for the documentation and the decision making in term of conservation and restoration. There is nowadays some challenging issues to merge scientific imaging techniques in a multimodal context (i.e. multi-sensors, multi-dimensions, multi-spectral and multi-temporal approaches). For decades those CH objects has been widely documented with Technical Photography (TP) which gives precious information to understand or retrieve the painting layouts and history. More recently there is an increasing demand of the use of digital photogrammetry in order to provide, as one of the possible output, an orthophotomosaic which brings a possibility for metrical quantification of conservators/restorators observations and actions planning. This paper presents some ongoing experimentations of the LabCom MAP-CICRP relying on the assumption that those techniques can be merged through a common pipeline to share their own benefits and create a more complete documentation.

Reuse and Interoperability of Avionics for Space Systems

NASA Technical Reports Server (NTRS)

Hodson, Robert F.

2007-01-01

The space environment presents unique challenges for avionics. Launch survivability, thermal management, radiation protection, and other factors are important for successful space designs. Many existing avionics designs use custom hardware and software to meet the requirements of space systems. Although some space vendors have moved more towards a standard product line approach to avionics, the space industry still lacks similar standards and common practices for avionics development. This lack of commonality manifests itself in limited reuse and a lack of interoperability. To address NASA s need for interoperable avionics that facilitate reuse, several hardware and software approaches are discussed. Experiences with existing space boards and the application of terrestrial standards is outlined. Enhancements and extensions to these standards are considered. A modular stack-based approach to space avionics is presented. Software and reconfigurable logic cores are considered for extending interoperability and reuse. Finally, some of the issues associated with the design of reusable interoperable avionics are discussed.

Nutrition and Pregnancy after Bariatric Surgery

PubMed Central

Kaska, Lukasz; Kobiela, Jarek; Abacjew-Chmylko, Anna; Chmylko, Lukasz; Wojanowska-Pindel, Magdalena; Kobiela, Paulina; Walerzak, Anna; Makarewicz, Wojciech; Proczko-Markuszewska, Monika; Stefaniak, Tomasz

2013-01-01

Obesity is an escalating problem in all age groups and it is observed to be more common in females than males. About 25% of women meet the criteria of obesity and one-third of them are in the reproductive age. Because morbid obesity requiring surgical treatment is observed with increasing frequency, surgeons and gynecologists are undergoing new challenges. It is not only a matter of women's health and their quality of life but also proper development of the fetus, which should be a concern during bariatric treatment. Therefore complex perinatal care has to be provided for morbid obesity patients. The paper reviews pregnancy and fertility issues in bariatric surgery patients. PMID:24555146

Conflicts of Interest in Sports Medicine.

PubMed

Tucker, Andrew M

2016-04-01

Conflict of interest is common in the practice of medicine, and likely more so in the practice of sports medicine at the highest levels of competition. Two areas where conflict of interest frequently manifest in sports medicine are confidentiality and clinical decision making. Confidentiality can be challenging by the team physician's dual responsibilities to the player-patient and the team. Clinical decision making, traditionally associated with a patient's long term health interests, can be complicated by short term interests rooted in pursuit of winning. These issues are reviewed, hopefully to increase awareness in clinicians who find themselves in these unique situations. Copyright © 2016 Elsevier Inc. All rights reserved.

Collusion-resistant multimedia fingerprinting: a unified framework

NASA Astrophysics Data System (ADS)

Wu, Min; Trappe, Wade; Wang, Z. Jane; Liu, K. J. Ray

2004-06-01

Digital fingerprints are unique labels inserted in different copies of the same content before distribution. Each digital fingerprint is assigned to an inteded recipient, and can be used to trace the culprits who use their content for unintended purposes. Attacks mounted by multiple users, known as collusion attacks, provide a cost-effective method for attenuating the identifying fingerprint from each coluder, thus collusion poses a reeal challenge to protect the digital media data and enforce usage policies. This paper examines a few major design methodologies for collusion-resistant fingerprinting of multimedia, and presents a unified framework that helps highlight the common issues and the uniqueness of different fingerprinting techniques.

The Undiagnosed Diseases Program Integrated Collaboration System (UDPICS): One Program’s Experience Developing Custom Software to Support Research for Complex-Disease Families

PubMed Central

Guzman, Jessica; Lee, Elizabeth; Draper, David; Valivullah, Zaheer; Yu, Guoyun; Sincan, Murat; Gahl, William A.; Adams, David R.

2015-01-01

The Undiagnosed Diseases Program (UDP) was started in 2008 with the goals of making diagnoses and facilitating related translational research. The individuals and families seen by the UDP are often unique and medically complex. Approximately 40% of UDP cases are pediatric. The Undiagnosed Diseases Program Integrated Collaboration System (UDPICS) was designed to create a collaborative workspace for researchers, clinicians and families. We describe our progress in developing the system to date, focusing on design rationale, challenges and issues that are likely to be common in the development of similar systems in the future. PMID:27417368

“It’s like we’re just renting over here”: The Pervasive Experiences of Discrimination of Filipino Immigrant Youth Gang Members in Hawai’i

PubMed Central

Kim, Su Yeong; Benner, Aprile D.; Takushi, Rena Mae Nalani; Ongbongan, Kathleen; Dennerlein, Donna; Spencer, Deborah K.

2009-01-01

Researchers, service providers, and policymakers must uncover and better understand the issues facing youths in Asian gangs in order to most effectively intervene with appropriate policies and programs. The present investigation sampled young male Filipino gang members in Hawai’i. Thematic analyses of the focus group data challenge the commonly held view of racial harmony in Hawai’i. It appears that racial and social discrimination from peers and authority figures propel Filipino boys to seek out gang membership as a way to protect themselves from being targets of oppression. PMID:19946383

Oil Extraction and Indigenous Livelihoods in the Northern Ecuadorian Amazon

PubMed Central

Bozigar, Matthew; Gray, Clark L.; Bilsborrow, Richard E.

2015-01-01

Globally, the extraction of minerals and fossil fuels is increasingly penetrating into isolated regions inhabited by indigenous peoples, potentially undermining their livelihoods and well-being. To provide new insight to this issue, we draw on a unique longitudinal dataset collected in the Ecuadorian Amazon over an 11-year period from 484 indigenous households with varying degrees of exposure to oil extraction. Fixed and random effects regression models of the consequences of oil activities for livelihood outcomes reveal mixed and multidimensional effects. These results challenge common assumptions about these processes and are only partly consistent with hypotheses drawn from the Dutch disease literature. PMID:26543302

A systems view of health care for the poor.

PubMed Central

Prasad, N.

1989-01-01

A systems view is a synthesis of health policy, medical sociology, public health, and common clinical problems to describe the current crisis in health care for the poor. Medical sociology and public health are particularly relevant to understand the complexity of clinical issues. Although preventive medicine is in desuetude, it is crucial if we are to reduce the future liability of postponed medical care among the poor. Medicaid metamorphosed to Medicare, as half of its outlays are spent on care of the elderly in nursing homes. Health care for the poor will remain a moral challenge to the architects of health policy and the medical profession. PMID:2659807

Identifying molecular drivers of gastric cancer through next-generation sequencing.

PubMed

Liang, Han; Kim, Yon Hui

2013-11-01

Gastric cancer is the second most common cause of cancer-related death in the world, representing a major global health issue. The high mortality rate is largely due to the lack of effective medical treatment for advanced stages of this disease. Recently next-generation sequencing (NGS) technology has become a revolutionary tool for cancer research, and several NGS studies in gastric cancer have been published. Here we review the insights gained from these studies regarding how use NGS to elucidate the molecular basis of gastric cancer and identify potential therapeutic targets. We also discuss the challenges and future directions of such efforts. Published by Elsevier Ireland Ltd.

Care of adolescent parents and their children.

PubMed

Pinzon, Jorge L; Jones, Veronnie F

2012-12-01

Teen pregnancy and parenting remain an important public health issue in the United States and the world, and many children live with their adolescent parents alone or as part of an extended family. A significant proportion of teen parents reside with their family of origin, significantly affecting the multigenerational family structure. Repeated births to teen parents are also common. This clinical report updates a previous policy statement on care of the adolescent parent and their children and addresses medical and psychosocial risks specific to this population. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

Finding the forest in the trees. The challenge of combining diverse environmental data

NASA Technical Reports Server (NTRS)

1995-01-01

Development of analytical and functional guidelines to help researchers and technicians engaged in interdisciplinary research to better plan and implement their supporting data management activities is addressed. An emphasis is on the projects that involve both geophysical and ecological issues. Six case studies were used to identify and to understand problems associated with collecting, integrating, and analyzing environmental data from local to global spatial scales and over a range of temporal scales. These case studies were also used to elaborate the common barriers to interfacing data of disparate sources and types. A number of lessons derived from the case studies are summarized and analyzed.

Meditations on the ubiquity and mutability of nano-sized materials in the environment.

PubMed

Wiesner, Mark R; Lowry, Gregory V; Casman, Elizabeth; Bertsch, Paul M; Matson, Cole W; Di Giulio, Richard T; Liu, Jie; Hochella, Michael F

2011-11-22

A wide variety of nanomaterials can be found naturally occurring in the environment, although finding and characterizing these materials remains a challenge due to their size. Recent studies in the field have shown that natural nanomaterials are common in many geochemical systems. In this issue of ACS Nano, Hutchison and co-workers make us realize that manmade nanomaterials can often be practically identical to those that spontaneously form in the environment. This Perspective discusses the prevalence of nanomaterials in nature, including anthropogenic and naturally occurring nanomaterials, and the dynamic behavior of these materials in the environment. © 2011 American Chemical Society

Aeroelasticity Benchmark Assessment: Subsonic Fixed Wing Program

NASA Technical Reports Server (NTRS)

Florance, Jennifer P.; Chwalowski, Pawel; Wieseman, Carol D.

