Optical Issues in Measuring Strabismus.

PubMed

Irsch, Kristina

2015-01-01

Potential errors and complications during examination and treatment of strabismic patients can be reduced by recognition of certain optical issues. This articles reviews basic as well as guiding principles of prism optics and optics of the eye to equip the reader with the necessary know-how to avoid pitfalls that are commonly encountered when using prisms to measure ocular deviations (e.g., during cover testing), and when observing the corneal light reflex to estimate ocular deviations (e.g., during Hirschberg or Krimsky testing in patients who do not allow for cover testing using prisms).

A survey of sports medicine physicians regarding psychological issues in patient-athletes.

PubMed

Mann, Barton J; Grana, William A; Indelicato, Peter A; O'Neill, Daniel F; George, Steven Z

2007-12-01

To determine the extent to which sports medicine physicians encounter and discuss psychological issues among athletes they treat and to evaluate physicians' perceptions of the availability and efficacy of sport psychologists and other mental health resources. Cross-sectional study. A survey was sent via e-mail to all physician members of 4 prominent sports medicine professional associations: the American Orthopaedic Society for Sports Medicine, American College of Sports Medicine, American Medical Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. The extent to which respondents discuss psychological issues with athletes varied by subspecialty and by specific issues assessed. Fears about reinjury, fears related to surgery, and lack of patience with recovery/rehabilitation were the 3 most common injury-related topics discussed with patient-athletes. The 3 most common non-injury-related topics discussed were stress/pressure, anxiety, and burnout. Family practitioners were more likely to discuss injury-related psychological issues than were orthopaedic surgeons. Orthopaedic surgeons reported the lowest frequencies of discussing non-injury-related psychological issues. Only 19% of all respondents indicated there were adequate numbers of sport psychologists and other mental health professionals in their geographical area to treat the needs of athletes. Three quarters of respondents reported they rarely or never referred athletes to sport psychologists for injury-related issues, and two thirds indicated they rarely or never referred athletes to sport psychologists for non-injury-related problems. Respondents rated sport psychologists and athletic trainers/physical therapists to be moderately effective in working with athletes regarding psychological problems. Sports medicine physicians frequently encounter psychological issues with patient-athletes. There is a need for tools to facilitate assessment of these problems as well as greater communication between the mental health community and sports medicine physicians. In addition, knowledge of and access to professionals who are specifically trained to deal with the sometimes unique psychological needs of athletes should be improved.

Erratum: Erratum to: Realistic interpretation of quantum mechanics and encounter-delayed-choice experiment

NASA Astrophysics Data System (ADS)

Long, GuiLu; Qin, Wei; Yang, Zhe; Li, Jun-Lin

2018-06-01

The article Realistic interpretation of quantum mechanics and encounter-delayed-choice experiment, written by GuiLu Long, Wei Qin, Zhe Yang, and Jun-Lin Li, was originally published online without open access. After publication in volume 61, issue 3: 030311 the author decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to The Author(s) 2017 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The original article has been corrected.

Patient perspectives of telemedicine quality

PubMed Central

LeRouge, Cynthia M; Garfield, Monica J; Hevner, Alan R

2015-01-01

Background The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. Methods We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. Results The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. Conclusion Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding. PMID:25565781

Tetralogy of Fallot: General Principles of Management.

PubMed

Downing, Tacy E; Kim, Yuli Y

2015-11-01

Repaired tetralogy of Fallot (TOF) is one of the most common diagnoses encountered when caring for adults with congenital heart disease. Although long-term survival after childhood TOF repair is excellent, morbidity is common and most patients require reintervention in adulthood. This review provides an overview of key surveillance and management issues for adults with TOF, including residual right ventricular outflow tract disease and timing of pulmonary valve replacement, arrhythmias and risk stratification, left-sided heart disease and heart failure, and pregnancy management. Copyright © 2015 Elsevier Inc. All rights reserved.

Bilingual Encounters: Spanish-English Medical and Legal Dialogues. A Practical Resource for Educators and Students of Interpreting. Interpreting and Translation Publications Series, No. 1.

ERIC Educational Resources Information Center

Hale, Sandra

Thirty-eight dialogues are presented, each illustrating a common, real-life interpreting situation involving medical and/or legal issues and terminology. Each involves both Spanish and English languages, and the situations are specific to New South Wales, Australia. They are designed to be used as a resource in teaching interpreting. The…

Using the CER Hub to ensure data quality in a multi-institution smoking cessation study.

PubMed

Walker, Kari L; Kirillova, Olga; Gillespie, Suzanne E; Hsiao, David; Pishchalenko, Valentyna; Pai, Akshatha Kalsanka; Puro, Jon E; Plumley, Robert; Kudyakov, Rustam; Hu, Weiming; Allisany, Art; McBurnie, MaryAnn; Kurtz, Stephen E; Hazlehurst, Brian L

2014-01-01

Comparative effectiveness research (CER) studies involving multiple institutions with diverse electronic health records (EHRs) depend on high quality data. To ensure uniformity of data derived from different EHR systems and implementations, the CER Hub informatics platform developed a quality assurance (QA) process using tools and data formats available through the CER Hub. The QA process, implemented here in a study of smoking cessation services in primary care, used the 'emrAdapter' tool programmed with a set of quality checks to query large samples of primary care encounter records extracted in accord with the CER Hub common data framework. The tool, deployed to each study site, generated error reports indicating data problems to be fixed locally and aggregate data sharable with the central site for quality review. Across the CER Hub network of six health systems, data completeness and correctness issues were prevalent in the first iteration and were considerably improved after three iterations of the QA process. A common issue encountered was incomplete mapping of local EHR data values to those defined by the common data framework. A highly automated and distributed QA process helped to ensure the correctness and completeness of patient care data extracted from EHRs for a multi-institution CER study in smoking cessation. 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.

Demographic and epidemiologic characterization of transfusion recipients from four US regions: evidence from the REDS-III recipient database.

PubMed

Karafin, Matthew S; Bruhn, Roberta; Westlake, Matt; Sullivan, Marian T; Bialkowski, Walter; Edgren, Gustaf; Roubinian, Nareg H; Hauser, Ronald G; Kor, Daryl J; Fleischmann, Debra; Gottschall, Jerome L; Murphy, Edward L; Triulzi, Darrell J

2017-12-01

Blood transfusion is one of the most common medical procedures during hospitalization in the United States. To understand the benefits of transfusion while mitigating potential risks, a multicenter database containing detailed information on transfusion incidence and recipient outcomes would facilitate research. The Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) program has developed a comprehensive transfusion recipient database utilizing data from hospital electronic health records at 12 participating hospitals in four geographic regions. Inpatient and outpatient data on transfusion recipients from January 1, 2013 to December 31, 2014 included patient age, sex, ethnicity, primary diagnosis, type of blood product provided, issue location, pretransfusion and post-transfusion hemoglobin (Hgb), and hospital outcomes. Transfusion incidence per encounter was calculated by blood product and various patient characteristics. During the 2-year study period, 80,362 (12.5%) inpatient encounters involved transfusion. Among inpatients, the most commonly transfused blood products were red blood cells (RBCs; 10.9% of encounters), followed by platelets (3.2%) and plasma (2.9%). Among patients who received transfusions, the median number of RBC units was one, the pretransfusion Hgb level was 7.6 g/dL, and the Hgb increment per unit was 1.4 g/dL. Encounter mortality increased with patient age, the number of units transfused, and the use of platelet or plasma products. The most commonly reported transfusion reaction was febrile nonhemolytic. The database contains comprehensive data regarding transfusion use and patient outcomes. The current report describes an evaluation of the first 2 years of a planned, 4-year, linked blood donor-component-recipient database, which represents a critical new resource for transfusion medicine researchers. © 2017 AABB.

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.

The wound/burn guidelines - 6: Guidelines for the management of burns.

PubMed

Yoshino, Yuichiro; Ohtsuka, Mikio; Kawaguchi, Masakazu; Sakai, Keisuke; Hashimoto, Akira; Hayashi, Masahiro; Madokoro, Naoki; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Ito, Takaaki; Inoue, Yuji; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ogawa, Fumihide; Kadono, Takafumi; Kawakami, Tamihiro; Kukino, Ryuichi; Kono, Takeshi; Kodera, Masanari; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hasegawa, Minoru; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Matsuo, Koma; Yamasaki, Osamu; Le Pavoux, Andres; Tachibana, Takao; Ihn, Hironobu

2016-09-01

Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures. © 2016 Japanese Dermatological Association.

Multiple myeloma: Diagnosis and management issues in patients with pre-existing chronic kidney disease.

PubMed

Vadlamudi, Srilatha; Annapareddy, Siva Nagendra Reddy

2016-01-01

Multiple myeloma is one of the most common malignancies encountered in clinical practice. Renal involvement in myeloma is a well-recognized entity. Although rare, another special situation that a nephrologist can encounter is myeloma occurring in a patient with preexisting chronic kidney disease (CKD) due to other etiologies. Anemia, bone pains and hypercalcemia, which commonly indicate the diagnosis of myeloma in the general population, are not useful in the presence of CKD. The sensitivity and specificity of serum free light chain assay is decreased in the presence of renal failure. Chemotherapy-related adverse effects are high compared with that in patients without CKD; this is attributed to the decreased clearance of drugs and the additive effect of chemotherapy-related adverse effects to the complications of CKD. Autologous and allogenic bone marrow transplantation can be attempted in this group of patients with non-myeloablative-conditioning regimens. Combined bone marrow and renal transplantation remains a viable option in this group of patients to increase life expectancy and quality of life.

Parallel software support for computational structural mechanics

NASA Technical Reports Server (NTRS)

Jordan, Harry F.

1987-01-01

The application of the parallel programming methodology known as the Force was conducted. Two application issues were addressed. The first involves the efficiency of the implementation and its completeness in terms of satisfying the needs of other researchers implementing parallel algorithms. Support for, and interaction with, other Computational Structural Mechanics (CSM) researchers using the Force was the main issue, but some independent investigation of the Barrier construct, which is extremely important to overall performance, was also undertaken. Another efficiency issue which was addressed was that of relaxing the strong synchronization condition imposed on the self-scheduled parallel DO loop. The Force was extended by the addition of logical conditions to the cases of a parallel case construct and by the inclusion of a self-scheduled version of this construct. The second issue involved applying the Force to the parallelization of finite element codes such as those found in the NICE/SPAR testbed system. One of the more difficult problems encountered is the determination of what information in COMMON blocks is actually used outside of a subroutine and when a subroutine uses a COMMON block merely as scratch storage for internal temporary results.

Towards the development of day one competences in veterinary behaviour medicine: survey of veterinary professionals experience in companion animal practice in Ireland.

PubMed

Golden, Olwen; Hanlon, Alison J

2018-01-01

Veterinary behaviour medicine should be a foundation subject of the veterinary curriculum because of its wide scope of applications to veterinary practice. Private practitioners are likely to be the primary source of information on animal behaviour for most pet owners, however studies indicate that behavioural issues are not frequently discussed during companion animal consultations and many practitioners lack confidence in dealing with behavioural problems, likely due to poor coverage of this subject in veterinary education.There is a need to identify learning outcomes to support day one competences in veterinary behaviour medicine and these should be informed by practice-based evidence. This study aimed to investigate the nature and frequency of behavioural queries experienced by veterinary professionals in Ireland, the provision of behavioural services at companion animal practices, behaviour referral practices and challenges associated with providing a behaviour service. Two online surveys were developed, one for private veterinary practitioners (PVP) and one for veterinary nurses (VN). Invitations to participate were distributed using contact details from the Premises Accreditation Scheme database on the Veterinary Council of Ireland website. Thirty-eight PVPs and 69 VNs completed the survey. Results indicated that less than half of companion animal practices offer behavioural consults and under a third of practices provide training and socialization events. Over half of the practices surveyed have referred cases to a behavioural specialist.The majority of respondents encountered behavioural queries weekly. Ninety-eight percent reported receiving queries regarding dog behaviour. Toilet training and unruly behaviour were two issues encountered frequently. Behavioural issues in cats were also common. House soiling and destructive behaviour were the problems most frequently encountered by respondents.The two most commonly cited barriers to providing behavioural consultations were lack of in-house or personal expertise, and that clients were not willing to pay for these services.Furthermore over half of all veterinary professionals surveyed indicated that they had received inadequate undergraduate training in veterinary behaviour medicine. Behavioural problems in companion animals can affect the quality of life of pets and their owners. Our survey findings indicate that many veterinary professionals frequently encounter behavioural problems and identify an opportunity for improved provision in behaviour medicine in veterinary education.

Commentary: On the wisdom and challenges of culturally attuned treatments for Latinos.

PubMed

Falicov, Celia Jaes

2009-06-01

In this commentary, I outline the common and distinctive components in the cultural adaptation studies in this special issue and compare cultural adaptations with universalistic and culture-specific perspectives. The term cultural attunement may be more reflective than cultural adaptation insofar as the cultural additions in these studies make the treatments more accessible by adding language translation, cultural values, and contextual stressors. These additions most likely enhance the level of engagement and retention in therapy for Latino families. The work ahead requires a deeper examination of the cultural theories of psychological distress and the cultural theories of change in therapy. A final proposal is made in this commentary for considering the bicultural aspects of the cultural adaptation or attunement enterprise, insofar as the clinical research encounters with immigrants are bicultural encounters. These encounters can reach beyond the notion of cultural "adaptation" of mainstream evidence-based treatments to ethnic minorities and present a unique opportunity for mutually enriching bicultural integration of theory, research, and practice.

The embedded software life cycle - An expanded view

NASA Technical Reports Server (NTRS)

Larman, Brian T.; Loesh, Robert E.

1989-01-01

Six common issues that are encountered in the development of software for embedded computer systems are discussed from the perspective of their interrelationships with the development process and/or the system itself. Particular attention is given to concurrent hardware/software development, prototyping, the inaccessibility of the operational system, fault tolerance, the long life cycle, and inheritance. It is noted that the life cycle for embedded software must include elements beyond simply the specification and implementation of the target software.

Safety pharmacology investigations on the nervous system: An industry survey.

PubMed

Authier, Simon; Arezzo, Joseph; Delatte, Marcus S; Kallman, Mary-Jeanne; Markgraf, Carrie; Paquette, Dominique; Pugsley, Michael K; Ratcliffe, Sian; Redfern, William S; Stevens, Joanne; Valentin, Jean-Pierre; Vargas, Hugo M; Curtis, Michael J

2016-01-01

The Safety Pharmacology Society (SPS) conducted an industry survey in 2015 to identify industry practices as they relate to central, peripheral and autonomic nervous system ('CNS') drug safety testing. One hundred fifty-eight (158) participants from Asia (16%), Europe (20%) and North America (56%) responded to the survey. 52% of participants were from pharmaceutical companies (>1000 employees). Oncology (67%) and neurology/psychiatry (66%) were the most frequent target indications pursued by companies followed by inflammation (48%), cardiovascular (43%), metabolic (39%), infectious (37%), orphan (32%) and respiratory (29%) diseases. Seizures (67% of participants), gait abnormalities (67%), tremors (65%), emesis (56%), sedation (52%) and salivation (47%) were the most commonly encountered CNS issues in pre-clinical drug development while headache (65%), emesis/nausea (60%), fatigue (51%) and dizziness (49%) were the most frequent issues encountered in Phase I clinical trials. 54% of respondents reported that a standard battery of tests applied to screen drug candidates was the approach most commonly used to address non-clinical CNS safety testing. A minority (14% of all participants) reported using electroencephalography (EEG) screening prior to animal inclusion on toxicology studies. The most frequent group size was n=8 for functional observation battery (FOB), polysomnography and seizure liability studies. FOB evaluations were conducted in a dedicated room (78%) by blinded personnel (66%) with control for circadian cycle (55%) effects (e.g., dosing at a standardized time; balancing time of day across treatment groups). The rat was reported as the most common species used for seizure liability, nerve conduction and drug-abuse liability testing. Copyright © 2016 Elsevier Inc. All rights reserved.

CURRENT CONCEPTS AND TREATMENT OF PATELLOFEMORAL COMPRESSIVE ISSUES.

PubMed

Mullaney, Michael J; Fukunaga, Takumi

2016-12-01

Patellofemoral disorders, commonly encountered in sports and orthopedic rehabilitation settings, may result from dysfunction in patellofemoral joint compression. Osseous and soft tissue factors, as well as the mechanical interaction of the two, contribute to increased patellofemoral compression and pain. Treatment of patellofemoral compressive issues is based on identification of contributory impairments. Use of reliable tests and measures is essential in detecting impairments in hip flexor, quadriceps, iliotibial band, hamstrings, and gastrocnemius flexibility, as well as in joint mobility, myofascial restrictions, and proximal muscle weakness. Once relevant impairments are identified, a combination of manual techniques, instrument-assisted methods, and therapeutic exercises are used to address the impairments and promote functional improvements. The purpose of this clinical commentary is to describe the clinical presentation, contributory considerations, and interventions to address patellofemoral joint compressive issues.

CURRENT CONCEPTS AND TREATMENT OF PATELLOFEMORAL COMPRESSIVE ISSUES

PubMed Central

Fukunaga, Takumi

2016-01-01

Patellofemoral disorders, commonly encountered in sports and orthopedic rehabilitation settings, may result from dysfunction in patellofemoral joint compression. Osseous and soft tissue factors, as well as the mechanical interaction of the two, contribute to increased patellofemoral compression and pain. Treatment of patellofemoral compressive issues is based on identification of contributory impairments. Use of reliable tests and measures is essential in detecting impairments in hip flexor, quadriceps, iliotibial band, hamstrings, and gastrocnemius flexibility, as well as in joint mobility, myofascial restrictions, and proximal muscle weakness. Once relevant impairments are identified, a combination of manual techniques, instrument-assisted methods, and therapeutic exercises are used to address the impairments and promote functional improvements. The purpose of this clinical commentary is to describe the clinical presentation, contributory considerations, and interventions to address patellofemoral joint compressive issues. PMID:27904792

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.

Managing Complications of Calcaneus Fractures.

PubMed

Clare, Michael P; Crawford, William S

2017-03-01

Calcaneus fractures remain among the most complicated fractures for orthopedic surgeons to manage because of the complexity of various fracture patterns, the limited surrounding soft tissue envelope, and the prolonged rehabilitation issues impacting function after successful treatment. Despite this, appropriate management of complications associated with calcaneus fractures is critical for the complete care of this injury, whether treated operatively or nonoperatively. The authors present the common complications encountered with fractures of the calcaneus and management thereof. Copyright © 2016 Elsevier Inc. All rights reserved.

[Hematological malignancy: management of anemia and leukopenia by primary care physicians].

PubMed

Burnand, J; Waeber, G; Duchosal, M A

2009-10-28

In hematological malignancies, the occurrence of anemia is very common and can have significant consequences on daily life. Treatment includes essentially red blood cell transfusions. The prescription of erythropoietic agents and/or iron is exceptionnal and often not registered in Switzerland. The onset of neutropenia is also frequently encountered and in some situations may require the prescription of myeloid growth factors. The purpose of this article is to focus on the current recommendations of these two issues for practitioners.

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.

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

PubMed

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

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.

Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I)

PubMed Central

Mohr, Nicholas M.; Moreno-Walton, Lisa; Mills, Angela M.; Brunett, Patrick H.; Promes, Susan B.

2010-01-01

For the first time in history, four generations are working together – Traditionalists, Baby Boomers, Generation Xers, and Millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine (SAEM) Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. PMID:21314779

Common skin problems in the community and primary care.

PubMed

Armstrong, Kirsty

2014-10-01

Skin problems can be hard to diagnose, leaving clinicians frustrated and patients incorrectly treated, but rashes and lesions can be markers of systemic disease and infections. However, by using simple history-taking and mnemonics, safety and correct diagnoses can be achieved. This article will consider some common problems encountered in primary and community care, issues that need to be excluded, resources that will help with diagnosis and some management guidelines. This is not an exhaustive guide, and advice should be sought from learned colleagues in specific cases. Pressure area care and the use of compression bandaging will not be discussed unless it is of relevance to the subject of rashes and lesions.

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.

Aircraft Survivability. Susceptibility Reduction. Fall 2010

DTIC Science & Technology

2010-01-01

limits flexibility when issues are encountered during development. Once a program enters Engineering, Manufacturing, and Development (EMD), the...using a flexible , efficient computational environment based on a credible set of components. Unfortunately, current survivability codes contain many...approach limits flexibility when issues are encountered during development. Once a program enters Engineering Manufacturing and Development (EMD), the

Pregnancy and autoimmune connective tissue diseases

PubMed Central

Marder, Wendy; Littlejohn, Emily A

2016-01-01

The autoimmune connective tissue diseases predominantly affect women and often occur during the reproductive years. Thus, specialized issues in pregnancy planning and management are commonly encountered in this patient population. This chapter provides a current overview of pregnancy as a risk factor for onset of autoimmune disease, considerations related to the course of pregnancy in several autoimmune connective tissue diseases, and disease management and medication issues before and during pregnancy and the postpartum period. A major theme that has emerged across these inflammatory diseases is that active maternal disease during pregnancy is associated with adverse pregnancy outcomes, and that maternal and fetal health can be optimized when conception is planned during times of inactive disease and through maintaining treatment regimens compatible with pregnancy. PMID:27421217

Neonatal Hypoglycemia: A Continuing Debate in Definition and Management.

PubMed

Stomnaroska-Damcevski, Orhideja; Petkovska, Elizabeta; Jancevska, Snezana; Danilovski, Dragan

2015-01-01

Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Maintaining glucose homeostasis is one of the important physiological events during fetal-to-neonatal transition. Transient low blood glucose concentrations are frequently encountered in the majority of healthy newborns and are the reflections of normal metabolic adaptation processes. Nevertheless, there is a great concern that prolonged or recurrent low blood glucose levels may result in long-term neurological and developmental consequences. Strikingly, it was demonstrated that the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia, did not find association between repetitive low glucose concentrations and poor neurodevelopmental outcomes. On the contrary, NH due to hyperinsulinism is strongly associated with brain injury. Fundamental issue of great professional controversy is concerning the best manner to manage asymptomatic newborns NH. Both, overtreating NH and undertreating NH are poles with significant potential disadvantages. Therefore, NH is one of the most important issues in the day-to-day practice. This article appraises the critical questions of definition (widely accepted blood glucose concentration: < 2.6 mmol/l or 47 mg/dl), follow-up ad management of NH.

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.

Resiliency of the Multiscale Retinex Image Enhancement Algorithm

NASA Technical Reports Server (NTRS)

Rahman, Zia-Ur; Jobson, Daniel J.; Woodell, Glenn A.

1998-01-01

The multiscale retinex with color restoration (MSRCR) continues to prove itself in extensive testing to be very versatile automatic image enhancement algorithm that simultaneously provides dynamic range compression, color constancy, and color rendition, However, issues remain with regard to the resiliency of the MSRCR to different image sources and arbitrary image manipulations which may have been applied prior to retinex processing. In this paper we define these areas of concern, provide experimental results, and, examine the effects of commonly occurring image manipulation on retinex performance. In virtually all cases the MSRCR is highly resilient to the effects of both the image source variations and commonly encountered prior image-processing. Significant artifacts are primarily observed for the case of selective color channel clipping in large dark zones in a image. These issues are of concerning the processing of digital image archives and other applications where there is neither control over the image acquisition process, nor knowledge about any processing done on th data beforehand.

Commentary: Pediatric eHealth Interventions: Common Challenges During Development, Implementation, and Dissemination

PubMed Central

Steele, Ric G.; Connelly, Mark A.; Palermo, Tonya M.; Ritterband, Lee M.

2014-01-01

Objective 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. Methods The article draws on the existing eHealth literature and the authors’ collective experience in pediatric eHealth research. Results and conclusions 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. PMID:24816766

Tumors of the Testis: Morphologic Features and Molecular Alterations.

PubMed

Howitt, Brooke E; Berney, Daniel M

2015-12-01

This article reviews the most frequently encountered tumor of the testis; pure and mixed malignant testicular germ cell tumors (TGCT), with emphasis on adult (postpubertal) TGCTs and their differential diagnoses. We additionally review TGCT in the postchemotherapy setting, and findings to be integrated into the surgical pathology report, including staging of testicular tumors and other problematic issues. The clinical features, gross pathologic findings, key histologic features, common differential diagnoses, the use of immunohistochemistry, and molecular alterations in TGCTs are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

Gastrointestinal gas.

PubMed Central

Fardy, J; Sullivan, S

1988-01-01

Complaints related to gastrointestinal gas are commonly encountered in clinical practice. Various therapies have been proposed, yet none has appeared to be extremely effective. A review of the literature revealed little hard evidence to support the use of simethicone, pancreatic enzymes, anticholinergic agents or antibiotics. Evidence supporting the use of prokinetic agents has been the strongest, and there may be a pathophysiologic basis for the use of these agents if the complaints are related to abnormal intestinal motility. The use of activated charcoal for adsorbing intestinal gas has been effective in healthy subjects but has not been properly investigated in patients with gas complaints. Dietary modification may be beneficial in certain cases. Additional controlled trials are necessary to clarify the issues in the treatment of this common problem. PMID:3058280

Evaluation of fatigue properties of EN31 steel heat treated using biodegradable gingili oil

NASA Astrophysics Data System (ADS)

Harichandra, B. P.; Prashanth, Mrudula; Prakash, S. V.

2016-09-01

Rotating bending fatigue is the most commonly encountered loading in most machines and machine tools. At the same time, modern literature in this area is very little. EN31 steel is a steel which is commonly used in load bearing applications which encounters fatigue loading. Further, studies on heat treated EN31 steel to improve fatigue strength is hardly reported. This paper takes this rare issue further ahead by using bio-degradable gingili oil to heat treat EN31 steel for fatigue applications. This paper reports the results of rotating bending fatigue study of EN31 steel. Fatigue tests were conducted for three conditions a) Untreated, b) Heat treated with water, and c) Heat treated with gingili oil, with cantilever loads ranging from 30% to 90% using double sided rotating bending fatigue testing machine. It is seen that EN31 steel heat treated using gingili oil has far superior fatigue properties than water treated and untreated ones, with gingili oil quenched specimen have ∼10 times more fatigue life than water quenched specimen and ∼100 times more than unquenched specimens when lower bending stresses are involved.

The ethical junior: a typology of ethical problems faced by house officers

PubMed Central

McDougall, Rosalind; Sokol, Daniel K

2008-01-01

Although many studies have explored the experiences of doctors in their first postgraduate year, few have focused on the ethical issues encountered by this group. Based on an extensive literature review of research involving house officers, we argue that these doctors encounter a broad range of ‘everyday’ ethical challenges, from truth-telling to working in non-ideal conditions. We propose a typology of house officers' ethical issues and advocate prioritizing these issues in undergraduate medical ethics and law curricula. PMID:18299625

The National Long Term Care Demonstration: operational issues encountered in developing the research design.

PubMed

Carcagno, G J; Kemper, P

1983-01-01

This paper describes the design of the National Long Term Care Demonstration and its evaluation and discusses a number of operational issues encountered in the design process: simultaneous design of research and operations, identification of the target population, randomization, collection of comparable data, development of an assessment instrument, potential changes in existing programs, and termination planning.

[Survey on drug-related problems in Lithuania's pharmacies].

PubMed

Kubiliene, Loreta; Liukenskyte, Simona; Savickas, Arūnas; Jureniene, Kristina

2006-01-01

to survey the most common and the most important drug-related problems in Lithuania, to explore their solution and factors influencing it, to formulate recommendations for solving drug-related problems. Pharmacists from community pharmacies participated in a random survey. They filled in questionnaires about drug-related problems and their solutions. It was the first survey on drug-related problems ever carried out in Lithuania. For the first time, it was found out that in Lithuania pharmacists most commonly encountered drug-related problem--additional drug therapy (52.03% of respondents)--and most rarely encountered drug-related problem--dosage too high (3% of respondents). Pharmacists stated that all categories of drug-related problems were of equal importance. It was established that pharmacists commonly solved drug-related problems associated with noncompliance with instructions (72.5% of respondents) and rarely met the problem when improper drug was selected (39.56% of respondents). Patients taking prescription medicines commonly encounter additional drug therapy problem, and patients taking nonprescription medications commonly encounter problems related to noncompliance with instructions.

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

PubMed

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

2013-08-01

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

A conceptual framework of organizational stressors in sport performers.

PubMed

Fletcher, D; Hanton, S; Mellalieu, S D; Neil, R

2012-08-01

In the study reported here, 12 sport performers (six elite and six non-elite) were interviewed with regard to organizational-related issues they had experienced in preparation for competition. Grounded theory procedures facilitated the development of a conceptual framework of organizational stressors consisting of five general dimensions: factors intrinsic to the sport, roles in the sport organization, sport relationships and interpersonal demands, athletic career and performance development issues, and organizational structure and climate of the sport. The data indicate that the stressors were encountered proportionately more by elite performers (#EPOS=315) than non-elite performers (#NPOS=228) with some demands being in common and some unique to each group. The results are discussed in relation to previous research and regarding their implications for professional practice. © 2010 John Wiley & Sons A/S.

Post discharge issues identified by a call-back program: identifying improvement opportunities.

PubMed

Ojeda, Patricia I; Kara, Areeba

2017-12-01

The period following discharge from the hospital is one of heightened vulnerability. Discharge instructions serve as a guide during this transition. Yet, clinicians receive little feedback on the quality of this document that ties into the patients' experience. We reviewed the issues voiced by discharged patients via a call-back program and compared them to the discharge instructions they had received. At our institution, patients receive an automated call forty-eight hours following discharge inquiring about progress. If indicated by the response to the call, they are directed to a nurse who assists with problem solving. We reviewed the nursing documentation of these encounters for a period of nine months. The issues voiced were grouped into five categories: communication, medications, durable medical equipment/therapies, follow up and new or ongoing symptoms. The discharge instructions given to each patient were reviewed. We retrieved data on the number of discharges from each specialty from the hospital over the same period. A total of 592 patients voiced 685 issues. The numbers of patients discharged from medical or surgical services identified as having issues via the call-back line paralleled the proportions discharged from medical and surgical services from the hospital during the same period. Nearly a quarter of the issues discussed had been addressed in the discharge instructions. The most common category of issues was related to communication deficits including missing or incomplete information which made it difficult for the patient to enact or understand the plan of care. Medication prescription related issues were the next most common. Resource barriers and questions surrounding medications were often unaddressed. Post discharge issues affect patients discharged from all services equally. Data from call back programs may provide actionable targets for improvement, identify the inpatient team's 'blind spots' and be used to provide feedback to clinicians.

Palliative Care in Heart Failure.

PubMed

Sood, Abhinav; Dobbie, Krista; Wilson Tang, W H

2018-04-19

This review illustrates the dynamic role of palliative care in heart failure management and encapsulates the commonly utilized pharmacologic and non-pharmacologic therapeutic strategies for symptom palliation in heart failure. In addition, we provide our experience regarding patient care issues common to the domain of heart failure and palliative medicine which are commonly encountered by heart failure teams. Addition of palliative care to conventional heart failure management plan results in improvement in quality of life, anxiety, depression, and spiritual well-being among patients. Palliative care should not be confused with hospice care. Palliative care teams should be involved early in the care of heart failure patients with the aims of improving symptom palliation, discussing goals of care and improving quality of life without compromising utilization of evidence-based heart failure therapies. A consensus on the appropriate timing of involvement and evidence for many symptom palliation therapies is still emerging.

Scientific misconduct encountered by APAME journals: an online survey.

PubMed

Looi, Lai-Meng; Wong, Li Xuan; Koh, Cing Chai

2015-12-01

In June 2015, invitations were sent by email to 151 APAME journals to participate in an online survey with an objective of gaining insight into the common publication misconduct encountered by APAME editors. The survey, conducted through SurveyMonkey over a 20-day-period, comprised 10 questions with expansions to allow anecdotes limited to 400 characters, estimated to take less than 10 minutes to complete. Only one invitation was issued per journal, targeting (in order of priority) editors, editorial board members and editorial staff, and limited by email availability. 54 (36%) journals responded. 98% of respondents held Editor or Editorial Board positions. All respondent journals have editorial policies on publication ethics and 96% provide instructions related to ethics. 45% use anti-plagiarism software to screen manuscripts, the most popular being iThenticate, CrossCheck and Turnitin. Up to 50% of journals had encountered studies without IRB approval. Author misconduct encountered were (in rank order): plagiarism (75%), duplicate publication (58%), unjustified authorship (39%), authorship disputes (33%), data falsification (29%), data/image manipulation (27%), conflict of interest (25%), copyright violation (17%) and breach of confidentiality (10%). Reviewer misconduct encountered were: conflict of interest (19%), plagiarism (17%), obstructive behavior (17%), abusive language (13%) and breach of confidentiality (13%). Notwithstanding the limitations of the survey and the response rate, a few insights have been gained: (1) the need for strengthening the ethical culture of researchers/authors and reviewers, (2) anti-plagiarism software can improve plagiarism detection by about 15%, and (3) the need for technical support to detect plagiarism, duplicate publication and image manipulation.

Defining chaos.

PubMed

Hunt, Brian R; Ott, Edward

2015-09-01

In this paper, we propose, discuss, and illustrate a computationally feasible definition of chaos which can be applied very generally to situations that are commonly encountered, including attractors, repellers, and non-periodically forced systems. This definition is based on an entropy-like quantity, which we call "expansion entropy," and we define chaos as occurring when this quantity is positive. We relate and compare expansion entropy to the well-known concept of topological entropy to which it is equivalent under appropriate conditions. We also present example illustrations, discuss computational implementations, and point out issues arising from attempts at giving definitions of chaos that are not entropy-based.

Chinese guidelines for treatment of adult primary immune thrombocytopenia.

PubMed

Liu, Xin-Guang; Bai, Xiao-Chuan; Chen, Fang-Ping; Cheng, Yun-Feng; Dai, Ke-Sheng; Fang, Mei-Yun; Feng, Jian-Ming; Gong, Yu-Ping; Guo, Tao; Guo, Xin-Hong; Han, Yue; Hong, Luo-Jia; Hu, Yu; Hua, Bao-Lai; Huang, Rui-Bing; Li, Yan; Peng, Jun; Shu, Mi-Mi; Sun, Jing; Sun, Pei-Yan; Sun, Yu-Qian; Wang, Chun-Sen; Wang, Shu-Jie; Wang, Xiao-Min; Wu, Cong-Ming; Wu, Wen-Man; Yan, Zhen-Yu; Yang, Feng-E; Yang, Lin-Hua; Yang, Ren-Chi; Yang, Tong-Hua; Ye, Xu; Zhang, Guang-Sen; Zhang, Lei; Zheng, Chang-Cheng; Zhou, Hu; Zhou, Min; Zhou, Rong-Fu; Zhou, Ze-Ping; Zhu, Hong-Li; Zhu, Tie-Nan; Hou, Ming

2018-06-01

Primary immune thrombocytopenia (ITP) is a bleeding disorder commonly encountered in clinical practice. The International Working Group (IWG) on ITP has published several landmark papers on terminology, definitions, outcome criteria, bleeding assessment, diagnosis, and management of ITP. The Chinese consensus reports for diagnosis and management of adult ITP have been updated to the 4th edition. Based on current consensus positions and new emerging clinical evidence, the thrombosis and hemostasis group of the Chinese Society of Hematology issued Chinese guidelines for management of adult ITP, which aim to provide evidence-based recommendations for clinical decision making.

Neural learning of constrained nonlinear transformations

NASA Technical Reports Server (NTRS)

Barhen, Jacob; Gulati, Sandeep; Zak, Michail

1989-01-01

Two issues that are fundamental to developing autonomous intelligent robots, namely, rudimentary learning capability and dexterous manipulation, are examined. A powerful neural learning formalism is introduced for addressing a large class of nonlinear mapping problems, including redundant manipulator inverse kinematics, commonly encountered during the design of real-time adaptive control mechanisms. Artificial neural networks with terminal attractor dynamics are used. The rapid network convergence resulting from the infinite local stability of these attractors allows the development of fast neural learning algorithms. Approaches to manipulator inverse kinematics are reviewed, the neurodynamics model is discussed, and the neural learning algorithm is presented.

Peregrine Sustainer Motor Development

NASA Technical Reports Server (NTRS)

Brodell, Chuck; Franklin, Philip

2015-01-01

The Peregrine sounding rocket is an in-house NASA design that provides approximately 15 percent better performance than the motor it replaces. The design utilizes common materials and well-characterized architecture to reduce flight issues encountered with the current motors. It engages NASA design, analysts, test engineers and technicians, ballisticians, and systems engineers. The in-house work and collaboration within the government provides flexibility to efficiently accommodate design and program changes as the design matures and enhances the ability to meet schedule milestones. It provides a valuable tool to compare industry costs, develop contracts, and it develops foundational knowledge for the next generation of NASA engineers.

Identification of commonly encountered Pratylenchus in Oregon

USDA-ARS?s Scientific Manuscript database

Pratylenchus species are commonly encountered in soil samples collected from a diversity of economically important crops in Oregon, including potato and small fruits. Proper identification is critical to the selection of an appropriate management strategy since, in many cases, populations are an as...

New classification of epilepsy-related neoplasms: The clinical perspective.

PubMed

Kasper, Burkhard S; Kasper, Ekkehard M

2017-02-01

Neoplastic CNS lesions are a common cause of focal epilepsy refractory to anticonvulsant treatment, i.e. long-term epilepsy-associated tumors (LEATs). Epileptogenic tumors encompass a variety of intriguing lesions, e.g. dysembryoplastic neuroepithelial tumors or gangliogliomas, which differ from more common CNS neoplasms in their clinical context as well as on histopathology. Long-term epilepsy-associated tumor classification is a rapidly evolving issue in surgical neuropathology, with new entities still being elucidated. One major issue to be resolved is the inconsistent tissue criteria applied to LEAT accounting for high diagnostic variability between individual centers and studies, a problem recently leading to a proposal for a new histopathological classification by Blümcke et al. in Acta Neuropathol. 2014; 128: 39-54. While a new approach to tissue diagnosis is appreciated and needed, histomorphological criteria alone will not suffice and we here approach the situation of encountering a neoplastic lesion in an epilepsy patient from a clinical perspective. Clinical scenarios to be supported by an advanced LEAT classification will be illustrated and discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Cultural Psychiatry: A Spotlight on the Experience of Clinical Social Workers' Encounter with Jewish Ultra-Orthodox Mental Health Clients.

PubMed

Freund, Anat; Band-Winterstein, Tova

2017-07-01

Community is a complex issue, especially in two particular populations overlap: Haredi society, which embraces cultural codes common to closed communities, and the mental health population characterized by its own unique needs. The present study explores the encounter experience of social workers with the cultural perceptions of mental health clients in the Haredi community in light of Community Cultural Psychiatry. A qualitative-phenomenological approach was adopted. In-depth semi-structured interviews were conducted with 27 social workers, mental health professionals, who are in contact with ultra-Orthodox Jewish clients. Three major themes emerged from the data analysis: (1) Exclusion vs. grace and compassion. (2) Mental health: A professional or cultural arena? (3) Mental health help-seeking changing processes. This study shows that the attitude in the Haredi community toward mental health therapy undergoes a process of change. It is important to strengthen this process, together with preserving existing community informal structures of help.

Psychiatric research: what ethical concerns do LRECs encounter? A postal survey. Local research ethics committees.