2010-01-01

The fundamental technical challenge in computational aeroelasticity is the accurate prediction of unsteady aerodynamic phenomena and the effect on the aeroelastic response of a vehicle. Currently, a benchmarking standard for use in validating the accuracy of computational aeroelasticity codes does not exist. Many aeroelastic data sets have been obtained in wind-tunnel and flight testing throughout the world; however, none have been globally presented or accepted as an ideal data set. There are numerous reasons for this. One reason is that often, such aeroelastic data sets focus on the aeroelastic phenomena alone (flutter, for example) and do not contain associated information such as unsteady pressures and time-correlated structural dynamic deflections. Other available data sets focus solely on the unsteady pressures and do not address the aeroelastic phenomena. Other discrepancies can include omission of relevant data, such as flutter frequency and / or the acquisition of only qualitative deflection data. In addition to these content deficiencies, all of the available data sets present both experimental and computational technical challenges. Experimental issues include facility influences, nonlinearities beyond those being modeled, and data processing. From the computational perspective, technical challenges include modeling geometric complexities, coupling between the flow and the structure, grid issues, and boundary conditions. The Aeroelasticity Benchmark Assessment task seeks to examine the existing potential experimental data sets and ultimately choose the one that is viewed as the most suitable for computational benchmarking. An initial computational evaluation of that configuration will then be performed using the Langley-developed computational fluid dynamics (CFD) software FUN3D1 as part of its code validation process. In addition to the benchmarking activity, this task also includes an examination of future research directions. Researchers within the Aeroelasticity Branch will examine other experimental efforts within the Subsonic Fixed Wing (SFW) program (such as testing of the NASA Common Research Model (CRM)) and other NASA programs and assess aeroelasticity issues and research topics.

Generating global political priority for urban health: the role of the urban health epistemic community

PubMed Central

Shawar, Yusra Ribhi; Crane, Lani G

2017-01-01

Abstract Over the past decade there has been much discussion of the challenges posed by rapid urbanization in the developing world; yet the health of the urban poor, and especially those residing in low- and middle-income countries, continues to receive little political priority in most developing countries and at the global level. This research applies social science scholarship and a public policy analytical framework to assess the factors that have challenged efforts to make health in urban poor settings a priority. We conducted 19 semi-structured phone interviews with key urban health proponents and experts representing agencies that shape opinions and manage resources in global health. We also conducted a literature review, which included published scholarly literature and reports from organizations involved in urban health provision and advocacy. Utilizing a process-tracing method, we triangulated among these sources of data to create a historical narrative and analyse the factors that shape the global level of attention to and resources for urban health. The urban health agenda continues to be challenged by six factors, three of which concern the political context or characteristics of the issue: long-standing competition with the dominant development agenda that is rural health oriented; limited data and measurement tools that can effectively gauge the extent of the problem; and lack of evidence on how to best to address the issue. The other three factors are directly under the control of the urban health community: the community’s ineffective governance; little common understanding among its members of the problem and how to address it; and an unconvincing framing of the issue to the public. The study offers suggestions as to what advocates can do to secure greater attention and resources in order to help address the health needs of the urban poor. PMID:28582532

Generating global political priority for urban health: the role of the urban health epistemic community.

PubMed

Shawar, Yusra Ribhi; Crane, Lani G

2017-10-01

Over the past decade there has been much discussion of the challenges posed by rapid urbanization in the developing world; yet the health of the urban poor, and especially those residing in low- and middle-income countries, continues to receive little political priority in most developing countries and at the global level. This research applies social science scholarship and a public policy analytical framework to assess the factors that have challenged efforts to make health in urban poor settings a priority. We conducted 19 semi-structured phone interviews with key urban health proponents and experts representing agencies that shape opinions and manage resources in global health. We also conducted a literature review, which included published scholarly literature and reports from organizations involved in urban health provision and advocacy. Utilizing a process-tracing method, we triangulated among these sources of data to create a historical narrative and analyse the factors that shape the global level of attention to and resources for urban health. The urban health agenda continues to be challenged by six factors, three of which concern the political context or characteristics of the issue: long-standing competition with the dominant development agenda that is rural health oriented; limited data and measurement tools that can effectively gauge the extent of the problem; and lack of evidence on how to best to address the issue. The other three factors are directly under the control of the urban health community: the community's ineffective governance; little common understanding among its members of the problem and how to address it; and an unconvincing framing of the issue to the public. The study offers suggestions as to what advocates can do to secure greater attention and resources in order to help address the health needs of the urban poor. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

6 Common Cancers - Prostate Cancer

MedlinePlus

... Bar Home Current Issue Past Issues 6 Common Cancers - Prostate Cancer Past Issues / Spring 2007 Table of Contents For ... early screening. Photo: AP Photo/Danny Moloshok Prostate Cancer The prostate gland is a walnut-sized structure ...

6 Common Cancers - Breast Cancer

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... Bar Home Current Issue Past Issues 6 Common Cancers - Breast Cancer Past Issues / Spring 2007 Table of Contents For ... her down. Photo: AP Photo/Brett Flashnick Breast Cancer Breast cancer is a malignant (cancerous) growth that ...

6 Common Cancers - Colorectal Cancer

MedlinePlus

... Bar Home Current Issue Past Issues 6 Common Cancers - Colorectal Cancer Past Issues / Spring 2007 Table of Contents For ... colon cancer. Photo: AP Photo/Ron Edmonds Colorectal Cancer Cancer of the colon (large intestine) or rectum ( ...

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

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.

Introduction to the Special Issue: Interventions to Reduce Challenging Behavior Among Individuals With Autism Spectrum Disorder.

PubMed

Davis, Tonya N; Rispoli, Mandy

2018-05-01

The prevalence of autism spectrum disorder (ASD) is on the rise. In addition to the social communication skill deficits and restrictive repetitive behaviors and interests, many individuals with ASD engage in challenging behavior. Challenging behavior is associated with a multitude of negative outcomes. Challenging behavior may cause harm to the individual with ASD as well as limit opportunities for educational, vocational, and social participation and development. In addition, caregivers experience high stress and low quality of mental health. As a result, challenging behavior warrants intervention that is specifically tailored to the unique characteristics of individuals with ASD. The purpose of this Special Issue is to showcase recent research in the treatment of challenging behavior for individuals with ASD. This two-part Special Issue contains 12 studies that range from systematic and quality reviews of the intervention literature, to innovative treatment approaches, to studies that develop and evaluate treatments for restrictive and repetitive behaviors and interests.

Listening for Prescriptions: A National Consultation on Pharmaceutical Policy Issues

PubMed Central

Morgan, Steve; Cunningham, Colleen M.

2010-01-01

Objectives and Methods: Pharmaceutical policy is an increasingly costly, essential and challenging component of health system management. We sought to identify priority pharmaceutical policy issues in Canada and to translate them into research priorities using key informant interviews, stakeholder surveys and a deliberative workshop. Results: We found consensus on overarching policy goals: to provide all Canadians with equitable and sustainable access to necessary medicines. We also found widespread frustration that many key pharmaceutical policy issues in Canada — including improving prescription drug financing and pricing — have been persistent challenges owing to a lack of policy coordination. The coverage of extraordinarily costly medicines for serious conditions was identified as a rapidly emerging policy issue. Conclusion: Targeted research and knowledge translation activities can help address key policy issues and, importantly, challenges of policy coordination in Canada and thereby reduce inequity and inefficiency in policy approaches and outcomes. PMID:22043223

Qualitative Approaches to Research in Counselling and Psychotherapy: Issues and Challenges.

ERIC Educational Resources Information Center

McLeod, John

1996-01-01

Discusses key issues which address the distinctive dilemmas and challenges associated with qualitative approaches to evaluating counseling. Investigates such concerns as relationships with research participants, ethics, reflexivity, methodological choice, communicability, perspective, and obviousness. Makes some suggestions regarding the link…

An analysis of the health status of the United Arab Emirates: the 'Big 4' public health issues.

PubMed

Loney, Tom; Aw, Tar-Ching; Handysides, Daniel G; Ali, Raghib; Blair, Iain; Grivna, Michal; Shah, Syed M; Sheek-Hussein, Mohamud; El-Sadig, Mohamed; Sharif, Amer A; El-Obaid, Yusra

2013-02-05

The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases.

Seeing through their eyes: lived experiences of people with retinitis pigmentosa

PubMed Central

Prem Senthil, M; Khadka, J; Pesudovs, K

2017-01-01

Purpose Retinitis pigmentosa (RP) is the most common retinal degeneration causing blindness. Although their clinical problems are amenable for the clinical diagnosis, their day-to-day problems for having to live with the disease are mostly unexplored. This study aims to explore and understand the issues and impact of people with RP on quality of life (QoL). Methods A qualitative research methodology to facilitate the understanding of the experiences of people with RP was carried out. Data were collected through audio-recorded semi-structured interviews. Thematic analysis occurred through the process of line-by-line coding, aggregation, and theme development using the NVivo-10 software. Results Twenty-three interviews were conducted (mean age=56 years; females, 14). We identified five major QoL themes: (1) struggle to perform important day-to-day tasks; (2) concerns about disease progression, disease outcome and personal safety; (3) facing a lot of emotional and psychological challenges; (4) experiencing a myriad of visual symptoms; and (5) adopting different strategies to cope and manage stressful circumstances. Difficulty in performing important day-to-day tasks was the most prominent QoL issue among these people. Their major concerns were going blind and uncertainties about their future. They face a lot of emotional and psychological challenges to adapt to the physiological stress associated with the progressive vision loss. However, they adopt several coping strategies to manage the stressful circumstances. Conclusions People with RP experience a myriad of QoL issues. Despite all the hardship, they remain optimistic and learn to accept their eye condition and move on in life. PMID:28085147

The next organizational challenge: finding and addressing diagnostic error.

PubMed

Graber, Mark L; Trowbridge, Robert; Myers, Jennifer S; Umscheid, Craig A; Strull, William; Kanter, Michael H

2014-03-01

Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error. WHY HEALTH CARE ORGANIZATIONS NEED TO GET INVOLVED: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error. FINDING DIAGNOSTIC ERRORS: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches--Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record--based reports that detect process breakdowns in the followup of abnormal findings--are described in case studies. By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A two-day consensus meeting was held on November 18-19, 2008 in Chicago, IL, United States of America, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock-production specialists, journal editors, assistant editors, and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines For Randomized Control Trials) statement for livestock and food safety (LFS) and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety by modifying the CONSORT statement.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-03-01

The conduct of randomized controlled trials in livestock with production, health and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A 2-day consensus meeting was held on 18-19 November 2008 in Chicago, IL, USA, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock-production specialists, journal editors, assistant editors and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety and 22-item checklist. Fourteen items were modified from the CONSORT checklist and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health and food-safety outcomes.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J N; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A two-day consensus meeting was held on November 18-19, 2008 in Chicago, Ill, United States of America, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock production specialists, journal editors, assistant editors, and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety (LFS) and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

What's gender got to do with it? Examining masculinities, health and safety and return to work in male dominated skilled trades.

PubMed

Stergiou-Kita, Mary; Mansfield, Elizabeth; Colantonio, Angela; Moody, Joel; Mantis, Steve

2016-06-16

Electrical injuries are a common cause of work-related injury in male dominated skilled trades. In this study we explored how issues of gender, masculinities and institutional workplace practices shape expectations of men and their choices when returning to work following a workplace electrical injury. Twelve workers, who suffered an electrical injury, and twelve employer representatives, completed semi-structured interviews. Using thematic analysis we identified key themes related to how masculinities influenced men's health and safety during the return to work process. Strong identification with worker roles can influence injured workers decisions to return to work 'too early'. A desire to be viewed as a strong, responsible, resilient worker may intersect with concerns about job loss, to influence participants' decisions to not report safety issues and workplace accidents, to not disclose post-injury work challenges, and to not request workplace supports. Institutionalized workplace beliefs regarding risk, de-legitimization of the severity of injuries, and the valorization of the "tough" worker can further re-enforce dominant masculine norms and influence return to work processes and health and safety practices. Workplaces are key sites where gender identities are constructed, affirmed and institutionalized. Further research is warranted to examine how established masculine norms and gendered workplace expectations can influence workplace health and safety in male dominated high risk occupations. Future research should also evaluate strategies that encourage men to discuss post-injury work challenges and request supports when work performance or health and safety issues arise during the return to work process.

Starting Over: Current Issues in Online Catalog User Interface Design.

ERIC Educational Resources Information Center

Crawford, Walt

1992-01-01

Discussion of online catalogs focuses on issues in interface design. Issues addressed include understanding the user base; common user access (CUA) with personal computers; common command language (CCL); hyperlinks; screen design issues; differences from card catalogs; indexes; graphic user interfaces (GUIs); color; online help; and remote users.…

Data quality can make or break a research infrastructure

NASA Astrophysics Data System (ADS)

Pastorello, G.; Gunter, D.; Chu, H.; Christianson, D. S.; Trotta, C.; Canfora, E.; Faybishenko, B.; Cheah, Y. W.; Beekwilder, N.; Chan, S.; Dengel, S.; Keenan, T. F.; O'Brien, F.; Elbashandy, A.; Poindexter, C.; Humphrey, M.; Papale, D.; Agarwal, D.

2017-12-01

Research infrastructures (RIs) commonly support observational data provided by multiple, independent sources. Uniformity in the data distributed by such RIs is important in most applications, e.g., in comparative studies using data from two or more sources. Achieving uniformity in terms of data quality is challenging, especially considering that many data issues are unpredictable and cannot be detected until a first occurrence of the issue. With that, many data quality control activities within RIs require a manual, human-in-the-loop element, making it an expensive activity. Our motivating example is the FLUXNET2015 dataset - a collection of ecosystem-level carbon, water, and energy fluxes between land and atmosphere from over 200 sites around the world, some sites with over 20 years of data. About 90% of the human effort to create the dataset was spent in data quality related activities. Based on this experience, we have been working on solutions to increase the automation of data quality control procedures. Since it is nearly impossible to fully automate all quality related checks, we have been drawing from the experience with techniques used in software development, which shares a few common constraints. In both managing scientific data and writing software, human time is a precious resource; code bases, as Science datasets, can be large, complex, and full of errors; both scientific and software endeavors can be pursued by individuals, but collaborative teams can accomplish a lot more. The lucrative and fast-paced nature of the software industry fueled the creation of methods and tools to increase automation and productivity within these constraints. Issue tracking systems, methods for translating problems into automated tests, powerful version control tools are a few examples. Terrestrial and aquatic ecosystems research relies heavily on many types of observational data. As volumes of data collection increases, ensuring data quality is becoming an unwieldy challenge for RIs. Business as usual approaches to data quality do not work with larger data volumes. We believe RIs can benefit greatly from adapting and imitating this body of theory and practice from software quality into data quality, enabling systematic and reproducible safeguards against errors and mistakes in datasets as much as in software.

6 Common Cancers - Lung Cancer

MedlinePlus

... Bar Home Current Issue Past Issues 6 Common Cancers - Lung Cancer Past Issues / Spring 2007 Table of Contents For ... Desperate Housewives. (Photo ©2005 Kathy Hutchins / Hutchins) Lung Cancer Lung cancer causes more deaths than the next ...

Convergent ethical issues in HIV/AIDS, tuberculosis and malaria vaccine trials in Africa: Report from the WHO/UNAIDS African AIDS Vaccine Programme's Ethics, Law and Human Rights Collaborating Centre consultation, 10-11 February 2009, Durban, South Africa

PubMed Central

2010-01-01

Background Africa continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges. Methods In order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009. Results Key cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing. Conclusion The consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields. PMID:20211030

Recruiting terminally ill patients into non-therapeutic oncology studies: views of health professionals.

PubMed

Kleiderman, Erika; Avard, Denise; Black, Lee; Diaz, Zuanel; Rousseau, Caroline; Knoppers, Bartha Maria

2012-12-05

Non-therapeutic trials in which terminally ill cancer patients are asked to undergo procedures such as biopsies or venipunctures for research purposes, have become increasingly important to learn more about how cancer cells work and to realize the full potential of clinical research. Considering that implementing non-therapeutic studies is not likely to result in direct benefits for the patient, some authors are concerned that involving patients in such research may be exploitive of vulnerable patients and should not occur at all, or should be greatly restricted, while some proponents doubt whether such restrictions are appropriate. Our objective was to explore clinician-researcher attitudes and concerns when recruiting patients who are in advanced stages of cancer into non-therapeutic research. We conducted a qualitative exploratory study by carrying out open-ended interviews with health professionals, including physicians, research nurses, and study coordinators. Interviews were audio-recorded and transcribed. Analysis was carried out using grounded theory. The analysis of the interviews unveiled three prominent themes: 1) ethical considerations; 2) patient-centered issues; 3) health professional issues. Respondents identified ethical issues surrounding autonomy, respect for persons, beneficence, non-maleficence, discrimination, and confidentiality; bringing to light that patients contribute to science because of a sense of altruism and that they want reassurance before consenting. Several patient-centered and health professional issues are having an impact on the recruitment of patients for non-therapeutic research. Facilitators were most commonly associated with patient-centered issues enhancing communication, whereas barriers in non-therapeutic research were most often professionally based, including the doctor-patient relationship, time constraints, and a lack of education and training in research. This paper aims to contribute to debates on the overall challenges of recruiting patients to non-therapeutic research. This exploratory study identified general awareness of key ethical issues, as well as key facilitators and barriers to the recruitment of patients to non-therapeutic studies. Due to the important role played by clinicians and clinician-researchers in the recruitment of patients, it is essential to facilitate a greater understanding of the challenges faced; to promote effective communication; and to encourage educational research training programs.

Everyday ethics in internal medicine resident clinic: an opportunity to teach.

PubMed

Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Catherine Beach, Mary; Hughes, Mark T

2011-07-01

Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor-resident interactions. This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor-Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor-System Interaction (financial issues; doctor-system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly identified or taught these issues during their interactions with residents. Ethics education is important and residents may regard teaching about the ethics-related issues they actually encounter to be highly relevant. A better understanding of the barriers to teaching is needed in order to promote education about everyday ethics in the out-patient setting. © Blackwell Publishing Ltd 2011.