PubMed

Osborn, D P J; Fulford, K W M

2003-02-01

Psychiatric research can occasionally present particular ethical dilemmas, but it is not clear what kind of problems local research ethics committees (LRECs) actually experience in this field. We aimed to assess the type of problems that committees encounter with psychiatric research, using a postal survey of 211 LRECs. One hundred and seven (51%) of those written to replied within the time limit. Twenty eight (26%) experienced few problems with psychiatric applications. Twenty six (24%) emphasised the value of a psychiatric expert on the committee. The most common issues raised were informed consent (n=64, 60%) and confidentiality (n=17, 16%). The use of placebos (and washout periods) (n=18, 17%), the validity of psychiatric questionnaires (n=16, 15%) and overuse of psychiatric "jargon" (n=14, 13%) in psychiatric applications also raised concern. Our results suggest that LRECs have specific concerns regarding methodology, consent, and confidentiality in psychiatric research, and that they find psychiatric input invaluable.

Inflight Medical Events in the Shuttle Program

NASA Technical Reports Server (NTRS)

Baisden, Denise L.; Effenhauser, R. K.; Wear, Mary L.

1999-01-01

Since the first launch of the Space Shuttle in 1981, the astronauts and their flight surgeons have dealt with a variety of inflight medical issues. A review will be provided of these issues as well as medications used in the treatment of these medical problems. Detailed medical debriefs are conducted by the flight ,surgeon with the individual crewmembers three days after landing. These debriefs were review for Shuttle flights from 1988 through 1999 to determine the frequency of inflight medical events. Medical events were grouped by ICD category and the frequency of medical events within those categories were reviewed. The ICD category of Symptoms, Signs and Ill-defined Conditions had the most medical events. Facial fullness and headache were the most common complaints within this category. The ICD category of Respiratory System had the next most common medical events with sinus congestion being the most common complaint. This was followed by Digestive System complaints and Nervous System/Sense Organ complaints. A variety of inflight medical events have occurred throughout the Shuttle program. Fortunately, the majority of these problems have been minor and have been well within the capability of the medical equipment flown and the skills of the Crew Medical Officers. Medical ,problems/procedures that are routine on the ground often present unique problems in the space flight environment. It is important that the flight surgeon understand the common medical problems encountered.

Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India.

PubMed

Hulland, Kristyna R S; Chase, Rachel P; Caruso, Bethany A; Swain, Rojalin; Biswal, Bismita; Sahoo, Krushna Chandra; Panigrahi, Pinaki; Dreibelbis, Robert

2015-01-01

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women's reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention.

Monitoring Reasons for Encounter via an Electronic Patient Record System: the Case of a Rural Practice Initiative

PubMed Central

Klinis, Spyridon; Markaki, Adelais; Kounalakis, Dimitrios; Symvoulakis, Emmanouil K.

2012-01-01

The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented. PMID:23091407

Identifying ethical issues of the Department of the Army civilian and Army Nurse Corps certified registered nurse anesthetists.

PubMed

Jenkins, Constance L; Elliott, Aaron R; Harris, Janet R

2006-08-01

The purposes of this study were to identify the ethical issues Department of the Army civilian and Army Nurse Corps certified registered nurse anesthetists (CRNAs) encountered in their anesthesia practice and how disturbed they were by these issues. This descriptive study used a secondary data analysis of a cross-sectional survey of Army Nurse Corps officers and Department of the Army civilian registered nurses (N = 5,293). The CRNA subset (n = 97) was obtained from questionnaires that indicated a primary practice setting as anesthesia. The most frequently occurring ethical issue identified was conflict in the nurse-physician relationship, whereas the most disturbing issue was working with incompetent/impaired colleagues. Unresolved ethical conflicts can negatively influence the nurses' morale, leading to avoidance of the issue and contributing to burnout. Identifying the ethical issues and disturbance level experienced by CRNAs should contribute to the development of an ethics education program that addresses issues encountered in CRNA practice.

Martial arts sports medicine: current issues and competition event coverage.

PubMed

Nishime, Robert S

2007-06-01

More sports medicine professionals are becoming actively involved in the care of the martial arts athlete. Although there are many different forms of martial arts practiced worldwide, certain styles have shown a potential for increased participation in competitive-type events. Further research is needed to better understand the prevalence and profiles of injuries sustained in martial arts full-contact competitive events. Breaking down the martial art techniques into basic concepts of striking, grappling, and submission maneuvers, including choking and joint locking, may facilitate better understanding and management of injuries. This article outlines this approach and reviews the commonly encountered injuries and problems during martial arts full-contact competitions.

Religious Traditions and Prenatal Genetic Counseling

PubMed Central

Anderson, Rebecca Rae

2009-01-01

Members of organized religious groups may look to their faith traditions for guidance regarding the moral implications of prenatal diagnosis and intervention. Many denominations have doctrinal statements relevant to these deliberations. In this paper, common spiritual issues arising in the genetic counseling encounter are described. Representative doctrinal positions, derived from the responses of 31 U.S. religious denominations to a survey relating to prenatal genetic counseling, are given. Because the long-term adjustment of patients may be dependent in part on their ability to reconcile their actions with their faith traditions, genetic counselors best serve their patients when they invite discussion of matters of faith. Unless invited, patients may assume these topics are ‘off limits’ or that care providers are indifferent to their beliefs. Although genetics professionals ought not assume the role of spiritual advisor, a working knowledge of doctrinal approaches should help counselors frame the issues, and avoid missteps. PMID:19170093

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.;

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.

Development of a replacement AMLCD used on multiple platforms

NASA Astrophysics Data System (ADS)

Walsh, Kevin L.; Gobron, Robert

2002-08-01

A goal of military display users and manufacturers is commonality: to utilize a given display on as many platforms as possible. The often-addressed concern of obsolescence of commercial AMLCDs used on military programs becomes a key issue, though, with regard to commonality. Obsolescence occurs as the tools used in the manufacture of an AMLCD age and as new and improved materials and processes are developed. The LCD manufacturer, at some point, decides to cease the manufacture of a particular AMLCD. The users of that AMLCD then have two choices: make a lifetime buy of LCDs, or find a replacement. For a display which has achieved some degree of commonality, this choice must be faced by a number of different users on a number of platforms. This paper addresses some of the problems encountered when such a choice is made, as an SVGA display made by one manufacturer is replaced by an XGA display made by a different manufacturer.

Improving Collaborative Learning by Supporting Casual Encounters in Distance Learning.

ERIC Educational Resources Information Center

Contreras, Juan; Llamas, Rafael; Vizcaino, Aurora; Vavela, Jesus

Casual encounters in a learning environment are very useful in reinforcing previous knowledge and acquiring new knowledge. Such encounters are very common in traditional learning environments and can be used successfully in social environments in which students can discover and construct knowledge through a process of dialogue, negotiation, or…

NASA flight cell and battery issues

NASA Technical Reports Server (NTRS)

Schulze, N. R.

1989-01-01

The author presents the important battery and cell problems, encompassing both test failures and accidents, which were encountered during the past year. Practical issues facing programs, which have to be considered in the development of a battery program strategy, are addressed. The problems of one program, the GRO (Gamma Ray Observatory), during the past year are focused on to illustrate the fundamental types of battery problems that occur. Problems encountered by other programs are briefly mentioned to complete the accounting. Two major categories of issues are defined, namely, whose which are quality and design related, i.e., problems having inherent manufacturing-process-related aspects with an impact on cell reliability, and these which are accident triggered or man induced, i.e., those operational issues having an impact on battery and cell reliability.

Using Issues-Based Art Education to Facilitate Middle School Students' Learning in Racial Issues

ERIC Educational Resources Information Center

Li, Dan

2018-01-01

Issues-based art education encourages students to express their perspectives on different social issues through art making. In this article, the author discusses racial issues with middle school students through contemporary artwork discussion and hands-on poster making. The difficulties that students encounter in their poster making session will…

Certified nurse-midwife and physician collaborative practice. Piloting a survey on the Internet.

PubMed

Miller, S; King, T; Lurie, P; Choitz, P

1997-01-01

This pilot study was designed to describe the clinical areas of collaboration, financial structures, and sources of conflict for certified nurse-midwives (CNMs) involved in nurse-midwife and physician collaborative practice (CP). A questionnaire was posted on an electronic bulletin board maintained by the Community-Based Nurse Midwifery Education Program of the Frontier School of Nursing. The nonrandom, convenience sample consisted of 78 respondents. Their mean age was 42 years; they had been in practice for a mean of 10 years, and 56% had graduate degrees. Eighty-nine percent reported involvement in CP. Eighty-three percent co-managed higher-risk women, and 46% performed vacuum-assisted deliveries or were first assistants at cesarean sections. Forty-eight percent of CNMs did not bill in their own names, and only 12% had full hospital privileges. The most common sources of conflict in CPs were clinical practice issues (100% ever encountered), power inequities (92%), financial issues (66%), and gender relations (58%). Collaborative practice is a common form of practice for CNMs and suggests a model for collaboration in other sectors of the health care system. Future research should explore methods of reducing the potential for conflict between CNMs and physicians.

Adapting an Effective Counseling Model from Patient-centered Care to Improve Motivation in Clinical Training Programs.

PubMed

Hamada, Hisayuki; Martin, Dawn; Batty, Helen P

2006-12-01

The value of establishing a patient-centered relationship within the context of the clinical encounter is well documented. The learner-centered method of medical education parallels the patient-centered clinical method; therefore, it should be explored as a method for teaching in the context of the learning encounter. In Japan and other Asian countries, rotations through services not related to the learner's chosen medical specialty are mandatory parts of the medical internship. Participation and effort in these rotations are often met with resistance from learners and are a common problem for medical educators. We adapted the counseling method for patients based on patient-centered methods such as motivational interviewing and solution-focused therapy to address this common problem. We show one case of a medical resident who lost his motivation to learn during his training. A resident has many kinds of mental and physical stress. One such problem arises from the gap between what they want to do and what they have to do. Strategies from motivational interviewing and solution-focused therapy were adapted to successfully resolve a common teaching problem in Japan. A physician teacher (preceptor) helped this resident solve the issue for himself instead of arguing in favor of change. The positive aspects of the counseling method were based on patient-centered medicine and proved useful and effective in counseling for medical residents. We may take the lessons learned from using patient-centered counseling methods to further develop a clear and systematic process of counseling methods for residents to conduct learner-centered medical education.

The establishment of research ethics consultation services (RECS): an emerging research resource.

PubMed

McCormick, Jennifer B; Sharp, Richard R; Ottenberg, Abigale L; Reider, Carson R; Taylor, Holly A; Wilfond, Benjamin S

2013-02-01

Emphasis on translational research to facilitate progression from the laboratory into the community also creates a dynamic in which ethics and social policy questions and solutions are ever pressing. In response, academic institutions are creating Research Ethics Consultation Services (RECS). All Clinical Translational Science Award institutions were surveyed in early 2010 to determine which institutions have a RECS in operation and what is their composition and function. Of the 46 institutions surveyed, 33 (70%) have a RECS. Only 15 RECS have received any consult requests in the last year. Issues that are common among these relatively nascent services include relationships with institutional oversight committees, balancing requestor concerns about confidentiality with research integrity and human subjects protection priorities, tracking consult data and outcomes, and developing systems for internal evaluation. There is variability in how these issues are approached. It will be important to be attentive to the institutional context to develop an appropriate approach. Further data about the issues raised by requestors and the recommendations provided are necessary to build a community of scholars who can navigate and resolve ethical issues encountered along the translational research pathway. © 2012 Wiley Periodicals, Inc.

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.

Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India

PubMed Central

Hulland, Kristyna R. S.; Chase, Rachel P.; Caruso, Bethany A.; Swain, Rojalin; Biswal, Bismita; Sahoo, Krushna Chandra; Panigrahi, Pinaki; Dreibelbis, Robert

2015-01-01

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women’s reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention. PMID:26551866

Psychosocial diagnoses occurring after patients present with fatigue.

PubMed

MacKean, Peter Reagh; Stewart, Moira; Maddocks, Heather L

2016-08-01

To discover the frequency of psychosocial and other diagnoses occurring at the end of a visit when patients present to their FPs with concerns about fatigue. Cross-sectional study of patient-FP encounters for fatigue. Ten FP practices in southwestern Ontario. A total of 259 encounters involving 167 patients presenting to their FPs between March 1, 2006, and June 30, 2010, with concerns about fatigue. The frequency of psychological and social diagnoses made at the end of visits, and whether diagnoses were made by FPs at the end of the visits versus whether the code for fatigue remained. The associations between patient age, sex, fatigue presenting with other symptoms, or the presence of previous chronic conditions and the outcomes was tested. Psychosocial diagnoses were made 23.9% of the time. Among psychosocial diagnoses made, depressive disorder and anxiety disorder or anxiety state were diagnosed more often in women (P = .048). Slightly less than 30% of the time, the cause of patients' fatigue remained undiagnosed at the end of the encounter. A diagnosis was made more often in men. Causes of fatigue frequently remain undiagnosed; however, when there is a diagnosis, psychosocial diagnoses are common. Therefore, it would be appropriate for FPs to screen for psychosocial issues when their patients present with fatigue, unless some other diagnosis is evident. Depression and anxiety could be considered particularly among female patients with fatigue. Copyright© the College of Family Physicians of Canada.

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.

Automated recognition of microcalcification clusters in mammograms

NASA Astrophysics Data System (ADS)

Bankman, Isaac N.; Christens-Barry, William A.; Kim, Dong W.; Weinberg, Irving N.; Gatewood, Olga B.; Brody, William R.

1993-07-01

The widespread and increasing use of mammographic screening for early breast cancer detection is placing a significant strain on clinical radiologists. Large numbers of radiographic films have to be visually interpreted in fine detail to determine the subtle hallmarks of cancer that may be present. We developed an algorithm for detecting microcalcification clusters, the most common and useful signs of early, potentially curable breast cancer. We describe this algorithm, which utilizes contour map representations of digitized mammographic films, and discuss its benefits in overcoming difficulties often encountered in algorithmic approaches to radiographic image processing. We present experimental analyses of mammographic films employing this contour-based algorithm and discuss practical issues relevant to its use in an automated film interpretation instrument.

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

Brown, Carrie; LaRue, Anna; Pigman, Margaret

As more and more zero net energy (ZNE) buildings are built and monitored, we can learn from both careful case studies of individual projects as well as a broader perspective of trends over time. In a forum sponsored by Pacific Gas and Electric Company (PG&E), eight expert speakers discussed: results and lessons from monitoring occupied ZNE buildings; best practices for setting performance targets and getting actionable performance information, and; things that have surprised them about monitored ZNE buildings. This paper distills the content of the forum by laying out the most common hurdles that are encountered in setting up monitoringmore » projects, frequent performance issues that the monitoring uncovers, and lessons learned that can be applied to future projects.« less

Spatial Control of Photoemitted Electron Beams using a Micro-Lens-Array Transverse-Shaping Technique

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

Halavanau, A.; Qiang, G.; Ha, G.

2017-07-24

A common issue encountered in photoemission electron sources used in electron accelerators is the transverse inhomogeneity of the laser distribution resulting from the laser-amplification process and often use of frequency up conversion in nonlinear crystals. A inhomogeneous laser distribution on the photocathode produces charged beams with lower beam quality. In this paper, we explore the possible use of microlens arrays (fly-eye light condensers) to dramatically improve the transverse uniformity of the drive laser pulse on UV photocathodes. We also demonstrate the use of such microlens arrays to generate transversely-modulated electron beams and present a possible application to diagnose the propertiesmore » of a magnetized beam.« less

The Major Environmentally-Based Land Use Issues on the Urban Fringe.

ERIC Educational Resources Information Center

Hordon, Robert M.

Types of land-use issues which form current problems in urban areas are discussed in this paper. The majority of these environmentally based issues revolve around the management of water. The five most often encountered water-oriented issues are denoted in rank order of importance. First, an ample water supply which is free from contamination must…

Methodological, technical, and ethical issues of a computerized data system.

PubMed

Rice, C A; Godkin, M A; Catlin, R J

1980-06-01

This report examines some methodological, technical, and ethical issues which need to be addressed in designing and implementing a valid and reliable computerized clinical data base. The report focuses on the data collection system used by four residency based family health centers, affiliated with the University of Massachusetts Medical Center. It is suggested that data reliability and validity can be maximized by: (1) standardizing encounter forms at affiliated health centers to eliminate recording biases and ensure data comparability; (2) using forms with a diagnosis checklist to reduce coding errors and increase the number of diagnoses recorded per encounter; (3) developing uniform diagnostic criteria; (4) identifying sources of error, including discrepancies of clinical data as recorded in medical records, encounter forms, and the computer; and (5) improving provider cooperation in recording data by distributing data summaries which reinforce the data's applicability to service provision. Potential applications of the data for research purposes are restricted by personnel and computer costs, confidentiality considerations, programming related issues, and, most importantly, health center priorities, largely focused on patient care, not research.

Virginia Department of Transportation public-private procurement : issues and accomplishments and interim report

DOT National Transportation Integrated Search

1997-01-01

This paper documents the contracting and procurement issues and opportunities encountered by VDOT in developing what was their first public-private partnership agreement for an Intelligent Transportation System (ITS).

Conquering common breast-feeding problems.

PubMed

Walker, Marsha

2008-01-01

Meeting mothers' personal breast-feeding goals depends on a number of factors, including the timely resolution of any problems she encounters. Nurses are often the first providers who interact with the mother during the perinatal period and are positioned to guide mothers through the prevention and solving of breast-feeding problems. Although many problems may be "common," failure to remedy conditions that cause pain, frustration, and anxiety can lead to premature weaning and avoidance of breast-feeding subsequent children. This article describes strategies and interventions to alleviate common problems that breast-feeding mothers frequently encounter.

Sensitivity Training and Group Encounter, an Introduction.

ERIC Educational Resources Information Center

Siroka, Robert W., Ed.; And Others

"Sensitivity Training and Group Encounter" attempts to explore group interaction on many levels--verbal, sensory, and physical. It can be utilized as a model for dealing with various forms of interpersonal relations, from ongoing social issues to the isolation, alienation, and distrust felt by the members of a group. Presented as a guide to this…

Spaces of Spiritual Citizenship: Children's Relational and Emotional Encounters with the Everyday School Environment

ERIC Educational Resources Information Center

Hemming, Peter J.

2013-01-01

This article addresses the issue of children's spiritual, relational and emotional encounters with the primary school environment, with reference to concepts and theories from both education studies and human geography. Drawing on mixed-method qualitative research in two case study institutions, the article examines pupils' photographed "special…

Beyond Dramatic Truth: Theatre within the Therapeutic Encounter

ERIC Educational Resources Information Center

Pendle, Andy; Rowe, Nick

2010-01-01

Recorded footage of counselling sessions with real clients can be a valuable educational resource that gives training counsellors the opportunity to analyse the theories and practices they encounter in their education. However, the use of such material raises complex ethical issues: what are the safeguards against the misuse of the material? Can…

The State of The Environment 1972-1982.

ERIC Educational Resources Information Center

United Nations Environment Programme, Nairobi (Kenya).

This report focuses on the changes (positive or negative) that occurred in the state of the world environment in the decade following the United Nations Conference on the Human Environment convened at Stockholm in June 1972. It also brings into focus the major environmental issues encountered or likely to be encountered. The first section focuses…

Helping Students Navigate Faith Challenges in the Biblical Studies Classroom

ERIC Educational Resources Information Center

Sharp, Carolyn J.; Clark-Soles, Jaime

2012-01-01

What happens when students encounter the academic study of the Bible in the seminary or undergraduate classroom? Does a teacher have a responsibility to help students navigate challenges to Christian faith that might arise? What pedagogical problems and opportunities does this encounter present? How does this issue manifest differently in…

The Methodological Benefits of Social Media: "Studying Up" in Brazil in the Facebook Age

ERIC Educational Resources Information Center

Straubhaar, Rolf

2015-01-01

While conducting research on the organizational cultures of elite nonprofit organizations in Rio de Janeiro, the author encountered many access issues identified in the current literature: in particular, difficulty in encountering research subjects due to the transitional nature of educational nonprofits and the role of secretaries and…

Quantifying the Effects of Gas-Rich Flyby Encounters on Galaxy Evolution

NASA Astrophysics Data System (ADS)

Dumas, Julie; Holley-Bockelmann, Kelly; Lang, Meagan

2017-01-01

Recent work has shown that flyby encounters may be a common event in a galaxy's lifetime. Galaxy flybys are a one-time encounter when two halos interpenetrate, but unlike a galaxy merger, the two halos later detach. Relatively little work has been done to assess how flybys affect galaxy evolution. We present preliminary results of a suite of high-resolution hydrodynamical + N-body simulations of gas-rich flyby encounters, concentrating on Milky Way-like primaries. We track the bulk changes in structure, star formation history, kinematics, and morphology over a broad span of flyby encounters.

A reliable sewage quality abnormal event monitoring system.

PubMed

Li, Tianling; Winnel, Melissa; Lin, Hao; Panther, Jared; Liu, Chang; O'Halloran, Roger; Wang, Kewen; An, Taicheng; Wong, Po Keung; Zhang, Shanqing; Zhao, Huijun

2017-09-15

With closing water loop through purified recycled water, wastewater becomes a part of source water, requiring reliable wastewater quality monitoring system (WQMS) to manage wastewater source and mitigate potential health risks. However, the development of reliable WQMS is fatally constrained by severe contamination and biofouling of sensors due to the hostile analytical environment of wastewaters, especially raw sewages, that challenges the limit of existing sensing technologies. In this work, we report a technological solution to enable the development of WQMS for real-time abnormal event detection with high reliability and practicality. A vectored high flow hydrodynamic self-cleaning approach and a dual-sensor self-diagnostic concept are adopted for WQMS to effectively encounter vital sensor failing issues caused by contamination and biofouling and ensure the integrity of sensing data. The performance of the WQMS has been evaluated over a 3-year trial period at different sewage catchment sites across three Australian states. It has demonstrated that the developed WQMS is capable of continuously operating in raw sewage for a prolonged period up to 24 months without maintenance and failure, signifying the high reliability and practicality. The demonstrated WQMS capability to reliably acquire real-time wastewater quality information leaps forward the development of effective wastewater source management system. The reported self-cleaning and self-diagnostic concepts should be applicable to other online water quality monitoring systems, opening a new way to encounter the common reliability and stability issues caused by sensor contamination and biofouling. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

The organisational stressors encountered by athletes with a disability.

PubMed

Arnold, Rachel; Wagstaff, Christopher R D; Steadman, Lauren; Pratt, Yasmin

2017-06-01

Organisational stressors have been found to be prevalent and problematic for sport performers, with research identifying demographic differences in the stressors encountered. Nevertheless, extant sport psychology research on the topic of stress has generally focused on able-bodied athletes; whilst that which has been conducted on performers with a disability has typically recruited relatively small samples to explore a narrow selection of organisational stressors, or examined other components of the stress process. The purpose of the present study was to explore the various organisational stressors that athletes with a disability encounter. The sample comprised 18 elite athletes with a disability (10 male, 8 female) who had a classified disability and experience of competing at a major championships in their sport (e.g., Paralympic Games, World Championships). Participants took part in a semi-structured interview which was analysed by drawing from grounded theory procedures. A total of 316 organisational stressors were identified, which were abstracted into 31 concepts and four, previously conceptualised, exploratory schemes: leadership and personnel issues, cultural and team issues, logistical and environmental issues, and performance and personal issues. This study not only provides the first illustration of the prevalence of organisational stressors for athletes with a disability, but also significantly points to salient similarities and distinct differences between the stress experiences of performers with and without a disability.

On-Board Sound Intensity (OBSI) study, phase 2 : [summary].

DOT National Transportation Integrated Search

2014-05-01

To many people, environmental issues might : suggest air pollution, water pollution, or similar : ideas. But an environmental issue of growing : concern is noise pollution, which many cities : in Florida are encountering as they grow, and : nei...

'Wouldn't it be easier if you continued to be a guy?' - a qualitative interview study of transsexual persons' experiences of encounters with healthcare professionals.

PubMed

von Vogelsang, Ann-Christin; Milton, Camilla; Ericsson, Ingrid; Strömberg, Lars

2016-12-01

To describe transsexual persons' experiences of encounters with healthcare professionals during the sex reassignment process. Transsexual persons are individuals who use varying means to alter their natal sex via hormones and/or surgery. Transsexual persons may experience stigma, which increases the risk of psychological distress. Mistreatments by healthcare professionals are common. Qualitative studies addressing transsexual persons' experiences of healthcare are scarce. Qualitative descriptive design. A Swedish non-clinical convenience sample was used, consisting of six persons who had been diagnosed as transsexual, gone through sex reassignment surgery or were at the time of the interview awaiting surgery. Semi-structured interviews were undertaken, and data were analysed using manifest qualitative content analysis. Three categories and 15 subcategories were identified. The encounters were perceived as good when healthcare professionals showed respect and preserved the transsexual person's integrity, acted in a professional manner and were responsive and built trust and confidence. However, the participants experienced that healthcare professionals varied in their level of knowledge, exploited their position of power, withheld information, expressed gender stereotypical attitudes and often used the wrong name. They felt vulnerable by having a condescending view of themselves, and they could not choose not to be transsexual. They felt dependent on healthcare professionals, and that the external demands were high. Transsexual persons are in a vulnerable position during the sex reassignment surgery process. The encounters in healthcare could be negatively affected if healthcare professionals show inadequate knowledge, exploit their position of power or express gender stereotypical attitudes. A good encounter is characterised by preserved integrity, respect, responsiveness and trust. Improved education on transgender issues in nursing and medical education is warranted. Healthcare professionals should be aware of how their attitudes and their level of knowledge affect the care given during the sex reassignment surgery process. © 2016 John Wiley & Sons Ltd.

Challenging Nurses’ Cultural Competence of Disability to Improve Interpersonal Interactions

PubMed Central

Roscigno, Cecelia I.

2013-01-01

Worldwide, at least 6.9 billion people have an impairment producing health condition (IPHC). Insensitive encounters with health care providers (HCPs) can result in negative appraisals, fear, and avoidance, but little is known about what things are commonly perceived as insensitive. A review of published narratives describing negative encounters with HCPs was conducted. Narrative analysis was used to compare, contrast, and synthesize six themes describing the common negative encounters: (a) ignoring or minimizing their knowledge; (b) detached interpersonal interactions; (c) placing a negative skew on their life quality; (d) a lack of HCP knowledge related to their complete needs; (e) assuming they should be asexual and childless; and, (f) an inherent power differential. The medical model of disability is perceived by individuals with IPHCs to inform negative encounters perceived as insensitive. This preliminary knowledge is important so we can address education needs, plan future research questions, and establish clinical practice improvements. PMID:23291869

Emergency management of blunt chest trauma in children: an evidence-based approach.

PubMed

Pauzé, Denis R; Pauzé, Daniel K

2013-11-01

Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

Three-dimensional rendering in medicine: some common misconceptions

NASA Astrophysics Data System (ADS)

Udupa, Jayaram K.

2001-05-01

As seen in the medical imaging literature and in the poster presentations at the annual conference of the Radiological Society of North America during the past 10 years, several mis conceptions are held relating to 3D rendering of medical images. The purpose of this presentation is to illustrate and clarify these with medical examples. Most of the misconceptions have to do with a mix up of the issues related to the common visualization techniques, viz., surface rendering (SR) and volume rendering (VR), and methods of image segmentation. In our survey, we came across the following most commonly held conceptions which we believe (and shall demonstrate) are not correct: (1) SR equated to thresholding. (2) VR considered not requiring segmentation. (3) VR considered to achieve higher resolution than SR. (4) SR/VR considered to require specialized hardware to achieve adequate speed. We shall briefly define and establish some fundamental terms to obviate any potential for terminology-related misconceptions. Subsequently, we shall sort out these issues and illustrate with examples as to why the above conceptions are incorrect. There are many SR methods that use segmentations that are far superior to thresholding. All VR techniques (except the straightforward MIP) require some form of fuzzy object specification, that is, fuzzy segmentation. The details seen in renditions depend fundamentally on, in addition to the rendering method, segmentation techniques also. There are fast-software-based rendering methods that give a performance on PCs similar to or exceeding that of expensive hardware systems. Most of the difficulties encountered in visualization (and also in image processing and analysis) stem from the difficulties in segmentation. It is important to identify these and separate them from the issues related purely to 3D rendering.

Common cold outbreaks: A network theory approach

NASA Astrophysics Data System (ADS)

Vishkaie, Faranak Rajabi; Bakouie, Fatemeh; Gharibzadeh, Shahriar

2014-11-01

In this study, at first we evaluated the network structure in social encounters by which respiratory diseases can spread. We considered common-cold and recorded a sample of human population and actual encounters between them. Our results show that the database structure presents a great value of clustering. In the second step, we evaluated dynamics of disease spread with SIR model by assigning a function to each node of the structural network. The rate of disease spread in networks was observed to be inversely correlated with characteristic path length. Therefore, the shortcuts have a significant role in increasing spread rate. We conclude that the dynamics of social encounters' network stands between the random and the lattice in network spectrum. Although in this study we considered the period of common-cold disease for network dynamics, it seems that similar approaches may be useful for other airborne diseases such as SARS.

Application of LAC-type processes and concepts to nonrecreation management issues in protected areas

Treesearch

Linda Merigliano; David N. Cole; David J. Parsons

1997-01-01

When Limits of Acceptable Change concepts are applied to nonrecreational issues, two primary problems are encountered: (1) developing zoning schemes which are compatible when multiple issues are addressed, and (2) defining the desired condition and establishing measurable standards for ecosystem attributes which change in unpredictable ways. Approaches to overcome...

Resistances Encountered in Starting a Group Therapy Program for Suicide Attempters in Varied Administrative Settings.

ERIC Educational Resources Information Center

Hackel, Jacqueline; Asimos, Chrisula T.

1980-01-01

Reports areas of difficulty (including funding issues, management and personal bias issues, and theoretical issues) which emerged in the development of five treatment groups of depressed and suicidal patients. Groups reflected efforts between the city-county mental health system and funding agencies. Strategies for overcoming difficulties are…

Exploring Operational Issues and Practices of School Nutrition Programs in Large School Districts

ERIC Educational Resources Information Center

Nettles, Mary Frances; Carr, Deborah H.; Johnson, James T.; Federico, Holly A.

2008-01-01

Purpose/Objectives: The purpose was to explore issues associated with school nutrition (SN) programs in large school districts. Specific objectives were to identify operational issues and practices SN directors encounter and describe characteristics of SN directors and their programs. Methods: A panel of seven SN professionals from large school…

Virginia Department of Transportation public-private procurement : issues and accomplishments and interim report

DOT National Transportation Integrated Search

1999-01-01

This paper documents the contracting and procurement issues and opportunities encountered by the Virginia Department of Transportation (VDOT) in developing what was their first public-private partnership agreement for an Intelligent Transportation Sy...

A Study on the Application of Creative Problem Solving Teaching to Statistics Teaching

ERIC Educational Resources Information Center

Hu, Ridong; Xiaohui, Su; Shieh, Chich-Jen

2017-01-01

Everyone would encounter the life issue of solving complicated problems generated by economic behaviors among all activities for making a living. Various life problems encountered therefore could be generalized by economic statistics. In other words, a lot of important events in daily life are related to economic statistics. For this reason,…

A Decolonizing Encounter: Ward Churchill and Antonia Darder in Dialogue. Counterpoints: Studies in the Postmodern Theory of Education. Volume 430

ERIC Educational Resources Information Center

Orelus, Pierre W., Ed.

2012-01-01

"A Decolonizing Encounter" examines the effects of western colonialism on historically marginalized and colonized populations living both in the West and the "third world". Specifically, it explores crucial issues such as the decolonizing of schools and communities of color; the decentralization of power of the capitalist and…

Factors Affecting Student Persistence at a Selected Community College in the Stann Creek District, Belize, Central America

ERIC Educational Resources Information Center

Martinez, Karen Charlette

2011-01-01

Students encounter many issues that influence their persistence in college; some they come with, others they encounter while enrolled. Factors influencing students' success in college have taken on much interest in recent years. Students' persistence studies have been increasing; however, there is much to be learned about factors influencing…

Barriers Encountered in the Transfer of Educational Training to Workplace Practice in Saudi Arabia

ERIC Educational Resources Information Center

Almannie, Mohamed

2015-01-01

This study introduces a critical issue in the practicality of training programs, not only in Saudi Arabia, but also in other developing countries where billions of dollars are spent on training human resources without evaluation of these programs on workplace practice and organization development. This study investigates barriers encountered in…

The Role of Individualism/Collectivism in Critical Classroom Encounters: A Four Country Study

ERIC Educational Resources Information Center

Frankel, Robert; Swanson, Scott R.; Sagan, Mariusz

2005-01-01

Internationalization raises the issue of whether, and to what extent, the inherent culture of a country may have particular influence on the nature of service interactions, and on education (i.e., student-professor interactions) specifically. Thus the service encounter in the classroom becomes a subject of increasing importance and interest with…

The Problem-Based Learning Process: Reflections of Pre-Service Elementary School Teachers

ERIC Educational Resources Information Center

Baysal, Zeliha Nurdan

2017-01-01

This study aims to identify the benefits acquired by third-year pre-service elementary school teachers participating in a problem-based learning process in social studies education, the issues they encountered in that process and those they are likely to encounter, and their feelings about the process. Semi-structured interviews were used as one…

Ciguatera poisoning: a global issue with common management problems.

PubMed

Ting, J Y; Brown, A F

2001-12-01

Ciguatera poisoning, a toxinological syndrome comprising an enigmatic mixture of gastrointestinal, neurocutaneous and constitutional symptoms, is a common food-borne illness related to contaminated fish consumption. As many as 50000 cases worldwide are reported annually, and the condition is endemic in tropical and subtropical regions of the Pacific Basin, Indian Ocean and Caribbean. Isolated outbreaks occur sporadically but with increasing frequency in temperate areas such as Europe and North America. Increase in travel between temperate countries and endemic areas and importation of susceptible fish has led to its encroachment into regions of the world where ciguatera has previously been rarely encountered. In the developed world, ciguatera poses a public health threat due to delayed or missed diagnosis. Ciguatera is frequently encountered in Australia. Sporadic cases are often misdiagnosed or not medically attended to, leading to persistent or recurrent debilitating symptoms lasting months to years. Without treatment, distinctive neurologic symptoms persist, occasionally being mistaken for multiple sclerosis. Constitutional symptoms may be misdiagnosed as chronic fatigue syndrome. A common source outbreak is easier to recognize and therefore notify to public health organizations. We present a case series of four adult tourists who developed ciguatera poisoning after consuming contaminated fish in Vanuatu. All responded well to intravenous mannitol. This is in contrast to a fifth patient who developed symptoms suggestive of ciguatoxicity in the same week as the index cases but actually had staphylococcal endocarditis with bacteraemia. In addition to a lack of response to mannitol, clinical and laboratory indices of sepsis were present in this patient. Apart from ciguatera, acute gastroenteritis followed by neurological symptoms may be due to paralytic or neurotoxic shellfish poisoning, scombroid and pufferfish toxicity, botulism, enterovirus 71, toxidromes and bacteraemia. Clinical aspects of ciguatera toxicity, its pathophysiology, diagnostic difficulties and epidemiology are discussed.

Experimental issues related to frequency response function measurements for frequency-based substructuring

NASA Astrophysics Data System (ADS)

Nicgorski, Dana; Avitabile, Peter

2010-07-01

Frequency-based substructuring is a very popular approach for the generation of system models from component measured data. Analytically the approach has been shown to produce accurate results. However, implementation with actual test data can cause difficulties and cause problems with the system response prediction. In order to produce good results, extreme care is needed in the measurement of the drive point and transfer impedances of the structure as well as observe all the conditions for a linear time invariant system. Several studies have been conducted to show the sensitivity of the technique to small variations that often occur during typical testing of structures. These variations have been observed in actual tested configurations and have been substantiated with analytical models to replicate the problems typically encountered. The use of analytically simulated issues helps to clearly see the effects of typical measurement difficulties often observed in test data. This paper presents some of these common problems observed and provides guidance and recommendations for data to be used for this modeling approach.

Measures of societal risk and their potential use in civil aviation.

PubMed

Horn, Mark E T; Fulton, Neale; Westcott, Mark

2008-12-01

This article seeks to clarify the conceptual foundations of measures of societal risk, to investigate how such measures may be used validly in commonly encountered policy contexts, and to explore the application of these measures in the field of civil aviation. The article begins by examining standard measures of societal and individual risk (SR and IR), with attention given to ethical as well as analytical considerations. A comprehensive technical analysis of SR is provided, encompassing scalar risk measures, barrier functions, and a utility-based formulation, and clarifications are offered with respect to the treatment of SR in recent publications. The policy context for SR measures is shown to be critically important, and an extension to a hierarchical setting is developed. The prospects for applying SR to civil aviation are then considered, and some technical and conceptual issues are identified. SR appears to be a useful analytical tool in this context, provided that careful attention is given to these issues.

Geometric convex cone volume analysis

NASA Astrophysics Data System (ADS)

Li, Hsiao-Chi; Chang, Chein-I.

2016-05-01

Convexity is a major concept used to design and develop endmember finding algorithms (EFAs). For abundance unconstrained techniques, Pixel Purity Index (PPI) and Automatic Target Generation Process (ATGP) which use Orthogonal Projection (OP) as a criterion, are commonly used method. For abundance partially constrained techniques, Convex Cone Analysis is generally preferred which makes use of convex cones to impose Abundance Non-negativity Constraint (ANC). For abundance fully constrained N-FINDR and Simplex Growing Algorithm (SGA) are most popular methods which use simplex volume as a criterion to impose ANC and Abundance Sum-to-one Constraint (ASC). This paper analyze an issue encountered in volume calculation with a hyperplane introduced to illustrate an idea of bounded convex cone. Geometric Convex Cone Volume Analysis (GCCVA) projects the boundary vectors of a convex cone orthogonally on a hyperplane to reduce the effect of background signatures and a geometric volume approach is applied to address the issue arose from calculating volume and further improve the performance of convex cone-based EFAs.

The attitudes of nursing students to euthanasia.

PubMed

Naseh, Ladan; Heidari, Mohammad

2017-01-01

One of the most common morally controversial issues in endof-life care is euthanasia. Examining the attitudes of nursing students to this issue is important because they may encounter situations related to euthanasia during their clinical courses. The aim of our study was to examine nursing students' attitudes to euthanasia in Shahrekord city in western Iran. This was done using the Euthanasia Attitude Scale. The scale is divided into four categories, ie ethical considerations, practical considerations, treasuring life and naturalistic beliefs. Of 132 nursing students, 120 participated in the study (response rate 93.1%). According to the study's findings, 52.5%, 2.5% and 45% of the students reported a negative, neutral and positive attitude to euthanasia, respectively. There was a significant correlation between the nursing students' attitudes to euthanasia and some demographic characteristics, including sex, age and religious beliefs. Iranian Muslim nursing students participating in the study had a negative attitude to euthanasia. Further studies are recommended among nursing students from different cultures and of different religious faiths.

Obstacles to adherence in living with type-2 diabetes: an international qualitative study using meta-ethnography (EUROBSTACLE).