Everyday ethics in internal medicine resident clinic: an opportunity to teach

PubMed Central

Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Beach, Mary Catherine; Hughes, Mark T

2011-01-01

OBJECTIVES Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor–resident interactions. METHODS This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. RESULTS Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor–Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor–System Interaction (financial issues; doctor–system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). CONCLUSIONS In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly identified or taught these issues during their interactions with residents. Ethics education is important and residents may regard teaching about the ethics-related issues they actually encounter to be highly relevant. A better understanding of the barriers to teaching is needed in order to promote education about everyday ethics in the out-patient setting. PMID:21649704

Determinants of immunogenic response to protein therapeutics.

PubMed

Singh, Satish K; Cousens, Leslie P; Alvarez, David; Mahajan, Pramod B

2012-09-01

Protein therapeutics occupy a very significant position in the biopharmaceutical market. In addition to the preclinical, clinical and post marketing challenges common to other drugs, unwanted immunogenicity is known to affect efficacy and/or safety of most biotherapeutics. A standard set of immunogenicity risk factors are routinely used to inform monitoring strategies in clinical studies. A number of in-silico, in vivo and in vitro approaches have also been employed to predict immunogenicity of biotherapeutics, but with limited success. Emerging data also indicates the role of immune tolerance mechanisms and impact of several product-related factors on modulating host immune responses. Thus, a comprehensive discussion of the impact of innate and adaptive mechanisms and molecules involved in induction of host immune responses on immunogenicity of protein therapeutics is needed. A detailed understanding of these issues is essential in order to fully exploit the therapeutic potential of this class of drugs. This Roundtable Session was designed to provide a common platform for discussing basic immunobiological and pharmacological issues related to the role of biotherapeutic-associated risk factors, as well as host immune system in immunogenicity against protein therapeutics. The session included overview presentations from three speakers, followed by a panel discussion with audience participation. Copyright © 2012. Published by Elsevier Ltd.. All rights reserved.

Interactive High-Relief Reconstruction for Organic and Double-Sided Objects from a Photo.

PubMed

Yeh, Chih-Kuo; Huang, Shi-Yang; Jayaraman, Pradeep Kumar; Fu, Chi-Wing; Lee, Tong-Yee

2017-07-01

We introduce an interactive user-driven method to reconstruct high-relief 3D geometry from a single photo. Particularly, we consider two novel but challenging reconstruction issues: i) common non-rigid objects whose shapes are organic rather than polyhedral/symmetric, and ii) double-sided structures, where front and back sides of some curvy object parts are revealed simultaneously on image. To address these issues, we develop a three-stage computational pipeline. First, we construct a 2.5D model from the input image by user-driven segmentation, automatic layering, and region completion, handling three common types of occlusion. Second, users can interactively mark-up slope and curvature cues on the image to guide our constrained optimization model to inflate and lift up the image layers. We provide real-time preview of the inflated geometry to allow interactive editing. Third, we stitch and optimize the inflated layers to produce a high-relief 3D model. Compared to previous work, we can generate high-relief geometry with large viewing angles, handle complex organic objects with multiple occluded regions and varying shape profiles, and reconstruct objects with double-sided structures. Lastly, we demonstrate the applicability of our method on a wide variety of input images with human, animals, flowers, etc.

Living with constipation--older people's experiences and strategies with constipation before and during hospitalization.

PubMed

Munch, Lene; Tvistholm, Nina; Trosborg, Ingelise; Konradsen, Hanne

2016-01-01

Constipation is a common problem among older people. This study aimed to explore how older patients experience constipation and which strategies they used in handling the condition before and during hospitalization. A qualitative exploratory research design was used. Fourteen semi-structured interviews were conducted with patients (61-91 years of age) during hospitalization. Data were analyzed by using content analysis. Themes concerning experiences were Bodily signs and symptoms of constipation; the participants described severe pain during constipation, as well as pronounced relief after bowel movements, Impact on well-being and social activities; being constipated negatively impacted their mood and limited social activities, Striving for bowel balance; the participants experienced an ongoing strive for balancing between constipation and diarrhea. Themes related to strategies were Struggling to find a solution; they were aware of different strategies to prevent and treat constipation, though the most common solution described was the use of laxatives, Wait and see; the participants were awaiting to take action until they experienced constipation symptoms, Constipation is a private problem being challenged during hospitalization; constipation was considered a private issue rarely discussed with health-care professionals. This study illuminates the need for health-care professionals to be attentive to this issue and initiate the conversation with patients in order to advise on the management of constipation.

Scientific authorship. Part 2. History, recurring issues, practices, and guidelines.

PubMed

Claxton, Larry D

2005-01-01

One challenge for most scientists is avoiding and resolving issues that center around authorship and the publishing of scientific manuscripts. While trying to place the research in proper context, impart new knowledge, follow proper guidelines, and publish in the most appropriate journal, the scientist often must deal with multi-collaborator issues like authorship allocation, trust and dependence, and resolution of publication conflicts. Most guidelines regarding publications, commentaries, and editorials have evolved from the ranks of editors in an effort to diminish the issues that faced them as editors. For example, the Ingelfinger rule attempts to prevent duplicate publications of the same study. This paper provides a historical overview of commonly encountered scientific authorship issues, a comparison of opinions on these issues, and the influence of various organizations and guidelines in regards to these issues. For example, a number of organizations provide guidelines for author allocation; however, a comparison shows that these guidelines differ on who should be an author, rules for ordering authors, and the level of responsibility for coauthors. Needs that emerge from this review are (a) a need for more controlled studies on authorship issues, (b) an increased awareness and a buy-in to consensus views by non-editor groups, e.g., managers, authors, reviewers, and scientific societies, and (c) a need for editors to express a greater understanding of authors' dilemmas and to exhibit greater flexibility. Also needed are occasions (e.g., an international congress) when editors and others (managers, authors, etc.) can directly exchange views, develop consensus approaches and solutions, and seek agreement on how to resolve authorship issues. Open dialogue is healthy, and it is essential for scientific integrity to be protected so that younger scientists can confidently follow the lead of their predecessors.

Rare genetic variants and the risk of cancer.

PubMed

Bodmer, Walter; Tomlinson, Ian

2010-06-01

There are good reasons to expect that common genetic variants do not explain all of the inherited risk of the common cancers, not least of these being the relatively low proportion of familial relative risk that common cancer SNPs currently explain. One promising source of the unexplained risk is rare, low-penetrance genetic variants, a class that ranges from low-frequency polymorphisms (allele frequency < 5%) through subpolymorphic variants (frequency 0.1-1.0%) to very low frequency or 'private' variants with frequencies of 0.1% or less. Examples of rare cancer variants include breast cancer susceptibility loci CHEK2, BRIP1 and PALB2. There are considerable challenges associated with the discovery and testing of rare predisposition alleles, many of which are illustrated by the issues associated with variants of unknown significance in the Mendelian cancer predisposition genes. However, whilst cost constraints remain, the technological barriers to rare variant discovery and large-scale genotyping no longer exist. If each individual carries many disease-causing rare variants, the so-called missing heritability of cancer might largely be explained. Whether or not rare variants do end up filling the heritability gap, it is imperative to look for them along side common variants.

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.

Attending to scalar ethical issues in emerging approaches to environmental health research and practice.

PubMed

Buse, Chris G; Smith, Maxwell; Silva, Diego S

2018-06-04

Accelerated changes to the planet have created novel spaces to re-imagine the boundaries and foci of environmental health research. Climate change, mass species extinction, ocean acidification, biogeochemical disturbance, and other emergent environmental issues have precipitated new population health perspectives, including, but not limited to, one health, ecohealth, and planetary health. These perspectives, while nuanced, all attempt to reconcile broad global challenges with localized health impacts by attending to the reciprocal relationships between the health of ecosystems, animals, and humans. While such innovation is to be encouraged, we argue that a more comprehensive engagement with the ethics of these emerging fields of inquiry will add value in terms of the significance and impact of associated interventions. In this contribution, we highlight how the concept of spatial and temporal scale can be usefully deployed to shed light on a variety of ethical issues common to emerging environmental health perspectives, and that the potential of scalar analysis implicit to van Potter's conceptualization of bioethics has yet to be fully appreciated. Specifically, we identify how scale interacts with key ethical issues that require consideration and clarification by one health, ecohealth, and planetary health researchers and practitioners to enhance the effectiveness of research and practice, including justice and governance.

Challenges in conducting qualitative research in health: A conceptual paper

PubMed Central

Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva

2015-01-01

Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. PMID:26793245

Lessons learned from national food fortification projects: experiences from Morocco, Uzbekistan, and Vietnam.

PubMed

Wirth, James P; Laillou, Arnaud; Rohner, Fabian; Northrop-Clewes, Christine A; Macdonald, Barbara; Moench-Pfanner, Regina

2012-12-01

Fortification of staple foods has been repeatedly recommended as an effective approach to reduce micronutrient deficiencies. With the increased number of fortification projects globally, there is a need to share practical lessons learned relating to their implementation and responses to project-related and external challenges. To document the achievements, challenges, lessons learned, and management responses associated with national fortification projects in Morocco, Uzbekistan, and Vietnam. Independent end-of-project evaluations conducted for each project served as the primary data source and contain the history of and project activities undertaken for, each fortification project. Other sources, including national policy documents, project reports from the Global Alliance for Improved Nutrition (GAIN) and other stakeholders, industry assessments, and peer-reviewed articles, were used to document the current responses to challenges and future project plans. All projects had key achievements related to the development of fortification standards and the procurement of equipment for participating industry partners. Mandatory fortification of wheat flour was a key success in Morocco and Uzbekistan. Ensuring the quality of fortified foods was a common challenge experienced across the projects, as were shifts in consumption patterns and market structures. Adjustments were made to the projects' design to address the challenges faced. National fortification projects are dynamic and must be continually modified in response to specific performance issues and broader shifts in market structure and consumption patterns.

Beyond "Two Cultures": Guidance for Establishing Effective Researcher/Health System Partnerships

PubMed Central

Bowen, Sarah; Botting, Ingrid; Graham, Ian D.; Huebner, Lori-Anne

2017-01-01

Background: The current literature proposing criteria and guidelines for collaborative health system research often fails to differentiate between: (a) various types of partnerships, (b) collaborations formed for the specific purpose of developing a research proposal and those based on long-standing relationships, (c) researcher vs. decision-maker initiatives, and (d) the underlying drivers for the collaboration. Methods: Qualitative interviews were conducted with 16 decision-makers and researchers who partnered on a Canadian major peer-reviewed grant proposal in 2013. Objectives of this exploration of participants’ experiences with health system research collaboration were to: (a) explore perspectives and experience with research collaboration in general; (b) identify characteristics and strategies associated with effective partnerships; and (c) provide guidance for development of effective research partnerships. Interviews were audio-recorded and transcribed: transcripts were qualitatively analyzed using a general inductive approach. Results: Findings suggest that the common "two cultures" approach to research/decision-maker collaboration provides an inadequate framework for understanding the complexity of research partnerships. Many commonly-identified challenges to researcher/knowledge user (KU) collaboration are experienced as manageable by experienced research teams. Additional challenges (past experience with research and researchers; issues arising from previous collaboration; and health system dynamics) may be experienced in partnerships based on existing collaborations, and interact with partnership demands of time and communication. Current research practice may discourage KUs from engaging in collaborative research, in spite of strong beliefs in its potential benefits. Practical suggestions for supporting collaborations designed to respond to real-time health system challenges were identified. Conclusion: Participants’ experience with previous research activities, factors related to the established collaboration, and interpersonal, intra- and inter-organizational dynamics may present additional challenges to research partnerships built on existing collaboration. Differences between researchers and KUs may pose no greater challenges than differences among KUs (at various levels, and representing diverse perspectives and organizations) themselves. Effective "relationship brokering" is essential for meaningful collaboration. PMID:28005540

6 Common Cancers - Gynecologic Cancers Cervical, Endometrial, and Ovarian

MedlinePlus

... Bar Home Current Issue Past Issues 6 Common Cancers - Gynecologic Cancers Cervical, Endometrial, and Ovarian Past Issues / Spring 2007 ... of this page please turn Javascript on. Gynecologic Cancers Cervical, Endometrial, and Ovarian NCI estimates that endometrial, ...

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

PubMed

Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco

2014-12-01

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

Good, now keep going: challenging the status quo in STEM pipeline and access programs

NASA Astrophysics Data System (ADS)

Wiseman, Dawn; Herrmann, Randy

2018-03-01

This contribution engages in conversation with McMahon, Griese, and Kenyon (this issue) to consider how the SURE program they describe represents a pragmatic approach to addressing the issue of underrepresentation of Indigenous people in STEM post-secondary programs. We explore how such programs are generally positioned and how they might be positioned differently to challenge the status quo within Western post-secondary institutions. The challenge arises from moving beyond the immediate pragmatics of addressing an identifiable issue framed as a problem to considering how post-secondary institutions and people developing access recruitment programs might begin unlearning colonialism.

HTA programme response to the challenges of dealing with orphan medicinal products: Process evaluation in selected European countries.

PubMed

Nicod, Elena; Annemans, Lieven; Bucsics, Anna; Lee, Anne; Upadhyaya, Sheela; Facey, Karen

2017-03-28

Challenges commonly encountered in HTA of orphan medicinal products (OMPs) were identified in Advance-HTA. Since then, new initiatives have been developed to specifically address issues related to HTA of OMPs. This study aimed to understand why these new HTA initiatives in England, Scotland and at European-level were established and whether they resolve the challenges of OMPs. The work of Advance-HTA was updated with a literature review and a conceptual framework of clinical, regulatory and economic challenges for OMPs was developed. The new HTA programmes were critiqued against the conceptual framework and outstanding challenges identified. The new programmes in England and Scotland recognise the challenges identified in demonstrating the value of ultra-OMPs (and OMPs) and that they require a different process to standard HTA approaches. Wider considerations of disease and treatment experiences from a multi-stakeholder standpoint are needed, combined with other measures to deal with uncertainty (e.g. managed entry agreements). While approaches to assessing this new view of value of OMPs, extending beyond cost/QALY frameworks, differ, their criteria are similar. These are complemented by a European initiative that fosters multi-stakeholder dialogue and consensus about value determinants throughout the life-cycle of an OMP. New HTA programmes specific to OMPs have been developed but questions remain about whether they sufficiently capture value and manage uncertainty in clinical practice. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Issues and Challenges Facing the Minority Woman Dentist.

ERIC Educational Resources Information Center

Sinkford, Jeanne C.

1992-01-01

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

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

None, None

The most common method of measuring air leakage is to perform single (or solo) blower door pressurization and/or depressurization test. In detached housing, the single blower door test measures leakage to the outside. In attached housing, however, this "solo" test method measures both air leakage to the outside and air leakage between adjacent units through common surfaces. Although minimizing leakage to neighboring units is highly recommended to avoid indoor air quality issues between units, reduce pressure differentials between units, and control stack effect, the energy benefits of air sealing can be significantly overpredicted if the solo air leakage number ismore » used in the energy analysis. Guarded blower door testing is more appropriate for isolating and measuring leakage to the outside in attached housing. This method uses multiple blower doors to depressurize adjacent spaces to the same level as the unit being tested. Maintaining a neutral pressure across common walls, ceilings, and floors acts as a "guard" against air leakage between units. The resulting measured air leakage in the test unit is only air leakage to the outside. Although preferred for assessing energy impacts, the challenges of performing guarded testing can be daunting.« less

75 FR 39443 - Implementation of OMB Guidance on Drug-Free Workplace Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-09

... (DOE) is removing its regulation implementing the Governmentwide common rule on drug-free workplace... drug legislation on November 18, 1988. Federal agencies issued an interim final common rule to... Governmentwide common rule on nonprocurement suspension and debarment. The agencies issued a final common rule...

The study of direct-to-consumer advertising for prescription drugs.

PubMed

Schommer, Jon C; Hansen, Richard A

2005-06-01

The objectives of this article are to (1) identify key methodological issues related to investigating the effects of direct-to-consumer advertising (DTCA) for prescription drugs, (2) highlight opportunities and challenges that these issues pose, and (3) provide suggestions to address these challenges and opportunities from a social and administrative pharmacy perspective. Through a review of existing literature and consultation with research colleagues, we identified 3 broad issues regarding the study of DTCA for prescription drugs: (1) the importance of problem formulation, (2) the role of health behavior and decision-making perspectives, and (3) data collection and data analysis challenges and opportunities. Based upon our findings, we developed recommendations for future research in this area. Clear problem formulation will be instructive for prioritizing research needs and for determining the role that health behavior and decision-making perspectives can serve in DTCA research. In addition, it appears that cluster bias, nonlinear relationships, mediating/moderating effects, time effects, acquiescent response, and case mix are particularly salient challenges for the DTCA research domain. We suggest that problem formulation, selection of sound theories upon which to base research, and data collection and data analysis challenges are key methodological issues related to investigating the effects of DTCA for prescription drugs.

Perceptions of caring for children with disabilities: Experiences from Moshi, Tanzania

PubMed Central

McNally, Anna

2013-01-01

Background Although there exist laws, policies and standards in Tanzania that serve to protect and improve the lives of children with disabilities, the individual human experiences and feelings of the carers and parents still remain the realities of caring for children with disabilities. There is a lack of qualitative studies examining experiences in a developing context. This research aimed to fill that gap. Objectives The objective of this research was to gain an insight into how having a child with a disability impacts upon participants lives and to examine both negative and positive experiences of care through the use of qualitative methods. Method This was a qualitative, exploratory study and followed a phenomenological method. Purposive convenience sampling methods were used to recruit 14 carers in Moshi, Tanzania. Qualitative, semi-structured interviews were undertaken with all 14 participants. Results Five main themes emerged from the data which shed light on the carers experiences, namely, objective challenges in terms of financial challenges, employment issues and demands of care; subjective challenges in the form of stigma, isolation and pity; positive experiences such as the child’s progress, respect and happiness; material and financial needs; and coping mechanisms which included beliefs, support and attitudes. Conclusion The findings of this research were that objective challenges are common and more significant than subjective challenges. Positive experiences were not as easily identified by the participants as the challenges faced. However, having analysed the data, carers do not experience their roles as entirely negative. They simply need the resources to deal with objective challenges which in a developing context are not easily attainable. PMID:28729981

The Professional Challenges for Counselors.