PubMed

Vermeire, Etienne; Hearnshaw, Hilary; Rätsep, Anneli; Levasseur, Gwenola; Petek, Davorina; van Dam, Henk; van der Horst, Frans; Vinter-Repalust, Nevenka; Wens, Johan; Dale, Jeremy; Van Royen, Paul

2007-02-01

Quantitative studies failed to determine variables which consistently explain adherence or non-adherence to treatment recommendations. Qualitative studies identified issues such as the quality of the health provider-health receiver relationship and the patient's health beliefs. According to these findings, 39 focus groups of 246 people living with type-2 diabetes were conducted in seven European countries, assessing health beliefs, communication with caregivers and problems encountered in adhering to treatment regimens. Meta-ethnography was later applied to make a qualitative meta-analysis. Obstacles to adherence are common across countries, and seem to be related less to issues of the health-care system and more to patient's knowledge about diabetes, beliefs and attitudes and the relationship with health-care professionals. The resulting key themes are course of diabetes, information, person and context, body awareness and relationship with the health care provider. Meta-ethnography is a feasible tool for the meta-analysis of multilingual qualitative data and leads to a richer account.

Workplace discrimination and disfigurement: the national EEOC ADA research project.

PubMed

Tartaglia, Alexander; McMahon, Brian T; West, Steven L; Belongia, Lisa

2005-01-01

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with disfigurement is documented. Key dimensions of workplace discrimination involving Americans with disfigurement and persons with missing limbs are compared and contrasted. Specifically, the researchers examine demographic characteristics of Charging Parties; the industry designation, location and size of Respondents/employers; the discrimination Issue (i.e., type of adverse action) alleged to occur; and the legal outcome or Resolution of these allegations. Charging Parties with disfigurement who are female or between 30 and 39 years of age are more likely to encounter employment discrimination than their counterparts with missing limbs. Harassment and Non-wage Benefits are the Issues that emerge in higher proportion. Allegations derived from persons with disfigurement are more common in among mid-size employers, those located in the South, or those in Retail or Service industries. Following investigation, allegations derived from persons with disfigurement are less likely to have Merit Resolutions than those brought by Charging Parties with missing limbs.

Development of the Spanish version of the Systematized Nomenclature of Medicine: methodology and main issues.

PubMed Central

Reynoso, G. A.; March, A. D.; Berra, C. M.; Strobietto, R. P.; Barani, M.; Iubatti, M.; Chiaradio, M. P.; Serebrisky, D.; Kahn, A.; Vaccarezza, O. A.; Leguiza, J. L.; Ceitlin, M.; Luna, D. A.; Bernaldo de Quirós, F. G.; Otegui, M. I.; Puga, M. C.; Vallejos, M.

2000-01-01

This presentation features linguistic and terminology management issues related to the development of the Spanish version of the Systematized Nomenclature of Medicine (SNOMED). It aims at describing the aspects of translating and the difficulties encountered in delivering a natural and consistent medical nomenclature. Bunge's three-layered model is referenced to analyze the sequence of symbolic concept representations. It further explains how a communicative translation based on a concept-to-concept approach was used to achieve the highest level of flawlessness and naturalness for the Spanish rendition of SNOMED. Translation procedures and techniques are described and exemplified. Both the computer-aided and human translation methods are portrayed. The scientific and translation team tasks are detailed, with focus on Newmark's four-level principle for the translation process, extended with a fifth further level relevant to the ontology to control the consistency of the typology of concepts. Finally the convenience for a common methodology to develop non-English versions of SNOMED is suggested. PMID:11079973

History-Enriched Spaces for Shared Encounters

NASA Astrophysics Data System (ADS)

Konomi, Shin'ichi; Sezaki, Kaoru; Kitsuregawa, Masaru

We discuss "history-enriched spaces" that use historical data to support shared encounters. We first examine our experiences with DeaiExplorer, a social network display that uses RFID and a historical database to support social interactions at academic conferences. This leads to our discussions on three complementary approaches to addressing the issues of supporting social encounters: (1) embedding historical data in embodied interactions, (2) designing for weakly involved interactions such as social navigation, and (3) designing for privacy. Finally, we briefly describe a preliminary prototype of a proxemics-based awareness tool that considers these approaches.

A general purpose subroutine for fast fourier transform on a distributed memory parallel machine

NASA Technical Reports Server (NTRS)

Dubey, A.; Zubair, M.; Grosch, C. E.

1992-01-01

One issue which is central in developing a general purpose Fast Fourier Transform (FFT) subroutine on a distributed memory parallel machine is the data distribution. It is possible that different users would like to use the FFT routine with different data distributions. Thus, there is a need to design FFT schemes on distributed memory parallel machines which can support a variety of data distributions. An FFT implementation on a distributed memory parallel machine which works for a number of data distributions commonly encountered in scientific applications is presented. The problem of rearranging the data after computing the FFT is also addressed. The performance of the implementation on a distributed memory parallel machine Intel iPSC/860 is evaluated.

Quantum physics and the beam splitter mystery

NASA Astrophysics Data System (ADS)

Hénault, François

2015-09-01

Optical lossless beam splitters are frequently encountered in fundamental physics experiments regarding the nature of light, including "which-way" determination or the EPR paradox and their measurement apparatus. Although they look as common optical components at first glance, their behaviour remains somewhat mysterious since they apparently exhibit stand-alone particle-like features, and then wave-like characteristics when inserted into a Mach-Zehnder interferometer. In this communication are examined and discussed some basic properties of these beamssplitters, both from a classical optics and quantum physics point of view. Herein the most evident convergences and contradictions are highlighted, and the results of a few emblematic experiments demonstrating photon existence are discussed. Alternative empirical models are also proposed in order to shed light on some remaining issues.

Negotiating Three Worlds: Academia, Nursing Science, and Tribal Communities

PubMed Central

Holkup, Patricia A.; Rodehorst, T. Kim; Wilhelm, Susan L.; Kuntz, Sandra W.; Weinert, Clarann; Stepans, Mary Beth Flanders; Salois, Emily Matt; Bull, Jacqueline Left Hand; Hill, Wade G.

2009-01-01

Purpose The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. Method Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. Results Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. Discussion Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities. PMID:18948449

Medical Student Documentation in the Electronic Medical Record: Patterns of Use and Barriers.

PubMed

Wittels, Kathleen; Wallenstein, Joshua; Patwari, Rahul; Patel, Sundip

2017-01-01

Electronic health records (EHR) have become ubiquitous in emergency departments. Medical students rotating on emergency medicine (EM) clerkships at these sites have constant exposure to EHRs as they learn essential skills. The Association of American Medical Colleges (AAMC), the Liaison Committee on Medical Education (LCME), and the Alliance for Clinical Education (ACE) have determined that documentation of the patient encounter in the medical record is an essential skill that all medical students must learn. However, little is known about the current practices or perceived barriers to student documentation in EHRs on EM clerkships. We performed a cross-sectional study of EM clerkship directors at United States medical schools between March and May 2016. A 13-question IRB-approved electronic survey on student documentation was sent to all EM clerkship directors. Only one response from each institution was permitted. We received survey responses from 100 institutions, yielding a response rate of 86%. Currently, 63% of EM clerkships allow medical students to document a patient encounter in the EHR. The most common reasons cited for not permitting students to document a patient encounter were hospital or medical school rule forbidding student documentation (80%), concern for medical liability (60%), and inability of student notes to support medical billing (53%). Almost 95% of respondents provided feedback on student documentation with supervising faculty being the most common group to deliver feedback (92%), followed by residents (64%). Close to two-thirds of medical students are allowed to document in the EHR on EM clerkships. While this number is robust, many organizations such as the AAMC and ACE have issued statements and guidelines that would look to increase this number even further to ensure that students are prepared for residency as well as their future careers. Almost all EM clerkships provided feedback on student documentation indicating the importance for students to learn this skill.

General practitioners’ views on consultations with interpreters: A triad situation with complex issues

PubMed Central

Fatahi, Nabi; Hellström, Mikael; Skott, Carola; Mattsson, Bengt

2008-01-01

Objective To study a group of general practitioners’ (GPs) views on cross-cultural consultations through interpreters in primary healthcare in Sweden. Design Two group interviews and three personal interviews with experienced GPs regarding clinical consultation through interpreters were carried out. The interviews were transcribed and analysed and the text was categorized according to content analysis. Setting Primary healthcare. Subjects Eight GPs were interviewed. Main outcome measures The response and opinions of the GPs. Results In the analysis it appeared that an optimal clinical encounter demands an active role by all participants involved in the consultation. The interpreter has to strive after being a stable neutral information bridge, and has a balancing role between the GP and the patient. The GP has to be open to cultural inequalities and recognize consultation through an interpreter as a part of her/his job. The patient needs to be an active and visible participant, not hiding behind the interpreter. Common obstacles and imperfections to reach the best possible triad were discussed. Additionally, practical assets in the encounter were delineated. Accurate physical placing of the persons in the room, adequate length of consultation time, and using the same interpreter from one visit to another were mentioned as factors influencing the outcome of the consultation. Conclusion Barriers in cross-cultural communications could originate from all persons involved, the interpreter, the GP, and the patient, as well as from tangible factors. Ways to reduce misunderstandings in GP–patient encounters through interpreters are suggested. PMID:18297562

Ethical issues confronted by medical students during clinical rotations.

PubMed

Fard, Nazila Nikravan; Asghari, Fariba; Mirzazadeh, Azim

2010-07-01

This study aimed to examine the most common and important ethical issues confronting medical students during clinical rotations so that ethics-related topics can be prioritised according to students' needs and this information used to develop a curriculum for the ethics course. In a cross-sectional approach, we reviewed the medical ethics-related cases recorded in the logbooks of all medical students (n=241) at Tehran University of Medical Sciences who attended the medical ethics course during October 2006 to July 2007. As part of a graded assignment, each student was required to record three encounters with ethics-related issues in his or her logbook. A total of 713 cases were assessed. Information related to the ethical issues and the conditions in which ethical issues arose was extracted and recorded by two experts, whose analysis showed agreement of kappa 0.77. In cases of discrepancy, both experts reviewed and discussed the record until they achieved agreement. A total of 713 cases were analysed. The most common issues reported by students related to ethics in medical education (20.1%, n=143), professionalism (18.8%, n=134), confidentiality (7.6%, n=54), the doctor-patient relationship (7.3%, n=52), informed consent (7.0%, n=50) and the doctor-peer relationship (7.0%, n=50). After adjusting for length of rotation, the highest numbers of ethics-related incidents were reported from urology, general surgery, orthopaedics, internal medicine, neurology, and obstetrics and gynaecology wards. The results of this study indicate that professionalism and related elements represent one of the most important areas of concern that need to be addressed when planning courses for medical students. The other significant area of concern is that of ethics in medical education, which, although the subject is not considered essential for medical practitioners, should be taught and respected so that student sensitivity to medical ethics is maintained and even increased.

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.

Challenges, Not Barriers: The Work and Family Issues of Women Superintendents

ERIC Educational Resources Information Center

Reecks-Rodgers, Debra Ann

2013-01-01

Prior studies have indicated that qualified female administrators have not applied for superintendency positions because of possible work/family conflicts, but little research has been done on the work/family issues encountered by women in the superintendency or on the strategies they use to resolve these issues. In response, this study is an…

Exploring Digital Encounters in the Public Arena

NASA Astrophysics Data System (ADS)

Schieck, Ava Fatah Gen.; Kostakos, Vassilis; Penn, Alan

In this chapter, we explore the types of encounters that technology enables. We consider the differences between digital and nondigital encounters through two pilot studies carried out in the city of Bath, United Kingdom. We investigate how technology can be appropriated for shared interactions that support conscious (or unconscious) social encounters, and highlight the importance of space and the role of place in providing temporal and spatial mechanisms facilitating different types of shared encounters. Here, we apply a method based on intervention through "sensing and projecting" Bluetooth names and digital identity in the public arena, and describe initial observations about people's reaction toward the projection of their Bluetooth names in public. In particular, we note the significance of constructing socially meaningful relations between people mediated by these technologies. We discuss initial results and outline issues raised in detail before finally describing the ongoing work.

Issues and Knowledge Concerning the Use of Heads-Up Displays in Air Transports

DOT National Transportation Integrated Search

2003-03-01

This document provides a literature review of design issues encountered by the Federal Aviation Administration (FAA) during the : certification of head-up displays (HUDs) for use in air transports. This review extracts certification advice from the l...

A PILOT SURVEY ON INJURY AND SAFETY CONCERNS IN INTERNATIONAL SLEDGE HOCKEY

PubMed Central

Finlayson, Heather; O'Connor, Russ; Anton, Hugh

2011-01-01

Objective: To describe sledge hockey injury patterns, safety issues and to develop potential injury prevention strategies. Design: Pilot survey study of international sledge hockey professionals, including trainers, physiotherapists, physicians, coaches and/or general managers. Setting: Personal encounter or online correspondence. Respondents: Sledge hockey professionals; a total of 10 respondents from the 5 top-ranked international teams recruited by personal encounter or online correspondence. Main Outcome Measurements: Descriptive Data reports on sledge athlete injury characteristics, quality of rules and enforcement, player equipment, challenges in the medical management during competition, and overall safety. Results: Muscle strains and concussions were identified as common, and injuries were reported to affect the upper body more frequently than the lower body. Overuse and body checking were predominant injury mechanisms. Safety concerns included excessive elbowing, inexperienced refereeing and inadequate equipment standards. Conclusions: This paper is the first publication primarily focused on sledge hockey injury and safety. This information provides unique opportunity for the consideration of implementation and evaluation of safety strategies. Safety interventions could include improved hand protection, cut-resistant materials in high-risk areas, increased vigilance to reduce intentional head-contact, lowered rink boards and modified bathroom floor surfacing. PMID:21904696

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.

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.

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

PubMed

Taylor, Holly A; McDonald, Erin L; Moon, Margaret; Hughes, Mark T; Carrese, Joseph A

2009-10-01

Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and their preceptors seeing patients in an out-patient general paediatrics clinic. Our objectives were to describe the everyday ethics-related issues paediatrics residents encounter as they interact with patients. Our ultimate goal is to use this knowledge to enhance current efforts to teach ethics to paediatrics residents. The study team directly observed paediatrics residents discussing patients with their faculty preceptors (19 half-day sessions, 76 hours) in an out-patient general paediatrics clinic located in an urban academic medical centre. Each interaction between resident and preceptor about a single patient was considered a case for further analysis. A total of 247 cases were recorded. Forty-one of the cases were coded as having ethics-related content. A constant comparative method of qualitative data analysis revealed that residents were most likely to encounter ethical issues when engaged in the following activities: (i) maintaining a therapeutic alliance with the caregiver (e.g. the parent); (ii) prioritising patient or family needs; (iii) adjusting to the power embodied by the role of doctors, and (iv) distinguishing suboptimal care from abuse or neglect. In addition, our findings indicate that it is through their efforts to maintain the therapeutic alliance with the caregivers of their patients that residents engage in and integrate three processes: developing their medical knowledge; adhering to professional norms, and balancing the power inherent in the doctor's role with their responsibility to serve the patient's interests. Medical faculty tasked with teaching ethics to paediatrics residents can utilise the results of this project to better target and enhance their ethics education efforts directed at residents in the out-patient setting. Future research could further examine and test these findings in other clinical settings (e.g. adult general medicine).

Acute adrenal insufficiency: an aide-memoire of the critical importance of its recognition and prevention.

PubMed

Gargya, A; Chua, E; Hetherington, J; Sommer, K; Cooper, M

2016-03-01

Adrenal crisis is a life-threatening emergency that causes significant excess mortality in patients with adrenal insufficiency. Delayed recognition by medical staff of an impending adrenal crisis and failure to give timely hydrocortisone therapy within the emergency department continue to be commonly encountered, even in metropolitan teaching hospitals. Within the authors' institutions, several cases of poorly handled adrenal crises have occurred over the last 2 years. Anecdotal accounts from members of the Addison's support group suggest that these issues are common in Australia. This manuscript is a timely reminder for clinical staff on the critical importance of the recognition, treatment and prevention of adrenal crisis. The manuscript: (i) outlines a case and the clinical outcome of sub-optimally managed adrenal crisis, (ii) summarises the clinical features and acute management of adrenal crisis, (iii) provides recommendations on the prevention of adrenal crisis and (iv) provides guidance on the management of 'sick days' in patients with adrenal insufficiency. © 2016 Royal Australasian College of Physicians.

The Full Scope of Family Physicians' Work Is Not Reflected by Current Procedural Terminology Codes.

PubMed

Young, Richard A; Burge, Sandy; Kumar, Kaparaboyna Ashok; Wilson, Jocelyn

2017-01-01

The purpose of this study was to characterize the content of family physician (FP) clinic encounters, and to count the number of visits in which the FPs addressed issues not explicitly reportable by 99211 to 99215 and 99354 Current Procedural Terminology (CPT) codes with current reimbursement methods and based on examples provided in the CPT manual. The data collection instrument was modeled on the National Ambulatory Medical Care Survey. Trained assistants directly observed every other FP-patient encounter and recorded every patient concern, issue addressed by the physician (including care barriers related to health care systems and social determinants), and treatment ordered in clinics affiliated with 10 residencies of the Residency Research Network of Texas. A visit was deemed to include physician work that was not explicitly reportable if the number or nature of issues addressed exceeded the definitions or examples for 99205/99215 or 99214 + 99354 or a preventive service code, included the physician addressing health care system or social determinant issues, or included the care of a family member. In 982 physician-patient encounters, patients raised 517 different reasons for visit (total, 5278; mean, 5.4 per visit; range, 1 to 16) and the FPs addressed 509 different issues (total issues, 3587; mean, 3.7 per visit; range, 1 to 10). FPs managed 425 different medications, 18 supplements, and 11 devices. A mean of 3.9 chronic medications were continued per visit (range, 0 to 21) and 4.6 total medications were managed (range, 0 to 22). In 592 (60.3%) of the visits the FPs did work that was not explicitly reportable with available CPT codes: 582 (59.3%) addressed more numerous issues than explicitly reportable, 64 (6.5%) addressed system barriers, and 13 (1.3%) addressed concerns for other family members. FPs perform cognitive work in a majority of their patient encounters that are not explicitly reportable, either by being higher than the CPT example number of diagnoses per code or the type of problems addressed, which has implications for the care of complex multi-morbid patients and the growth of the primary care workforce. To address these limitations, either the CPT codes and their associated rules should be updated to reflect the realities of family physicians' practices or new billing and coding approaches should be developed. © Copyright 2017 by the American Board of Family Medicine.

Ethical issues in physiotherapy--reflected from the perspective of physiotherapists in private practice.

PubMed

Praestegaard, Jeanette; Gard, Gunvor

2013-02-01

An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues as they are understood and experienced by Danish physiotherapists in outpatient, private practice. A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analyzed, using a phenomenological hermeneutic framework. One main theme emerged: The ideal of being beneficent toward the patient. Here, the ethical issues uncovered in the interviews were embedded in three code-groups: 1) ethical issues related to equality; 2) feeling obligated to do one's best; and 3) transgression of boundaries. In an ethical perspective, physiotherapy in private practice is on a trajectory toward increased professionalism. Physiotherapists in private practice have many reflections on ethics and these reflections are primarily based on individual common sense arguments and on deontological understandings. As physiotherapy by condition is characterized by asymmetrical power encounters where the parties are in close physical and emotional contact, practiced physiotherapy has many ethical issues embedded. Some physiotherapists meet these issues in a professional manner, but others meet them in unconscious or unprofessional ways. An explicit ethical consciousness among Danish physiotherapists in private practice seems to be needed. A debate of how to understand and respect the individual physiotherapist's moral versus the ethics of the profession needs to be addressed.

Physician-based transactions: the sale of medical practices, ambulatory surgery centers, and dialysis facilities.

PubMed

Becker, S; Pristave, R J

1995-01-01

This article provides an overview of the critical business and legal issues encountered in sales of practices, ambulatory surgery centers, and dialysis facilities. Specifically, it discusses prototypical valuations, transaction structures, and the principal legal issues that must be addressed.

Ethical Challenges in Promoting the Implementation of Preventive Interventions: Report of the SPR Task Force.

PubMed

Leadbeater, Bonnie J; Dishion, Tom; Sandler, Irwin; Bradshaw, Catherine P; Dodge, Kenneth; Gottfredson, Denise; Graham, Phillip W; Lindstrom Johnson, Sarah; Maldonado-Molina, Mildred M; Mauricio, Anne M; Smith, Emilie Phillips

2018-06-23

Prevention science researchers and practitioners are increasingly engaged in a wide range of activities and roles to promote evidence-based prevention practices in the community. Ethical concerns invariably arise in these activities and roles that may not be explicitly addressed by university or professional guidelines for ethical conduct. In 2015, the Society for Prevention Research (SPR) Board of Directors commissioned Irwin Sandler and Tom Dishion to organize a series of roundtables and establish a task force to identify salient ethical issues encountered by prevention scientists and community-based practitioners as they collaborate to implement evidence-based prevention practices. This article documents the process and findings of the SPR Ethics Task Force and aims to inform continued efforts to articulate ethical practice. Specifically, the SPR membership and task force identified prevention activities that commonly stemmed from implementation and scale-up efforts. This article presents examples that illustrate typical ethical dilemmas. We present principles and concepts that can be used to frame the discussion of ethical concerns that may be encountered in implementation and scale-up efforts. We summarize value statements that stemmed from our discussion. We also conclude that the field of prevention science in general would benefit from standards and guidelines to promote ethical behavior and social justice in the process of implementing evidence-based prevention practices in community settings. It is our hope that this article serves as an educational resource for students, investigators, and Human Subjects Review Board members regarding some of the complexity of issues of fairness, equality, diversity, and personal rights for implementation of preventive interventions.

A systematic review of religious beliefs about major end-of-life issues in the five major world religions.

PubMed

Chakraborty, Rajshekhar; El-Jawahri, Areej R; Litzow, Mark R; Syrjala, Karen L; Parnes, Aric D; Hashmi, Shahrukh K

2017-10-01

The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded. Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity. Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care.

A Case Study of Professional Boundary Issues Experienced by Undergraduate Psychology Students in a Supervised Field Experience Course

ERIC Educational Resources Information Center

Sharp, Gwen; Yao, Richard; Cresiski, Robin; Hahn, Kate

2013-01-01

There has been little research on the types of boundary issues encountered in undergraduate psychology field experience courses, despite the increased popularity of such courses. This case study identifies the frequency and types of boundary issues faced by undergraduate psychology students enrolled in such a course, including the most common…

'To Trust or Not to Trust--Pupils' Ways of Judging Information Encountered in a Socio-Scientific Issue.

ERIC Educational Resources Information Center

Kolsto, Stein Dankert

2001-01-01

Describes a qualitative study in which 16-year-old Norwegian pupils dealt with a socio-scientific issue. Investigates aspects of students' decision-making concerning a local version of the well-known controversial issue of whether or not power transmission lines increase the risk for childhood leukemia. Some of the resolution strategies imply that…

Operational Issues Encountered by School Nutrition Directors in School Districts with Less than 30,000 Student Enrollment

ERIC Educational Resources Information Center

Rushing, Keith; Nettles, Mary Frances; Johnson, James T.

2009-01-01

Purpose: To identify operational issues and practices associated with operating school nutrition (SN) programs in school districts with less than 30,000 student enrollment. Method: The survey was adapted from a similar study that explored operational issues in school districts with enrollments of 30,000 or more students. The survey asked SN…

Clinical encounters between nurses and First Nations women in a Western Canadian hospital.

PubMed

Browne, Annette J

2007-05-01

Based on findings from an ethnographic study, this paper explores the sociopolitical context of nurses' encounters with First Nations women in a Western Canadian hospital. Data were collected using in-depth interviews and participant observation of clinical encounters involving nurses and First Nations women who were in-patients in the hospital. Four themes in the data are discussed: relating across presumed "cultural differences"; constructing the Other; assumptions influencing clinical practice; and responding to routine patient requests. The findings illustrate how discourses and assumptions about Aboriginal people, culture, and presumed differences can become interwoven into routine clinical encounters. These results highlight the importance of analyzing health-care encounters in light of the wider sociopolitical and historical forces that give rise to racialization, culturalism and Othering, and underscore the need for critical awareness of these issues among nurses and other heath-care providers.

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.

Issues Affecting Cross-Cultural Adaptation of International Graduate Students

ERIC Educational Resources Information Center

Hartshorne, Richard; Baucom, Jennifer

2007-01-01

The purpose of this study was to identify and analyze the adjustment problems encountered by international graduate students enrolled in American universities. Issues of interest included motives for attending graduate school, factors involved in facilitating and constraining the graduate school experience, personality traits that contribute to…

Burn Survivors' Perceptions regarding Relevant Sexual Education Strategies

ERIC Educational Resources Information Center

Parrott, Yolan; Esmail, Shaniff

2010-01-01

Purpose: This paper aims to investigate the unique issues childhood burn survivors experience in relation to sex education and sexual development. Design/methodology/approach: Using a phenomenological approach, participants described their lived experiences with regards to sex education and the sexuality issues they encountered as child burn…

Patients' experiences of healthcare encounters in severe irritable bowel syndrome: an analysis based on narrative and feminist theory.

PubMed

Björkman, Ida; Simrén, Magnus; Ringström, Gisela; Jakobsson Ung, Eva

2016-10-01

This study aimed to explore patients' experiences of healthcare encounters in severe irritable bowel syndrome. Irritable bowel syndrome is a common functional disorder with symptoms such as abdominal pain and disturbed bowel habits, the cause of which is not completely known. Treatments options are limited, and healthcare encounters in irritable bowel syndrome have been described as unsatisfying and frustrating for both patients and professional healthcare providers. Furthermore, the influence of power on healthcare encounters has long been recognised, especially regarding the disadvantaged position of those suffering from functional illness which cannot be identified by commonly used tests or investigations. We interviewed 10 patients during 2014, all attending an outpatient clinic and suffering from severe irritable bowel syndrome. Relying on narrative and feminist theory, we explored how they actively negotiate professional discourse communicated to them in the clinical encounter. The patients' experiences of healthcare encounters in irritable bowel syndrome were mostly described as negative, and often induced feelings of confusion and self-doubt. Positive encounters were described as being listened to, believed and taken seriously. Narrators found it especially problematic when healthcare professionals described irritable bowel syndrome as a minor disorder with primarily stress or psychological aetiology and put the responsibility for recovery onto the patient. Patients' actively negotiated such professional discourse by presenting a counternarrative describing their own suffering and strengths, experienced healthcare shortcomings and possible organic aetiology of irritable bowel syndrome. Patients suffering from severe irritable bowel syndrome described how they often felt a need to protect their positive identities in the face of trivialisation and disbelief by healthcare professionals. A deepened understanding of patients' experiences of healthcare encounters in irritable bowel syndrome could enable more helpful and supporting interventions by healthcare professionals. © 2016 John Wiley & Sons Ltd.

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

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.

Radiocarbon dating of terrestrial carbonates

USGS Publications Warehouse

Pigati, Jeffrey S.; Rink, W. Jack; Thompson, Jeroen

2014-01-01

Terrestrial carbonates encompass a wide range of materials that potentially could be used for radiocarbon (14C) dating. Biogenic carbonates, including shells and tests of terrestrial and aquatic gastropods, bivalves, ostracodes, and foraminifera, are preserved in a variety of late Quaternary deposits and may be suitable for 14C dating. Primary calcareous deposits (marls, tufa, speleothems) and secondary carbonates (rhizoliths, fracture fill, soil carbonate) may also be targeted for dating when conditions are favorable. This chapter discusses issues that are commonly encountered in 14C dating of terrestrial carbonates, including isotopic disequilibrium and open-system behavior, as well as methods used to determine the reliability of ages derived from these materials. Recent methodological advancements that may improve the accuracy and precision of 14C ages of terrestrial carbonates are also highlighted.

The tired teen: A review of the assessment and management of the adolescent with sleepiness and fatigue

PubMed Central

Findlay, Sheri M

2008-01-01

The symptoms of sleepiness and fatigue are frequently encountered when caring for adolescents. Up to 40% of healthy teens experience regular sleepiness, defined as an increased tendency to fall asleep. Fatigue is the perception of low energy following normal activity and is reported by up to 30% of well teens. Chronic fatigue syndrome is an unusual syndrome with severe fatigue accompanied by other physical and neurological symptoms. A thorough assessment is required for all teens with sleepiness and fatigue; however, a treatable underlying medical condition is rarely found. Most fatigue and sleepiness in teens is attributable to lifestyle issues, notably too little time spent sleeping. Physicians are in a position to screen for, assess and manage these common conditions in teens. PMID:19119351

Managing Workplace Violence With Evidence-Based Interventions: A Literature Review.

PubMed

Martinez, Angel Johann Solorzano

2016-09-01

Workplace violence in health care settings is an occupational issue concerning nurses and other health care professionals. Patient aggression against nurses is often the most common form of violence in clinical settings, occurring in emergency departments, inpatient psychiatric settings, and nursing homes. Physical and verbal assaults are the major forms of workplace violence encountered by nurses. Current research has identified staff, environmental, and patient risk factors as the major precursors of workplace violence initiated by patients. Nurses often experience significant physical and psychological negative consequences after an episode of workplace violence. A review of the evidence was conducted to identify current evidence-based interventions that can help nurses minimize the incidence of workplace violence. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 31-36.]. Copyright 2016, SLACK Incorporated.

Children with Cancer: School Related Issues

ERIC Educational Resources Information Center

Gartin, Barbara C.; Murdick, Nikki L.

2009-01-01

School gives purpose to a student's life. Today, students with cancer and cancer survivors are encouraged to continue their educational experiences to maintain a sense of normalcy. This manuscript discusses the research findings on medical, physical, and cognitive issues that students with cancer and cancer survivors may encounter in their…

School Consultants as Agents of Social Justice for Multicultural Children and Families

ERIC Educational Resources Information Center

Li, Chieh; Vazquez-Nuttall, Ena

2009-01-01

This article discusses some of the social justice issues that multicultural students and families encounter that are directly relevant to school consultation practice. The issues include culturally fair education, fair expectations of the child from the family and school, fair assessment, evidence-based intervention, and evaluation of…

Dietary Issues Inpatients Face With Being Vegetarian

PubMed Central

Potter-Dunlop, Julie A.; Tse, Alice M.

2016-01-01

This article reviews the literature from 1985 through 2010 on research related to the dietary issues vegetarian inpatients may encounter in the acute care setting. A thematic portrayal of vegetarianism in the context of the inpatient setting is described. Implications for future research and nursing practice are identified. PMID:22157507

Road Signs in Ethical Quicksand.

ERIC Educational Resources Information Center

Jerrell, S. Lee; Jerrell, Jeanette M.

1985-01-01

Some of the major moral and ethical dilemmas illustrated by authors in this special journal issue are highlighted. From an ethical viewpoint, the complexity of evaluation activities is likened to "quicksand" terrain in which directional or warning signs should be erected to aid personal choices when such issues are encountered.…

Teachers Teaching Teachers (T3)[TM]. Volume 5, Number 3

ERIC Educational Resources Information Center

Crow, Tracy, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Building Bridges: Data Help Instructional Coach Make Vital Connections with Teachers (Theresa Long); (2) NSDC Tool: Instructional…

Improving Olympic health services: what are the common health care planning issues?

PubMed

Kononovas, Kostas; Black, Georgia; Taylor, Jayne; Raine, Rosalind

2014-12-01

Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care planning issues for future hosts. A structured, critical, qualitative analysis of all available Olympic health care reports was conducted. Recommendations and issues with implications for future Olympic host cities were extracted from each report. The six identified themes were: (1) the importance of early planning and relationship building: clarifying roles early to agree on responsibility and expectations, and engaging external and internal groups in the planning process from the start; (2) the development of appropriate medical provision: most health care needs are addressed inside Olympic venues rather than by hospitals which do not experience significant increases in attendance during the Games; (3) preparing for risks: gastrointestinal and food-borne illnesses are the most common communicable diseases experienced during the Games, but the incidence is still very low; (4) addressing the security risk: security arrangements are one of the most resource-demanding tasks; (5) managing administration and logistical issues: arranging staff permission to work at Games venues ("accreditation") is the most complex administrative task that is likely to encounter delays and errors; and (6) planning and assessing health legacy programs: no previous Games were able to demonstrate that their health legacy initiatives were effective. Although each report identified similar health care planning issues, subsequent Olympic host cities did not appear to have drawn on the transferable experiences of previous host cities. Repeated recommendations and lessons from host cities show that similar health care planning issues occur despite different health systems. To improve health care planning and delivery, host cities should pay heed to the specific planning issues that have been highlighted. It is also advisable to establish good communication with organizers from previous Games to learn first-hand about planning from previous hosts.

The Library and Human Memory. Final Report on Mechanized Information Services in the University Library, Phase I - Planning. Part 13.

ERIC Educational Resources Information Center

Norman, Donald A.

This paper discusses the differences between the storage problems encountered in a large library and those encountered in the human memory. Some of the properties of the human memory system and some of the major issues which affect the interaction between human users and the existing library systems are outlined. The problem of browsing is used as…

Common Data Acquisition Systems (DAS) Software Development for Rocket Propulsion Test (RPT) Test Facilities

NASA Technical Reports Server (NTRS)

Hebert, Phillip W., Sr.; Davis, Dawn M.; Turowski, Mark P.; Holladay, Wendy T.; Hughes, Mark S.

2012-01-01

The advent of the commercial space launch industry and NASA's more recent resumption of operation of Stennis Space Center's large test facilities after thirty years of contractor control resulted in a need for a non-proprietary data acquisition systems (DAS) software to support government and commercial testing. The software is designed for modularity and adaptability to minimize the software development effort for current and future data systems. An additional benefit of the software's architecture is its ability to easily migrate to other testing facilities thus providing future commonality across Stennis. Adapting the software to other Rocket Propulsion Test (RPT) Centers such as MSFC, White Sands, and Plumbrook Station would provide additional commonality and help reduce testing costs for NASA. Ultimately, the software provides the government with unlimited rights and guarantees privacy of data to commercial entities. The project engaged all RPT Centers and NASA's Independent Verification & Validation facility to enhance product quality. The design consists of a translation layer which provides the transparency of the software application layers to underlying hardware regardless of test facility location and a flexible and easily accessible database. This presentation addresses system technical design, issues encountered, and the status of Stennis development and deployment.

Unique Construction and Social Experiences in Residential Remediation Sites - 13423

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

Jung, Paul; Scarborough, Rebecca

2013-07-01

Sevenson Environmental Services, Inc., (Sevenson) has performed several radiological remediation projects located in residential urban areas. Over the course of these projects, there has been a wide variety of experiences encountered from construction related issues to unique social situations. Some of the construction related issues included the remediation of interior basements where contaminated material was located under the footers of the structure or was used in the mortar between cinder block or field stone foundations. Other issues included site security, maintaining furnaces or other utilities, underpinning, backfilling and restoration. In addition to the radiological hazards associated with this work theremore » were occupational safety and industrial hygiene issues that had to be addressed to ensure the safety and health of neighboring properties and residents. The unique social situations at these job sites have included arson, theft/stolen property, assault/battery, prostitution, execution of arrest warrants for residents, discovery of drugs and paraphernalia, blood borne pathogens, and unexploded ordnance. Some of these situations have become a sort of comical urban legend throughout the organization. One situation had historical significance, involving the demolition of a house to save a tree older than the Declaration of Independence. All of these projects typically involve the excavation of early 20. century items such as advertisement signs, various old bottles (milk, Listerine, perfume, whisky) and other miscellaneous common trash items. (authors)« less

Cloud encounter statistics in the 28.5-43.5 KFT altitude region from four years of GASP observations

NASA Technical Reports Server (NTRS)

Jasperson, W. H.; Nastrom, G. D.; Davis, R. E.; Holdeman, J. D.

1983-01-01

The results of an analysis of cloud encounter measurements taken at aircraft flight altitudes as part of the Global Atmospheric Sampling Program are summarized. The results can be used in estimating the probability of cloud encounter and in assessing the economic feasibility of laminar flow control aircraft along particular routes. The data presented clearly show the tropical circulation and its seasonal migration; characteristics of the mid-latitude regime, such as the large-scale traveling cyclones in the winter and increased convective activity in the summer, can be isolated in the data. The cloud encounter statistics are shown to be consistent with the mid-latitude cyclone model. A model for TIC (time-in-clouds), a cloud encounter statistic, is presented for several common airline routes.

Safety in bear country: protective measures and bullet performance at short range.

Treesearch

W.R. Meehan; J.F. Thilenius

1983-01-01

Bears are frequently encountered by people working in or enjoying the outdoors. Some government agencies have regulations concerning the firearms their personnel carry for protection against bears.Guidelines to prevent hazardous encounters with bears are presented, and the performance of commonly used weapons and ammunition is discussed. The ballistic...

Russian-English Glossary of International Maritime Law Terms (and Selected Terms in Related Disciplines.)

ERIC Educational Resources Information Center

Naval Intelligence Support Center, Washington, DC.

This glossary contains over 750 terms encountered in international maritime law texts. It includes terms of the art, fairly common abbreviations, geographic names, and prepositional phrases routinely encountered in international treaties, conventions, and agreements. The prepositional phrases are recorded exactly as they appear in formal texts.…

Ecological Knowledge Among Communities, Managers and Scientists: Bridging Divergent Perspectives to Improve Forest Management Outcomes

NASA Astrophysics Data System (ADS)

Rist, Lucy; Shackleton, Charlie; Gadamus, Lily; Chapin, F. Stuart; Gowda, C. Made; Setty, Siddappa; Kannan, Ramesh; Shaanker, R. Uma

2016-04-01

Multiple actors are typically involved in forest management, namely communities, managers and researchers. In such cases, suboptimal management outcomes may, in addition to other factors, be symptomatic of a divergence in perspectives among these actors driven by fundamental differences in ecological knowledge. We examine the degree of congruence between the understandings of actors surrounding key issues of management concern in three case studies from tropical, subtropical and boreal forests. We identify commonly encountered points of divergence in ecological knowledge relating to key management processes and issues. We use these to formulate seven hypotheses about differences in the bodies of knowledge that frequently underlie communication and learning failures in forest management contexts where multiple actors are involved and outcomes are judged to be suboptimal. Finally, we present a set of propositions to acknowledge and narrow these differences. A more complete recognition of the full triangulation between all actors involved, and of the influence that fundamental differences in ecological knowledge can exert, may help lead to a more fruitful integration between local knowledge and practice, manager knowledge and practice, and contemporary science in forest management.

Lessons Learned From the Implementation of Seek, Test, Treat, Retain Interventions Using Mobile Phones and Text Messaging to Improve Engagement in HIV Care for Vulnerable Populations in the United States.

PubMed

Christopoulos, Katerina A; Cunningham, William E; Beckwith, Curt G; Kuo, Irene; Golin, Carol E; Knight, Kevin; Flynn, Patrick M; Spaulding, Anne C; Coffin, Lara S; Kruszka, Bridget; Kurth, Ann; Young, Jeremy D; Mannheimer, Sharon; Crane, Heidi M; Kahana, Shoshana Y

2017-11-01

In the United States, little is known about interventions that rely on mobile phones and/or text messaging to improve engagement in HIV care for vulnerable populations. Domestic studies using these technologies as part of the National Institute on Drug Abuse "Seek, Test, Treat, Retain" research initiative were queried regarding intervention components, implementation issues, participant characteristics, and descriptive statistics of mobile phone service delivery. Across five studies with 1,135 predominantly male, minority participants, implementation challenges occurred in three categories: (1) service interruptions; (2) billing/overage issues, and; (3) the participant user experience. Response rules for automated text messages frequently frustrated participants. The inability to reload minutes/texting capacity remotely was a significant barrier to intervention delivery. No study encountered confidentiality breaches. Service interruption was common, even if studies provided mobile phones and plans. Future studies should attend to the type of mobile phone and service, the participant user experience, and human subjects concerns.