ERIC Educational Resources Information Center

Garfield, Nancy J.; And Others

This document consists of the fourth section of a book written to educate and inform those in the helping professions on how to deal with Acquired Immune Deficiency Syndrome (AIDS). The three chapters in section 4 are devoted to special issues for counselors, issues that directly affect the caregiver. They examine professional challenges to…

Contextual Influences on Faculty Diversity Conceptualizations when Working with Trainee Competence Problems

ERIC Educational Resources Information Center

Shen-Miller, David S.; Forrest, Linda; Burt, Michelle

2012-01-01

Trainees with problems of professional competence (TPPC) present trainers with unique challenges. When TPPC situations include diversity issues, the complexity of such challenges increases. Although attention to such intersections is important, little is known about what influences faculty thinking about diversity issues when trainee competence…

Intervening: Managerial Issues and Challenges in an Educational Management Development Program.

ERIC Educational Resources Information Center

Barrilleaux, Louis E.; Schermerhorn, John R., Jr.

The literature on intervention theory tends to overlook the pragmatic managerial issues and challenges of intervening. This paper analyzes the formative period of a school management development program to establish crucial differences between the program director's espoused theory and the actual experience of the intervention. These differences…

Trends, Issues and Challenges in English Language Education in Pakistan

ERIC Educational Resources Information Center

Shamim, Fauzia

2008-01-01

This paper aims to critically examine the trends, issues and challenges in policy and practice of English language education in Pakistan. This is done first by historically reviewing the English language education policies since Pakistan's independence in 1947, looking particularly at policy objectives, implementation strategies and outcomes, and…

Trends in Inclusive Education at Regional and Interregional Levels: Issues and Challenges

ERIC Educational Resources Information Center

Opertti, Renato; Belalcazar, Carolina

2008-01-01

The UNESCO International Bureau of Education (IBE), through the Community of Practice (COP) in Curriculum Development, organized eight Regional Preparatory Workshops on Inclusive Education in 2007. These workshops had the overall goal of initiating a participatory, consultative process in order to highlight key issues and challenges regarding…

Implementation of Service-Learning in Business Education: Issues and Challenges

ERIC Educational Resources Information Center

Poon, Patrick; Chan, Tsang Sing; Zhou, Lianxi

2011-01-01

This paper examines the issues and challenges in the implementation of service-learning in undergraduate business education. It also provides an assessment of the students' learning efficacy and outcomes over time through the service-learning participation. Service-learning is a pedagogical approach that integrates academic learning and community…

Teaching Culture: The Challenges and Opportunities of International Public Relations.

ERIC Educational Resources Information Center

George, Amiso M.

2003-01-01

Focuses on the challenges and opportunities for international public relations practice. Looks at current United States-Arab relations issues in international crisis communication. Discusses those issues, especially the role of culture and media. Proposes strategies including a case study that teachers can use to help students become effective…

Major Trends and Issues in Early Childhood Education: Challenges, Controversies, and Insights. (Second Edition).

ERIC Educational Resources Information Center

Isenberg, Joan Packer, Ed.; Jalongo, Mary Renck, Ed.

Noting that understanding the contexts, continuities, and controversies of early childhood education is especially challenging because of the diversity in the field, this book provides a critical examination of the issues and controversies surrounding early childhood practices, policies, and professional development. Following an introduction…

Facing the Issues: Challenges, Censorship, and Reflection through Dialogue

ERIC Educational Resources Information Center

Lent, ReLeah Cossett

2008-01-01

ReLeah Cossett Lent provides practical advice for ensuring that books are kept on shelves and in classrooms for students to read. She outlines steps for creating professional learning communities that engage with censorship issues and prepare schools to deal with book challenges in thoughtful, supportive ways. (Contains 4 figures.)

Continuing Education in Architecture: The Process, the Issues, the Challenge.

ERIC Educational Resources Information Center

Frandson, Phillip E.

1980-01-01

The author sees three critical issues facing the architecture field: (1) the communications gap between client and practitioner; (2) humanization of the environment; and (3) financial, spatial, material, and societal constraints. He examines the role of continuing education and professional associations in responding to those challenges, which are…

Launching a Laboratory Testing Process Quality Improvement Toolkit: From the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

PubMed

Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David

2015-01-01

Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.

Rotorcraft Health Management Issues and Challenges

NASA Technical Reports Server (NTRS)

Zakrajsek, James J.; Dempsey, Paula J.; Huff, Edward M.; Augustin, Michael; Safa-Bakhsh, Robab; Ephraim, Piet; Grabil, Paul; Decker, Harry J.

2006-01-01

This paper presents an overview of health management issues and challenges that are specific to rotorcraft. Rotorcraft form a unique subset of air vehicles in that their propulsion system is used not only for propulsion, but also serves as the primary source of lift and maneuvering of the vehicle. No other air vehicle relies on the propulsion system to provide these functions through a transmission system with single critical load paths without duplication or redundancy. As such, health management of the power train is a critical and unique part of any rotorcraft health management system. This paper focuses specifically on the issues and challenges related to the dynamic mechanical components in the main power train. This includes the transmission and main rotor mechanisms. This paper will review standard practices used for rotorcraft health management, lessons learned from fielded trials, and future challenges.

International and cross-cultural issues: six key challenges for our professions.

PubMed

Marshall, Julie

2003-01-01

This paper discusses a number of key challenges facing professionals who work with people who have communication disabilities. The challenges are related to working internationally and in a cross-culturally competent way. Each challenge is discussed, drawing on material from a range of sources, including the papers in the final 2003 edition of FOLIA PHONIATRICA ET LOGOPAEDICA ('International and Cross-Cultural Issues'). The challenges discussed cover how experiences from majority world countries can be used to benefit services elsewhere, 'mainstreaming' commitment to cross-cultural competence, learning from relationships with other professionals, influencing research practice, responding to requests to work internationally and finally, dealing with cultural differences that challenge working practices. Some solutions are suggested and additional questions posed. Copyright 2003 S. Karger AG, Basel

78 FR 19742 - Centennial Challenges: 2014 Night Rover Challenge

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice 13-032] Centennial Challenges: 2014 Night... Centennial Challenges 2014 Night Rover Challenge. SUMMARY: This notice is issued in accordance with 51 U.S.C.... Centennial Challenges is a program of prize competitions to stimulate innovation in technologies of interest...

Issues for eHealth in Psychiatry: Results of an Expert Survey

PubMed Central

Huckvale, Kit; Larsen, Mark Erik; Basu, Ashna; Batterham, Philip J; Shaw, Frances; Sendi, Shahbaz

2017-01-01

Background Technology has changed the landscape in which psychiatry operates. Effective, evidence-based treatments for mental health care are now available at the fingertips of anyone with Internet access. However, technological solutions for mental health are not necessarily sought by consumers nor recommended by clinicians. Objective The objectives of this study are to identify and discuss the barriers to introducing eHealth technology-supported interventions within mental health. Methods An interactive polling tool was used to ask “In this brave new world, what are the key issues that need to be addressed to improve mental health (using technology)?” Respondents were the multidisciplinary attendees of the “Humans and Machines: A Quest for Better Mental Health” conference, held in Sydney, Australia, in 2016. Responses were categorized into 10 key issues using team-based qualitative analysis. Results A total of 155 responses to the question were received from 66 audience members. Responses were categorized into 10 issues and ordered by importance: access to care, integration and collaboration, education and awareness, mental health stigma, data privacy, trust, understanding and assessment of mental health, government and policy, optimal design, and engagement. In this paper, each of the 10 issues are outlined, and potential solutions are discussed. Many of the issues were interrelated, having implications for other key areas identified. Conclusions As many of the issues identified directly related to barriers to care, priority should be given to addressing these issues that are common across mental health delivery. Despite new challenges raised by technology, technology-supported mental health interventions represent a tremendous opportunity to address in a timely way these major concerns and improve the receipt of effective, evidence-based therapy by those in need. PMID:28246068

Common Carrier Access to Cable Communications: Regulatory and Economic Issues.

ERIC Educational Resources Information Center

Kestenbaum, Lionel

The implications of cable television (CATV) common carrier access and economic and regulatory issues associated with it are examined in this paper. The first section provides a discussion of the feasibility and legal basis of common carrier access; the next section contrasts common carrier access with existing over-the-air television broadcasting…

76 FR 76609 - Implementation of Office of Management and Budget Guidance on Drug-Free Workplace Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-08

... removing its regulation implementing the Governmentwide common rule on drug-free workplace requirements for....) as a part of omnibus drug legislation. Federal agencies issued an interim final common rule to... Governmentwide common rule on nonprocurement suspension and debarment. The agencies issued a final common rule...

Foundational Methane Propulsion Related Technology Efforts, and Challenges for Applications to Human Exploration Beyond Earth Orbit

NASA Technical Reports Server (NTRS)

Brown, Thomas; Klem, Mark; McRight, Patrick

2016-01-01

Current interest in human exploration beyond earth orbit is driving requirements for high performance, long duration space transportation capabilities. Continued advancement in photovoltaic power systems and investments in high performance electric propulsion promise to enable solar electric options for cargo delivery and pre-deployment of operational architecture elements. However, higher thrust options are required for human in-space transportation as well as planetary descent and ascent functions. While high thrust requirements for interplanetary transportation may be provided by chemical or nuclear thermal propulsion systems, planetary descent and ascent systems are limited to chemical solutions due to their higher thrust to weight and potential planetary protection concerns. Liquid hydrogen fueled systems provide high specific impulse, but pose challenges due to low propellant density and the thermal issues of long term propellant storage. Liquid methane fueled propulsion is a promising compromise with lower specific impulse, higher bulk propellant density and compatibility with proposed in-situ propellant production concepts. Additionally, some architecture studies have identified the potential for commonality between interplanetary and descent/ascent propulsion solutions using liquid methane (LCH4) and liquid oxygen (LOX) propellants. These commonalities may lead to reduced overall development costs and more affordable exploration architectures. With this increased interest, it is critical to understand the current state of LOX/LCH4 propulsion technology and the remaining challenges to its application to beyond earth orbit human exploration. This paper provides a survey of NASA's past and current methane propulsion related technology efforts, assesses the accomplishments to date, and examines the remaining risks associated with full scale development.