Legal Support for Palliative Care Patients.

PubMed

Ezer, Tamar; Burke-Shyne, Naomi; Hepford, Kiera

2018-02-01

Palliative care patients face legal issues that impact their quality of life. Legal support, embedded in holistic palliative care services, has developed globally over the last decade to address this. This article aims to trace the origins of legal support for palliative care patients, detail models of legal support, and describe achievements and challenges. The article draws on years of work in this area and the available literature. Common legal issues include disposing of property and drafting wills, planning for children, dealing with debt and securing social benefits, and addressing discrimination. Diverse approaches to integrating legal support include developing paralegal skills, accessing skilled legal advice, empowering patients and families, and building awareness of rights among health care workers. There is robust and growing acceptance of legal support as a key component of holistic palliative care, and many palliative care professionals are identifying and addressing the legal needs they encounter through mediation, guidance on basic rights, or referrals to a lawyer. Addressing legal problems can contribute to peace of mind, well-being, and the health of patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

[Neuro-ophthalmology: the eye as a window to the brain].

PubMed

Kesler, Anat

2013-02-01

Neuro-ophthalmology focuses on the diagnosis and treatment of visual disorders related to the neurological system rather than the globe itself. Being a subspecialty of both neurology and ophthalmology, it requires specialized training and expertise in diseases of the eye, brain, nerves and muscles. Commonly encountered pathologies in neuro-ophthalmology include: optic neuropathies (such as optic neuritis and ischemic optic neuropathy), visual field loss (transient, constant, unexplained), transient visual loss, unspecified visual disturbances, diplopia, abnormal eye movements, thyroid eye disease, myasthenia gravis, anisocoria, and eyelid abnormalities. The current issue of "Harefuah" is dedicated to contemporary knowledge in neuro-opthalmology, and spans from studies of neuromyelitis optica (NMO), ischemic optic neuropathies, and optic neuropathies induced by phosphodiesterase inhibitors, to the management of sight-threatening carotid-cavernous fistulas, and more. These studies emphasize the importance of an interdisciplinary treatment team consisting of a neuro-ophthalmologist, a neuro-radiologist, and sometimes, even a neuro-surgeon. Such an approach may prove to be beneficial to the patient, by optimizing follow-up and treatment decisions. This issue emphasizes how a correct and timely diagnosis is of paramount significance in patients with neuro-ophthalmological disorders.

The ethics of animal research: a UK perspective.

PubMed

Perry, Pauline

2007-01-01

The Nuffield Council on Bioethics, an independent body in the United Kingdom, has published a 2005 report titled The Ethics of Research Involving Animals. The Report, produced by a Working Party that represented a wide range of views, seeks to clarify the debate that surrounds this topic and aims to help people identify and analyze the relevant scientific and ethical issues. The Working Party considered the arguments surrounding whether animal research yields useful results, and recommends that its predictability and transferability should be evaluated more fully, particularly in controversial areas. Commonly encountered ethical questions and arguments were considered in order to understand what lies behind disagreement on the moral justification of animal research. Four possible ethical positions on animal research, which represent points on a continuum, are described. Despite the range of views that exist among members of the Working Party, the Report presents a "Consensus Statement" that identifies agreement on several important issues. Building on this statement, recommendations are made for improving the quality of the debate and promoting the 3Rs (refinement, reduction, and replacement).

Conservation of living resources in a changing world

NASA Astrophysics Data System (ADS)

Teer, James G.

1996-11-01

Conservation of living resources is no longer parochial in scope; it is a global challenge. Ecological, social, political, and business interests operate in a network that reaches across seas, continents, and nations. Industries, including the electric utility industry, are diversifying in products and expanding into international markets. They soon discover that, while all nations have common goals for their peoples, conservation and environmental issues in less-developed nations have different dimensions and norms than are encountered in Western, affluent societies. In developing countries, survival is more of an issue than quality of life, and burgeoning human numbers have put tremendous pressures on resources including wildlife and its habitats. Human population, urbanization of society, changes in single-species to ecosystem and landscape levels of management, and protectionists and animal rights philosophies are influences with which conservation of resources and the environment must contend. The human condition and conservation efforts are inextricably linked. Examples to demonstrate this fact are given for Project Tiger in India, the jaguar in Latin America, and the Serengeti ecosystem in Kenya and Tanzania.

Care coordination for children with special health care needs: a cohort study.

PubMed

Zanello, Elisa; Calugi, Simona; Sanders, Lee M; Lenzi, Jacopo; Faldella, Giacomo; Rucci, Paola; Fantini, Maria Pia

2017-02-03

Care coordination is widely recognized as a key element of care for patients with chronic and complex medical conditions and their families. In care for children with special health care needs the Family Pediatrician (FP) plays a central role as care coordinator. This study aims to evaluate the FPs' activities of care coordination for children with special health care needs in the pediatric primary care setting, using an on-line measurement tool. Within the prospective cohort study SpeNK (Special Needs Kids), newborns and children with special health care needs were recruited at discharge from three hospital facilities in Bologna province, from October 1st 2012 to September 30th 2014. Their FPs were invited to complete a questionnaire (SpeNK-FP) at each encounter for the patient during a 9-month period after hospital discharge. SpeNK-FP was developed by adapting the Care Coordination Measurement Tool (CCMT©) developed by Antonelli et al., to the Italian organizational context. The outcome of interest, derived from the questionnaire, is inappropriate use of services. Forty FPs completed assessments for 49 children at each of 382 clinical encounters. The majority of children (71.4%) had special health care needs, without complicating social issues. FPs reported "no need for care coordination" in 50.8% of the encounters and 41.1% of records about patient needs requiring care coordination. The most common activity implemented to meet children's needs was telephone contact with a medical provider. According to FPs, 80% of encounters prevented inappropriate services use. In multivariate regression, pediatric-specialist contact (telephone or in person) was associated with reduced odds of physician report of preventable hospitalization (OR = 0.06, 95% CI 0.01-0.42, p = 0.005). The study shows the potential for FPs in Italy to serve as care coordinators and facilitate the implementation of integrated care pathways for children with special health care needs.

A comparison of ethical issues in nursing practice across nursing units.

PubMed

Park, Mihyun; Jeon, Sang Hee; Hong, Hyun-Ja; Cho, Sung-Hyun

2014-08-01

The complexity and variety of ethical issues in nursing is always increasing, and those issues lead to special concerns for nurses because they have critical impacts on nursing practice. The purpose of this study was to gather comprehensive information about ethical issues in nursing practice, comparing the issues in different types of nursing units including general units, oncology units, intensive care units, operating rooms, and outpatient departments. The study used a descriptive research design. Ethics/human rights issues encountered by nurses in their daily nursing practice were identified by using the Ethical Issues Scale. The study sample included 993 staff nurses working in a university hospital in South Korea. This study was approved by the University Institutional Review Board. Completed questionnaires were returned sealed with signed informed consent. The most frequently and disturbingly encountered issues across nursing units were "conflicts in the nurse-physician relationship," "providing care with a possible risk to your health," and "staffing patterns that limit patient access to nursing care." The findings of this study showed that nurses from different nursing units experienced differences in the types or frequency of ethical issues. In particular, intensive care units had the greatest means of all the units in all three component scales including end-of-life treatment issues, patient care issues, and human rights issues. Nurses experienced various ethical challenges in their daily practice. Of the ethical issues, some were distinctively and frequently experienced by nurses in a specific unit. This study suggested that identifying and understanding specific ethical issues faced by nurses in their own areas may be an effective educational approach to motivate nurses and to facilitate nurses' reflection on their experiences. © The Author(s) 2014.

Teachers Teaching Teachers (T3). Volume 6, Number 3

ERIC Educational Resources Information Center

Armstrong, Anthony, Ed.

2010-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Teaching English Language Learners: Mainstream Teachers Make a Stellar Journey as a Team to Transform Classroom Practices (Elsa M.…

Ethical Issues in the Assessment and Treatment of a Rational Suicidal Client.

ERIC Educational Resources Information Center

Snipe, Rosetta M.

1988-01-01

Notes that rational client's decision to commit suicide may present complex ethical issues for therapist. Presents and discusses three-month account of therapy with client, from perspective of ethical values and principles upon which assessment and treatment decisions were made, and complex ethical dilemmas encountered as therapist juxtaposed…

Doctoral Supervision in a Cross-Cultural Context: Issues Affecting Supervisors and Candidates

ERIC Educational Resources Information Center

Winchester-Seeto, Theresa; Homewood, Judi; Thogersen, Jane; Jacenyik-Trawoger, Christa; Manathunga, Catherine; Reid, Anna; Holbrook, Allyson

2014-01-01

This article presents an analysis of rich data, gathered from interviews with 46 candidates and 38 supervisors from three Australian universities, about experiences of doctoral supervision in cross-cultural situations. Our analysis shows that many of the issues reported by international candidates are the same as those encountered by domestic…

Teachers Teaching Teachers (T3)[TM]. Volume 4, Number 7

ERIC Educational Resources Information Center

von Frank, Valerie, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Learning Cycle Spins Individuals into a Team (Valerie von Frank); (2) NSDC Tool: The Professional Teaching and Learning Cycle; (3)…

Family Home Childcare Providers: A Comparison of Subsidized and Non-Subsidized Working Environments and Employee Issues

ERIC Educational Resources Information Center

Shriner, Michael; Schlee, Bethanne M.; Mullis, Ronald L.; Cornille, Thomas A.; Mullis, Ann K.

2008-01-01

Federal and State Governments provide childcare subsidies for low-income working families. This study compares the encountered issues and working environments of family home providers of subsidized and non-subsidized childcare. Questionnaires were distributed throughout a southeastern state in the United States to 548 family home childcare…

Teachers Teaching Teachers (T3)[TM]. Volume 4, Number 8

ERIC Educational Resources Information Center

von Frank, Valerie, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Tackling Behavior from All Sides (Valerie von Frank); (2) Tools: Effective Behavior Support Self-Assessment Survey; (3) Lessons from…

Teachers Teaching Teachers (T3)[TM]. Volume 4, Number 6

ERIC Educational Resources Information Center

von Frank, Valerie, Ed.

2009-01-01

"Teachers Teaching Teachers" ("T3") focuses on coaches' roles in the professional development of teachers. Each issue also explores the challenges and rewards that teacher leaders encounter. This issue includes: (1) Values and Clarity Build Classroom Language (Valerie von Frank); (2) Tools: Identifying and Clarifying Beliefs about Learning; (3)…

A Case Study Approach to Ethics in Career Development, Second Edition. Monograph Series

ERIC Educational Resources Information Center

Makela, Julia Panke; Perlus, Jessamyn G.

2017-01-01

This second edition tackles some of the most vexing questions that career development professionals encounter today. Using a case study design, it offers a hands-on experience with ethical terminology, resources, and issues. Each dilemma presented includes detailed, guided discussion of key issues and recommendations, with direct connections to…

Numerical Study of a Convective Turbulence Encounter

NASA Technical Reports Server (NTRS)

Proctor, Fred H.; Hamilton, David W.; Bowles, Roland L.

2002-01-01

A numerical simulation of a convective turbulence event is investigated and compared with observational data. The specific case was encountered during one of NASA's flight tests and was characterized by severe turbulence. The event was associated with overshooting convective turrets that contained low to moderate radar reflectivity. Model comparisons with observations are quite favorable. Turbulence hazard metrics are proposed and applied to the numerical data set. Issues such as adequate grid size are examined.

A qualitative description of service providers' experiences of ethical issues in HIV care.

PubMed

Sabone, Motshedisi B; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther I; Corless, Inge B; Cuca, Yvette P; Holzemer, William L; Dawson-Rose, Carol; Baez, Solymar S Soliz; Rivero-Mendz, Marta; Webel, Allison R; Eller, Lucille Sanzero; Reid, Paula; Johnson, Mallory O; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice K; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, Ellen

2018-01-01

Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Audiologic and otologic phenotype in children with Duane's Retraction Syndrome: A rare ophthalmologic disorder.

PubMed

Weir, Forest W; Kreicher, Kathryn L; Hatch, Jonathan L; Nguyen, Shaun A; Meyer, Ted A

2016-10-01

The focus of this study was to evaluate the prevalence, type, and severity of hearing impairment in patients with Duane's Retraction Syndrome and to relate these measures to patient demographics and other otologic and audiologic factors. Retrospective AudGen Database analysis Tertiary academic referral center Pediatric patients in AudGenDB with a diagnosis of Duane's Retraction Syndrome (DRS). Appropriate audiologic, otologic, and demographic data were recorded. Seventy-nine patients (n = 79) met inclusion criteria. The first encounter with available audiometric data or the first encounter with hearing loss were documented. Audiograms were stratified by type and severity of hearing loss, and common associated medical issues were documented. 57 children had normal hearing; 22 had hearing loss. 9 ears had pure conductive hearing loss, 1 had pure sensorineural, 14 ears had components of both, and 79 had hearing loss that could not be specified. Multivariate regression revealed episodes of chronic otitis and craniofacial anomalies are associated with worse hearing loss. This study presents a detailed characterization of hearing loss in patients with Duane's retraction syndrome. Conductive and sensorineural hearing loss are both prevalent among these children. Careful and early audiologic evaluation of all patients with DRS is important. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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.

Physicochemical code for quinary protein interactions in Escherichia coli

PubMed Central

Mu, Xin; Choi, Seongil; Lang, Lisa; Mowray, David; Danielsson, Jens; Oliveberg, Mikael

2017-01-01

How proteins sense and navigate the cellular interior to find their functional partners remains poorly understood. An intriguing aspect of this search is that it relies on diffusive encounters with the crowded cellular background, made up of protein surfaces that are largely nonconserved. The question is then if/how this protein search is amenable to selection and biological control. To shed light on this issue, we examined the motions of three evolutionary divergent proteins in the Escherichia coli cytoplasm by in-cell NMR. The results show that the diffusive in-cell motions, after all, follow simplistic physical−chemical rules: The proteins reveal a common dependence on (i) net charge density, (ii) surface hydrophobicity, and (iii) the electric dipole moment. The bacterial protein is here biased to move relatively freely in the bacterial interior, whereas the human counterparts more easily stick. Even so, the in-cell motions respond predictably to surface mutation, allowing us to tune and intermix the protein’s behavior at will. The findings show how evolution can swiftly optimize the diffuse background of protein encounter complexes by just single-point mutations, and provide a rational framework for adjusting the cytoplasmic motions of individual proteins, e.g., for rescuing poor in-cell NMR signals and for optimizing protein therapeutics. PMID:28536196

A systematic review of religious beliefs about major end-of-life issues in the five major world religions

PubMed Central

CHAKRABORTY, RAJSHEKHAR; EL-JAWAHRI, AREEJ R.; LITZOW, MARK R.; SYRJALA, KAREN L; PARNES, ARIC D.; HASHMI, SHAHRUKH K.

2018-01-01

Objective The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). Method This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded. Results Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity. Significance of results Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care. PMID:28901283

Online pre-race education improves test scores for volunteers at a marathon.

PubMed

Maxwell, Shane; Renier, Colleen; Sikka, Robby; Widstrom, Luke; Paulson, William; Christensen, Trent; Olson, David; Nelson, Benjamin

2017-09-01

This study examined whether an online course would lead to increased knowledge about the medical issues volunteers encounter during a marathon. Health care professionals who volunteered to provide medical coverage for an annual marathon were eligible for the study. Demographic information about medical volunteers including profession, specialty, education level and number of marathons they had volunteered for was collected. A 15-question test about the most commonly encountered medical issues was created by the authors and administered before and after the volunteers took the online educational course and compared to a pilot study the previous year. Seventy-four subjects completed the pre-test. Those who participated in the pilot study last year (N = 15) had pre-test scores that were an average of 2.4 points higher than those who did not (mean ranks: pilot study = 51.6 vs. non-pilot = 33.9, p = 0.004). Of the 74 subjects who completed the pre-test, 54 also completed the post-test. The overall post-pre mean score difference was 3.8 ± 2.7 (t = 10.5 df = 53 p < 0.001). While subjects with all levels of volunteer experience demonstrated improvement, only change among first time marathon volunteers was significantly different from the others. Subjects reporting all degree/certification levels demonstrated improvement, but no difference in improvement was found between degree/certification levels. In this follow-up to the previous year's pilot study, online education demonstrated a long-term (one-year) increase in test scores. Testing also continued to show short-term improvement in post-course test scores, compared to pre-course test scores. In general, marathon medical volunteers who had no volunteer experience demonstrated greater improvement than those who had prior volunteer experience.

Some Physical and Computational Issues in Land Surface Data Assimilation of Satellite Skin Temperatures

NASA Astrophysics Data System (ADS)

Mackaro, Scott M.; McNider, Richard T.; Biazar, Arastoo Pour

2012-03-01

Skin temperatures that reflect the radiating temperature of a surface observed by infrared radiometers are one of the most widely available products from polar orbiting and geostationary satellites and the most commonly used satellite data in land surface assimilation. Past work has indicated that a simple land surface scheme with a few key parameters constrained by observations such as skin temperatures may be preferable to complex land use schemes with many unknown parameters. However, a true radiating skin temperature is sometimes not a prognostic variable in weather forecast models. Additionally, recent research has shown that skin temperatures cannot be directly used in surface similarity forms for inferring fluxes. This paper examines issues encountered in using satellite derived skin temperatures to improve surface flux specifications in weather forecast and air quality models. Attention is given to iterations necessary when attempting to nudge the surface energy budget equation to a desired state. Finally, the issue of mathematical operator splitting is examined in which the surface energy budget calculations are split with the atmospheric vertical diffusion calculations. However, the high level of connectivity between the surface and first atmospheric level means that the operator splitting leads to high frequency oscillations. These oscillations may hinder the assimilation of skin temperature derived moisture fluxes.

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

Pharmaceutical issues during the review of European Marketing Authorisation Applications in Malta.

PubMed

Chetcuti, Michael; Serracino-Inglott, Anthony; Flores, Gavril; Borg, John J

2018-07-01

The aim of this study was to identify pharmaceutical issues encountered during regulatory review in European Procedures. A database of issues from Day 70 assessment reports of 150 EU procedures was compiled; most procedures were for generics (108). Frequencies of common deficiencies have been calculated and summarised for use of all stakeholders. Out of the 150 procedures reviewed, covering 309 products, a total of 4796 concerns were identified. Of these concerns, 167 were Potential Serious Risks to Public Health, 67 were raised on drug substance and 100 on the drug product. The distribution of total concerns was as follows: 2168 concerns on drug substance and 2584 on drug product. Most concerns raised were on control of drug substance and drug product (834 & 626 for 3.2.S.4 and 3.2.P.5, respectively), followed by concerns on the manufacturing (482 & 564 for 3.2.S.2 and 3.2.P.3, respectively) and stability 147 & 398 for 3.2.S.7 and 3.2.P.8, respectively). In conclusion, the frequencies and trends of identified deficiencies together with their impact were discussed from a regulatory point of view. The main findings indicate that applicants would benefit from following published guidelines so that delays in the registration of medicines could be avoided.

The evolving definition of essential tremor: What are we dealing with?

PubMed

Louis, Elan D

2018-01-01

Although essential tremor (ET) is commonly encountered in clinical practice, historically, there has been considerable disagreement as how to best define it, and now with a growing sense of its clinical complexity, how to best encapsulate it. Here, I draw attention to five issues of current uncertainty. A PubMed search conducted on June 19, 2017 crossed "essential tremor" with 9 second search terms (e.g., definition, diagnosis). There are several major issues of clinical and diagnostic uncertainty. Underlying each issue is a larger question about the nature of the underlying pathophysiology of ET. Does age of onset of ET matter? How much dystonia is acceptable in ET? How much in the way of "cerebellar signs" are acceptable? Are non-motor features due to the underlying disease or merely secondary to the clinical features? Is ET a single disease entity or something else? We are learning more about ET and, as a by-product of these efforts, are struggling with its definition. Further understanding the nature of the underlying disease pathogenesis as well as the role the cerebellum and cerebellar relays play in this process will likely provide important clues to enable us to bring order to areas of uncertainty. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving inferences from fisheries capture-recapture studies through remote detection of PIT tags

USGS Publications Warehouse

Hewitt, David A.; Janney, Eric C.; Hayes, Brian S.; Shively, Rip S.

2010-01-01

Models for capture-recapture data are commonly used in analyses of the dynamics of fish and wildlife populations, especially for estimating vital parameters such as survival. Capture-recapture methods provide more reliable inferences than other methods commonly used in fisheries studies. However, for rare or elusive fish species, parameter estimation is often hampered by small probabilities of re-encountering tagged fish when encounters are obtained through traditional sampling methods. We present a case study that demonstrates how remote antennas for passive integrated transponder (PIT) tags can increase encounter probabilities and the precision of survival estimates from capture-recapture models. Between 1999 and 2007, trammel nets were used to capture and tag over 8,400 endangered adult Lost River suckers (Deltistes luxatus) during the spawning season in Upper Klamath Lake, Oregon. Despite intensive sampling at relatively discrete spawning areas, encounter probabilities from Cormack-Jolly-Seber models were consistently low (< 0.2) and the precision of apparent annual survival estimates was poor. Beginning in 2005, remote PIT tag antennas were deployed at known spawning locations to increase the probability of re-encountering tagged fish. We compare results based only on physical recaptures with results based on both physical recaptures and remote detections to demonstrate the substantial improvement in estimates of encounter probabilities (approaching 100%) and apparent annual survival provided by the remote detections. The richer encounter histories provided robust inferences about the dynamics of annual survival and have made it possible to explore more realistic models and hypotheses about factors affecting the conservation and recovery of this endangered species. Recent advances in technology related to PIT tags have paved the way for creative implementation of large-scale tagging studies in systems where they were previously considered impracticable.

Correlation Filtering of Modal Dynamics using the Laplace Wavelet

NASA Technical Reports Server (NTRS)

Freudinger, Lawrence C.; Lind, Rick; Brenner, Martin J.

1997-01-01

Wavelet analysis allows processing of transient response data commonly encountered in vibration health monitoring tasks such as aircraft flutter testing. The Laplace wavelet is formulated as an impulse response of a single mode system to be similar to data features commonly encountered in these health monitoring tasks. A correlation filtering approach is introduced using the Laplace wavelet to decompose a signal into impulse responses of single mode subsystems. Applications using responses from flutter testing of aeroelastic systems demonstrate modal parameters and stability estimates can be estimated by correlation filtering free decay data with a set of Laplace wavelets.

Problems Encountered by Novice Pair Programmers

ERIC Educational Resources Information Center

Hanks, Brian

2008-01-01

In a study of the types of problems encountered by students that led them to seek assistance, Robins et al. [2006] found that the most common problems were related to trivial mechanics. The students in this study worked by themselves on their programming exercises. This article discusses a replication of the Robins et al. study in which the…

Issues for South Asian Indian patients surrounding sexuality, fertility, and childbirth in the US health care system.

PubMed

Fisher, Judith A; Bowman, Marjorie; Thomas, Tessie

2003-01-01

In 1998 ethnic minorities comprised 28% of the US population, and India is the third most common country of origin for immigrants. Many recently immigrated South Asian Indian patients are seen in health care settings in the United States. To deliver health care effectively to these patients, it is helpful for physicians to understand common cultural beliefs and practices of South Asian Indian patients. Two illustrative cases are reported. One author's observations of the care of pregnant and parturient women in India and similar experiences in our own office spurred a literature search of the cultural behaviors surrounding sexuality, fertility, and childbirth. A literature search was conducted in Index Medicus, Grateful Med, and the catalogue of the University of Pennsylvania Arts and Sciences library, using the terms "Indian," "South Asian," "male and female gender roles," "gynecology in third world," "sexuality," "sexual health," "women's health," "women's health education," "obstetrical practices/India," and "female roles/India." Issues surrounding sexuality and childbirth that arise during the US physician-South Asian Indian patient encounter might not correspond to the commonly held knowledge, beliefs, and behaviors of the US health care system. Common cultural beliefs and behaviors of South Asian Indian patients around sexuality and childbirth experience include the role of the individual patient's duty to society, the patient's sense of place in society, lack of formal sexual education, prearranged marriages, importance of the birth of the first child, little premarital contraceptive education, dominance of the husband in contraceptive decisions, and predominant role of women and lack of role for men (including the husband) in the childbirth process. Lack of understanding of the Indian cultural mores surrounding sexual education, sexual behavior, and the childbirth experiences can form barriers to Indian immigrants in need of health care. These misunderstandings can also lead to patient dissatisfaction with the health provider and health system, underutilization of health services, and poorer health outcomes for Indian immigrants and their families. For this reason, it is important to teach cultural issues during undergraduate, graduate, and continuing medical education.

Interactions between sleep disorders and oral diseases.

PubMed

Huynh, N T; Emami, E; Helman, J I; Chervin, R D

2014-04-01

Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Survey of editors and reviewers of high-impact psychology journals: statistical and research design problems in submitted manuscripts.

PubMed

Harris, Alex; Reeder, Rachelle; Hyun, Jenny

2011-01-01

The authors surveyed 21 editors and reviewers from major psychology journals to identify and describe the statistical and design errors they encounter most often and to get their advice regarding prevention of these problems. Content analysis of the text responses revealed themes in 3 major areas: (a) problems with research design and reporting (e.g., lack of an a priori power analysis, lack of congruence between research questions and study design/analysis, failure to adequately describe statistical procedures); (b) inappropriate data analysis (e.g., improper use of analysis of variance, too many statistical tests without adjustments, inadequate strategy for addressing missing data); and (c) misinterpretation of results. If researchers attended to these common methodological and analytic issues, the scientific quality of manuscripts submitted to high-impact psychology journals might be significantly improved.

Salbutamol in paediatrics: pharmacology, prescribing and controversies.

PubMed

Andrzejowski, Paul; Carroll, Will

2016-08-01

Salbutamol has become a key drug in respiratory medicine since it was first developed by Sir David Jack et al in 1968, 5000 years after the β agonist ephedrine was first used in its raw form, as the Ma Huang herb in Chinese medicine to treat asthma. It is one of the most commonly encountered medicines in paediatric practice and the authors have found that an understanding of its pharmacology in clinical practice is incredibly helpful. In this article, we discuss its pharmacology and pharmacodynamics, practical prescribing points and some unresolved issues surrounding its use, which should serve to provide an essential working knowledge for the busy paediatrician. 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/

Potentially malignant disorders of the oral cavity: a clinical study.

PubMed

Shukla, Anirudh

2014-01-01

Oral cancers in India, unlike in the West are the most common cancers encountered, be it a primary or a tertiary referral practice. This makes the study and management of these cancers an important issue especially for the otolaryngologist. It is well known that the most common variant of oral cancers is the squamous cell carcinoma. Also the etiology is well established; with tobacco use in both smoking and smokeless forms, alcohol, betel nut and recently the Human Papilloma virus infection being implicated. Certain conditions which definitely increase the probability of getting oral cancers are known and this study aims in revisiting these aspects of pre-malignancy. The progression from a pre-cancerous lesion/condition to frank cancer is well established across many studies and many specialties. Also timely recognizing these pre-cancerous conditions and administration of proper treatment will greatly help in reducing the morbidity and mortality from subsequent much advanced and dangerous oral cancer. Keeping these facts in mind this study was planned to study the established pre-cancerous lesions which are known to progress to oral cancers.

The Off-Campus Center: Extending the Reach of Higher Education. Organizational Issues.

ERIC Educational Resources Information Center

Gabor, Stanley C.; Heggan, Jon P.

Based on a study of basic organizational issues typically encountered in opening, managing, and closing an off-campus center (OCC), this monograph is designed for colleges and universities wishing to explore the possibility of creating or expanding an OCC for adult students. The definition of an OCC is provided. After a brief statistical overview…

An Analysis of Technological Issues Emanating from Faculty Transition to a New Learning Management System

ERIC Educational Resources Information Center

Sanga, Mapopa William

2016-01-01

This case study investigated the process 119 faculty members underwent as they transitioned from using Desire to Learn (D2L) learning management system (LMS), to using Canvas LMS. Other than analyzing technological issues faculty members encountered while navigating various aspects of the Canvas interface, the study also analyzed technological…

Friending, IMing, and Hanging out Face-to-Face: Overlap in Adolescents' Online and Offline Social Networks

ERIC Educational Resources Information Center

Reich, Stephanie M.; Subrahmanyam, Kaveri; Espinoza, Guadalupe

2012-01-01

Many new and important developmental issues are encountered during adolescence, which is also a time when Internet use becomes increasingly popular. Studies have shown that adolescents are using these online spaces to address developmental issues, especially needs for intimacy and connection to others. Online communication with its potential for…

Identity Crisis in Cormac McCarthy's "All the Pretty Horses"

ERIC Educational Resources Information Center

Gebreen, Hayder A. K.

2016-01-01

The issue of identity is one of the main issues that encounters man in each culture. Identity is a set of behaviors, emotions, and thought patterns which are unique to every individual that define him as a member of a certain group. Identity is shaped by race, ethnicity, religious beliefs, language, physical features, childhood experiences, sexual…

Desperate Shadows of "Belonging": Revealing Pedagogical Issues with Teaching Prescribed English Texts in the NSW Higher School Certificate (HSC)

ERIC Educational Resources Information Center

Jogie, Melissa R.

2015-01-01

As New South Wales (NSW) bids farewell to the 2009-2014 Area of Study concept "Belonging", this article summarises some critical reflections from English teachers on the main pedagogical issues encountered when using prescribed texts to teach "Belonging" to both the Standard and Advanced English courses in contemporary…

Live Scale Active Shooter Exercise: Lessons Learned

ERIC Educational Resources Information Center

Ervin, Randy

2008-01-01

On October 23, 2007, the Lake Land College Public Safety Department conducted a full-scale live exercise that simulated an active shooter and barricaded hostage. In this article, the author will emphasize what they learned, and how they intend to benefit from it. He will list the law enforcement issues and general issues they encountered, and then…

Issues encountered in a qualitative secondary analysis of help-seeking in the prodrome to psychosis.

PubMed

Gladstone, Brenda M; Volpe, Tiziana; Boydell, Katherine M

2007-10-01

Primary data are rarely used explicitly as a source of data outside of the original research purpose for which they were collected. As a result, qualitative secondary analysis (QSA) has been described as an "invisible enterprise" for which there is a "notable silence" amongst the qualitative research community. In this paper, we report on the methodological implications of conducting a secondary analysis of qualitative data focusing on parents' narratives of help-seeking activities in the prodrome to psychosis. We review the literature on QSA, highlighting the main characteristics of the approach, and discuss issues and challenges encountered in conducting a secondary analysis. We conclude with some thoughts on the implications for conducting a QSA in children's mental health services and research.

How humans transmit language: horizontal transmission matches word frequencies among peers on Twitter.

PubMed

Bryden, John; Wright, Shaun P; Jansen, Vincent A A

2018-02-01

Language transmission, the passing on of language features such as words between people, is the process of inheritance that underlies linguistic evolution. To understand how language transmission works, we need a mechanistic understanding based on empirical evidence of lasting change of language usage. Here, we analysed 200 million online conversations to investigate transmission between individuals. We find that the frequency of word usage is inherited over conversations, rather than only the binary presence or absence of a word in a person's lexicon. We propose a mechanism for transmission whereby for each word someone encounters there is a chance they will use it more often. Using this mechanism, we measure that, for one word in around every hundred a person encounters, they will use that word more frequently. As more commonly used words are encountered more often, this means that it is the frequencies of words which are copied. Beyond this, our measurements indicate that this per-encounter mechanism is neutral and applies without any further distinction as to whether a word encountered in a conversation is commonly used or not. An important consequence of this is that frequencies of many words can be used in concert to observe and measure language transmission, and our results confirm this. These results indicate that our mechanism for transmission can be used to study language patterns and evolution within populations. © 2018 The Author(s).

Chiropractic Observation and Analysis Study (COAST): providing an understanding of current chiropractic practice.

PubMed

French, Simon D; Charity, Melanie J; Forsdike, Kirsty; Gunn, Jane M; Polus, Barbara I; Walker, Bruce F; Chondros, Patty; Britt, Helena C

2013-11-18

COAST (Chiropractic Observation and Analysis Study) aimed to describe the clinical practices of chiropractors in Victoria, Australia. Cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice. 180 chiropractors in active clinical practice in Victoria were randomly selected from the list of 1298 chiropractors registered on Chiropractors Registration Board of Victoria. Twenty-four chiropractors were ineligible, 72 agreed to participate, and 52 completed the study. Each participating chiropractor documented encounters with up to 100 consecutive patients. For each chiropractor-patient encounter, information collected included patient health profile, patient reasons for encounter, problems and diagnoses, and chiropractic care. Data were collected on 4464 chiropractor-patient encounters from 52 chiropractors between 11 December 2010 and 28 September 2012. In most (71%) encounters, patients were aged 25-64 years; 1% of encounters were with infants (age < 1 year; 95% CI, 0.3%-3.2%). Musculoskeletal reasons for encounter were described by patients at a rate of 60 per 100 encounters (95% CI, 54-67 encounters) and maintenance and wellness or check-up reasons were described at a rate of 39 per 100 encounters (95% CI, 33-47 encounters). Back problems were managed at a rate of 62 per 100 encounters (95% CI, 55-71 encounters). The most frequent care provided by the chiropractors was spinal manipulative therapy and massage. A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related. These results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.

Systemic Right Ventricle in Adults With Congenital Heart Disease: Anatomic and Phenotypic Spectrum and Current Approach to Management.

PubMed

Brida, Margarita; Diller, Gerhard-Paul; Gatzoulis, Michael A

2018-01-30

The systemic right ventricle (SRV) is commonly encountered in congenital heart disease representing a distinctly different model in terms of its anatomic spectrum, adaptation, clinical phenotype, and variable, but overall guarded prognosis. The most common clinical scenarios where an SRV is encountered are complete transposition of the great arteries with previous atrial switch repair, congenitally corrected transposition of the great arteries, double inlet right ventricle mostly with previous Fontan palliation, and hypoplastic left heart syndrome palliated with the Norwood-Fontan protocol. The reasons for the guarded prognosis of the SRV in comparison with the systemic left ventricle are multifactorial, including distinct fibromuscular architecture, shape and function, coronary artery supply mismatch, intrinsic abnormalities of the tricuspid valve, intrinsic or acquired conduction abnormalities, and varied SRV adaptation to pressure or volume overload. Management of the SRV remains an ongoing challenge because SRV dysfunction has implications on short- and long-term outcomes for all patients irrespective of underlying cardiac morphology. SRV dysfunction can be subclinical, underscoring the need for tertiary follow-up and timely management of target hemodynamic lesions. Catheter interventions and surgery have an established role in selected patients. Cardiac resynchronization therapy is increasingly used, whereas pharmacological therapy is largely empirical. Mechanical assist device and heart transplantation remain options in end-stage heart failure when other management strategies have been exhausted. The present report focuses on the SRV with its pathological subtypes, pathophysiology, clinical features, current management strategies, and long-term sequelae. Although our article touches on issues applicable to neonates and children, its main focus is on adults with SRV. © 2018 American Heart Association, Inc.

Diagnosis and Management of Nasopharyngeal Stenosis.

PubMed

Berent, Allyson C

2016-07-01

Choanal atresia is rare in small animal veterinary medicine, and most cases are misdiagnosed and are actually a nasopharyngeal stenosis (NPS), which is frustrating to treat because of the high recurrence rates encountered after surgical intervention. Minimally invasive treatment options like balloon dilation (BD), metallic stent placement (MS), or covered metallic stent (CMS) placement have been met with success but are associated with various complications that must be considered. The most common complication with BD alone is stenosis recurrence. The most common complications encountered with MS placement is tissue in-growth, chronic infections and the development of an oronasal fistula. The most common complications with a CMS is chronic infections and the development of an oronasal fistula, but stricture recurrence is avoided. Copyright © 2016 Elsevier Inc. All rights reserved.

Using Machine Learning for Behavior-Based Access Control: Scalable Anomaly Detection on TCP Connections and HTTP Requests

DTIC Science & Technology

2013-11-01

machine learning techniques used in BBAC to make predictions about the intent of actors establishing TCP connections and issuing HTTP requests. We discuss pragmatic challenges and solutions we encountered in implementing and evaluating BBAC, discussing (a) the general concepts underlying BBAC, (b) challenges we have encountered in identifying suitable datasets, (c) mitigation strategies to cope...and describe current plans for transitioning BBAC capabilities into the Department of Defense together with lessons learned for the machine learning

Teaching evolution in the Australian classroom

NASA Astrophysics Data System (ADS)

Vozzo, Les

A summary of the key issues of controversy encountered by science teachers in Australian classrooms. Evolution, cloning and gene manipulation, fertility control, artificial intelligence, irradiation of food, the use of nuclear energy, radiation from powerlines are some of the topics discussed and debated in classrooms. What are some of the difficulties encountered by teachers when students ask questions that raise moral dilemmas and challenges entrenched beliefs and views of the world. What are some of the teaching strategies used that deal with these difficulties.

Diastolic dysfunction and heart failure with a preserved ejection fraction: Relevance in critical illness and anaesthesia

PubMed Central

Maharaj, R.

2012-01-01

Epidemiological and clinical studies suggest that HF with a preserved ejection fraction will become the more common form of HF which clinicians will encounter. The spectrum of diastolic disease extends from the asymptomatic phase to fulminant cardiac failure. These patients are commonly encountered in operating rooms and critical care units. A clearer understanding of the underlying pathophysiology and clinical implications of HF with a preserved ejection fraction is fundamental to directing further research and to evaluate interventions. This review highlights the impact of diastolic dysfunction and HF with a preserved ejection fraction during the perioperative period and during critical illness. PMID:23960679

Managing ethical issues in patient care and the need for clinical ethics support.

PubMed

Doran, Evan; Fleming, Jennifer; Jordens, Christopher; Stewart, Cameron L; Letts, Julie; Kerridge, Ian H

2015-02-01

To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia.

North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues.

PubMed

Colwell, Janice C; McNichol, Laurie; Boarini, Joy

The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues. Descriptive study. Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns. Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points. Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems. WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged.

Mutual Benefit for Foreign Medical Students and Chinese Postgraduates: A Mixed Team-Based Learning Method Overcomes Communication Problems in Hematology Clerkship

ERIC Educational Resources Information Center

Chen, Xianling; Chen, Buyuan; Li, Xiaofan; Song, Qingxiao; Chen, Yuanzhong

2017-01-01

Hematology is difficult for students to learn. A beneficial education method for hematology clerkship training is required to help students develop clinical skills. Foreign medical students often encounter communication issues in China. To address this issue, Chinese post-graduates from our institute are willing to assist with educating foreign…

The Basics of School Law: A Guide for School Directors

ERIC Educational Resources Information Center

Washington State School Directors' Association (NJ1), 2010

2010-01-01

This guide is intended to give individual school board directors an introduction to some of the legal issues they may encounter in their board service. This material is not intended to answer every question, even in the subject matter areas they cover. This guide is merely intended to alert directors to the legal issues that they will encounter…

Bioethical issues and health care chaplaincy in aotearoa New Zealand.

PubMed

Carey, Lindsay B

2012-06-01

This paper summarizes survey and interview results from a cross-sectional study of New Zealand health care chaplaincy personnel concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. Some implications of this study concerning health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and recommendations presented.

Confronting Common Folklore: Catching a Cold

ERIC Educational Resources Information Center

Keeley, Page

2012-01-01

Almost every child has experienced the sniffly, stuffy, and achy congestion of the common cold. In addition, many have encountered the "old wives tales" that forge a link between personal actions and coming down with this common respiratory infection. Much of this health folklore has been passed down from generation to generation (e.g., getting a…

A preliminary study on travel health issues of medical students undertaking electives.

PubMed

Goldsmid, John M; Bettiol, Silvana S; Sharples, Nadine

2003-01-01

With the inclusion of elective programs, often overseas, in many medical courses, it was decided that a preliminary retrospective analysis of health problems associated with these programs in medical students from the University of Tasmania would be desirable. A questionnaire covering general travel health issues was distributed to all medical students in the University of Tasmania, on return from their elective. They were asked to complete the questionnaire and return it on an anonymous and voluntary basis. In addition, student elective submissions were consulted for information relating to their chosen destination. Results of the study indicate that general practitioners were the most common source of pretravel advice for Tasmanian medical students. Overall, 64% of students experienced some sort of health problem of which travelers' diarrhea was the most common. Most problems were mild and self-limiting, but a number of serious infections were recorded, including acute leptospirosis, paratyphoid, and Staphylococcus aureus cellulitis. Of particular concern were the reports of assault and sexual harassment recorded by several students. Elective programs are an important part of many medical courses. With the widespread destinations chosen by students, it is important that they be given adequate pretravel health advice. Most of the health problems encountered by students from the University of Tasmania were mild, but exposure to serious infections was recorded. It is thus imperative that students take out travel health insurance and that they are counseled on how to avoid dangerous situations while abroad.

Common Data Acquisition Systems (DAS) Software Development for Rocket Propulsion Test (RPT) Test Facilities - A General Overview

NASA Technical Reports Server (NTRS)

Hebert, Phillip W., Sr.; Hughes, Mark S.; Davis, Dawn M.; Turowski, Mark P.; Holladay, Wendy T.; Marshall, PeggL.; Duncan, Michael E.; Morris, Jon A.; Franzl, Richard W.

2012-01-01

The advent of the commercial space launch industry and NASA's more recent resumption of operation of Stennis Space Center's large test facilities after thirty years of contractor control resulted in a need for a non-proprietary data acquisition system (DAS) software to support government and commercial testing. The software is designed for modularity and adaptability to minimize the software development effort for current and future data systems. An additional benefit of the software's architecture is its ability to easily migrate to other testing facilities thus providing future commonality across Stennis. Adapting the software to other Rocket Propulsion Test (RPT) Centers such as MSFC, White Sands, and Plumbrook Station would provide additional commonality and help reduce testing costs for NASA. Ultimately, the software provides the government with unlimited rights and guarantees privacy of data to commercial entities. The project engaged all RPT Centers and NASA's Independent Verification & Validation facility to enhance product quality. The design consists of a translation layer which provides the transparency of the software application layers to underlying hardware regardless of test facility location and a flexible and easily accessible database. This presentation addresses system technical design, issues encountered, and the status of Stennis' development and deployment.

Amino Acids, Aromatic Compounds, and Carboxylic Acids: How Did They Get Their Common Names?

ERIC Educational Resources Information Center

Leung, Sam H.

2000-01-01

Surveys the roots of the common names of organic compounds most likely to be encountered by undergraduate organic chemistry students. Includes information for 19 amino acids, 17 aromatic compounds, and 21 carboxylic acids. (WRM)

Serious Illness, Injury, and Death in Child Protection and Preparation for End-of-Life Situations among Child Welfare Services Workers

ERIC Educational Resources Information Center

Csikai, Ellen L.; Herrin, Charlotte; Tang, Maggie; Church, Wesley T., II

2008-01-01

A mailed survey of child welfare workers in one southern state assessed various aspects of encounters with end-of-life situations in practice. Findings revealed that child deaths, children with life-threatening or life-limiting illnesses, and parental deaths were most commonly encountered and that coworkers were relied on for support. Many had no…

Issues Encountered by Physicians During International Travel With Youth National Soccer Teams

PubMed Central

Rosenbaum, Daryl A.; Davis, Stephen W.

2011-01-01

Background: Little information is available to guide the selection, preparation, and support of a traveling team physician. Purpose: To determine the types of injuries and medical problems, as well as general team health and performance issues, encountered by physicians traveling internationally with youth national soccer teams. Study Design: Descriptive epidemiology. Methods: Physicians assigned to travel abroad with the under-17 men’s and women’s US national soccer teams during a 2-year period documented all encounters with team and staff members. Physicians also documented consultations related to team health and performance issues. Results: The 108 cases (5.71 per 10 days) were evenly divided between injuries (n = 54) and noninjuries (n = 54). Players sought care at a higher rate than did staff (2.28 vs 1.09 per 100 person days). Mean severity for all player cases was 5.19 days missed (injuries, 10.48; noninjuries, 0.23). Nearly 69% of injuries involved the lower extremities: strains, sprains, and contusions accounted for 74.1% of injuries. Gastrointestinal, dermatologic, and otolaryngologic complaints accounted for 77.8% of noninjuries. Medications were administered in 71% of cases, with analgesics, cough and cold remedies, antibiotics, and gastrointestinal agents accounting for the majority. The leading team health and performance concerns were nutrition/hydration, conditioning, prevention, and doping control. Conclusion: Physicians traveling internationally with youth soccer teams manage an equal proportion of musculoskeletal and medical problems using simple medications. PMID:23016012

Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation.

PubMed

Clement, T; Brown, J; Morrison, J; Nestel, D

2016-05-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.

Connection between encounter volume and diffusivity in geophysical flows

NASA Astrophysics Data System (ADS)

Rypina, Irina I.; Smith, Stefan G. Llewellyn; Pratt, Larry J.

2018-04-01

Trajectory encounter volume - the volume of fluid that passes close to a reference fluid parcel over some time interval - has been recently introduced as a measure of mixing potential of a flow. Diffusivity is the most commonly used characteristic of turbulent diffusion. We derive the analytical relationship between the encounter volume and diffusivity under the assumption of an isotropic random walk, i.e., diffusive motion, in one and two dimensions. We apply the derived formulas to produce maps of encounter volume and the corresponding diffusivity in the Gulf Stream region of the North Atlantic based on satellite altimetry, and discuss the mixing properties of Gulf Stream rings. Advantages offered by the derived formula for estimating diffusivity from oceanographic data are discussed, as well as applications to other disciplines.

Investigating tiredness in Australian general practice. Do pathology tests help in diagnosis?

PubMed

Gialamas, Angela; Beilby, Justin J; Pratt, Nicole L; Henning, Rhys; Marley, John E; Roddick, John F

2003-08-01

Tiredness is a common presentation in general practice for which pathology tests are commonly ordered. Our aim was to study their utilisation for tiredness. We examined an integrated database which contains the medical records for 58,139 patients and their 696,518 associated general practitioner encounters. Three hundred and forty-two patients and their 1652 associated encounters were randomly selected out of 12,291 patients and their 26,748 associated encounters that had mentioned tiredness (or a synonym). One hundred and eighty-one patients (53%) had at least one pathology test ordered at any time in their episode of care. Patients over 60 years of age, patients who consulted their GP more than once and patients without comorbidity were more likely to have a pathology test ordered. Only 12 patients (3%) had a significant clinical diagnosis based on an abnormal pathology test. Pathology testing for patients presenting with tiredness is high. Most tests do not yield a significant clinical diagnosis.

Triaging: common complaints in the workplace.

PubMed

Zimmermann, Polly Gerber; Wachs, Joy E

2003-06-01

Occupational health nurses regularly encounter clients with benign, common complaints. However, the mundane nature should not detract from the need for careful evaluation and guidance. Obtaining a comprehensive history and making key assessments help guide the occupational health nurse to properly manage the client's complaint.

Space station human productivity study. Volume 4: Issues

NASA Technical Reports Server (NTRS)

1985-01-01

The 305 Issues contained represent topics recommended for study in order to develop requirements in support of space station crew performance/productivity. The overall subject matter, space station elements affecting crew productivity, was organized into a coded subelement listing, which is included for the reader's reference. Each issue is numbered according to the 5-digit topical coding scheme. The requirements column on each Issue page shows a cross-reference to the unresolved requirement statement(s). Because topical overlaps were frequently encountered, many initial Issues were consolidated. Apparent gaps, therefore, may be accounted for by an Issue described within a related subelement. A glossary of abbreviations used throughout the study documentation is also included.

Towards agreement on best practice for publishing raw clinical trial data.

PubMed

Hrynaszkiewicz, Iain; Altman, Douglas G

2009-03-18

Many research-funding agencies now require open access to the results of research they have funded, and some also require that researchers make available the raw data generated from that research. Similarly, the journal Trials aims to address inadequate reporting in randomised controlled trials, and in order to fulfil this objective, the journal is working with the scientific and publishing communities to try to establish best practice for publishing raw data from clinical trials in peer-reviewed biomedical journals. Common issues encountered when considering raw data for publication include patient privacy - unless explicit consent for publication is obtained - and ownership, but agreed-upon policies for tackling these concerns do not appear to be addressed in the guidance or mandates currently established. Potential next steps for journal editors and publishers, ethics committees, research-funding agencies, and researchers are proposed, and alternatives to journal publication, such as restricted access repositories, are outlined.

Baccalaureate Minority Nursing Students Perceived Barriers and Facilitators to Clinical Education Practices: An Integrative Review.

PubMed

Graham, Crystal L; Phillips, Shannon M; Newman, Susan D; Atz, Teresa W

2016-01-01

This integrative review synthesized baccalaureate minority nursing students' perceptions of their clinical experiences. The diversity of the nursing workforce does not mirror the United States population. Attrition rates of minority nursing students remain higher than rates for White students. Literature examining facilitators and barriers to minority student success predominantly focuses on academic factors, excluding those relevant to clinical education. An integrative review using literature from nursing and education. Three common perceived barriers were identified: discrimination from faculty, peers, nursing staff, and patients; bias in faculty grading practices; and isolation. Although little is known about the relationship between clinical failures and overall attrition, this review provides evidence that minority students encounter significant barriers in clinical education. To increase the diversity of the nursing workforce, faculty must address these issues and make modifications to ensure an equal opportunity at a quality education for all students.

Adapting pediatric psychology interventions: lessons learned in treating families from the Middle East.

PubMed

Hilliard, Marisa E; Ernst, Michelle M; Gray, Wendy N; Saeed, Shehzad A; Cortina, Sandra

2012-09-01

Pediatric psychologists are increasingly called upon to treat children from non-Western countries, whose cultures may contrast with a Western medical setting. Research on cultural adaptations of evidence-based treatments (EBTs), particularly for individuals from the Middle East, is sparse. To address this need, we discuss clinical issues encountered when working with patients from the Middle East. Synthesis of the literature regarding culturally adapted EBTs and common themes in Middle Eastern culture. Case vignettes illustrate possible EBT adaptations. Integrating cultural values in treatment is an opportunity to join with patients and families to optimize care. Expectations for medical and psychological treatment vary, and collaborations with cultural liaisons are beneficial. Critical next steps include systematic development, testing, and training in culturally adapting EBTs in pediatric medical settings. Increased dialogue between clinicians, researchers, and cultural liaisons is needed to share knowledge and experiences to enhance patient care.

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

Rapidly progressing facial leishmaniasis: effective treatment with liposomal amphotericin B and a review of the management of Old World cutaneous leishmaniasis.

PubMed

Islam, Shamim

2018-05-01

Cutaneous leishmaniasis (CL), a common condition in many parts of the world, is being increasingly encountered in non-endemic countries secondary to immigration. The clinical manifestations and course can vary substantially, with appropriate management ranging from observation for self-healing lesions to urgent treatment to prevent damaging anatomical and cosmetic sequelae. While there are now several effective medications, optimal therapy is not well defined, and decision-making can be challenged by the location of lesions and various drug issues, including availability, mode of delivery and adverse effects. A 7-year-old Afghani boy who presented shortly after arriving in the United States with a rapidly progressing crusting and ulcerative facial rash caused by Leishmania tropica is described. The various drugs currently available for CL and experience of using liposomal amphotericin B specifically are reviewed.

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age.

PubMed

Shaw, Jonathon; Marshall, Tracey; Morris, Helen; Hayton, Conal; Chaudhuri, Nazia

2017-11-01

Idiopathic pulmonary fibrosis (IPF) is the most common cause of interstitial lung disease (ILD) and carries a worse prognosis than many cancers. Until recently, there were no active treatment options available for patients with IPF, meaning palliation or lung transplantation in selected patients were the only options. The management of IPF has changed dramatically over the last decade with the advent of two antifibrotic agents; pirfenidone and nintedanib. These new agents have been shown to reduce decline in lung function and pirfenidone has been shown to reduce mortality. The changing landscape of IPF diagnosis and management present a number of issues that may be encountered including management of side effects related to antifibrotic therapy. This article aims to give an overview of the holistic approach to the management of patients with IPF, including antifibrotic management, symptom management and the invaluable role of the ILD specialist nurse.

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age

PubMed Central

Shaw, Jonathon; Marshall, Tracey; Morris, Helen; Chaudhuri, Nazia

2017-01-01

Idiopathic pulmonary fibrosis (IPF) is the most common cause of interstitial lung disease (ILD) and carries a worse prognosis than many cancers. Until recently, there were no active treatment options available for patients with IPF, meaning palliation or lung transplantation in selected patients were the only options. The management of IPF has changed dramatically over the last decade with the advent of two antifibrotic agents; pirfenidone and nintedanib. These new agents have been shown to reduce decline in lung function and pirfenidone has been shown to reduce mortality. The changing landscape of IPF diagnosis and management present a number of issues that may be encountered including management of side effects related to antifibrotic therapy. This article aims to give an overview of the holistic approach to the management of patients with IPF, including antifibrotic management, symptom management and the invaluable role of the ILD specialist nurse. PMID:29268540

"That's What 'College Experience' is": Exploring Cultural Narratives and Descriptive Norms College Students Construct for Legitimizing Alcohol Use.

PubMed

Russell, Laura D; Arthur, Tabytha

2016-08-01

Among the many health issues relevant to college students, overconsumption of alcohol remains a prevalent concern. Circumscribing the drinking habits occurring on campuses are innumerable social norms furthering popular beliefs that alcohol is an inherent part of college life. This case study examines how students encounter, interpret and express the social norms they conceive as constituting their campus culture. Through triangulating ethnographic practices with in-depth interviews, we utilize a narrative lens to explore how students construct meanings and values for alcohol's roles in campus life. Our findings demonstrate how students validate uses of alcohol by coupling its presence with stress, social enhancement, peer responsibility and identity. Moreover, interviewees expressed there being subcultural differences between younger and older students' discourse around alcohol use. We draw from these observations to offer suggestions for engaging students actively in campus interventions that give rise to voices excluded from commonly construed social norms.

Human Factors Effecting Forensic Decision Making: Workplace Stress and Well-being.

PubMed

Jeanguenat, Amy M; Dror, Itiel E

2018-01-01

Over the past decade, there has been a growing openness about the importance of human factors in forensic work. However, most of it focused on cognitive bias, and neglected issues of workplace wellness and stress. Forensic scientists work in a dynamic environment that includes common workplace pressures such as workload volume, tight deadlines, lack of advancement, number of working hours, low salary, technology distractions, and fluctuating priorities. However, in addition, forensic scientists also encounter a number of industry-specific pressures, such as technique criticism, repeated exposure to crime scenes or horrific case details, access to funding, working in an adversarial legal system, and zero tolerance for "errors". Thus, stress is an important human factor to mitigate for overall error management, productivity and decision quality (not to mention the well-being of the examiners themselves). Techniques such as mindfulness can become powerful tools to enhance work and decision quality. © 2017 American Academy of Forensic Sciences.

Key issues in addressing the comorbidity of attention deficit hyperactivity disorder and pediatric epilepsy.

PubMed

Salpekar, Jay A; Mishra, Gaurav

2014-08-01

Attention deficit hyperactivity disorder (ADHD) is a common comorbidity of epilepsy encountered by clinicians. However, relatively little information is available to guide optimal diagnostic and treatment strategies. Differentiating ADHD from effects of epilepsy requires careful history taking and emphasis upon characteristic symptoms and course of illness. Rating scales for ADHD are well validated and may aid clinical management. Use of antiepileptic drugs may cause cognitive or behavioral side effects yet may improve behavior in some cases. Historically, clinicians have been hesitant to treat ADHD comorbidity for fear of lowering the seizure threshold. However, an aggregate of recent evidence now suggests that stimulants may be well tolerated and effective for ADHD comorbid with epilepsy. Studies that further clarify pathophysiology and treatment outcomes are needed in order to enhance clinical efficacy and quality of life for this population. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

Practical Tips for Working as an Expedition Doctor on High-Altitude Expeditions.

PubMed

Brants, Anne; Metcalfe, Tracee

2017-09-01

Brants, Anne, and Tracee Metcalfe. Practical tips for working as an expedition doctor on high-altitude expeditions. High Alt Med Biol. 18:193-198, 2017.-With the explosion of adventure travel over the past decade, there has been a concurrent increase in mountaineering expeditions to extreme elevations, including many of the 8000-m peaks. This trend has created an increased demand for qualified expedition doctors to provide specialized medical advice and care to climbers and expedition staff. This review is intended to help physicians prepare for work on such expeditions. The authors rely heavily on their own experience and discuss the types of work available on high-altitude expeditions; how to identify a safe and reputable guiding company; personal and medical preparation; priorities in selecting or building an appropriate medical kit; and medical conditions commonly encountered on expeditions. The review concludes by considering ethical dilemmas and other difficult issues unique to this work.

Exploring the role of contextual information in bloodstain pattern analysis: A qualitative approach.

PubMed

Osborne, Nikola K P; Taylor, Michael C; Zajac, Rachel

2016-03-01

During Bloodstain Pattern Analysis (BPA), an analyst may encounter various sources of contextual information. Although contextual bias has emerged as a valid concern for the discipline, little is understood about how contextual information informs BPA. To address this issue, we asked 15 experienced bloodstain pattern analysts from New Zealand and Australia to think aloud as they classified bloodstain patterns from two homicide cases. Analysts could request items of contextual information, and were required to state how each item would inform their analysis. Pathology reports and additional photographs of the scene were the most commonly requested items of information. We coded analysts' reasons for requesting contextual information--and the way in which they integrated this information--according to thematic analysis. We identified considerable variation in both of these variables, raising important questions about the role and necessity of contextual information in decisions about bloodstain pattern evidence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Barriers to diagnosing and managing hypertension - a qualitative study in Australian general practice.

PubMed

Howes, Faline; Hansen, Emily; Williams, Danielle; Nelson, Mark

2010-07-01

Elevated blood pressure (BP) is a major modifiable risk factor. However hypertension still remains underdiagnosed, untreated or suboptimally treated. This study aimed to identify and explore barriers to initiating medication and treating elevated BP to target levels in the general practice setting. Six focus groups involving 30 clinicians were audio recorded, transcribed in full and analysed for common emerging themes using an iterative thematic analysis. After making the decision to commence treatment, medication initiation was relatively straightforward. Clinical uncertainty about true underlying BP, distrust of measurement technology, and distrust of the evidence underpinning hypertension management were expressed. Patient age, gender and comorbidity influenced treatment strategy. Related themes included perceived patient attitude, clinical inertia, and patient centred care. Systems issues included lack of resources and lack of time. The management of an asymptomatic chronic disease within a patient centred, encounter based primary care context can be challenging.

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.

Encountering a Neglected Area of a Healthcare System: A Decade of Improvement in Cancer Pain Clinical Practice in Iran.

PubMed

Gharehdaghi, Farid A; Gorginzadeh, Mansoureh; Safari, Saeid

2016-12-01

With the increase in the prevalence of cancer, cancer-related issues also deserve more attention especially in developing countries where there is already limited access to high-quality healthcare. Cancer-related pain, the most common and the most annoying one, is not only a symptom but also an important subspecialty and its management is still challenging. To assess the level of pain and cancer pain knowledge in Iran in comparison with the whole world. A search of the literature including papers published in PubMed before March 2016 was carried out. There have been an increasing number of publications on pain since 1842 and a growing number of publications on cancer pain since 1929. There has also been remarkable growth in our understanding of cancer pain, particularly since 2010. More than one-third of studies on pain and cancer-related pain were published after 2010. There is a need to be more inventive with the management of cancer-related issues, especially pain in developing countries, to maximize the quality and quantity of healthcare delivery to cancer-stricken patients. It seems that non-governmental organizations like MAHAK can play a significant role in this goal.

Nanocarrier for poorly water-soluble anticancer drugs--barriers of translation and solutions.

PubMed

Narvekar, Mayuri; Xue, Hui Yi; Eoh, June Young; Wong, Ho Lun

2014-08-01

Many existing chemotherapeutic drugs, repurposed drugs and newly developed small-molecule anticancer compounds have high lipophilicity and low water-solubility. Currently, these poorly water-soluble anticancer drugs (PWSAD) are generally solubilized using high concentrations of surfactants and co-solvents, which frequently lead to adverse side effects. In recent years, researchers have been actively exploring the use of nanotechnology as an alternative to the solvent-based drug solubilization approach. Several classes of nanocarrier systems (lipid-based, polymer-based and albumin-based) are widely studied for encapsulation and delivery of the existing and new PWSAD. These nanocarriers were also shown to offer several additional advantages such as enhanced tumour accumulation, reduced systemic toxicity and improved therapeutic effectiveness. In this article, the recent nanotechnological advances in PWSAD delivery will be reviewed. The barriers commonly encountered in the development of PWSAD nanoformulations (e.g. formulation issues and nanotoxicity issues) and the strategies to overcome these barriers will also be discussed. It is our goal to provide the pharmaceutical scientists and clinicians with more in-depth information about the nanodelivery approach, thus, more efficacious and safe PWSAD nanoformulations can be developed with improved translational success.

Ethical considerations in aesthetic rhinoplasty: a survey, critical analysis, and review.

PubMed

Karimi, Kian; McKneally, Martin F; Adamson, Peter A

2012-11-01

Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of experienced and novice facial plastic surgeons. The survey consisted of 15 clinical vignettes addressing ethical quandaries in aesthetic rhinoplasty. The vignettes are based on the experience and observations of the senior author (P.A.A.) over nearly 30 years of practice and teaching. Fellowship directors and facial plastic surgery fellows of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed anonymously. Five of the 15 vignettes demonstrated significant differences between the responses of the fellowship directors and the fellows. No single vignette had a unanimous consensus in either group. Aesthetic rhinoplasty surgeons encounter ethical issues that should be reflected on by both experienced and inexperienced facial plastic surgeons, preferably before being faced with them in practice. We present a practical approach to ethical issues in clinical practice. Our survey can also be used as a stimulus for further discussion and teaching.

Investigating the role of content knowledge, argumentation, and situational features to support genetics literacy

NASA Astrophysics Data System (ADS)

Shea, Nicole Anne

Science curriculum is often used as a means to train students as future scientists with less emphasis placed on preparing students to reason about issues they may encounter in their daily lives (Feinstein, Allen, & Jenkins, 2013; Roth & Barton, 2004). The general public is required to think scientifically to some degree throughout their life and often across a variety of issues. From an empirical standpoint, we do not have a robust understanding of what scientific knowledge the public finds useful for reasoning about socio-scientific issues in their everyday lives (Feinstein, 2011). We also know very little about how the situational features of an issue influences reasoning strategy (i.e., the use of knowledge to generate arguments). Rapid advances in science - particularly in genetics - increasingly challenge the public to reason about socio-scientific issues. This raises questions about the public's ability to participate knowledgeably in socio-scientific debates, and to provide informed consent for a variety of novel scientific procedures. This dissertation aims to answer the questions: How do individuals use their genetic content knowledge to reason about authentic issues they may encounter in their daily lives? Individuals' scientific knowledge is a critical aspect of scientific literacy, but what scientific literacy looks like in practice as individuals use their content knowledge to reason about issues comprised of different situational features is still unclear. The purpose of this dissertation is to explore what knowledge is actually used by individuals to generate and support arguments about a variety of socio-scientific issues, and how the features of those issues influences reasoning strategy. Three studies were conducted to answer questions reflecting this purpose. Findings from this dissertation provide important insights into what scientific literacy looks like in practice.

Common difficulties encountered in collecting native seed

Treesearch

Richard Dunne

1999-01-01

The increased demand for native seed has surpassed our ability to provide high quality range-collected seed. This paper discusses some of the hazards and common mistakes associated with the collection of wildland native seed. Among the common difficulties in collecting native seed are: (1) native species do not produce seed often in the arid West; (2) there is a...

Issues in Implementing a Structured Problem-Based Learning Strategy in a Volcano Unit: A Case Study

ERIC Educational Resources Information Center

Lee, Hyunju; Bae, Sungah

2008-01-01

The purpose of this study was to understand how an 8th grade science class used a structured problem-based learning (PBL) strategy to study volcanoes and to discuss some of the issues that science teachers might encounter when designing and implementing the PBL strategy. This study took place at Collins Middle School, which is located in a…

Flight software issues in onboard automated planning: lessons learned on EO-1

NASA Technical Reports Server (NTRS)

Tran, Daniel; Chien, Steve; Rabideau, Gregg; Cichy, Benjamin

2004-01-01

This paper focuses on the onboard planner and scheduler CASPER, whose core planning engine is based on the ground system ASPEN. Given the challenges of developing flight software, we discuss several of the issues encountered in preparing the planner for flight, including reducing the code image size, determining what data to place within the engineering telemetry packet, and performing long term planning.

The Use of Video Technology for Providing Feedback to Students: Can It Enhance the Feedback Experience for Staff and Students?

ERIC Educational Resources Information Center

Crook, Anne; Mauchline, Alice; Maw, Stephen; Lawson, Clare; Drinkwater, Robyn; Lundqvist, Karsten; Orsmond, Paul; Gomez, Stephen; Park, Julian

2012-01-01

There are numerous issues surrounding the provision of assessment-related feedback in Higher Education, which in recent years have been highlighted in the National Student Survey. In this paper questionnaire data from staff and students at the University of Reading are used to confirm the main issues encountered with feedback, namely problems of…

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

Implementing a Course in Business Environment and Public Policy: A Case Study.

ERIC Educational Resources Information Center

Wooten, Bob E.; Snider, Walter D.

1982-01-01

Describes a course of study dealing with business values, ethics, and environment. The course focuses on issues concerning ethical and moral considerations that may be encountered in the marketplace. (JOW)

Variability in opioid prescribing for children undergoing ambulatory surgery in the United States.

PubMed

Van Cleve, William C; Grigg, Eliot B

2017-09-01

We attempted to describe the opioid prescribing patterns for ambulatory pediatric surgery in the United States from 2007 to 2014. Retrospective database review. Operating room ambulatory encounters as determined by the Truven Health Marketscan Commercial Claims and Encounters database. A total of 929,874 ambulatory surgical encounters were identified in patients <18years of age and, of these, 439,286 encounters generated an analgesic prescription. N/A MEASUREMENTS: The analgesic prescription was described in terms of the type of opioid along with the inclusion of acetaminophen and/or NSAIDs. The probability of receiving a post-operative analgesic prescription increased with age, ranging from 18.2% of infants to 71.7% of teens. Acetaminophen with codeine (APAP/C) was the most common drug for infants (63.8%), while acetaminophen with hydrocodone (APAP/H) was the most common analgesic prescription for teens (53.6%). APAP/C and APAP/H were the predominant drugs used for all procedure types. Substantial variability in analgesic prescribing at the level of the procedure performed, both in terms of the probability of receiving a prescription and in which drugs were prescribed. We observed significant age and procedure-based variability in opioid prescribing following pediatric ambulatory surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Primary care access for mental illness in Australia: Patterns of access to general practice from 2006 to 2016.

PubMed

Farrer, Louise M; Walker, Jennie; Harrison, Christopher; Banfield, Michelle

2018-01-01

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.

Human Trafficking in the Emergency Department

PubMed Central

Patel, Ronak B.; Ahn, Roy; Burke, Thomas F.

2010-01-01

Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify potential trafficking cases by increasing their awareness of this phenomenon, using qualified interpreters, isolating potential victims by providing privacy and using simple clear reassuring statements ensuring security. A multidisciplinary approach can then be mobilized to help these patients. PMID:21293753

[Poisonous animals at bathing beaches].

PubMed

Junghanss, T; Bodio, M

2000-05-18

Tourists and native inhabitants of tropical and subtropical regions differ significantly with regard to the risk and nature of incidents involving venomous and poisonous animals. While the indigenous population encounters such risks daily during work and other activities, tourists are usually endangered while swimming or diving, or by ingesting toxin-containing fish and/or other seafood. Whether abroad or at home, allergic reactions to the stings of bees, wasps and hornets are probably the most common manifestations of an encounter with a "poisonous animal". Travellers should be well acquainted with the dangers entailed in encountering or ingesting a venomous or poisonous animal--prevention is the most important measure.

Pharmacists' Assessment of the Difficulty and Frequency of Ethical Issues Encountered in Community Pharmacy Settings.

PubMed

Crnjanski, Tatjana; Krajnovic, Dusanka; Savic, Mirko

2017-05-23

Researching ethical problems and their frequency could give us a complex picture and greater insight into the types of ethical issues that pharmacists face in providing health care. The overall aim of this study was to assess the pharmacist's perception of difficulty and frequency of selected ethical issues encountered by the community pharmacists in their everyday practice. A quantitative cross sectional multicenter study was performed using a validated survey instrument - Ethical Issue Scale for Community Pharmacy (EISP). The results of the analysis of 690 completely filled out instruments (response rate 78.49%) showed the difference between the ethical issues which always occurred ("A pharmacist is prevented from dispensing a medicine to the patient due to an administrative error in the prescription"), and the ones that pharmacists found most difficult ("A pharmacist dispenses a medicine he/she personally considers inadequate for the therapeutic treatment of the patient, in order to avoid any conflicts with the physician" and "A pharmacist is considering violating the rules and regulations in order to perform an act of humanity"). The majority of respondents (84.78%) were familiar with the Code of Ethics but the correlation between the familiarity and the perceived usefulness of the code in resolving problems in everyday practice was negative (ρ = -0.17, p < 0.001). Results showed that patients' well-being had a high influence on pharmacists' behavior. The results provided quantitative data by the examination of specific ethical issues and their occurrence. Further empirical research is recommended in order to systematically identify the ethical issues faced by community pharmacists.

Post-deployment usability evaluation of a radiology workstation.

PubMed

Jorritsma, Wiard; Cnossen, Fokie; Dierckx, Rudi A; Oudkerk, Matthijs; Van Ooijen, Peter M A

2016-01-01

To determine the number, nature and severity of usability issues radiologists encounter while using a commercially available radiology workstation in clinical practice, and to assess how well the results of a pre-deployment usability evaluation of this workstation generalize to clinical practice. The usability evaluation consisted of semi-structured interviews and observations of twelve users using the workstation during their daily work. Usability issues and positive usability findings were documented. Each issue was given a severity rating and its root cause was determined. Results were compared to the results of a pre-deployment usability evaluation of the same workstation. Ninety-two usability issues were identified, ranging from issues that cause minor frustration or delay, to issues that cause significant delays, prevent users from completing tasks, or even pose a potential threat to patient safety. The results of the pre-deployment usability evaluation had limited generalizability to clinical practice. This study showed that radiologists encountered a large number and a wide variety of usability issues when using a commercially available radiology workstation in clinical practice. This underlines the need for effective usability engineering in radiology. Given the limitations of pre-deployment usability evaluation in radiology, which were confirmed by our finding that the results of a pre-deployment usability evaluation of this workstation had limited generalizability to clinical practice, it is vital that radiology workstation vendors devote significant resources to usability engineering efforts before deployment of their workstation, and to continue these efforts after the workstation is deployed in a hospital. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

What matters most to people in musculoskeletal physiotherapy consultations? A qualitative study.

PubMed

Stenner, Rob; Palmer, Shea; Hammond, Ralph

2018-06-01

Person-centred approaches to care require clinicians to engage in trying to understand the full range of problems and concerns, treatment and investigation requests, and emotional and social issues that people bring to the consultation. If, however, the main issues of importance are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving the care that clinicians think they need, rather than care based on individual needs and preferences. To understand people's abilities to express the issues of importance to them within a consultation and clinicians' abilities to acknowledge and address those issues. A qualitative study using an interpretive phenomenological approach. Fifteen people and their physiotherapists were interviewed and their consultations recorded. The resulting data sets were analysed to identify and report themes within the data. The findings revealed that people present with what are often simple issues, but which are sometimes expressed in an unstructured way in clinical encounters and are often difficult for clinicians to establish. Three linked themes emerged: (1) clear versus unstructured agendas; (2) people need information and understanding; and (3) developing a sense of collaboration. The issues of importance that people bring to a consultation are varied and often vague. This research highlights the importance of communication to elicit, identify and address the issues of importance to people in clinical encounters to ensure a positive experience and outcome for both the individual person and clinician. Achieving desirable health outcomes is more likely when people are supported to think about their priorities and 'what matters to them'. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effects of Soundscapes on Perceived Crowding and Encounter Norms

NASA Astrophysics Data System (ADS)

Kim, Sang-Oh; Shelby, Bo

2011-07-01

Soundscapes in recreation settings are becoming an important issue, but there are few studies of the effects of sounds on recreation experiences, especially crowding perceptions and encounter norms. This study compared effects of six types of sounds (an airplane, a truck engine, children playing, birds, water, and a control) on perceived crowding (PC) and encounter norms for hikers. Data were collected from 47 college students through lab experiments using simulated images, with moving hikers inserted in the original photo taken in the Jungmeori area of Mudeungsan Provincial Park in Korea. Overall, the motor-made sounds of the airplane and truck engine increased PC and decreased acceptability ratings, and the natural sounds of birds and water decreased PC and increased acceptability ratings. Ratings of the sound of children playing were similar to those in the control (i.e., no sound). In addition, as numbers of hikers increased, the overall effects of sounds decreased, and there were few significant differences in PC or acceptability ratings at the highest encounter levels. Theoretical and methodological implications are discussed.

Effects of soundscapes on perceived crowding and encounter norms.

PubMed

Kim, Sang-Oh; Shelby, Bo

2011-07-01

Soundscapes in recreation settings are becoming an important issue, but there are few studies of the effects of sounds on recreation experiences, especially crowding perceptions and encounter norms. This study compared effects of six types of sounds (an airplane, a truck engine, children playing, birds, water, and a control) on perceived crowding (PC) and encounter norms for hikers. Data were collected from 47 college students through lab experiments using simulated images, with moving hikers inserted in the original photo taken in the Jungmeori area of Mudeungsan Provincial Park in Korea. Overall, the motor-made sounds of the airplane and truck engine increased PC and decreased acceptability ratings, and the natural sounds of birds and water decreased PC and increased acceptability ratings. Ratings of the sound of children playing were similar to those in the control (i.e., no sound). In addition, as numbers of hikers increased, the overall effects of sounds decreased, and there were few significant differences in PC or acceptability ratings at the highest encounter levels. Theoretical and methodological implications are discussed.

The work of nurses in Australian general practice: A national survey.

PubMed

Joyce, Catherine M; Piterman, Leon

2011-01-01

Following recent reforms to Australia's health system, nurses now comprise a significant and growing sector of the Australian primary care workforce, but there is little data describing the services they provide. This study aimed to describe the patient consultations of nurses in Australian general practice, including patient characteristics, reasons for the consultation, treatments provided and other actions taken. The study was a national cross-sectional survey, with each participating nurse collecting information about 50 nurse-patient encounters. General practice settings in all regions of Australia. 108 nurses volunteered in response to advertisements and 104 returned completed study materials. Participants included Registered (Division 1) and Enrolled (Division 2) nurses working in a general practice setting. Data were collected between May 2007 and May 2008 using a profile questionnaire and a series of encounter forms. Information was gathered on reasons for encounter, patient characteristics, and actions taken. Data were classified using the International Classification of Primary Care. The final data set included 5,253 nurse-patient encounters. 37.2% of patients (95% CI 33.3-41.2) were aged 65 and over, and 57.1% were female (95% CI 54.9-59.5). The majority of encounters (90.7%) were with existing patients of the practice (95% CI 89.1-92.7). The most common reasons for encounter were general and unspecified problems (35.4 per 100 encounters; 95% CI 31.8-39.1), followed by skin-related problems (20.0; 95% CI 17.3-22.8), and cardiovascular problems (11.0; 95% CI 8.7-13.3). Common management actions included medical examinations (20.7 per 100 encounters), immunisations (22.5), diagnostic tests (10.6), and dressings (15.8). Approximately 30% of encounters involved advice-giving. The findings confirm the generalist nature of the General Practice Nurse role, with a wide range of patient types and clinical conditions. There is a clear influence of current funding and organisational arrangements on work patterns, with tasks that have specific funding (including immunisations and wound care) featuring prominently in nurses' work. Whilst nurses' rates for presenting conditions were similar to doctors at a general level, specific actions taken and problems managed differed. New policy reforms in Australia are supporting greater flexibility in the General Practice Nurse role, maximising efficient use of nurses' skills in the primary health care context. Copyright © 2010 Elsevier Ltd. All rights reserved.

Duodenal Injury: Analysis of Common Misconceptions in Diagnosis and Treatment

PubMed Central

Flint, Lewis M.; McCoy, Martha; Richardson, J. David; Polk, Hiram C.

1980-01-01

Seventy-five consecutive patients who sustained injuries to the duodenum were admitted to our hospital over a nine-year period. Nineteen blunt injuries and 56 penetrating injuries were encountered. Blunt injuries were usually the result of motor vehicle accidents and steering wheel impact was frequently implicated. Penetrating injuries most commonly followed gunshot wounds, particularly those where the bullet tract travelled transversely across the peritoneal cavity. Seventy-nine per cent of the patients had two or more associated intra-abdominal organ injuries with other intestinal injuries, biliary tract injuries, and pancreatic injuries predominating. Forty-seven per cent of the patients were admitted in shock. Following blunt injury, diagnostic delay was encountered in two patients. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels, and contrast gastroduodenography, were not helpful. Peritoneal lavage, however, was valuable in patients with equivocal physical findings. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum to provide exposure of the entire duodenum was necessary. Six injuries that initially appeared trivial would have been missed had this procedure not been followed. Suture closure was the most common reparative technique used. Tube decompression of the duodenum was a valuable addition. No suture line dehiscences were encountered in ten patients so treated. Overall mortality in patients surviving more than 24 hours was 12%. PMID:7387230

Occupational health and safety issues among nurses in the Philippines.

PubMed

de Castro, A B; Cabrera, Suzanne L; Gee, Gilbert C; Fujishiro, Kaori; Tagalog, Eularito A

2009-04-01

Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety.

'They don't just come for Machu Picchu': locals' views of tourist-local sexual relationships in Cuzco, Peru.

PubMed

Bauer, Irmgard

2008-08-01

Sexual and romantic relationships between local people and tourists have long taken place. Such encounters are not a modern phenomenon, but the potential of sexually transmitted infections (STIs), including HIV/AIDS, warrants greater research into the issue. This paper analyses local people's views of local-tourist relationships in Cuzco/Peru. Data were obtained through in-depth interviews, participant and non-participant observation and informal discussions. Attraction based on physical difference was reportedly the main trigger for such relationships. Emerging themes discussed include issues of self-esteem, strategies of approach, tourists' motives, emotional involvement and expectations from such encounters. Levels of unprotected sexual behaviour and lack of STI awareness are of sufficient concern to recommend urgent action. Suggestions for sexual health education are made with particular emphasis on targeting local people involved in the tourism and hospitality industries.