Randomized clinical trials in pediatric critical care: Rarely done but desperately needed.

PubMed

Randolph, Adrienne G.; Lacroix, Jacques

2002-04-01

OBJECTIVE: To review the benefits and challenges of using the randomized, controlled trial (RCT) study design to evaluate preventive and therapeutic interventions in pediatric critical care medicine. CONCLUSIONS: The RCT design is able to control for many sources of potential bias that other types of study designs cannot. The findings of RCTs often contradict the findings of less rigorous study designs. Before performing an RCT, there must exist a state of clinical equipoise, a sufficient number of eligible patients must be available, and the epidemiology of the disorder in question must be well studied. There are many challenges to performing high-quality RCTs. Studying multiple element support strategies in the critically ill patient population is more complex than studying a single drug therapy. High patient and practice variability and hazy diagnostic definitions can dilute the signal-to-noise ratio. Most interventions in critical care are expected to have a modest or small effect. This markedly increases the requisite sample size. There is a paucity of accepted clinically important measurements of the outcome of critical care, making mortality a common outcome to evaluate with a not-so-common incidence. Developmental issues, the inability to give informed consent, and the failure to perform the appropriate pharmacokinetic and safety studies are additional challenges facing pediatric investigators. Despite these limitations, a good RCT remains the best way to prove that an intervention is working or not. Indeed, RCTs are and will remain the "gold standard" method to estimate the efficacy of a therapeutic or prophylactic intervention.

Social media use in medical education: a systematic review.

PubMed

Cheston, Christine C; Flickinger, Tabor E; Chisolm, Margaret S

2013-06-01

The authors conducted a systematic review of the published literature on social media use in medical education to answer two questions: (1) How have interventions using social media tools affected outcomes of satisfaction, knowledge, attitudes, and skills for physicians and physicians-in-training? and (2) What challenges and opportunities specific to social media have educators encountered in implementing these interventions? The authors searched the MEDLINE, CINAHL, ERIC, Embase, PsycINFO, ProQuest, Cochrane Library, Web of Science, and Scopus databases (from the start of each through September 12, 2011) using keywords related to social media and medical education. Two authors independently reviewed the search results to select peer-reviewed, English-language articles discussing social media use in educational interventions at any level of physician training. They assessed study quality using the Medical Education Research Study Quality Instrument. Fourteen studies met inclusion criteria. Interventions using social media tools were associated with improved knowledge (e.g., exam scores), attitudes (e.g., empathy), and skills (e.g., reflective writing). The most commonly reported opportunities related to incorporating social media tools were promoting learner engagement (71% of studies), feedback (57%), and collaboration and professional development (both 36%). The most commonly cited challenges were technical issues (43%), variable learner participation (43%), and privacy/security concerns (29%). Studies were generally of low to moderate quality; there was only one randomized controlled trial. Social media use in medical education is an emerging field of scholarship that merits further investigation. Educators face challenges in adapting new technologies, but they also have opportunities for innovation.

Army Communicator. Volume 32, Number 3, Summer 2007

DTIC Science & Technology

2007-01-01

goal of bringing people from across the Army together to talk about the issues and challenges they are experiencing in the field and try to work out...actually facing the challenges . Each work- shop had a mediator who collected information on issues being faced and suggested solutions to these problems...these possible items that Signal Center actions may be put forth to bring about resolutions to the challenges facing the warfighter in the field. “I

The Top 10 Challenges in Extreme-Scale Visual Analytics

PubMed Central

Wong, Pak Chung; Shen, Han-Wei; Johnson, Christopher R.; Chen, Chaomei; Ross, Robert B.

2013-01-01

In this issue of CG&A, researchers share their R&D findings and results on applying visual analytics (VA) to extreme-scale data. Having surveyed these articles and other R&D in this field, we’ve identified what we consider the top challenges of extreme-scale VA. To cater to the magazine’s diverse readership, our discussion evaluates challenges in all areas of the field, including algorithms, hardware, software, engineering, and social issues. PMID:24489426

Stresses and satisfactions of the two-pharmacist relationship.

PubMed

Stanton, A L; Berger, B A

1987-12-01

Potential advantages and disadvantages of dual-career relationships are identified, and strategies for addressing common issues encountered by dual-career couples are presented. With regard to career issues, clarification of expectations and discussion between partners regarding career commitment, job selection and mobility, and maintenance of professional identity is emphasized. Benefits of dual-career relationships include shared occupational interests, financial rewards, and respect for each partner's professional expertise. Strategies for managing domestic responsibilities include modifying standards, setting priorities, and distributing tasks evenly among family members. Pharmacist couples who are parents have chosen several routes in managing child-care issues, including postponing childbearing until each adult's career is established, decreasing one partner's career involvement, and hiring community or in-home caretakers. Sharing equally in child care can help prevent an excessive workload for one parent. Progressive family-oriented employment practices may also aid dual-career couples with children. Striking a balance between career and family is identified as perhaps the most challenging task facing the dual-career couple; time distribution must be adjusted according to the couple's priorities. Identifying realistic priorities, negotiating honestly regarding attainment of mutual and individual goals, and maintaining flexibility are key in achieving success in the professional and private lives of two-pharmacist couples.

Ethical issues associated with medical tourism in Africa.

PubMed

Mogaka, John J O; Mupara, Lucia; Tsoka-Gwegweni, Joyce M

2017-01-01

Global disparities in medical technologies, laws, economic inequities, and social-cultural differences drive medical tourism (MT), the practice of travelling to consume healthcare that is either too delayed, unavailable, unaffordable or legally proscribed at home. Africa is simultaneously a source and destination for MT. MT however, presents a new and challenging health ethics frontier, being largely unregulated and characterized by policy contradictions, minority discrimination and conflict of interest among role-players. This article assesses the level of knowledge of MT and its associated ethical issues in Africa; it also identifies critical research gaps on the subject in the region. Exploratory design guided by Arksey and O'Malley's (2005) framework was used. Key search terms and prior determined exclusion/inclusion criteria were used to identify relevant literature sources. Fifty-seven articles met the inclusion criteria. Distributive justice, healthcare resource allocation, experimental treatments and organ transplant were the most common ethical issues of medical tourism in Africa. The dearth of robust engagement of MT and healthcare ethics, as identified through this review, calls for more rigorous research on this subject. Although the bulk of the medical tourism industry is driven by global legal disparities based on ethical considerations, little attention has been given to this subject.

Nursing practice and work environment issues in the 21st century: a leadership challenge.

PubMed

Manojlovich, Milisa; Barnsteiner, Jane; Bolton, Linda Burnes; Disch, Joanne; Saint, Sanjay

2008-01-01

A leadership conference titled "Have Patient Safety and the Workforce Shortage Created the Perfect Storm?" was held in honor of Dr. Ada Sue Hinshaw, who was ending her tenure as dean of the University of Michigan School of Nursing. A morning panel on the preferred future for practice featured plenary speaker Dr. Linda Burnes Bolton and participating panelists Dr. Sanjay Saint, Dr. Jane Barnsteiner, and Dr. Joanne Disch. Each speaker presented a unique yet complementary perspective, with several common themes permeating the morning's presentations. For example, all of the speakers mentioned how important interprofessional collaboration is to promoting patient safety. The themes can be categorized broadly as nursing practice and work environment issues, with subthemes of interprofessional communication and collaboration, systems solutions to patient safety problems, and future directions in nursing education. A synopsis of comments made during the morning practice panel and empirical support for the themes and subthemes identified by panelists are provided in this article.

Diagnosing and managing anorexia nervosa in UK primary care: a focus group study.

PubMed

Hunt, D; Churchill, R

2013-08-01

Anorexia is a leading cause of adolescent hospital admission and death from psychiatric disorder. Despite the potential role of general practitioners in diagnosis, appropriate referral and coordinating treatment, few existing studies provide fine-grained accounts of GPs' beliefs about anorexia. To identify GPs' understandings and experiences of diagnosing and managing patients with anorexia in primary care. Case-based focus groups with co-working general practitioners in the East Midlands region of England were used to explore attitudes towards issues common to patients with eating disorders. Group discussions were transcribed and analysed using corpus linguistic and discourse analytic approaches. Participants' discussion focused on related issues of making hesitant diagnoses, the utility of the body mass index, making referrals and overcoming patient resistance. Therapeutic relationships with patients with anorexia are considered highly complex, with participants using diagnostic tests as rhetorical strategies to help manage communicative obstacles. Overcoming patient repudiation and securing referrals are particular challenges with this patient group. Successfully negotiating these problems appears to require advanced communication skills.