Occupational Health and Safety Issues Among Nurses in the Philippines

PubMed Central

de Castro, A. B.; Cabrera, Suzanne L.; Gee, Gilbert C.; Fujishiro, Kaori; Tagalog, Eularito A.

2009-01-01

Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association 2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year, and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses in other countries. Future research should examine the work organization factors that contribute to these concerns and strengthen policies to promote health and safety. PMID:19438081

School Grounds Guide: A Pictured Guide for Identifying Common Organisms Found In and Around the School Ground.

ERIC Educational Resources Information Center

Bain, Rodney

Designed for quick, easy identification of some of the most commonly encountered organisms found in and around the school ground, this illustrated guide identifies by a picture and a short biological description the common animals and plants found in and around school lawns, house lawns, parks, fence rows, flower gardens, vacant lots, and…

Specific Learning Difficulties--What Teachers Need to Know

ERIC Educational Resources Information Center

Hudson, Diana

2015-01-01

This book clearly explains what Specific Learning Difficulties (SpLD) are, and describes the symptoms of conditions most commonly encountered in the mainstream classroom: dyslexia, dyspraxia, dyscalculia, dysgraphia, Autism Spectrum Disorder, ADHD, and OCD. The author provides an overview of the strengths and weaknesses commonly associated with…

Co-infection with cytomegalovirus and Epstein-Barr virus in mononucleosis: case report and review of literature.

PubMed

Olson, Douglas; Huntington, Mark K

2009-09-01

A 25-year-old woman presented with infectious mononucleosis. Serological studies demonstrated elevated IgM titres to both cytomegalovirus (CMV) and Epstein-Barr virus (EBV). The role of each of these agents in infectious mononucleosis is reviewed, as are literature reports of co-infection by these two viruses. Both near-simultaneous infections and temporally remote sequential infections with acute CMV triggering an immunoreactivation of EBV are reported in the literature. We believe the current case is most consistent with the latter. Infectious mononucleosis is a common infection of childhood and young adulthood. Although a variety of agents may be associated with infectious mononucleosis, EBV is the most common etiology. We encountered a patient with serological findings that were suggestive of the simultaneous presence of two etiological agents of infectious mononucleosis: EBV and CMV. This prompted an inquiry into how commonly dual infections are encountered and their significance.

Lessons Learned During Solutions of Multidisciplinary Design Optimization Problems

NASA Technical Reports Server (NTRS)

Patnaik, Suna N.; Coroneos, Rula M.; Hopkins, Dale A.; Lavelle, Thomas M.

2000-01-01

Optimization research at NASA Glenn Research Center has addressed the design of structures, aircraft and airbreathing propulsion engines. During solution of the multidisciplinary problems several issues were encountered. This paper lists four issues and discusses the strategies adapted for their resolution: (1) The optimization process can lead to an inefficient local solution. This deficiency was encountered during design of an engine component. The limitation was overcome through an augmentation of animation into optimization. (2) Optimum solutions obtained were infeasible for aircraft and air-breathing propulsion engine problems. Alleviation of this deficiency required a cascading of multiple algorithms. (3) Profile optimization of a beam produced an irregular shape. Engineering intuition restored the regular shape for the beam. (4) The solution obtained for a cylindrical shell by a subproblem strategy converged to a design that can be difficult to manufacture. Resolution of this issue remains a challenge. The issues and resolutions are illustrated through six problems: (1) design of an engine component, (2) synthesis of a subsonic aircraft, (3) operation optimization of a supersonic engine, (4) design of a wave-rotor-topping device, (5) profile optimization of a cantilever beam, and (6) design of a cvlindrical shell. The combined effort of designers and researchers can bring the optimization method from academia to industry.

System Engineering and Integration of Controls for Advanced Life Support

NASA Technical Reports Server (NTRS)

Overland, David; Hoo, Karlene; Ciskowski, Marvin

2006-01-01

The Advanced Integration Matrix (AIM) project at the Johnson Space Center (JSC) was chartered to study and solve systems-level integration issues for exploration missions. One of the first issues identified was an inability to conduct trade studies on control system architectures due to the absence of mature evaluation criteria. Such architectures are necessary to enable integration of regenerative life support systems. A team was formed to address issues concerning software and hardware architectures and system controls.. The team has investigated what is required to integrate controls for the types of non-linear dynamic systems encountered in advanced life support. To this end, a water processing bioreactor testbed is being developed which will enable prototyping and testing of integration strategies and technologies. Although systems such as the water bioreactors exhibit the complexities of interactions between control schemes most vividly, it is apparent that this behavior and its attendant risks will manifest itself among any set of interdependent autonomous control systems. A methodology for developing integration requirements for interdependent and autonomous systems is a goal of this team and this testbed. This paper is a high-level summary of the current status of the investigation, the issues encountered, some tentative conclusions, and the direction expected for further research.

Piloted-simulation evaluation of escape guidance for microburst wind shear encounters. M.S. Thesis - George Washington Univ.

NASA Technical Reports Server (NTRS)

Hinton, David A.

1989-01-01

Numerous air carrier accidents and incidents result from encounters with the atmospheric wind shear associated with microburst phenomena, in some cases resulting in heavy loss of life. An important issue in current wind shear research is how to best manage aircraft performance during an inadvertent wind shear encounter. The goals of this study were to: (1) develop techniques and guidance for maximizing an aircraft's ability to recover from microburst encounters following takeoff, (2) develop an understanding of how theoretical predictions of wind shear recovery performance might be achieved in actual use, and (3) gain insight into the piloting factors associated with recovery from microburst encounters. Three recovery strategies were implemented and tested in piloted simulation. Results show that a recovery strategy based on flying a flight path angle schedule produces improved performance over constant pitch attitude or acceleration-based recovery techniques. The best recovery technique was initially counterintuitive to the pilots who participated in the study. Evidence was found to indicate that the techniques required for flight through the turbulent vortex of a microburst may differ from the techniques being developed using classical, nonturbulent microburst models.

Drug-related police encounters across the globe: How do they compare?

PubMed

Hughes, Caitlin E; Barratt, Monica J; Ferris, Jason A; Maier, Larissa J; Winstock, Adam R

2018-06-01

Drug law enforcement subsumes the majority of drug policy expenditure across the globe. Fuelled by knowledge that much of this investment is ineffective or counter-productive there have been increasing calls for cross-national comparisons to identify where policing approaches differ and what types of approaches may be more effective. Yet, to date cross-national comparison of drug law enforcement has proven a methodologically hazardous affair. Using a new drug policing module added to the 2017 Global Drug Survey, this study seeks to provide the first cross-national comparison of the incidence, nature and intensity of illicit drug-related police encounters amongst people who use drugs. The Global Drug Survey was administered in late 2016. Across 26 countries including Australia, Germany, Italy, Mexico, Switzerland, the UK and the USA a total of 45,942 people who had recently used drugs completed the drug policing module. Key variables assessed included the incidence and frequency of drug-related police encounters in the last 12 months that involved: a) being stopped and searched; b) encountering a drug detection dog; c) being given a caution or warning; d) being charged and arrested; and e) paying a bribe. Multi-level models were used to control for pre-existing national differences in drug use prevalence and non-drug specific policing (including the total number of police personnel in each country). Drug-related police encounters were most commonly reported in Italy and Scotland. Conversely, police encounters were most likely to lead to arrest in Norway, Finland and Sweden. The type and locations of encounters further differed across countries, with for example stop and search most reported in Greece and Colombia, and encounters with drug detection dogs most reported in Scotland, Italy, UK and Australia. Multi-level models showed that the incidence of reported policing encounters continued to differ significantly across countries after controlling for pre-existing national differences in drug use prevalence and policing, and that drug policing encounters were 4 to 14 times more common in some nations than others. The findings unearth significant cross-national differences in the incidence and nature of drug-related policing of people who use drugs. This suggests that there may be opportunities for countries to learn from each other about how and why they differ, and the potential benefits of switching to lower intensity modes of drug policing. Copyright © 2018 Elsevier B.V. All rights reserved.

Antepartum Mastitis: A Rare Occurrence.

PubMed

Malik, Sushma; Patil, Varsha Anant; Korday, Charusheela Sujit; Shah, Dipti Parag

2015-08-01

Puerperal or lactational mastitis is an inflammatory condition of the breast that is commonly encountered in breastfeeding mothers. It occurs most commonly in the postpartum period, generally in the first 6 weeks of breastfeeding. In contrast, antepartum mastitis is an uncommon condition, and if not treated adequately, it may be complicated by the formation of a breast abscess. The authors present a case of a 24-year-old, second gravida mother who developed unilateral antepartum mastitis with abscess formation at 34 weeks of gestation, which was initially treated with antibiotics and surgical drainage. However, her symptoms persisted over the next 2 weeks, and she was referred to the authors' institution, where she was managed with antibiotics and surgical drainage after delivering a healthy near-term infant. The abscesses healed completely 2 months later, with sequelae of residual scarring and a nonprotractile nipple. The authors wish to emphasize that health care providers should be aware of the occurrence of mastitis in the antepartum period. Early recognition with adequate treatment of mastitis is the key to avoiding complications, and this will prevent lactation issues and also reduce morbidity in the mother and neonate. © The Author(s) 2015.

The Math You Need at Baylor University: Improving Quantitative Skills in an Introductory Geology Lab Course

NASA Astrophysics Data System (ADS)

Browning, S.

2014-12-01

The Math You Need (TMYN) modules were introduced at Baylor University in fall 2012 to address issues of math anxiety common among freshmen non-majors completing their lab science requirement, and to reduce lab time spent reviewing basic math concepts. Modules and associated assessment questions commonly use geoscience examples to illustrate the mathematical principles involved, reinforcing topics addressed in lab. Large enrollments in the course selected for these modules necessitate multiple graduate teaching assistants in the lab, making the online nature of the modules and minimal required involvement of the teaching assistants even more valuable. Students completed three selected modules before encountering associated topics in lab, as well as a pre and post-test to gauge improvement. This presentation will review lessons learned and changes made in the first two years of TMYN at Baylor. Results indicate continued increases in mean pre to post test scores (e.g. 3.2% in fall 2012 to 11.9% in spring 2014), percentage of student pre to post- test improvement (59% in fall 2012 to 72% in spring 2014) and student participation (95 in fall 2012 to 186 in spring 2014). Continued use of these modules is anticipated.

Seven common mistakes in population genetics and how to avoid them.

PubMed

Meirmans, Patrick G

2015-07-01

As the data resulting from modern genotyping tools are astoundingly complex, genotyping studies require great care in the sampling design, genotyping, data analysis and interpretation. Such care is necessary because, with data sets containing thousands of loci, small biases can easily become strongly significant patterns. Such biases may already be present in routine tasks that are present in almost every genotyping study. Here, I discuss seven common mistakes that can be frequently encountered in the genotyping literature: (i) giving more attention to genotyping than to sampling, (ii) failing to perform or report experimental randomization in the laboratory, (iii) equating geopolitical borders with biological borders, (iv) testing significance of clustering output, (v) misinterpreting Mantel's r statistic, (vi) only interpreting a single value of k and (vii) forgetting that only a small portion of the genome will be associated with climate. For every of those issues, I give some suggestions how to avoid the mistake. Overall, I argue that genotyping studies would benefit from establishing a more rigorous experimental design, involving proper sampling design, randomization and better distinction of a priori hypotheses and exploratory analyses. © 2015 John Wiley & Sons Ltd.

The physics, chemistry and dynamics of explosions.

PubMed

Oran, Elaine S; Williams, Forman A

2012-02-13

The motivation for devoting a Theme Issue to explosions is discussed. As subsequent articles in the issue are written with the assumption that the reader has had a certain amount of previous exposure to the subject, some of the history and necessary background information are presented here. The topics on explosions that will be encountered in the remaining articles are previewed. Finally, several important future outstanding research problems, beyond those addressed in the following articles, are discussed, with the objective of complementing the coverage of explosions in this issue.

Observation of a Pharmacist-Conducted Group A Streptococcal Pharyngitis Point-of-Care Test: A Time and Motion Study.

PubMed

Corn, Carolyn E; Klepser, Donald G; Dering-Anderson, Allison M; Brown, Terrence G; Klepser, Michael E; Smith, Jaclyn K

2018-06-01

Acute pharyngitis is among the most common infectious diseases encountered in the United States, resulting in 13 million patient visits annually, with group A streptococcus (GAS) being a common causative pathogen. It is estimated that annual expenditures for the treatment of adult pharyngitis will exceed US$1.2 billion annually. This substantial projection reinforces the need to evaluate diagnosis and treatment of adult pharyngitis in nontraditional settings. The objective of this research is to quantify the amount of pharmacist time required to complete a point-of-care (POC) test for a patient presenting with pharyngitis symptoms. A standardized patient with pharyngitis symptoms visited 11 pharmacies for POC testing services for a total of 33 patient encounters. An observer was present at each encounter and recorded the total encounter time, divided into 9 categories. Pharmacists conducted POC testing in 1 of 2 ways: sequence 1-pharmacists performed all service-related tasks; sequence 2-both pharmacists and pharmacist interns performed service-related tasks. The average time for completion of a POC test for GAS pharyngitis was 25.3 ± 4.8 minutes. The average pharmacist participation time per encounter was 12.7 ± 3.0 minutes (sequence 1), which decreased to 2.6 ± 1.1 minutes when pharmacist interns were involved in the testing (sequence 2). Although additional studies are required to further assess service feasibility, this study indicates that a GAS POC testing service could be implemented in a community pharmacy with limited disruption or change to workflow and staff.

Psychological Maltreatment in Schools: Emerging Issues for Counselors.

ERIC Educational Resources Information Center

Neese, Lynda A.

1989-01-01

Defines psychological maltreatment of children. Discusses the damage done to children as a result of abusive behavior encountered at the school. Examines situations in which either peers or educators are perpetrators. Discusses the ethical implications for counselors. (BH)

Engineering Encounters: Teaching Educators about Engineering

ERIC Educational Resources Information Center

Tank, Kristina M.; Raman, D. Raj; Lamm, Monica H.; Sundararajan, Sriram; Estapa, Anne

2017-01-01

This column presents ideas and techniques to enhance science teaching. This month's issue describes preservice elementary teachers learning engineering principles from engineers. Few elementary teachers have experience with implementing engineering into the classroom. While engineering professional development opportunities for inservice teachers…

Transforming an educational virtual reality simulation into a work of fine art.

PubMed

Panaiotis; Addison, Laura; Vergara, Víctor M; Hakamata, Takeshi; Alverson, Dale C; Saiki, Stanley M; Caudell, Thomas Preston

2008-01-01

This paper outlines user interface and interaction issues, technical considerations, and problems encountered in transforming an educational VR simulation of a reified kidney nephron into an interactive artwork appropriate for a fine arts museum.

The Common Forces: Conservative or Nonconservative?

ERIC Educational Resources Information Center

Keeports, David

2006-01-01

Of the forces commonly encountered when solving problems in Newtonian mechanics, introductory texts usually limit illustrations of the definitions of conservative and nonconservative forces to gravity, spring forces, kinetic friction and fluid resistance. However, at the expense of very little class time, the question of whether each of the common…

Identifying and Reconstructing Common Cold Misconceptions among Developing K-12 Educators

ERIC Educational Resources Information Center

Johnson, Marcus Lee; Bungum, Timothy

2013-01-01

Background: Common cold misconceptions may contribute to ill-informed decisions and recommendations made by K-12 educators who often encounter infected students. Understanding the structure of educators' misconceptions can be used to improve health instruction in teacher professional preparation programs. Purpose: The purposes of this project were…

Assessing contextual factors that influence acceptance of pedestrian alerts by a night vision system.

PubMed

Källhammer, Jan-Erik; Smith, Kip

2012-08-01

We investigated five contextual variables that we hypothesized would influence driver acceptance of alerts to pedestrians issued by a night vision active safety system to inform the specification of the system's alerting strategies. Driver acceptance of automotive active safety systems is a key factor to promote their use and implies a need to assess factors influencing driver acceptance. In a field operational test, 10 drivers drove instrumented vehicles equipped with a preproduction night vision system with pedestrian detection software. In a follow-up experiment, the 10 drivers and 25 additional volunteers without experience with the system watched 57 clips with pedestrian encounters gathered during the field operational test. They rated the acceptance of an alert to each pedestrian encounter. Levels of rating concordance were significant between drivers who experienced the encounters and participants who did not. Two contextual variables, pedestrian location and motion, were found to influence ratings. Alerts were more accepted when pedestrians were close to or moving toward the vehicle's path. The study demonstrates the utility of using subjective driver acceptance ratings to inform the design of active safety systems and to leverage expensive field operational test data within the confines of the laboratory. The design of alerting strategies for active safety systems needs to heed the driver's contextual sensitivity to issued alerts.

Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department.

PubMed

Bhambani, Shiloni; Phan, Tammy H; Brown, Lance; Thorp, Andrea W

2017-06-01

A dislodged gastrostomy tube (GT) is a common complaint that requires evaluation in the pediatric emergency department (ED) and, on occasion, will require stoma dilation to successfully replace the GT. The objective of this study was to describe the frequency that stoma dilation is required, the success rate of replacement, complications encountered, and the techniques used to confirm placement of the GT after dilation. We conducted a retrospective medical record review of children 0-18 years who presented to the pediatric ED from February 2013 through February 2015 with a dislodged GT that required stoma dilation by pediatric emergency physicians with serially increasing Foley catheter sizes prior to successful placement of the GT. We reviewed a total of 302 encounters in 215 patients, with 97 (32%) of the encounters requiring stoma dilation prior to replacing a GT. The median amount of dilation was 2 French between the initial Foley catheter size and the final GT size. There was a single complication of a mal-positioned balloon that was identified at the index visit. No delayed complications were encountered. We performed confirmation of placement in all patients. The two most common forms of confirmation were aspiration of gastric contents (56/97 [58%]) followed by contrast radiograph in 39 (40%). The practice of serial dilation of a gastrostomy stoma site to allow successful replacement of a gastrostomy tube in pediatric patients who present to the ED with a dislodged gastrostomy tube is generally successful and without increased complication. All patients received at least one form of confirmation for appropriate GT placement with the most common being aspiration of gastric contents.

Abdominal calcifications and diagnostic imaging decision making: a topic review

PubMed Central

Bassano, John M.

2006-01-01

Abstract Objective To review commonly encountered calcifications found within the abdomen as seen on the lumbar spine radiograph and to determine which advanced imaging modality is best to thoroughly assess the patient. Methods Searches of electronic databases and textbooks were conducted to construct this narrative overview. Discussion By categorizing the type of calcification and localizing it anatomically, most often a definitive diagnosis can be reached. Two commonly encountered conditions, abdominal aortic aneurysms and urinary calculi, are used to compare the main advanced imaging modalities (diagnostic ultrasound and computed tomography) used to further assess abdominal calcifications. Conclusion In most circumstances, either diagnostic ultrasound or computed tomography will establish a definitive diagnosis and offer thorough imaging assessment for abdominal calcifications. PMID:19674671

The supervisory encounter and the senior GP trainee: managing for, through and with.

PubMed

Brown, James; Nestel, Debra; Clement, Tim; Goldszmidt, Mark

2018-02-01

Help-seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP) trainee. Without knowing what happens during these encounters, we cannot know how to maximise their educational potential. This study aimed to understand what happens when senior GP trainees call on their supervisor when caring for patients and how learning can be enhanced when this occurs. This is an analysis of data from a multi-case study of five GP supervisory pairs, each with a GP registrar and their supervisor. The data are recordings of 45 supervisory encounters, 78 post-encounter reflections and six interviews. We used Wenger's communities of practice theory and rhetorical genre theory as analytical lenses. The supervisory encounters followed a consistent format, which fitted the form of a genre. Within this genre, three dominant interactional patterns were identified, which we labelled 'managing for', 'managing through' and 'managing with'. Each pattern presented different opportunities and drew on different skills. The primary agenda was always developing a plan for the patient. Education agendas included acquiring knowledge, developing skills and achieving independence. Other agendas were issues of control, credibility and relationship building. Both supervisor and trainee could be purposeful in their supervisory engagement. For supervisors and trainees to achieve the educational potential of their supervisory encounters they require flexibility. This depends on understanding the genre of the supervisory encounter, the agendas at play, the options they have in engaging and having the skills to utilise these options. Educators can facilitate supervisors and trainees in acquiring this understanding and these skills. We recommend further research into the genre of the supervisory encounter. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

A comparison of various algorithms to extract Magic Formula tyre model coefficients for vehicle dynamics simulations

NASA Astrophysics Data System (ADS)

Vijay Alagappan, A.; Narasimha Rao, K. V.; Krishna Kumar, R.

2015-02-01

Tyre models are a prerequisite for any vehicle dynamics simulation. Tyre models range from the simplest mathematical models that consider only the cornering stiffness to a complex set of formulae. Among all the steady-state tyre models that are in use today, the Magic Formula tyre model is unique and most popular. Though the Magic Formula tyre model is widely used, obtaining the model coefficients from either the experimental or the simulation data is not straightforward due to its nonlinear nature and the presence of a large number of coefficients. A common procedure used for this extraction is the least-squares minimisation that requires considerable experience for initial guesses. Various researchers have tried different algorithms, namely, gradient and Newton-based methods, differential evolution, artificial neural networks, etc. The issues involved in all these algorithms are setting bounds or constraints, sensitivity of the parameters, the features of the input data such as the number of points, noisy data, experimental procedure used such as slip angle sweep or tyre measurement (TIME) procedure, etc. The extracted Magic Formula coefficients are affected by these variants. This paper highlights the issues that are commonly encountered in obtaining these coefficients with different algorithms, namely, least-squares minimisation using trust region algorithms, Nelder-Mead simplex, pattern search, differential evolution, particle swarm optimisation, cuckoo search, etc. A key observation is that not all the algorithms give the same Magic Formula coefficients for a given data. The nature of the input data and the type of the algorithm decide the set of the Magic Formula tyre model coefficients.

Common Core Standards for Middle School English Language Arts: A Quick-Start Guide

ERIC Educational Resources Information Center

Kendall, John; Frazee, Dana J.; Ryan, Susan

2012-01-01

Go in depth on Common Core Standards for middle schools to learn how they help students build on and extend skills acquired in earlier grades and prepare them for the nuanced communication and analytical work they will encounter in high school. Getting a copy for every teacher ensures they'll know: (1) The key focus areas of the Common Core…

Working with a patient claiming a direct relationship with god: encountering otherness.

PubMed

Charles, Marilyn

2009-01-01

Although we expect to encounter otherness in the consulting room, some types of otherness are more difficult to encounter than others. Differing ethnicities, religions, lifestyles, or other aspects of worldview can bring us into uneasy alliance with the other, as we also encounter disowned or unclaimed aspects of self in this process. I will discuss some of my difficulties working with a man who was born into my own religion-thus offering some common heritage of world view-but subsequently adopted another religion with such intensity that his faith seemed to have psychotic aspects. I struggled to keep my bearings with a man who could at times be cogent, at other times seem quite crazy, and also struggled to keep in mind how prejudices in my own culture might skew my perspective such that intense faith and devoted adherence to scripture seems suspect rather than worthy of respect.

Ethical issues in a pediatric private practice.

PubMed

Jakubowitz, Melissa

2011-11-01

Building a successful pediatric private practice requires clinical expertise and an understanding of the business process, as well as familiarity with the American Speech-Language-Hearing Association Code of Ethics. This article provides an overview of the ethical issues that may be encountered when building a practice, including a look at marketing and advertising, financial management, privacy, and documentation. Ethically sound decision making is a key to a successful business. © Thieme Medical Publishers.

Existential Assessment

ERIC Educational Resources Information Center

Dana, Richard H.; Leech, Shirley

1974-01-01

Present psychological assessment stems from a philosophy of science that values objectivity but fails to comprehend the existence of the person being evaluated. A humanistic-existential model shifts the focus from omnipotence to encounter and encourages client responsibility. Some pertinent assessment issues are formulated and specific instruments…

Host group formation decreases exposure to vector-borne disease: a field experiment in a 'hotspot' of West Nile virus transmission.

PubMed

Krebs, Bethany L; Anderson, Tavis K; Goldberg, Tony L; Hamer, Gabriel L; Kitron, Uriel D; Newman, Christina M; Ruiz, Marilyn O; Walker, Edward D; Brawn, Jeffrey D

2014-12-07

Animals can decrease their individual risk of predation by forming groups. The encounter-dilution hypothesis extends the potential benefits of gregariousness to biting insects and vector-borne disease by predicting that the per capita number of insect bites should decrease within larger host groups. Although vector-borne diseases are common and can exert strong selective pressures on hosts, there have been few tests of the encounter-dilution effect in natural systems. We conducted an experimental test of the encounter-dilution hypothesis using the American robin (Turdus migratorius), a common host species for the West Nile virus (WNV), a mosquito-borne pathogen. By using sentinel hosts (house sparrows, Passer domesticus) caged in naturally occurring communal roosts in the suburbs of Chicago, we assessed sentinel host risk of WNV exposure inside and outside of roosts. We also estimated per capita host exposure to infected vectors inside roosts and outside of roosts. Sentinel birds caged inside roosts seroconverted to WNV more slowly than those outside of roosts, suggesting that social groups decrease per capita exposure to infected mosquitoes. These results therefore support the encounter-dilution hypothesis in a vector-borne disease system. Our results suggest that disease-related selective pressures on sociality may depend on the mode of disease transmission. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Mass Property Measurements of the Mars Science Laboratory Rover

NASA Technical Reports Server (NTRS)

Fields, Keith

2012-01-01

The NASA/JPL Mars Science Laboratory (MSL) spacecraft mass properties were measured on a spin balance table prior to launch. This paper discusses the requirements and issues encountered with the setup, qualification, and testing using the spin balance table, and the idiosyncrasies encountered with the test system. The final mass measurements were made in the Payload Hazardous Servicing Facility (PHSF) at Kennedy Space Center on the fully assembled and fueled spacecraft. This set of environmental tests required that the control system for the spin balance machine be at a remote location, which posed additional challenges to the operation of the machine

A day in the life of a junior doctor: everyday ethical encounters.

PubMed

Quarini, Catherine J

2010-11-01

This paper presents a hypothetical 'day in the life' of junior doctors working on a busy hospital ward. It illustrates the fact that, although the everyday ethical encounters faced by doctors are generally not as dramatic as some of the ethical issues discussed at medical school, the underlying principles, such as consent, confidentiality and resource allocation, are highly relevant to daily practice. After presenting some of the ethical challenges faced by junior doctors, from patients confused by poor explanations to inadequate consent procedures, the paper ends with suggestions on how to improve the situation.

Institutional Animal Care and Use Committee Considerations for the Use of Wildlife in Research and Education.

PubMed

Sikes, Robert S; Bryan, John A

2016-01-01

Ethical and effective oversight of the use of wildlife species in research and education requires consideration of issues and methods not relevant to work with traditional laboratory or domesticated animals, just as the effective oversight of biomedical research requires consideration of issues and methods not germane to wildlife research. Institutional Animal Care and Use Committees or other institutional review committees can meet their responsibilities in these disparate types of animal activities only by using resources tailored to the animals and situations encountered. Here we review the issues and the resources that facilitate effective oversight of such activities in the wildlife research arena available to researchers, institutional review committees, regulatory bodies, and accrediting bodies. Issues covered include an understanding of the fundamental differences between wildlife research and biomedical research; the profound differences between wildlife species and traditional laboratory subjects, most of which are domesticated animals; and the unique issues presented when the research subjects are members of wild populations and communities. We review the resources available for effective oversight of wildlife projects and emphasize that competent oversight of wildlife research demands the use of appropriate resources. These resources include guidelines designed for the use of wild species (taxon-specific guidelines) and protocol forms tailored for the species and situations encountered. © The Author 2016. Published by Oxford University Press on behalf of the Institute for Laboratory Animal Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Management of vertebral compression fracture in general practice: BEACH program.

PubMed

Megale, Rodrigo Z; Pollack, Allan; Britt, Helena; Latimer, Jane; Naganathan, Vasi; McLachlan, Andrew J; Ferreira, Manuela L

2017-01-01

The pain associated with vertebral compression fractures can cause significant loss of function and quality of life for older adults. Despite this, there is little consensus on how best to manage this condition. To describe usual care provided by general practitioners (GPs) in Australia for the management of vertebral compression fractures. Data from the Bettering the Evaluation And Care of Health (BEACH) program collected between April 2005 and March 2015 was used for this study. Each year, a random sample of approximately 1,000 GPs each recorded information on 100 consecutive encounters. We selected those encounters at which vertebral compression fracture was managed. Analyses of management options were limited to encounters with patients aged 50 years or over. i) patient demographics; ii) diagnoses/problems managed; iii) the management provided for vertebral compression fracture during the encounter. Robust 95% confidence intervals, adjusted for the cluster survey design, were used to assess significant differences between group means. Vertebral compression fractures were managed in 211 (0.022%; 95% CI: 0.018-0.025) of the 977,300 BEACH encounters recorded April 2005- March 2015. That provides a national annual estimate of 26,000 (95% CI: 22,000-29,000) encounters at which vertebral fractures were managed. At encounters with patients aged 50 years or over (those at higher risk of primary osteoporosis), prescription of analgesics was the most common management action, particularly opioids analgesics (47.1 per 100 vertebral fractures; 95% CI: 38.4-55.7). Prescriptions of paracetamol (8.2; 95% CI: 4-12.4) or non-steroidal anti-inflammatory drugs (4.1; 95% CI: 1.1-7.1) were less frequent. Non-pharmacological treatment was provided at a rate of 22.4 per 100 vertebral fractures (95% CI: 14.6-30.1). At least one referral (to hospital, specialist, allied health care or other) was given for 12.3 per 100 vertebral fractures (95% CI: 7.8-16.8). The prescription of oral opioid analgesics remains the common general practice approach for vertebral compression fractures management, despite the lack of evidence to support this. Clinical trials addressing management of these fractures are urgently needed to improve the quality of care patients receive.

Accommodating Students with Epilepsy or Seizure Disorders: Effective Strategies for Teachers

ERIC Educational Resources Information Center

Hart Barnett, Juliet E.; Gay, Catherine

2015-01-01

The most common chronic neurological condition in children is epilepsy. Because it often occurs in childhood, epilepsy is likely the most common neurological condition encountered by school professionals including teachers. Given the impact that epilepsy can have on academic functioning and specifically on the day-to-day performance of a student…

Evidence-Based Practice at a Crossroads: The Timely Emergence of Common Elements and Common Factors

ERIC Educational Resources Information Center

Barth, Richard P.; Lee, Bethany R.; Lindsey, Michael A.; Collins, Kathryn S.; Strieder, Frederick; Chorpita, Bruce F.; Becker, Kimberly D.; Sparks, Jacqueline A.

2012-01-01

Social work is increasingly embracing evidence-based practice (EBP) as a decision-making process that incorporates the best available evidence about effective treatments given client values and preferences, in addition to social worker expertise. Yet, social work practitioners have typically encountered challenges with the application of…

Flipped Classroom Implementation: A Case Report of Two Higher Education Institutions in the United States and Australia

ERIC Educational Resources Information Center

McLaughlin, Jacqueline E.; White, Paul J.; Khanova, Julia; Yuriev, Elizabeth

2016-01-01

This case report explored the implementation of flipped classrooms at two higher education institutions. Experiences and publications from the institutions were used to identify and describe common themes, including successes and challenges encountered along with potential solutions to common misalignments, particularly as related to…

Learning to Play--Common Concerns for the Visually Impaired Preschool Child.

ERIC Educational Resources Information Center

Recchia, Susan L.

Certain play situations are very difficult for young visually impaired children. This booklet focuses on three areas of play: exploring toys and materials, making transitions from one activity to another, and playing with other children. Through anecdotal descriptions of common situations encountered by caregivers, the booklet discusses why these…

Post-procedural Care in Interventional Radiology: What Every Interventional Radiologist Should Know-Part II: Catheter Care and Management of Common Systemic Post-procedural Complications.

PubMed

Taslakian, Bedros; Sridhar, Divya

2017-09-01

Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant comprehensive patient care responsibilities. Providing excellent and thorough clinical care is as essential to the practice of IR as achieving technical success in procedures. Basic clinical skills that every interventional radiologist should learn include routine management of percutaneously inserted drainage and vascular catheters and rapid effective management of common systemic post-procedural complications. A structured approach to post-procedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety. The aim of this second part, in conjunction with part 1, is to complete the comprehensive review of post-procedural care in patients undergoing interventional radiology procedures. We discuss common problems encountered after insertion of drainage and vascular catheters and describe effective methods of troubleshooting these problems. Commonly encountered systemic complications in IR are described, and ways for immediate identification and management of these complications are provided.

The Problems Encountered in a CTEV Clinic: Can Better Casting and Bracing Be Accomplished?

PubMed

Agarwal, Anil; Kumar, Anubrat; Shaharyar, Abbas; Mishra, Madhusudan

2016-09-07

The aim of the study is to create awareness in the practicing health care workers toward the problems encountered during casting and bracing of clubfoot following Ponseti method, and in turn avoid them. Retrospective audit of 6 years' clubfoot clinic records to analyze problems associated with Ponseti method. Problems were encountered in 26 cast and in 6 braced patients. Just 4 patients out of 71 syndromic (5.6%) experienced problems during casting compared with 3% overall incidence. The common problems encountered in casted patients were moisture lesions, hematoma, dermatitis due to occlusion, pressure sores, and fractures. There was excessive bleeding in 1 patient at time of tenotomy. In braced patients, pressure sores and tenderness at tenotomy site were major problems. None of the syndromic patients experienced difficulties during bracing. Problems were encountered with Ponseti method during casting, tenotomy, or bracing. Syndromic children had lesser complication rate than idiopathic clubfeet. It is important to be aware of these problems so that appropriate intervention can be done early. Level IV: Retrospective. © 2016 The Author(s).

Development and Characterization of a High Throughput Screen to investigate the delayed Effects of Radiations Commonly Encountered in Space

NASA Astrophysics Data System (ADS)

Morgan, W. F.

Astronauts based on the space station or on long-term space missions will be exposed to high Z radiations in the cosmic environment In order to evaluate the potentially deleterious effects of exposure to radiations commonly encountered in space we have developed and characterized a high throughput assay to detect mutation deletion events and or hyperrecombination in the progeny of exposed cells This assay is based on a plasmid vector containing a green fluorescence protein reporter construct We have shown that after stable transfection of the vector into human or hamster cells this construct can identify mutations specifically base changes and deletions as well as recombination events e g gene conversion or homologous recombination occurring as a result of exposure to ionizing radiation Our focus has been on those events occurring in the progeny of an irradiated cell that are potentially associated with radiation induced genomic instability rather than the more conventional assays that evaluate the direct immediate effects of radiation exposure Considerable time has been spent automating analysis of surviving colonies as a function of time after irradiation in order to determine when delayed instability is induced and the consequences of this delayed instability The assay is now automated permitting the evaluation of potentially rare events associated with low dose low dose rate radiations commonly encountered in space

70,489 primary care encounters: retrospective analysis of morbidity at a primary care centre in Ireland.

PubMed

Molony, D; Beame, C; Behan, W; Crowley, J; Dennehy, T; Quinlan, M; Cullen, W

2016-11-01

While considerable changes are happening in primary care in Ireland and considerable potential exists in intelligence derived from practice-based data to inform these changes, relatively few large-scale general morbidity surveys have been published. To examine the most common reasons why people attend primary care, specifically 'reasons for encounter' (RFEs) among the general practice population and among specific demographic groups (i.e., young children and older adults). We retrospectively examined clinical encounters (which had a diagnostic code) over a 4-year time period. Descriptive analyses were conducted on anonymised data. 70,489 RFEs consultations were recorded (mean 13.53 recorded RFEs per person per annum) and consultations involving multiple RFEs were common. RFE categories for which codes were most commonly recorded were: 'general/unspecified' (31.6 %), 'respiratory' (15.4 %) and 'musculoskeletal' (12.6 %). Most commonly recorded codes were: 'medication renewal' (6.8 %), 'cough' (6.6 %), and 'health maintenance/prevention' (5.8 %). There was considerable variation in the number of RFEs recorded per age group. 6239 RFEs (8.9 %) were recorded by children under 6 years and 15,295 RFEs (21.7 %) were recorded by adults aged over 70. RFEs recorded per calendar month increased consistently through the study period and there was a marked seasonal and temporal variation in the number of RFEs recorded. Practice databases can generate intelligence on morbidity and health service utilisation in the community. Future research to optimise diagnostic coding at a practice level and to promote this activity in a more representative sample of practices is a priority.

Supporting women with postpartum anxiety: exploring views and experiences of specialist community public health nurses in the UK.

PubMed

Ashford, Miriam T; Ayers, Susan; Olander, Ellinor K

2017-05-01

Anxiety is common among postpartum women and can have adverse effects on mother's and child's somatic and psychological health if left untreated. In the UK, nurses or midwifes with a specialisation in community public health nursing, also called health visitors (HVs), work with families who have children younger than 5 years of age and are therefore in a key position to identify and support women with postpartum mental health issues. Until recently, postpartum mental health support provided by HVs mainly focused on identifying and managing depression, but the updated clinical guidance by the National Institute for Health and Care Excellence also includes guidance regarding screening and psychological interventions for perinatal anxiety. This study therefore aimed to explore HVs' experiences of supporting women with postpartum anxiety and their views on currently available care. Using a qualitative approach, in-depth semi-structured interviews were conducted with 13 HVs from the UK between May and October 2015. Participants were interviewed in person at their workplace or on the phone/Skype. Using thematic analysis, four main themes emerged: identification and screening issues; importance of training; service usage; and status of current service provision. Women with postpartum anxiety were commonly encountered by HVs in their clinical practice and described as often heavily using their or other related healthcare services, which puts additional strain on HVs' already heavy workload. Issues with identifying and screening for postpartum anxiety were raised and the current lack of perinatal mental health training for HVs was highlighted. In addition, HVs described a current lack of good perinatal mental health services in general and specifically for anxiety. The study highlights the need for HV perinatal mental health training in general and postpartum anxiety specifically, as well as better coverage of specialist mental health services and the need for development of interventions targeted at postpartum anxiety. © 2017 John Wiley & Sons Ltd.

Musings on privacy issues in health research involving disaggregate geographic data about individuals.

PubMed

Boulos, Maged N Kamel; Curtis, Andrew J; Abdelmalik, Philip

2009-07-20

This paper offers a state-of-the-art overview of the intertwined privacy, confidentiality, and security issues that are commonly encountered in health research involving disaggregate geographic data about individuals. Key definitions are provided, along with some examples of actual and potential security and confidentiality breaches and related incidents that captured mainstream media and public interest in recent months and years. The paper then goes on to present a brief survey of the research literature on location privacy/confidentiality concerns and on privacy-preserving solutions in conventional health research and beyond, touching on the emerging privacy issues associated with online consumer geoinformatics and location-based services. The 'missing ring' (in many treatments of the topic) of data security is also discussed. Personal information and privacy legislations in two countries, Canada and the UK, are covered, as well as some examples of recent research projects and events about the subject. Select highlights from a June 2009 URISA (Urban and Regional Information Systems Association) workshop entitled 'Protecting Privacy and Confidentiality of Geographic Data in Health Research' are then presented. The paper concludes by briefly charting the complexity of the domain and the many challenges associated with it, and proposing a novel, 'one stop shop' case-based reasoning framework to streamline the provision of clear and individualised guidance for the design and approval of new research projects (involving geographical identifiers about individuals), including crisp recommendations on which specific privacy-preserving solutions and approaches would be suitable in each case.

Maintaining Sexual Health throughout Gynecologic Cancer Survivorship: A Comprehensive Review and Clinical Guide

PubMed Central

Huffman, Laura B.; Hartenbach, Ellen M.; Carter, Jeanne; Rash, Joanne K.; Kushner, David M.

2016-01-01

Objective The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. Methods A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. Results Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy--negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. Conclusion Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems. PMID:26556768

Musings on privacy issues in health research involving disaggregate geographic data about individuals

PubMed Central

Boulos, Maged N Kamel; Curtis, Andrew J; AbdelMalik, Philip

2009-01-01

This paper offers a state-of-the-art overview of the intertwined privacy, confidentiality, and security issues that are commonly encountered in health research involving disaggregate geographic data about individuals. Key definitions are provided, along with some examples of actual and potential security and confidentiality breaches and related incidents that captured mainstream media and public interest in recent months and years. The paper then goes on to present a brief survey of the research literature on location privacy/confidentiality concerns and on privacy-preserving solutions in conventional health research and beyond, touching on the emerging privacy issues associated with online consumer geoinformatics and location-based services. The 'missing ring' (in many treatments of the topic) of data security is also discussed. Personal information and privacy legislations in two countries, Canada and the UK, are covered, as well as some examples of recent research projects and events about the subject. Select highlights from a June 2009 URISA (Urban and Regional Information Systems Association) workshop entitled 'Protecting Privacy and Confidentiality of Geographic Data in Health Research' are then presented. The paper concludes by briefly charting the complexity of the domain and the many challenges associated with it, and proposing a novel, 'one stop shop' case-based reasoning framework to streamline the provision of clear and individualised guidance for the design and approval of new research projects (involving geographical identifiers about individuals), including crisp recommendations on which specific privacy-preserving solutions and approaches would be suitable in each case. PMID:19619311

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations123

PubMed Central

Calvo, Mona S.; Moshfegh, Alanna J.; Tucker, Katherine L.

2014-01-01

The Western dietary pattern of intake common to many Americans is high in fat, refined carbohydrates, sodium, and phosphorus, all of which are associated with processed food consumption and higher risk of life-threatening chronic diseases. In this review, we focus on the available information on current phosphorus intake with this Western dietary pattern, and new knowledge of how the disruption of phosphorus homeostasis can occur when intake of phosphorus far exceeds nutrient needs and calcium intake is limited. Elevation of extracellular phosphorus, even when phosphorus intake is seemingly modest, but excessive relative to need and calcium intake, may disrupt the endocrine regulation of phosphorus balance in healthy individuals, as it is known to do in renal disease. This elevation in serum phosphate, whether episodic or chronically sustained, may trigger the secretion of regulatory hormones, whose actions can damage tissue, leading to the development of cardiovascular disease, renal impairment, and bone loss. Therefore, we assessed the health impact of excess phosphorus intake in the context of specific issues that reflect changes over time in the U.S. food supply and patterns of intake. Important issues include food processing and food preferences, the need to evaluate phosphorus intake in relation to calcium intake and phosphorus bioavailability, the accuracy of various approaches used to assess phosphorus intake, and the difficulties encountered in evaluating the relations of phosphorus intake to chronic disease markers or incident disease. PMID:24425729

The Brown University Child and Adolescent Behavior Letter, 1999.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1999-01-01

These 12 monthly issues from 1999 explore problems encountered by children and adolescents. Regular features include "Keep Your Eye On...," brief accounts of research into childhood and adolescent problems; "What's New in Research," summarizing research from recent publications and professional conferences;…

Student Activity Funds: Procedures & Controls.

ERIC Educational Resources Information Center

Cuzzetto, Charles E.

Student activity funds may create educational opportunities for students, but they frequently create problems for business administrators. The first part of this work reviews the types of organizational issues and transactions an organized student group is likely to encounter, including establishing a constitution, participant roles,…

International Students' Confidence and Academic Success

ERIC Educational Resources Information Center

Telbis, Nicola Miky; Helgeson, Lars; Kingsbury, Cheryl

2014-01-01

Research shows that the international student population is showing significant growth. This article deals with issues affecting a growing international student population. Studies show that foreign students are encountering difficulties in social adaptability, language barriers, academic ability, and financial need. There is evidence that a…

Fire Down Below.

ERIC Educational Resources Information Center

Drummond, Steven

2000-01-01

Explores some of the problems associated with coal burning boilers in educational facilities and the extent of their use in the New York City public school system. Also highlighted are some of the changes and issues schools encounter when they convert from coal to oil or gas. (GR)

End-Users: Dollars but Doubts.

ERIC Educational Resources Information Center

Arnold, Stephen E.

1989-01-01

Identifies existing categories of end users of online information retrieval systems, discusses problems that have been encountered by information providers and customers, and suggests strategies for capturing new end-user markets. Issues discussed include user cordial interfaces, CD-ROM products, ethics involved in information provision, and…

Dealing with Sexual Harassment.

ERIC Educational Resources Information Center

Rowe, Mary P.

1981-01-01

Advice is presented for managers who encounter sexual harassment problems. Three recommendations are offered: complainants can be helped to help themselves, such conflicts can be resolved through procedures designed to deal with all kinds of complaints, and the issue of power differences should be confronted. (MLW)

The Brown University Child and Adolescent Behavior Letter, 1998.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1998-01-01

These 12 monthly issues from 1998 explore problems encountered by children and adolescents. Regular features include "Keep Your Eye On...," brief accounts of research into childhood and adolescent problems, "What's New in Research," summarizing research from recent publications and professional conferences;…

Resolving the false-negative issues of the nonpolar organic amendment in whole-sediment toxicity identification evaluations.

PubMed

Mehler, W Tyler; Keough, Michael J; Pettigrove, Vincent

2018-04-01

Three common false-negative scenarios have been encountered with amendment addition in whole-sediment toxicity identification evaluations (TIEs): dilution of toxicity by amendment addition (i.e., not toxic enough), not enough amendment present to reduce toxicity (i.e., too toxic), and the amendment itself elicits a toxic response (i.e., secondary amendment effect). One such amendment in which all 3 types of false-negatives have been observed is with the nonpolar organic amendment (activated carbon or powdered coconut charcoal). The objective of the present study was to reduce the likelihood of encountering false-negatives with this amendment and to increase the value of the whole-sediment TIE bioassay. To do this, the present study evaluated the effects of various activated carbon additions to survival, growth, emergence, and mean development rate of Chironomus tepperi. Using this information, an alternative method for this amendment was developed which utilized a combination of multiple amendment addition ratios based on wet weight (1%, lower likelihood of the secondary amendment effect; 5%, higher reduction of contaminant) and nonconventional endpoints (emergence, mean development rate). This alternative method was then validated in the laboratory (using spiked sediments) and with contaminated field sediments. Using these multiple activated carbon ratios in combination with additional endpoints (namely, emergence) reduced the likelihood of all 3 types of false-negatives and provided a more sensitive evaluation of risk. Environ Toxicol Chem 2018;37:1219-1230. © 2017 SETAC. © 2017 SETAC.

Sources of noise in magneto-optical readout

NASA Technical Reports Server (NTRS)

Mansuripur, M.

1991-01-01

The various sources of noise which are often encountered in magneto-optical readout systems are analyzed. Although the focus is on magneto-optics, most sources of noise are common among the various optical recording systems and one can easily adapt the results to other media and systems. A description of the magneto-optical readout system under consideration is given, and the standard methods and the relevant terminology of signal and noise measurement are described. The characteristics of thermal noise, which originates in the electronic circuitry of the readout system, are described. The most fundamental of all sources of noise, the shot noise, is considered, and a detailed account of its statistical properties is given. Shot noise, which is due to random fluctuations in photon arrival times, is an ever-present noise in optical detection. Since the performance of magneto-optical recording devices in use today is approaching the limit imposed by the shot noise, it is important that the reader have a good grasp of this particular source of noise. A model for the laser noise is described, and measurement results which yield numerical values for the strength of the laser power fluctuations are presented. Spatial variations of the disk reflectivity and random depolarization phenomena also contribute to the overall level of noise in readout; these and related issues are treated. Numerical simulation results describing some of the more frequently encountered sources of noise which accompany the recorded waveform itself, namely, jitter noise and signal-amplitude fluctuation noise are presented.

A simulation and video-based training program to address adverse childhood experiences.

PubMed

Wen, Frances K; Miller-Cribbs, Julie E; Coon, Kim A; Jelley, Martina J; Foulks-Rodriguez, Kristin A

2017-05-01

Adverse childhood experiences (ACEs) are 10 categories of childhood abuse and maltreatment, which have a dose-response relationship with common adult health concerns seen in primary care including health risk behaviors, chronic disease, and mental illness. Many of the ACEs-associated biopsychosocial risk factors are modifiable. However, physicians may not address these issues for fear of opening "Pandora's Box", that is, a source of extensive problems for which they are not sufficiently prepared with training, resources, or time. Residents need training in how to conduct trauma-focused conversations within the limited scope of an office visit. To address this need, a 4-hour simulation and video-based training program was developed for primary care residents about how to conduct brief interventions connecting their patients' current health concerns with their experiences of ACEs. Resident participants have evaluated this program as preparatory for real-life encounters and as being designed to allow for educational mastery. This article describes a workshop presenting this training program which was given at the 37th Annual Behavioral Science Forum in Family Medicine. Five skills targeted in the program were presented and a demonstration was made of the components, that is, didactics, provider and patient videos, simulated patient encounters, trainee feedback, and facilitated discussion that encompasses targeted skills, clinical implementation, and self-care. Companion tools were shared, including the syllabus, evaluation rubric, and provider and patient resources. Participants practiced trainee feedback and discussed the challenges in implementation.

What happens when the doctor denies a patient's request? A qualitative interview study among general practitioners in Norway.

PubMed

Nilsen, Stein; Malterud, Kirsti

2017-06-01

To explore general practitioners (GPs') experiences from consultations when a patient's request is denied, and outcomes of such incidents. We conducted a qualitative study with semi-structured individual interviews with six GPs in Norway. We asked them to tell about experiences from specific encounters where they had refused a patient's request. The texts were analysed with Systematic Text Condensation, a method for thematic cross-case analysis. Accounts of experiences from consultations when GPs refused their patients' requests. Subjects of dispute included clinical topics like investigation and treatment, certification regarding welfare benefits and medico-legal issues, and administrative matters. The arguments took different paths, sometimes settled by reaching common ground but more often as unresolved disagreement with anger or irritation from the patient, sometimes with open hostility and violence. The aftermath and outcomes of these disputes lead to strong emotional impact where the doctors reflected upon the incidents and sometimes regretted their handling of the consultation. Some long-standing and close patient-doctor relationships were injured or came to an end. The price for denying a patient's request may be high, and GPs find themselves uncomfortable in such encounters. Skills pertaining to this particular challenge could be improved though education and training, drawing attention to negotiation of potential conflicts. Also, the notion that doctors have a professional commitment to his or her own autonomy and to society should be restored, through increased emphasis on core professional ethics in medical education at all levels.

Dentist-patient communication in the multilingual dental setting.

PubMed

Goldsmith, C; Slack-Smith, L; Davies, G

2005-12-01

Communication between dentists and patients can be exceptionally challenging when the patient and the dentist do not speak the same language, as is frequently the case in multicultural Australia. The aim of this study was to describe the issues involved in dealing with limited-English speaking patients in order to formulate recommendations on how to improve dental communication. A cross sectional study was performed using a postal survey to Australian Dental Association member dental practitioners in Western Australia. Responses were collated and data analysis was performed using SPSS 11.5 for Windows. Most respondents encounter language-related communication barriers weekly or monthly, and the most satisfactory method of communication is informal interpreters. Despite reporting satisfaction working with professional chairside interpreters or dental staff interpreters, most respondents did not use them. The most common alternative communication methods were diagrams and models. Endodontics and periodontics provided the greatest challenge in communication. Informed consent was reportedly compromised due to language barriers by 29 per cent of respondents. Recommendations to improve communication included access to interpretation services, dentist technique/attitude to communication and patient preparedness for English-speaking encounters. Many respondents do not utilize the preferential communication methods, creating a potential compromise to both informed consent and the patients' best interests. The use of professional interpreters is recommended, and discussion should be supplemented with means of non-verbal communication. Dentists require access to lists of multilingual dentists and greater awareness of interpretation services to improve multilingual dentist-patient communication.

Medical coverage of winter Nordic sports: an overview from the field.

PubMed

Gaul, Lawrence W

2010-01-01

Traveling with sports teams requires flexibility and a wide range of knowledge, as well as problem-solving abilities. Dominating the medical types of problems in the Nordic sports are the respiratory illnesses, especially asthma and upper respiratory infections (URI). Additionally, the team physician must have an awareness of antidoping issues. This overview highlights many of the issues encountered traveling domestically as well as internationally with high-level Nordic teams. Helpful links are included to facilitate the care of all levels of athletes. Additionally, a few side issues such as altitude illness and minor trauma are mentioned.

A method for communication analysis in prosthodontics.

PubMed

Sondell, K; Söderfeldt, B; Palmqvist, S

1998-02-01

Particularly in prosthodontics, in which the issues of esthetic preferences and possibilities are abundant, improved knowledge about dentist patient communication during clinical encounters is important. Because previous studies on communication used different methods and patient materials, the results are difficult to evaluate. There is, therefore, a need for methodologic development. One method that makes it possible to quantitatively describe different interaction behaviors during clinical encounters is the Roter Method of Interaction Process Analysis (RIAS). Since the method was developed in the USA for use in the medical context, a translation of the method into Swedish and a modification of the categories for use in prosthodontics were necessary. The revised manual was used to code 10 audio recordings of dentist patient encounters at a specialist clinic for prosthodontics. No major alterations of the RIAS manual were made during the translation and modification. The study shows that it is possible to distinguish patterns of communication in audio-recorded dentist patient encounters. The method also made the identification of different interaction profiles possible. These profiles distinguished well among the audio-recorded encounters. The coding procedures were tested for intra-rater reliability and found to be 97% for utterance classification and lambda = 0.76 for categorization definition. It was concluded that the revised RIAS method is applicable in communication studies in prosthodontics.

Does assisted driving behavior lead to safety-critical encounters with unequipped vehicles' drivers?

PubMed

Preuk, Katharina; Stemmler, Eric; Schießl, Caroline; Jipp, Meike

2016-10-01

With Intelligent Transport Systems (e.g., traffic light assistance systems) assisted drivers are able to show driving behavior in anticipation of upcoming traffic situations. In the years to come, the penetration rate of such systems will be low. Therefore, the majority of vehicles will not be equipped with these systems. Unequipped vehicles' drivers may not expect the driving behavior of assisted drivers. However, drivers' predictions and expectations can play a significant role in their reaction times. Thus, safety issues could arise when unequipped vehicles' drivers encounter driving behavior of assisted drivers. This is why we tested how unequipped vehicles' drivers (N=60) interpreted and reacted to the driving behavior of an assisted driver. We used a multi-driver simulator with three drivers. The three drivers were driving in a line. The lead driver in the line was a confederate who was followed by two unequipped vehicles' drivers. We varied the equipment of the confederate with an Intelligent Transport System: The confederate was equipped either with or without a traffic light assistance system. The traffic light assistance system provided a start-up maneuver before a light turned green. Therefore, the assisted confederate seemed to show unusual deceleration behavior by coming to a halt at an unusual distance from the stop line at the red traffic light. The unusual distance was varied as we tested a moderate (4m distance from the stop line) and an extreme (10m distance from the stop line) parameterization of the system. Our results showed that the extreme parametrization resulted in shorter minimal time-to-collision of the unequipped vehicles' drivers. One rear-end crash was observed. These results provided initial evidence that safety issues can arise when unequipped vehicles' drivers encounter assisted driving behavior. We recommend that future research identifies counteractions to prevent these safety issues. Moreover, we recommend that system developers discuss the best parameterizations of their systems to ensure benefits but also the safety in encounters with unequipped vehicles' drivers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Basics of elder law and legal liabilities of negligence and malpractice for physicians as they apply to individuals with disabilities.

PubMed

Ullman, David; Zuller, Michael E

2005-02-01

This article provides information regarding the issues that physicians face when dealing with elderly patients with cognitive deficits. It includes a discussion of basic legal terms and concepts that medical personnel should understand, various difficulties encountered by patients and families in crisis situations, and how the legal system deals with these issues. It concludes with a general discussion of the legal liabilities of negligence and malpractice.

Global D-brane models with stabilised moduli and light axions

NASA Astrophysics Data System (ADS)

Cicoli, Michele

2014-03-01

We review recent attempts to try to combine global issues of string compactifications, like moduli stabilisation, with local issues, like semi-realistic D-brane constructions. We list the main problems encountered, and outline a possible solution which allows globally consistent embeddings of chiral models. We also argue that this stabilisation mechanism leads to an axiverse. We finally illustrate our general claims in a concrete example where the Calabi-Yau manifold is explicitly described by toric geometry.

Can we improve the performance and reporting of investigator-initiated clinical trials? Rheumatoid arthritis as an example.

PubMed

Landewé, Robert B M; Smolen, Josef S; Weinblatt, Michael E; Emery, Paul; Dougados, Maxime; Fleischmann, Roy; Aletaha, Daniel; Kavanaugh, Arthur; van der Heijde, Désirée

2014-10-01

Investigator-initiated trials, some of which have been referred to as comparative effectiveness trials, pragmatic trials, or strategy trials, are sometimes considered to be of greater clinical importance than industry-driven trials, because they address important but unresolved clinical questions that differ from the questions asked in industry-driven trials. Regulatory authorities have provided methodological guidance for industry-driven trials for the approval of new treatments, but such guidance is less clear for investigator-initiated trials. The European League Against Rheumatism (EULAR) task force for the update of the recommendations for the management of rheumatoid arthritis has critically looked at the methodological quality and conduct of many investigator-initiated trials, and has identified a number of concerns. In this Viewpoint paper, we highlight commonly encountered issues that are discussed using examples of well-known investigator-initiated trials. These issues cover three themes: (1) design choice (superiority vs non-inferiority designs); (2) statistical power and (3) convenience reporting. Since we acknowledge the importance of investigator-initiated research, we also propose a shortlist of points-to-consider when designing, performing and reporting investigator-initiated trials. 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.

Gaps in nutritional research among older adults with cancer

PubMed Central

Presley, Carolyn J.; Dotan, Efrat; Soto-Perez-de-Celis, Enrique; Jatoi, Aminah; Mohile, Supriya G.; Won, Elizabeth; Alibhai, Shabbir; Kilari, Deepak; Harrison, Robert; Klepin, Heidi D.; Wildes, Tanya M.; Mustian, Karen; Demark-Wahnefried, Wendy

2016-01-01

Nutritional issues among older adults with cancer are an understudied area of research despite significant prognostic implications for treatment side effects, cancer-specific mortality, and overall survival. In May of 2015, the National Cancer Institute and the National Institute on Aging co-sponsored a conference focused on future directions in geriatric oncology research. Nutritional research among older adults with cancer was highlighted as a major area of concern as most nutritional cancer research has been conducted among younger adults, with limited evidence to guide the care of nutritional issues among older adults with cancer. Cancer diagnoses among older adults are increasing, and the care of the older adult with cancer is complicated due to multimorbidity, heterogeneous functional status, polypharmacy, deficits in cognitive and mental health, and several other non-cancer factors. Due to this complexity, nutritional needs are dynamic, multifaceted, and dependent on the clinical scenario. This manuscript outlines the proceedings of this conference including knowledge gaps and recommendations for future nutritional research among older adults with cancer. Three common clinical scenarios encountered by oncologists include (1) weight loss during anti-cancer therapy, (2) malnutrition during advanced disease, and (3) obesity during survivorship. In this manuscript, we provide a brief overview of relevant cancer literature within these three areas, knowledge gaps that exist, and recommendations for future research. PMID:27197919

Technology-enhanced focus groups as a component of instrument development.

PubMed

Strout, Tania D; DiFazio, Rachel L; Vessey, Judith A

2017-06-22

Background Bullying is a critical public health problem and a screening tool for use in healthcare is needed. Focus groups are a common tool for generating qualitative data when developing an instrument and evidence suggests that technology-enhanced focus groups can be effective in simultaneously engaging participants from diverse settings. Aim To examine the use of technology-enhanced focus groups in generating an item pool to develop a youth-bullying screening tool. Discussion The authors explore methodological and ethical issues related to conducting technology-enhanced focus groups, drawing on their experience in developing a youth-bullying measure. They conducted qualitative focus groups with professionals from the front lines of bullying response and intervention. They describe the experience of conducting technology-enhanced focus group sessions, focusing on the methodological and ethical issues that researchers engaging in similar work may encounter. Challenges associated with this methodology include establishing rapport among participants, privacy concerns and limited non-verbal communication. Conclusion The use of technology-enhanced focus groups can be valuable in obtaining rich data from a wide variety of disciplines and contexts. Organising these focus groups was inexpensive and preferred by the study's participants. Implications for practice Researchers should consider using technology-enhanced focus groups to generate data to develop health-related measurement tools.

Mydriasis during Orbital Floor Fracture Reconstruction: A Novel Diagnostic and Treatment Algorithm

PubMed Central

Yeo, Matthew S.; Al-Mousa, Radwan; Sundar, Gangadhara; Lim, Thiam Chye

2010-01-01

Orbital floor fractures are the most commonly encountered traumatic fractures in the facial skeleton. Mydriasis that is detected during orbital floor fracture reconstruction may cause significant distress to surgeons, as it may be associated with sinister events such as visual loss. It is not an uncommon problem; previous studies have shown the incidence of mydriasis to be 2.1%. The combination of careful preoperative evaluation and planning, as well as specific intraoperative investigations when mydriasis is encountered, can be immensely valuable in allaying surgeons' anxiety during orbital floor fracture reconstruction. In this review article, the authors discuss the common causes of mydriasis and present a novel systematic approach to its diagnostic evaluation devised by our unit that has been successfully implemented since 2008. PMID:22132259

Editorial Commentary: Anteromedial Meniscofemoral Ligament of the Anterior Horn of the Medial Meniscus: I've Never Seen That Before; but Has It Seen Me?

PubMed

Nelson, Eric W

2018-05-01

Although there is frequently an element of variability found in human anatomy, we tend to think of anatomic structures as following the pattern in which we, as surgeons, most frequently encounter them. Though it is possible that a variant pattern of a commonly encountered anatomic structure has "never been seen" by us as surgeons, the constant process of learning sometimes leads us to ask ourselves whether we have truly never encountered such a structure or condition before or whether we simply did not recognize it when it "saw us." Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Disrespect, harassment, and abuse: all in a day's work for family physicians.

PubMed

Miedema, Baukje; Easley, Julie; Fortin, Pierrette; Hamilton, Ryan; Tatemichi, Sue

2009-03-01

To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. Qualitative case study using semistructured interviews. Province of New Brunswick. Forty-eight family physicians from across the province. A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick's physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters--young, female, rural physicians appeared to experience such encounters most often. Abusive encounters in the workplace are concerning. It is essential to address these issues of workplace harassment and abuse in order to protect physician safety and avoid workplace dissatisfaction. Abusive encounters might push family physicians to leave clinical practice prematurely or refuse to work in higher-risk environments, such as emergency departments or rural areas.

Selective common and uncommon imaging manifestations of blunt nonaortic chest trauma: when time is of the essence.

PubMed

Altoos, Rola; Carr, Robert; Chung, Jonathan; Stern, Eric; Nevrekar, Dipti

2015-01-01

This is a pictorial essay in which we review and illustrate a variety of thoracic injuries related to blunt trauma. Non-aortic blunt thoracic trauma can be divided anatomically into injuries of the chest wall, lungs, pleura, mediastinum, and diaphragm. Some injuries involve more than one anatomic compartment, and multiple injuries commonly coexist. This article provides common imaging findings and discussion of both common and uncommon but critical thoracic injuries encountered. Published by Elsevier Inc.

North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues

PubMed Central

McNichol, Laurie; Boarini, Joy

2017-01-01

PURPOSE: The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues. DESIGN: Descriptive study. SUBJECTS AND SETTING: Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns. METHODS: Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points. RESULTS: Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems. CONCLUSION: WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged. PMID:28362656

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.

MRI: unique costing and pricing issues.

PubMed

Schwartz, H W; Jarl, D F

1985-01-01

Acquisition of magnetic resonance imaging (MRI) involves a plethora of costs not traditionally encountered in radiology procedure cost accounting models. Experiences with MRI gained at the University of Minnesota Hospitals and Clinics during 1984 uncovered a wide variety of unique costing issues which were eventually identified at the time when the MRI hospital charge was being established. Our experience at UMHC can provide those radiology departments now acquiring MRI with an earlier awareness of these special costing issues, hopefully resulting in better and more timely data collection. Current reimbursement and pricing issues are also having a dramatic impact on MRI costs at each institution and must be assessed in terms of third-party payor intentions.

Transformative Theatre: A Promising Educational Tool for Improving Health Encounters With LGBT Older Adults.

PubMed

Hughes, Anne K; Luz, Clare; Hall, Dennis; Gardner, Penny; Hennessey, Chris Walker; Lammers, Lynn

2016-01-01

Lesbian, gay, bisexual, or transgender (LGBT) older adults are often unaware or fearful of aging services that contribute to greater vulnerability, isolation, and risk when services are needed. In addition, they may perceive or experience bias in health care encounters. Providers may not recognize their own biases or their impact on such encounters. In response, a group of LGBT community activists, aging professionals, researchers, and a theatre ensemble developed an interactive theatre experience, described herein, that portrays challenges faced by LGBT older adults needing services. Goals included raising awareness among LGBT older adults and providers about issues such as the limited legal rights of partners, limited family support, and fear of being mistreated as a result of homophobia. Evaluations and feedback reflected the potential of interactive theatre to engage people in sensitive discussions that can lead to increased awareness, reduced bias, practice change, and ultimately improved care for LGBT older adults.

Bone pain or tenderness

MedlinePlus

McCormack RG, Lopez CA. Commonly encountered fractures in sports medicine. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ...

EXTRAPOLATION MODELING: ADVANCEMENTS AND RESEARCH ISSUES IN LUNG DOSIMETRY

EPA Science Inventory

Many of the environmental pollutants to which humans are exposed are increasing rapidly, in terms of number, complexity, and concentration. ne of the great challenges in environmental medicine is to define more accurately the adverse health effects likely to be encountered by exp...

Everyday Ethics: Reflections on Practice

ERIC Educational Resources Information Center

Rossman, Gretchen B.; Rallis, Sharon F.

2010-01-01

This introductory article frames the contributions for this issue on everyday ethics--moments that demand moral considerations and ethical choices that researchers encounter. We discuss concerns raised within the research community about the tendency to observe merely obligatory ethical procedures as outlined in Human Subjects Review regulations.…

ENVIRONMENTAL TOXINS AND BEHAVIORAL DEVELOPMENT: A NEW ROLE FOR PSYCHOLOGICAL RESEARCH

EPA Science Inventory

Childhood exposure to chemicals routinely encountered in the environment has become an issue of scientific and public concern. Recent research has revealed the inadequacy of traditional notions in which chemically induced illness was likened to overt biological disease. The new m...

The Dyslexic Student and Mathematics in Higher Education

ERIC Educational Resources Information Center

Perkin, Glynis; Croft, Tony

2007-01-01

Difficulties that are encountered by dyslexic undergraduates with their learning and understanding of mathematics are explored. Specific consideration is given to issues arising through mathematical content, its delivery, the procedures and processes of doing mathematics, and its assessment. Particular difficulties, which have emerged through…

Meeting the Challenge: Teaching Sensitive Subject Matter

ERIC Educational Resources Information Center

Crosby, Dorian B.

2012-01-01

When teaching diversity courses that discuss sensitive issues, such as racial, gender, sexuality, religious, and ethnic discrimination, it is possible to encounter student resistance, which can subsequently prevent students from comprehending the content. While teaching an introductory course on African American history in a Black Studies…

Making a Comeback

ERIC Educational Resources Information Center

Ramaswami, Rama

2008-01-01

As technology grows more pervasive in education, the data recovery issues that school systems encounter are becoming increasingly problematic, as districts work to accommodate a range of concerns that do not encumber commercial businesses. State and federal laws often require schools to report on student populations and educational progress…

Negotiating Sexuality and Masculinity in School Sport: An Autoethnography

ERIC Educational Resources Information Center

Carless, David

2012-01-01

This autoethnography explores challenging and ethically sensitive issues around sexual orientation, sexual identity and masculinity in the context of school sport. Through storytelling, I aim to show how sometimes ambiguous encounters with heterosexism, homophobia and hegemonic masculinity through sport problematise identity development for young…

High speed passenger trains in freight railroad corridors : operations and safety considerations

DOT National Transportation Integrated Search

1994-12-01

This report presents the results of a study into some operations and technical issues likely to be encountered when planning for high-speed rail passenger service on corridors that presently carry freight or commuter traffic. The study starts with a ...

Methodological and Ethical Challenges in a Web-Based Randomized Controlled Trial of a Domestic Violence Intervention

PubMed Central

Valpied, Jodie; Koziol-McLain, Jane; Glass, Nancy; Hegarty, Kelsey

2017-01-01

The use of Web-based methods to deliver and evaluate interventions is growing in popularity, particularly in a health care context. They have shown particular promise in responding to sensitive or stigmatized issues such as mental health and sexually transmitted infections. In the field of domestic violence (DV), however, the idea of delivering and evaluating interventions via the Web is still relatively new. Little is known about how to successfully navigate several challenges encountered by the researchers while working in this area. This paper uses the case study of I-DECIDE, a Web-based healthy relationship tool and safety decision aid for women experiencing DV, developed in Australia. The I-DECIDE website has recently been evaluated through a randomized controlled trial, and we outline some of the methodological and ethical challenges encountered during recruitment, retention, and evaluation. We suggest that with careful consideration of these issues, randomized controlled trials can be safely conducted via the Web in this sensitive area. PMID:28351830

Cyberdermatoethics I: ethical, legal, technologic, and clinical aspects of patient-physician e-mail.

PubMed

Luo, John; Logan, Christopher; Long, Thomas P; Bercovitch, Lionel

2009-01-01

As Internet access has become ubiquitous, electronic mail (e-mail) is becoming more widely used as a means of communication between patient and dermatologist. Dealing with the ethical, legal, and clinical consequences has lagged behind the technology. Privacy of e-mail cannot exist without security, and as a foundation for understanding e-mail security, the elements of e-mail technology are reviewed. One of the greatest risks of e-mail is compromise of privacy. Although self-documenting and convenient, e-mail lacks the emotional cues of face-to-face encounters, is asynchronous and not always read in timely fashion, and is not suitable for certain clinical concerns such as urgent matters and cancer diagnoses. Legal issues relating to federal privacy regulations, ethical issues such as autonomy and justice, and guidelines for the use of e-mail in clinical practice are reviewed. Case scenarios are used to present the pitfalls in clinical e-mail encounters, including establishment of the doctor-patient relationship, diagnosis and treatment over the Internet, and curbside consultations.

Clarifying perspectives: Ethics case reflection sessions in childhood cancer care.

PubMed

Bartholdson, Cecilia; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

2016-06-01

Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child's growing autonomy are known ethical concerns that involve the whole professional team around the child's care. The purpose of this study was to explore healthcare professionals' experiences of participating in ethics case reflection sessions in childhood cancer care. Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Healthcare professionals working at a publicly funded children's hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. The children's and their parents' integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants' articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals. © The Author(s) 2015.

Cultural influences on the physician-patient encounter: The case of shared treatment decision-making.

PubMed

Charles, Cathy; Gafni, Amiram; Whelan, Tim; O'Brien, Mary Ann

2006-11-01

In this paper we discuss the influence of culture on the process of treatment decision-making, and in particular, shared treatment decision-making in the physician-patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect treatment decision-making; (2) cultural issues and assumptions underlying the development and use of treatment decision aids. This is a conceptual paper. Based on our knowledge and reading of the key literature in the treatment decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician-patient encounter and when designing instruments (decision aids) to help patients participate in making decisions. Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared decision-making as well as on the applicability across cultural groups of decision aids developed to facilitate patient participation in treatment decision-making with physicians. Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.

The principles of Catholic social teaching: A guide for decision making from daily clinical encounters to national policy-making.

PubMed

Wright, Karen Shields

2017-02-01

Catholic social teaching (CST), a branch of moral theology, addresses contemporary issues within the political, economic, and cultural structures of society. The threefold cornerstone of CST contains the principles of human dignity, solidarity, and subsidiarity. It is the foundation on which to form our conscience in order to evaluate the framework of society and is the Catholic criteria for prudential judgment and direction in developing current policy-making. With knowledge of these social principles, in combination with our faith, we will be more armed and informed as to articulate the Catholic vision of reality, the truthful nature of the human person and society, to apply and integrate the social teachings in our everyday administrative and clinical encounters, and through the virtue of charity take action within the social, political, and economic spheres in which we have influence. Summary: The Church's social encyclicals are a reflection upon the issues of the day using the light of faith and reason. They offer commentary on the ways to evaluate and address particular social problems-also using natural law principles-in the areas of politics, economics, and culture. Quotes were selected from the encyclicals that define and expand upon the primary principles for the purpose of representing them for study, reflection, and use in everyday personal and business encounters and decision making for healthcare professionals.

The principles of Catholic social teaching: A guide for decision making from daily clinical encounters to national policy-making

PubMed Central

2017-01-01

Catholic social teaching (CST), a branch of moral theology, addresses contemporary issues within the political, economic, and cultural structures of society. The threefold cornerstone of CST contains the principles of human dignity, solidarity, and subsidiarity. It is the foundation on which to form our conscience in order to evaluate the framework of society and is the Catholic criteria for prudential judgment and direction in developing current policy-making. With knowledge of these social principles, in combination with our faith, we will be more armed and informed as to articulate the Catholic vision of reality, the truthful nature of the human person and society, to apply and integrate the social teachings in our everyday administrative and clinical encounters, and through the virtue of charity take action within the social, political, and economic spheres in which we have influence. Summary: The Church's social encyclicals are a reflection upon the issues of the day using the light of faith and reason. They offer commentary on the ways to evaluate and address particular social problems—also using natural law principles—in the areas of politics, economics, and culture. Quotes were selected from the encyclicals that define and expand upon the primary principles for the purpose of representing them for study, reflection, and use in everyday personal and business encounters and decision making for healthcare professionals. PMID:28392595

Revealing the Naturalization of Language and Literacy: The Common Sense of Text Complexity

ERIC Educational Resources Information Center

Newhouse, Erica H.

2017-01-01

This article illustrates the process and obstacles encountered when applying the Common Core's three-part model of determining text complexity to an urban literature text. This analysis revealed how the model privileges language and literacy practices that limit the range of texts used in classrooms through a process of naturalization and by…

Common Dermatoses of Infancy

PubMed Central

Gora, Irv

1986-01-01

Within the pediatric population of their practices, family physicians frequently encounter infants with skin rashes. This article discusses several of the more common rashes of infancy: atopic dermatitis, cradle cap, diaper dermatitis and miliaria. Etiology, clinical picture and possible approaches to treatment are presented. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7 PMID:21267297

A Portal into Biology Education: An Annotated List of Commonly Encountered Terms

ERIC Educational Resources Information Center

Miller, Sarah; Tanner, Kimberly D.

2015-01-01

In an introductory biology course, undergraduate students are expected to become familiar with, and be able to use, hundreds of new terms to navigate the complex ideas in biology. And this is just in the introductory course! Juxtapose this student situation with the common frustration expressed by biologists that there is "just too much…

Constrained Maximum Likelihood Estimation for Two-Level Mean and Covariance Structure Models

ERIC Educational Resources Information Center

Bentler, Peter M.; Liang, Jiajuan; Tang, Man-Lai; Yuan, Ke-Hai

2011-01-01

Maximum likelihood is commonly used for the estimation of model parameters in the analysis of two-level structural equation models. Constraints on model parameters could be encountered in some situations such as equal factor loadings for different factors. Linear constraints are the most common ones and they are relatively easy to handle in…

Tapering Timbers: Finding the Volume of Conical Frustums

ERIC Educational Resources Information Center

Jones, Dustin L.; Coleman, Max

2012-01-01

Throughout history, humans have developed and refined methods of measuring. For the volumes of some common shapes, they have derived formulas. One such formula is that for the volume of a conical frustum. The conical frustum is not usually on a short list of common geometric shapes, but students encounter it in their everyday experience. In the…

Common Adult Skin and Soft Tissue Lesions

PubMed Central

Trost, Jeffrey G.; Applebaum, Danielle S.; Orengo, Ida

2016-01-01

A strong foundational knowledge of dermatologic disease is crucial for a successful practice in plastic surgery. A plastic surgeon should be able to identify and appreciate common dermatologic diseases that may require medical and/or surgical evaluation and management. In this article, the authors describe epidermal/dermal, infectious, pigmented, and malignant cutaneous lesions that are commonly encountered in practice. Descriptions include the epidemiology, pathogenesis, clinical course, and management options for each type of lesion. PMID:27478418

Wet Labs, Computers, and Spreadsheets.

ERIC Educational Resources Information Center

Durham, Bill

1990-01-01

Described are some commonly encountered chemistry experiments that have been modified for computerized data acquisition. Included are exercises in radioactivity, titration, calorimetry, kinetics, and electrochemistry. Software considerations and laboratory procedures are discussed. (CW)

Characteristics of aggression among psychiatric inpatients by ward type in Japan: Using the Staff Observation Aggression Scale - Revised (SOAS-R).

PubMed

Sato, Makiko; Noda, Toshie; Sugiyama, Naoya; Yoshihama, Fumihiro; Miyake, Michi; Ito, Hiroto

2017-12-01

Aggressive behaviour by psychiatric patients is a serious issue in clinical practice, and adequate management of such behaviour is required, with careful evaluation of the factors causing the aggression. To examine the characteristics of aggressive incidents by ward type, a cross-sectional descriptive study was conducted for 6 months between April 2012 and June 2013 using the Staff Observation Aggression Scale - Revised, Japanese version (SOAS-R) in 30 wards across 20 Japanese psychiatric hospitals. Participating wards were categorized into three types based on the Japanese medical reimbursement system: emergency psychiatric, acute psychiatric, and standard wards (common in Japan, mostly treating non-acute patients). On analyzing the 443 incidents reported, results showed significant differences in SOAS-R responses by ward type. In acute and emergency psychiatric wards, staff members were the most common target of aggression. In acute psychiatric wards, staff requiring patients to take medication was the most common provocation, and verbal aggression was the most commonly used means. In emergency psychiatric wards, victims felt threatened. In contrast, in standard wards, both the target and provocation of aggression were most commonly other patients, hands were used, victims reported experiencing physical pain, and seclusion was applied to stop their behaviour. These findings suggest that ward environment was an important factor influencing aggressive behaviour. Ensuring the quality and safety of psychiatric care requires understanding the characteristics of incidents that staff are likely to encounter in each ward type, as well as implementing efforts to deal with the incidents adequately and improve the treatment environment. © 2016 Australian College of Mental Health Nurses Inc.