The Role of Emotion in Psychological Therapy

PubMed Central

Ehrenreich, Jill T.; Fairholme, Christopher P.; Buzzella, Brian A.; Ellard, Kristen K.; Barlow, David H.

2008-01-01

This Special Issue of Clinical Psychology: Science and Practice provides a series of articles detailing efforts to consider the concepts of emotion and emotion regulation in relation to clinical assessment and psychopathology intervention efforts across the lifespan. In our commentary, we review some common themes and challenges presented in these articles to move forward the discussion of emotion’s role in psychological therapy. We discuss efforts to conceptualize the role of context in defining emotion concepts and maximizing the relevancy of such concepts to treatment. We review the importance of imbuing efforts to develop emotion-focused treatments with emphases on positive, as well as negative, emotions and flexibility in the expression of these emotions. We also highlight the relevance of a lifespan developmental approach to the accurate use of emotion and emotion regulation concepts within treatment. Finally, we discuss the application of these issues to our own treatment development and evaluation efforts regarding a unified approach to the treatment of emotional disorders in adults and adolescents. PMID:18843381

Deconstructing Biomass [part of The frontiers of energy

DOE PAGES

Armstrong, Robert C.; Wolfram, Catherine; de Jong, Krijn P.; ...

2016-01-11

Great strides have been made over the past century in our ability to harness energy sources, leading to profound transformations — both good and bad — in society. Looking at the energy system of today, it is clear that meeting the energy needs of the world now and in the years to come requires the concerted efforts of many different actors across a range of technologies and approaches. In this Feature, ten leading experts in energy research share their vision of what challenges their respective fields need to address in the coming decades. The issues being faced are diverse andmore » multifaceted, from the search for better materials for fuels, to the design of energy policy and markets for the developing world. However, a common theme emerges: changes to adapt and improve our energy system are greatly needed. As a result, by improving our mutual understanding of the issues faced by each area of energy research, these changes can happen more smoothly, efficiently and rapidly.« less

Foetal images: the power of visual technology in antenatal care and the implications for women's reproductive freedom.

PubMed

Zechmeister, I

2001-01-01

Continuing medico-technical progress has led to an increasing medicalisation of pregnancy and childbirth. One of the most common technologies in this context is ultrasound. Based on some identified 'pro-technology feminist theories', notably the postmodernist feminist discourse, the technology of ultrasound is analysed focusing mainly on social and political rather than clinical issues. As empirical research suggests, ultrasound is welcomed by the majority of women. The analysis, however, shows that attitudes and decisions of women are influenced by broader social aspects. Furthermore, it demonstrates how the visual technology of ultrasound, in addition to other reproductive technology in maternity care, is linked to the 'personification' of the foetus and has therefore contributed to a new image of the foetus. The exploration of these issues challenges some arguments of feminist discourse. It draws attention to possible adverse implications of the technology for women's reproductive freedom and indicates the importance of the topic for political discussions.

Integrity, standards, and QC-related issues with big data in pre-clinical drug discovery.

PubMed

Brothers, John F; Ung, Matthew; Escalante-Chong, Renan; Ross, Jermaine; Zhang, Jenny; Cha, Yoonjeong; Lysaght, Andrew; Funt, Jason; Kusko, Rebecca

2018-06-01

The tremendous expansion of data analytics and public and private big datasets presents an important opportunity for pre-clinical drug discovery and development. In the field of life sciences, the growth of genetic, genomic, transcriptomic and proteomic data is partly driven by a rapid decline in experimental costs as biotechnology improves throughput, scalability, and speed. Yet far too many researchers tend to underestimate the challenges and consequences involving data integrity and quality standards. Given the effect of data integrity on scientific interpretation, these issues have significant implications during preclinical drug development. We describe standardized approaches for maximizing the utility of publicly available or privately generated biological data and address some of the common pitfalls. We also discuss the increasing interest to integrate and interpret cross-platform data. Principles outlined here should serve as a useful broad guide for existing analytical practices and pipelines and as a tool for developing additional insights into therapeutics using big data. Copyright © 2018 Elsevier Inc. All rights reserved.

A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.

PubMed

Lehn, Alexander Christoph; Lettieri, Jennie; Grimley, Rohan

2012-05-01

Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported. We describe a 64-year-old man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with dramatic physiological derangement causing severe management challenges. Apart from debilitating postural hypotension, he developed dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions and variable respiratory control. This is the first report of a patient with traumatic bilateral cranial nerve IX and X nerve palsies. This detailed report and the summary of all 6 previous case reports of traumatic bilateral lower cranial nerve palsies illustrate clinical features, treatment strategies, and outcomes of these rare events.

Rethinking Headache Chronification

PubMed Central

Turner, Dana P.; Smitherman, Todd A.; Penzien, Donald B.; Lipton, Richard B.; Houle, Timothy T.

2013-01-01

The objective of this series is to examine several threats to the interpretation of headache chronification studies that arise from methodological issues. The study of headache chronification has extensively used longitudinal designs with two or more measurement occasions. Unfortunately, application of these designs when combined with the common practice of extreme score selection as well as the extant challenges in measuring headache frequency rates (eg, unreliability, regression to the mean), induces substantive threats to accurate interpretation of findings. Partitioning the amount of observed variance in rates of chronification and remission attributable to regression artifacts is a critical yet previously overlooked step to learning more about headache as a potentially progressive disease. In this series on rethinking headache chronification, we provide an overview of methodological issues in this area (this paper), highlight the influence of rounding error on estimates of headache frequency (second paper), examine the influence of random error and regression artifacts on estimates of chronification and remission (third paper), and consider future directions for this line of research (fourth paper). PMID:23721237

Child pornography: a hidden dimension of child abuse.

PubMed

Pierce, R L

1984-01-01

In the decade of the 70s, much was learned about abused and neglected children and their families. Public outcry demanded action at the state, regional and national level hoping that the effort would generate more effective methods of identification, intervention and treatment. Consequently, researchers and theoreticians initiated efforts that were aimed at providing a better understanding of why some parents abuse or neglect their children while others do not. In spite of all the energy and time, one form of child abuse continues to flourish relatively unnoticed--child pornography, or as it is more commonly known in the trade, "kiddie" or "chicken" porn. Because of the dearth of information about the subject, this paper addresses five key issues: Who are the children who become the young stars of pornographic films? How many children are estimated to be involved in this activity? What are the presumed effects of such involvement on children? Legal issues related to the control of the pornographic industry; and What is the challenge to social work and other helping professionals?

The management of scabies outbreaks in residential care facilities for the elderly in England: a review of current health protection guidelines.

PubMed

White, L C J; Lanza, S; Middleton, J; Hewitt, K; Freire-Moran, L; Edge, C; Nicholls, M; Rajan-Iyer, J; Cassell, J A

2016-11-01

Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.

Ethical Issues in Sports Medicine

PubMed Central

Greenfield, Bruce H.; West, Charles Robert

2012-01-01

Ethical issues present a challenge for health care professionals working with athletes of sports teams. Health care professionals—including the team physician, the physical therapist, and the athletic trainer—are faced with the challenge of returning an athlete to competition as quickly as possible but as safely as possible. Conflicts of interest arise due to conflicting obligations of the team physician to the athlete and other members of the sports organization, including coaches and the team owner. The multiple stakeholders involved in sports teams challenge the traditional notion of confidentiality and autonomy. The aims of this article are to explicate the ethics of sports medicine, highlight the ethical issues, and provide some strategies and suggestions for ethical decision making. PMID:24179585

How to implement live video recording in the clinical environment: A practical guide for clinical services.

PubMed

Lloyd, Adam; Dewar, Alistair; Edgar, Simon; Caesar, Dave; Gowens, Paul; Clegg, Gareth

2017-06-01

The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. To provide a practical guide for clinical services to embed live video recording. Using Kotter's 8-step process for leading change, we provide a 'how to' guide to navigate the challenges required to implement a continuous video-audit system based on our experience of video recording in our emergency department resuscitation rooms. The most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. Clinicians are faced with considerable ethical, legal and data protection challenges which are the primary barriers for services that pursue video recording of patient care. Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. This article outlines core implementation issues that need to be addressed if video is to become part of routine care delivery. By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care. © 2017 John Wiley & Sons Ltd.

Deregulation strategies for local governments and the role/opportunities for energy efficiency services in the utility industry deregulation

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

Tseng, P.C.

As the future shape of the electric utility industry continues to unfold and as retail competition becomes a reality, local governments are faced with balancing the need for: (1) economic development; (2) and to avoid the potential impact of cost-shifting among residents and businesses, while ensuring reliable and universal energy services. Furthermore, local governments need to find ways to recoup potential loss of franchise and tax revenues, to ensure fair and adequate energy-efficiency programs, and to continue other social programs for low income families. This paper will address two important issues every local government in the US are facing: (1)more » the development of viable deregulation strategies before, during and after the promulgation of utility deregulation; (2) opportunities for energy efficiency services in the competitive markets to serve local governments, which typically constitutes the largest market segment in utility's service territory. This paper presents issues and challenges common to all local governments. It documents strategies that several local governments are utilizing to embrace the coming electric utility restructuring and competition challenge to the benefits of their respective communities. This paper presents the results on deregulation work by the City of Portland, Oregon, Barnstable County, Massachusetts, and Montgomery County, Maryland. The research by these local governments was sponsored by the Urban Consortium Energy Task Force and Public Technology, Inc.« less