Acute Symptomatic Seizures Caused by Electrolyte Disturbances

PubMed Central

Nardone, Raffaele; Brigo, Francesco

2016-01-01

In this narrative review we focus on acute symptomatic seizures occurring in subjects with electrolyte disturbances. Quite surprisingly, despite its clinical relevance, this issue has received very little attention in the scientific literature. Electrolyte abnormalities are commonly encountered in clinical daily practice, and their diagnosis relies on routine laboratory findings. Acute and severe electrolyte imbalances can manifest with seizures, which may be the sole presenting symptom. Seizures are more frequently observed in patients with sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia. They do not entail a diagnosis of epilepsy, but are classified as acute symptomatic seizures. EEG has little specificity in differentiating between various electrolyte disturbances. The prominent EEG feature is slowing of the normal background activity, although other EEG findings, including various epileptiform abnormalities may occur. An accurate and prompt diagnosis should be established for a successful management of seizures, as rapid identification and correction of the underlying electrolyte disturbance (rather than an antiepileptic treatment) are of crucial importance in the control of seizures and prevention of permanent brain damage. PMID:26754778

Fibromyalgia and chronic fatigue syndrome: management issues.

PubMed

Bourke, Julius

2015-01-01

Fibromyalgia and chronic fatigue syndrome represent two of the most commonly encountered functional somatic syndromes in clinical practice. Both have been contentious diagnoses in the past, and this diagnostic dispute has resulted in a therapeutic nihilism that has been of great detriment to their management and to alleviation of the intense suffering and disability that they have caused their innumerable sufferers. A new age has dawned in terms of a better understanding of these syndromes' physiology and improved approaches to their management. Here, the diagnosis and management of these closely related disorders are discussed, with particular reference to the recent empirical evidence that has come to light as a consequence of neurophysiological insights and robustly designed randomised clinical trials. Much work remains to be done in this vein, but we are better placed to facilitate recovery from these disorders than we have been previously. Whilst remission should always be a goal, complete symptom resolution is not the norm, but 'moderate' improvements are certainly attainable with appropriate management. © 2015 S. Karger AG, Basel.

Preemptive financial strategies help IPAs avoid insolvency.

PubMed

Karling, J; Silberman, L

2000-11-01

The 1999 collapse in California of practice management giants FPA Medical Management, Inc. and MedPartners, Inc. has caused healthcare provider organizations, particularly independent practice associations (IPAs), to examine critical issues related to financial solvency. Problems such as declining membership, ineffective management, weak contracting, and lack of strategic vision frequently are encountered by troubled provider organizations. The common thread that runs through IPA failures is a combination of unreliable accounting data and inadequate reporting systems. This lack of satisfactory financial and reporting information impairs the ability of the provider group to maintain sufficient funds to cover expenses and pay physicians. Successful, financially stable provider networks use well-defined reporting procedures based on fundamental accounting and financial concepts, as well as a sound methodology for measuring and calculating claims liability estimates. In California, new regulations aimed at encouraging provider organizations to assume preemptive financial strategies are in the process of being adopted. IPAs in every state should consider reviewing these regulations as benchmarks by which to assess their financial procedures.

A novice teacher's reflections on lecturing as a teaching strategy: covering the content or uncovering the meaning.

PubMed

Clynes, Mary P

2009-01-01

The lecture is the most widely used teaching strategy in adult education programmes. While it has advantages, it is criticised for its lack of student engagement and inability to stimulate higher-order thinking. The aim of this paper is to detail a novice teacher's journey using the lecture as a teaching strategy. The use of an action research approach provided the teacher with a framework to research own learning. In addition, the collaborative process inherent in action research resulted in students being invited to evaluate the teaching. The journey takes the teacher from a teacher-centred approach to teaching and learning to a student-centred approach. The influence of the teacher's own educational encounters is explored. In common with many novice teachers, the focus on content delivery and difficulty asking questions are two key issues. The gradual implementation of strategies to allow for more student engagement is discussed and advice is offered to the novice teacher.

[Systemic safety following intravitreal injections of anti-VEGF].

PubMed

Baillif, S; Levy, B; Girmens, J-F; Dumas, S; Tadayoni, R

2018-03-01

The goal of this manuscript is to assess data suggesting that intravitreal injection of anti-vascular endothelial growth factors (anti-VEGFs) could result in systemic adverse events (AEs). The class-specific systemic AEs should be similar to those encountered in cancer trials. The most frequent AE observed in oncology, hypertension and proteinuria, should thus be the most common expected in ophthalmology, but their severity should be lower because of the much lower doses of anti-VEGFs administered intravitreally. Such AEs have not been frequently reported in ophthalmology trials. In addition, pharmacokinetic and pharmacodynamic data describing systemic diffusion of anti-VEGFs should be interpreted with caution because of significant inconsistencies reported. Thus, safety data reported in ophthalmology trials and pharmacokinetic/pharmacodynamic data provide robust evidence that systemic events after intravitreal injection are very unlikely. Additional studies are needed to explore this issue further, as much remains to be understood about local and systemic side effects of anti-VEGFs. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

The origins and consequences of patient autonomy: a 25-year retrospective.

PubMed

Rothman, D J

2001-01-01

This essay explores the evolution of the tension between the principles of autonomy and beneficence in American health care over the past several decades. In retrospect it is clear that the social movements of the 1960s and 70s set the tone and the goals for the emergence of a new emphasis on patient autonomy. Indeed, the impact of civil liberties-minded lawyers on the promotion of a commitment to autonomy is far more vital than the term "bioethics" commonly suggests. Tracing the impact of this principle on clinical encounters over the past 25 years makes apparent that consumers have extended their influence over a wide range of treatment decisions. This influence is now being reinforced by an extraordinary information revolution, which includes the computer, the web, the dot.coms, the search engines, and such novel practices as Direct-to-Consumer advertising by pharmaceutical companies. The impact of these developments may be seen in such diverse issues as physician-assisted suicide and the failure of national health insurance initiatives.

Patients' willingness to pay for electronic communication with their general practitioner.

PubMed

Bergmo, Trine Strand; Wangberg, Silje Camilla

2007-06-01

Despite the common use of electronic communication in other aspects of everyday life, its use between patients and health care providers has been slow to diffuse. Possible explanations are security issues and lack of payment mechanisms. This study investigated how patients value secure electronic access to their general practitioner (GP). One hundred and ninety-nine patients were asked an open-ended willingness-to-pay (WTP) question as part of a randomised controlled trial. We compared the WTP values between two groups of respondents; one group had had the opportunity to communicate electronically with their GP for a year and the other group had not. Fifty-two percent of the total sample was willing to pay for electronic GP contact. The group of patients with access revealed a significantly lower WTP than the group without such access. Possible explanations are that the system had fewer benefits than expected, a presence of hypothetical bias or simply a preference for face-to-face encounters.

Stability of pharmaceutical salts in solid oral dosage forms.

PubMed

Nie, Haichen; Byrn, Stephen R; Zhou, Qi Tony

2017-08-01

Using pharmaceutical salts in solid dosage forms can raise stability concerns, especially salt dissociation which can adversely affect the product performance. Therefore, a thorough understanding of the salt instability encountered in solid-state formulations is imperative to ensure the product quality. The present article uses the fundamental theory of acid base, ionic equilibrium, relationship of pH and solubility as a starting point to illustrate and interpret the salt formation and salt disproportionation in pharmaceutical systems. The criteria of selecting the optimal salt form and the underlying theory of salt formation and disproportionation are reviewed in detail. Factors influencing salt stability in solid dosage forms are scrutinized and discussed with the case studies. In addition, both commonly used and innovative strategies for preventing salt dissociations in formulation, on storage and during manufacturing will be suggested herein. This article will provide formulation scientists and manufacturing engineers an insight into the mechanisms of salt disproportionation and salt formation, which can help them to avoid and solve the instability issues of pharmaceutical salts in the product design.

Progress in overcoming the chain association issue in bispecific heterodimeric IgG antibodies

PubMed Central

Klein, Christian; Sustmann, Claudio; Thomas, Markus; Stubenrauch, Kay; Croasdale, Rebecca; Schanzer, Jürgen; Brinkmann, Ulrich; Kettenberger, Hubert; Regula, Jörg T.; Schaefer, Wolfgang

2012-01-01

The development of bispecific antibodies has attracted substantial interest, and many different formats have been described. Those specifically containing an Fc part are mostly tetravalent, such as stabilized IgG-scFv fusions or dual-variable domain (DVD) IgGs. However, although they exhibit IgG-like properties and technical developability, these formats differ in size and geometry from classical IgG antibodies. Thus, considerable efforts focus on bispecific heterodimeric IgG antibodies that more closely mimic natural IgG molecules. The inherent chain association problem encountered when producing bispecific heterodimeric IgG antibodies can be overcome by several methods. While technologies like knobs-into-holes (KiH) combined with a common light chain or the CrossMab technology enforce the correct chain association, other approaches, e.g., the dual-acting Fab (DAF) IgGs, do not rely on a heterodimeric Fc part. This review discusses the state of the art in bispecific heterodimeric IgG antibodies, with an emphasis on recent progress. PMID:22925968

Psychiatric education in the correctional setting: challenges and opportunities.

PubMed

Holoyda, Brian J; Scott, Charles L

2017-02-01

As the need for mental healthcare services within correctional settings in the US increases, so does the need for a mental health workforce that is motivated to work within such systems. One potentially effective method by which to increase the number of psychiatrists working in jails, prisons, and parole clinics is to provide exposure to these environments during their training. Correctional settings can serve as unique training sites for medical students and psychiatric residents and fellows. Such training experiences can provide a host of benefits to both trainees and staff within the correctional mental health system. Alongside many potential benefits exist substantial potential barriers to coordinating correctional training experiences, including both programme directors' and residents' concerns regarding safety and enjoyment and negative perceptions of inmate and prisoner patients. The establishment of academic affiliations with correctional institutions and didactic instruction on commonly encountered clinical issues with inmate populations may be methods of diffusing these concerns. Improving residents' and fellows' training experiences offers a hope for increasing the attractiveness of a career in correctional psychiatry.

Quantitative evidence of the continuing significance of race: tableside racism in full-service restaurants.

PubMed

Brewster, Zachary W; Rusche, Sarah Nell

2012-01-01

Despite popular claims that racism and discrimination are no longer salient issues in contemporary society, members of racially underrepresented groups continue to experience disparate treatment in everyday public interactions. The context of full-service restaurants is one such public setting wherein African Americans, in particular, encounter racial prejudices and discriminatory treatment. To further understand the pervasiveness of such anti-Black attitudes and actions within the restaurant context, this article analyzes primary survey data derived from a community sample of servers (N = 200). Participants were asked a series of questions ascertaining information about the racial climate of their workplaces. Findings reveal substantial server negativity toward African Americans' tipping and dining behaviors. Racialized discourse and discriminatory behaviors are also shown to be quite common in the restaurant context. The anti-Black attitudes and actions that the authors document in this research are illustrative of the continuing significance of race in contemporary society, and the authors encourage further research on this relatively neglected area of inquiry.

An exploration of attitudes towards pedigree dogs and their disorders as expressed by a sample of companion animal veterinarians in New Zealand.

PubMed

Farrow, T; Keown, A J; Farnworth, M J

2014-09-01

To explore veterinary perceptions of inherited disorders in pedigree dogs within New Zealand and how these affect animal health and welfare. An online questionnaire was distributed to the 647 members of the Companion Animal Society of the New Zealand Veterinary Association using an online survey system. The questionnaire collected details of practitioners, pedigree dog breeds and disorders most often encountered in practice, and responses to questions and statements regarding inherited disorders and pedigree dogs. Of the 216 respondents, 194 (89.8%) believed inherited disorders in dogs were a significant issue. The most commonly identified breeds presenting with inherited disorders were Boxer, Bulldog and German Shepherd dog. The most commonly reported inherited disorders were hip dysplasia, brachycephalic syndromes and elbow dysplasia. Of 207 respondents, 100 (48.3%) had advised clients against purchasing a pedigree dog due to common inherited disorders and 183 (85.6%) considered the health and welfare of some breeds to be too compromised to continue breeding. Of 199 respondents, 132 (66.3%) reported seeing no change in prevalence of inherited conditions, 103/204 (50.5%) reported seeing a positive change in attitudes towards inherited disorders among dog owners, and 81/207 (39.1%) thought legislative support would help decrease inherited disorders in pedigree dogs. Attitudes were not associated with time since graduation or ownership of a New Zealand Kennel Club registered breed of dog. The most common suggestions to decrease prevalence of inherited disorders were to alter breed standards, educate public or buyers and compulsory genetic testing. Among respondents, veterinarians considered inherited disorders as significant issues in a number of pedigree breeds. Veterinarians were concerned about inherited disorders in pedigree dogs, felt they had an obligation to treat such animals and were supportive of measures to make genetic testing for inheritable disorders a requirement for registration of pedigree breeds. Prevalence and perceived importance of inherited disorders influences how clinicians advise their clients. Respondents to this survey provided a number of mechanisms by which inherited disorders may be managed and these could form the basis of future discussions within the profession.

Reliability issues in PACS

NASA Astrophysics Data System (ADS)

Taira, Ricky K.; Chan, Kelby K.; Stewart, Brent K.; Weinberg, Wolfram S.

1991-07-01

Reliability is an increasing concern when moving PACS from the experimental laboratory to the clinical environment. Any system downtime may seriously affect patient care. The authors report on the several classes of errors encountered during the pre-clinical release of the PACS during the past several months and present the solutions implemented to handle them. The reliability issues discussed include: (1) environmental precautions, (2) database backups, (3) monitor routines of critical resources and processes, (4) hardware redundancy (networks, archives), and (5) development of a PACS quality control program.

Ethical Issues in Providing Online Psychotherapeutic Interventions

PubMed Central

2000-01-01

The Internet offers psychotherapists a new communication medium through which they can deliver psychotherapeutic interventions that are appropriate to the medium. Yet online psychotherapy also offers new ethical challenges for therapists interested in providing online psychotherapeutic services. The differences between interactive text-based communication and in-person verbal communication create new ethical challenges not previously encountered in face-to-face therapy. This article will examine the Internet's potential for providing online psychotherapeutic interventions and will review the ethical issues involved with providing interactive text-based psychotherapy. PMID:11720924

Database of non-canonical base pairs found in known RNA structures

NASA Technical Reports Server (NTRS)

Nagaswamy, U.; Voss, N.; Zhang, Z.; Fox, G. E.

2000-01-01

Atomic resolution RNA structures are being published at an increasing rate. It is common to find a modest number of non-canonical base pairs in these structures in addition to the usual Watson-Crick pairs. This database summarizes the occurrence of these rare base pairs in accordance with standard nomenclature. The database, http://prion.bchs.uh.edu/, contains information such as sequence context, sugar pucker conformation, anti / syn base conformations, chemical shift, p K (a)values, melting temperature and free energy. Of the 29 anticipated pairs with two or more hydrogen bonds, 20 have been encountered to date. In addition, four unexpected pairs with two hydrogen bonds have been reported bringing the total to 24. Single hydrogen bond versions of five of the expected geometries have been encountered among the single hydrogen bond interactions. In addition, 18 different types of base triplets have been encountered, each of which involves three to six hydrogen bonds. The vast majority of the rare base pairs are antiparallel with the bases in the anti configuration relative to the ribose. The most common are the GU wobble, the Sheared GA pair, the Reverse Hoogsteen pair and the GA imino pair.

That sinking feeling: Suspended sediments can prevent the ascent of coral egg bundles

PubMed Central

Ricardo, Gerard F.; Jones, Ross J.; Negri, Andrew P.; Stocker, Roman

2016-01-01

Spawning synchrony represents a common reproductive strategy in sessile marine organisms and for broadcast spawning corals, buoyancy of egg-sperm bundles is critical to maximise fertilisation at the ocean surface. Here we demonstrate a novel threat to coral reproduction whereby buoyant egg-sperm bundles intercept and are “ballasted” by sediment grains on their journey to the ocean surface, preventing them from reaching the ocean surface and greatly reducing egg-sperm encounter rates. Empirical observations of this mechanism are successfully captured by a mathematical model that predicts the reduction in ascent probability and egg-sperm encounters as a function of sediment load. When applied to 15 m deep reefs, the model predicts that 10% and 50% reductions in egg-sperm encounters occur at 35 mg L−1 and 87 mg L−1 suspended sediment concentrations, respectively, and for a 5 m deep reef a 10% reduction occurs at 106 mg L−1. These concentrations are commonly associated with sediment plumes from dredging or natural resuspension events. The potential for sediments to sink coral gametes highlights the need to carefully manage the timing of turbidity-generating human activities near reefs during spawning periods. PMID:26898352

That sinking feeling: Suspended sediments can prevent the ascent of coral egg bundles.

PubMed

Ricardo, Gerard F; Jones, Ross J; Negri, Andrew P; Stocker, Roman

2016-02-22

Spawning synchrony represents a common reproductive strategy in sessile marine organisms and for broadcast spawning corals, buoyancy of egg-sperm bundles is critical to maximise fertilisation at the ocean surface. Here we demonstrate a novel threat to coral reproduction whereby buoyant egg-sperm bundles intercept and are "ballasted" by sediment grains on their journey to the ocean surface, preventing them from reaching the ocean surface and greatly reducing egg-sperm encounter rates. Empirical observations of this mechanism are successfully captured by a mathematical model that predicts the reduction in ascent probability and egg-sperm encounters as a function of sediment load. When applied to 15 m deep reefs, the model predicts that 10% and 50% reductions in egg-sperm encounters occur at 35 mg L(-1) and 87 mg L(-1) suspended sediment concentrations, respectively, and for a 5 m deep reef a 10% reduction occurs at 106 mg L(-1). These concentrations are commonly associated with sediment plumes from dredging or natural resuspension events. The potential for sediments to sink coral gametes highlights the need to carefully manage the timing of turbidity-generating human activities near reefs during spawning periods.

The Rules of the Game

ERIC Educational Resources Information Center

Tay, Lee Yong; Lim, Cher Ping

2012-01-01

This response to Rachel Muehrer, Jennifer Jenson, Jeremy Friedberg and Nicole Husain's paper, "Challenges and opportunities: Using a science-based video game in secondary school settings," explores the issues encountered while a science-based video game is introduced in secondary school settings. It highlights the importance of the context, the…

The Brown University Child and Adolescent Behavior Letter, 1997.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1997-01-01

These 12 monthly issues, one special report, and index from 1997 explore problems encountered by children and adolescents. Regular features include "Keep Your Eye On...," brief accounts of research into childhood and adolescent problems; "What's New in Research," summarizing research from recent publications and professional…

Encounters and Places: Project Negotiations in Galessa, Ethiopia

ERIC Educational Resources Information Center

Habermann, Birgit; Felt, Ulrike; Vogl, Christian R.; Bekele, Kassahun; Mekonnen, Kindu

2012-01-01

Purpose: Reflections on negotiation processes between farmers and scientists in research projects provide insights into issues of participation, power and equity. The purpose of this paper is to illustrate how actors chose places to meet, negotiate and represent technologies. Design/methodology/approach: The research involved semi-structured…

Mathematics Teacher Professional Development as a Virtual Boundary Encounter

ERIC Educational Resources Information Center

Matranga, Anthony Vincent

2017-01-01

Mathematics instruction in US schools is largely inconsistent with visions of research and policy, which suggest instruction should be student-centered, maintain high levels of cognitive demand, and support rich mathematical discussion and argumentation. Professional development (PD) figures prominently in addressing this issue, and studies have…

An Ethnographic Diary Study

ERIC Educational Resources Information Center

Hall, Graham

2008-01-01

This article examines a small-scale ethnographic survey of a single classroom. Drawing on the collected data, the discussion focuses on some of the problems encountered whilst collecting and interpreting data through self-report diaries. Amongst the issues considered are the perceptions of teachers and learners and their ability to articulate…

Internet and Computer Technology Hazards: Perspectives for Family Counselling.

ERIC Educational Resources Information Center

Oravec, Jo Ann

2000-01-01

Explores the social construction of the various computer hazards that households are encountering, such as computer addiction and children's access to on-line pornography. Discusses these issues in terms of constructivist counseling perspectives that are sensitive to cultural and environmental contexts. Outlines specific strategies for countering…

Interdisciplinarity within an Academic Career

ERIC Educational Resources Information Center

Blackmore, Paul; Kandiko, Camille B.

2011-01-01

This project identified academics who have been involved with interdisciplinary leadership initiatives and sought to find out what had motivated them, what issues they had encountered and how they had resolved them. A powerful message emerging is the central importance of motivation in interdisciplinary work. Interviewees spoke of leaving their…

Managing Curriculum Change and "Ontological Uncertainty" in Tertiary Education

ERIC Educational Resources Information Center

Keesing-Styles, Linda; Nash, Simon; Ayres, Robert

2014-01-01

Curriculum reform at institutional level is a challenging endeavour. Those charged with leading this process will encounter both enthusiasm and multiple obstacles to teacher engagement including the particularly complex issue of confronting existing teacher identities. At Unitec Institute of Technology (Unitec), the "Living Curriculum"…

Engineering Encounters: Building a Spaghetti Structure

ERIC Educational Resources Information Center

Llewellyn, Douglas; Pray, Sandra; DeRose, Rob; Ottman, William

2016-01-01

This column presents ideas and techniques to enhance science teaching. In this month's issue an upper elementary Science, technology, engineering, and math (STEM) challenge brings an engineer into the classroom while emphasizing cooperation, communication, and creativity. STEM activities come in various shapes and sizes. Some are quite involved…

Examining Dissatisfaction with an Online Doctoral Program

ERIC Educational Resources Information Center

Fenby, Frank

2006-01-01

Background: Online learning community based education is still new. As institutions implement new programs they can encounter learner satisfaction issues. Purpose: To investigate learner unhappiness during the second semester of a new online doctoral program and develop a substantive grounded theory concerning its cause(s). Setting: The Doctorado…

The Case of Jessica Chang.

ERIC Educational Resources Information Center

Chen, Stephen; Leong, Frederick T. L.

1997-01-01

Reports on a case study that explores the culture-related issues of Asian Americans in the workplace. Focuses on a young, second-generation, Chinese-American woman, Jessica Chang, and the employment challenges that Dr. Chang encountered. Discusses her job strategies and some of the ethical dilemmas that she faced. (RJM)

Management Training for Directors.

ERIC Educational Resources Information Center

Yaptinchay, Karen

1998-01-01

Describes a management program for Head Start directors called the Head Start-Johnson & Johnson Management Fellows program that focuses on issues and problems encountered by directors in implementing and operating programs at the local level. Notes that the management program represents a response to increasing need for cost-effective and…

War, Terrorism, and Children

ERIC Educational Resources Information Center

DeRanieri, Joseph T.; Clements, Paul T.; Clark, Kathleen; Kuhn, Douglas Wolcik; Manno, Martin S.

2004-01-01

Many caregivers are encountering the issue of communicating with children and adolescents about current world events, specifically war and terrorism. As health care providers, it is important to raise awareness of how children may understand, interpret, and respond to related fears and concerns. Although honesty and reassurance are clearly the…

Stellar encounters involving neutron stars in globular cluster cores

NASA Technical Reports Server (NTRS)

Davies, M. B.; Benz, W.; Hills, J. G.

1992-01-01

Encounters between a 1.4 solar mass neutron star and a 0.8 solar mass red giant (RG) and between a 1.4 solar mass neutron star (NS) and an 0.8 solar mass main-sequence (MS) star have been successfully simulated. In the case of encounters involving an RG, bound systems are produced when the separation at periastron passage R(MIN) is less than about 2.5 R(RG). At least 70 percent of these bound systems are composed of the RG core and NS forming a binary engulfed in a common envelope of what remains of the former RG envelope. Once the envelope is ejected, a tight white dwarf-NS binary remains. For MS stars, encounters with NSs will produce bound systems when R(MIN) is less than about 3.5 R(MS). Some 50 percent of these systems will be single objects with the NS engulfed in a thick disk of gas almost as massive as the original MS star. The ultimate fate of such systems is unclear.

Management of new hyperglycemia in patients prescribed antipsychotics.

PubMed

Viverito, Kristen; Owen, Richard; Mittal, Dinesh; Li, Chenghui; Williams, James Silas

2014-12-01

This study examined the extent to which patients found to have clinically significant hyperglycemia after beginning a new antipsychotic receive guideline concordant management. This retrospective cohort analysis (N=403) used U.S. Department of Veterans Affairs databases and multivariable logistic regression models to examine the association of patient characteristics with the likelihood of receiving recommended management. Overall, 63% of patients (N=254) received at least one type of management action within 30 days of identification of hyperglycemia. A primary care encounter was the most common action. Weight management program encounter, nutrition encounter, diabetes clinic encounter, and change in antipsychotic medications were underutilized interventions. Counseling related to weight management, nutrition, and diabetes that occurred during other visits with providers was not measured. Older patients and female patients were less likely to receive timely management. Preexisting comorbidities inconsistently influenced management practices. Timely hyperglycemia management actions were not recorded in administrative data for a sizable minority of patients. Further research is needed to determine the full extent of appropriate management actions in this context.

Border Injuries: An Analysis of Prehospital Demographics, Mechanisms, and Patterns of Injuries Encountered by USBP EMS Agents in the El Paso (Texas USA) Sector.

PubMed

Baker, Russell A

2017-08-01

Study Objective The aim of this study was to evaluate Emergency Medical Services (EMS), use, injury mechanisms, prehospital assessments, and injuries among those receiving aid from the United States Border Patrol (USBP) in the El Paso (Texas USA) Sector. This is a time-series, retrospective analysis of all prehospital data for injuries among patients receiving care from USBP EMS on the US Mexico border in the El Paso sector from February 6, 2014 to February 6, 2016. A total of 473 documented EMS encounters occurred in this two-year period and demonstrated a male gender predominance (male 63%; female 37%) with the most prominent ages between 22-40 years old. The most prevalent EMS call types were medical (55%) and trauma (42%). The most common chief complaints were an injured or painful extremity (35%) and rash (13%). The most common USBP EMS provider primary impression was traumatic injury (34%), followed by fever/infection (17%) and extremity injury (7%); however, the most common secondary impression was also extremity injury (20%). The most common mechanism of injury was fall (26%) and motor vehicle accident (MVA; 22%). The USBP EMS was the first provider on scene in 96% of the MVAs. The author reports on injury patterns, mechanisms, chief complaints, EMS impressions, as well as demographics of patients reporting to USBP EMS. A knowledge of these injury patterns will be useful to EMS administrators and physicians along the US Mexico border. Baker RA . Border injuries: an analysis of prehospital demographics, mechanisms, and patterns of injuries encountered by USBP EMS agents in the El Paso (Texas USA) Sector. Prehosp Disaster Med. 2017;32(4):431-436.

Issues in Hypertriglyceridemic Pancreatitis - An Update

PubMed Central

Scherer, John; Singh, Vijay; Pitchumoni, C. S; Yadav, Dhiraj

2014-01-01

Hypertriglyceridemia (HTG) is a well established but underestimated cause of acute (AP) and recurrent AP (RAP). The clinical presentation of HTG-induced pancreatitis (HTG pancreatitis) is similar to other causes. Pancreatitis secondary to HTG is typically seen in the presence of one or more secondary factors (uncontrolled diabetes, alcoholism, medications, pregnancy) in a patient with an underlying common genetic abnormality of lipoprotein metabolism (Familial combined hyperlipidemia or Familial HTG). Less commonly, a patient with rare genetic abnormality (Familial chylomicronemic syndrome) with or without an additional secondary factor is encountered. The risk of AP in patients with serum triglycerides >1000 mg/dl and >2000 mg/dl is ∼5% and 10-20% respectively. It is not clear whether HTG pancreatitis is more severe than when it is due to other causes. Clinical management of HTG pancreatitis is similar to that of other causes. Insulin infusion in diabetic patients with HTG can rapidly reduce triglyceride levels. Use of apheresis is still experimental and better designed studies are needed to clarify its role in management of HTG pancreatitis. Diet, lifestyle changes, control of secondary factors are key to the treatment and medications are useful adjuncts to long term management of triglyceride levels. Control of triglyceride levels to well below 500 mg/dl can effectively prevent recurrences of pancreatitis. PMID:24172179

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.

Model-Based Knowing: How Do Students Ground Their Understanding About Climate Systems in Agent-Based Computer Models?

NASA Astrophysics Data System (ADS)

Markauskaite, Lina; Kelly, Nick; Jacobson, Michael J.

2017-12-01

This paper gives a grounded cognition account of model-based learning of complex scientific knowledge related to socio-scientific issues, such as climate change. It draws on the results from a study of high school students learning about the carbon cycle through computational agent-based models and investigates two questions: First, how do students ground their understanding about the phenomenon when they learn and solve problems with computer models? Second, what are common sources of mistakes in students' reasoning with computer models? Results show that students ground their understanding in computer models in five ways: direct observation, straight abstraction, generalisation, conceptualisation, and extension. Students also incorporate into their reasoning their knowledge and experiences that extend beyond phenomena represented in the models, such as attitudes about unsustainable carbon emission rates, human agency, external events, and the nature of computational models. The most common difficulties of the students relate to seeing the modelled scientific phenomenon and connecting results from the observations with other experiences and understandings about the phenomenon in the outside world. An important contribution of this study is the constructed coding scheme for establishing different ways of grounding, which helps to understand some challenges that students encounter when they learn about complex phenomena with agent-based computer models.

Outpatient Palliative Cardiology Service Embedded Within a Heart Failure Clinic: Experiences With an Emerging Model of Care.

PubMed

Gandesbery, Benjamin; Dobbie, Krista; Gorodeski, Eiran Z

2018-04-01

The role of palliative care consultation in the outpatient treatment of patients with symptomatic heart failure (HF) is poorly studied. In August 2015, we created an outpatient palliative care service embedded within the HF clinic at Cleveland Clinic main campus. To characterize patients cared for by our novel outpatient palliative cardiology service, including their degree of HF, symptoms, comorbidities, topics addressed in clinic, palliative treatments prescribed, advanced directives status, and mortality. We conducted a retrospective chart review of all patients evaluated by this outpatient service. Eighty patients were seen in 229 outpatient encounters. The most commonly reported symptoms were tiredness (74%), pain (64%), dyspnea (57%), drowsiness (45%), anxiety (45%), and depression (43%). The most frequently addressed issues were pain management (55%) and advanced care planning (54%). The most common palliative medications prescribed in palliative care clinic were opiates (48%), laxatives (22%), antineuropathics (22%), and antidepressants (16%). The 1-year survival rate was 70% (CI 65-75%). Embedding palliative medicine services in an HF outpatient clinic is feasible. Patients seen in this setting had an array of quality-of-life limiting symptoms and were medically managed with several interventions familiar to palliative medicine specialists. Outpatients with chronic HF have a significant symptom burden and may benefit from outpatient specialist palliative care.

What inhibits working women with mental disorders from returning to their workplace?-A study of systematic re-employment support in a medical institution.

PubMed

Hayashi, Karin; Taira, Yoichi; Maeda, Takamitsu; Matsuda, Yumie; Kato, Yuki; Hashi, Kozue; Kuroki, Nobuo; Katsuragawa, Shuichi

2016-01-01

It has been customary for working women in Japan to retire when they marry and to devote themselves to household work as well as having children. However, according to a report published by the Ministry of Internal Affairs and Communications in 2013, the number of working women has increased consistently. As more women are advancing into society, they have more options with respect to lifestyle but may encounter new psychological burdens. Therefore, we reviewed trends among participants in a re-work day care program (hereinafter referred to as "re-work program") to clarify various problems encountered by working women and the prevalence of mental disorders. A total of 454 participants (352 males, mean age 46.5 ± 9.4 years; 102 females, mean age 39.8 ± 9.4 years) who participated in our re-work program were included in this study. We reviewed their basic characteristics: life background, clinical diagnoses, outcomes after use of the re-work program, and reasons for failing to return to the workplace or start working where applicable. The number of female participants was small and accounted for less than one fourth of all participants. As many as 67.3 % of the males succeeded in returning to the workplace, but only 48.0 % of the females were successful. The most common reason for failing to return to the workplace in both sexes was the exacerbation of symptoms; among females, other reasons, such as pregnancy, marriage, and family circumstances, were observed occasionally, but these reasons were not reported by the males. We found that female-specific problems were not the only issue, but rather work-life balance, relationships in the workplace, and gender differences in work roles could also trigger psychiatric disorders. A deeper understanding of the problems encountered by women in the workforce is important for the treatment of their psychiatric disorders. Therefore, it is considered essential for family members, co-workers, medical staff, and others to understand the various problems encountered by working women. Coping with these problems appropriately will aid in treating mental disorders and creating an environment suitable to prevent their development among women.

Field Evaluation of Temperature Differential in HMA Mixtures

DOT National Transportation Integrated Search

2012-05-15

Segregation is a common occurrence in hot mix asphalt (HMA) construction. The two types of : segregation encountered are gradation segregation and thermal segregation. This investigation report : involves mainly thermal segregation, which occurs when...

Data Overview: Overview of an Epidemic

MedlinePlus

... the Epidemic Commonly Used Terms Prescription Opioids Heroin Fentanyl Data Opioid Data Analysis Drug Overdose Death Data ... Overdose Data Heroin Overdose Data Synthetic Opioid Data Fentanyl Encounters Data Overdose Prevention Improve Opioid Prescribing Prevent ...

Exploring the effects of individual customer incivility encounters on employee incivility: the moderating roles of entity (in)civility and negative affectivity.

PubMed

Walker, David D; van Jaarsveld, Danielle D; Skarlicki, Daniel P

2014-01-01

Incivility between customers and employees is common in many service organizations. These encounters can have negative outcomes for employees, customers, and the organization. To date, researchers have tended to study incivility as an aggregated and accumulated phenomenon (entity perspective). In the present study, we examined incivility as it occurs during a specific service encounter (event perspective) alongside the entity perspective. Using a mixed-method multilevel field study of customer service interactions, we show that individual customer incivility encounters (i.e., events) trigger employee incivility as a function of the employee's overall accumulated impression of the (in)civility in his or her customer interactions, such that the effects are more pronounced among employees who generally perceive their customer interactions to be more versus less civil. We also find that these interactive effects occur only among employees who are lower (vs. higher) in negative affectivity. Our results show that, in order to expand the understanding of customer incivility, it is important to study the incivility encounter, the social context in which negative customer interactions occur, and individual differences. PsycINFO Database Record (c) 2014 APA, all rights reserved

Patients' and relatives' complaints about encounters and communication in health care: evidence for quality improvement.

PubMed

Jangland, Eva; Gunningberg, Lena; Carlsson, Maria

2009-05-01

The aim of this study was to describe patients' and relatives' complaints to the local Patients' Advisory Committee about their encounters and communication in health care. Complaints (n=105) regarding patients' and relatives' dissatisfaction with communication and encounters in health care, registered at a local Patients' Advisory Committee between 2002 and 2004, were included. The texts were analysed using content analysis. Three categories were identified: "Not receiving information or being given the option to participate", "Not being met in a professional manner" and "Not receiving nursing or practical support". Insufficient information, insufficient respect and insufficient empathy were described as the most common reasons for a negative professional encounter. Patients and relatives experienced unnecessary anxiety and reduced confidence in health care after negative professional encounters. The complaints reported to the Patients' Advisory Committee could be used more effectively in health care and be regarded as important evidence when working with quality improvement. To systematically use patient stories, such as those obtained in this report, as a reflective tool in education and supervision could be one way to improve communication and bring new understanding about the patient's perspective in health care.

Extramedullary plasmacytoma in the carotid space: Expanding the differential diagnosis.

PubMed

Deshpande, Sneha Satish; Kane, Shubhada; Arya, Supreeta

2014-10-01

Plasma cell neoplasms have been classified into various types, with a range of clinical and radiological presentations. Extramedullary plasmacytoma (EMP) is a subset of plasma cell neoplasms which presents as an isolated non-osseous soft tissue mass. Though carotid space neoplasms are commonly encountered, EMP in the carotid space is rare and seldom considered in the initial differential diagnosis of a carotid space mass. These tumors can be treated by surgery or radiotherapy. On the other hand, the commonly encountered tumors in the carotid space are treated surgically. Also, it is mandatory to exclude multiple myeloma in the patients presenting with EMP. Hence, accurate and early diagnosis has therapeutic and prognostic implications. We report a rare case of EMP of the carotid space, describing the imaging features and the differential diagnoses with clues pointing to this rare entity.

Chimpanzee responses to researchers in a disturbed forest-farm mosaic at Bulindi, western Uganda.

PubMed

McLennan, Matthew R; Hill, Catherine M

2010-09-01

We describe the behavior of a previously unstudied community of wild chimpanzees during opportunistic encounters with researchers in an unprotected forest-farm mosaic at Bulindi, Uganda. Data were collected during 115 encounters between May 2006 and January 2008. Individual responses were recorded during the first minute of visual contact. The most common responses were "ignore" for arboreal chimpanzees and "monitor" for terrestrial individuals. Chimpanzees rarely responded with "flight". Adult males were seen disproportionately often relative to adult females, and accounted for 90% of individual responses recorded for terrestrial animals. Entire encounters were also categorized based on the predominant response of the chimpanzee party to researcher proximity. The most frequent encounter type was "ignore" (36%), followed by "monitor" (21%), "intimidation" (18%) and "stealthy retreat" (18%). "Intimidation" encounters occurred when chimpanzees were contacted in dense forest where visibility was low, provoking intense alarm and agitation. Adult males occasionally acted together to repel researchers through aggressive mobbing and pursuit. Chimpanzee behavior during encounters reflects the familiar yet frequently agonistic relationship between apes and local people at Bulindi. The chimpanzees are not hunted but experience high levels of harassment from villagers. Human-directed aggression by chimpanzees may represent a strategy to accommodate regular disruptions to foraging effort arising from competitive encounters with people both in and outside forest. Average encounter duration and proportion of encounters categorized as "ignore" increased over time, whereas "intimidation" encounters decreased, indicating some habituation occurred during the study. Ecotourism aimed at promoting tolerance of wildlife through local revenue generation is one possible strategy for conserving great apes on public or private land. However, the data imply that habituating chimpanzees for viewing-based ecotourism in heavily human-dominated landscapes, such as Bulindi, is ill-advised since a loss of fear of humans could lead to increased negative interactions with local people. 2010 Wiley-Liss, Inc.

Law and Marketing: Implications for the Secondary Curriculum.

ERIC Educational Resources Information Center

Beck-Dudley, Caryn L.; Stull, William A.

1990-01-01

Provides a basic understanding of some of the legal issues that should be included in a secondary education marketing curriculum. Teaching legal concepts in the areas of contract, antitrust, agency, employment law, and finance is an excellent way to introduce students to legal problems they may encounter in business. (Author)

A White Teacher Talks about Race.

ERIC Educational Resources Information Center

Landsman, Julie

In this book, a veteran teacher examines a typical day of teaching and reflects on her work with high school students from a variety of cultures, speaking honestly about issues of race, poverty, institutional responsibility, and white privilege by describing her experiences in the classroom. Throughout the day, she encounters bigotry, deals with…

Performing Prodigals and Dissident Acolytes: Supporting Queer Postgraduates in the Visual Arts

ERIC Educational Resources Information Center

Ings, Welby

2015-01-01

Supervisors supporting queer individuals engaged in postgraduate research in Visual Arts face a number of issues. Beyond concerns with balancing the autobiographical and the scholarly, a supervisor may also encounter questions relating to safety, identity, tokenism, exoticisation and the pressure candidates feel to develop work that has…

Rethinking What Is Entrepreneurship Education: A Macro Integrative Perspective

ERIC Educational Resources Information Center

Wu, Hongyun; Gu, Jibao

2017-01-01

Research on entrepreneurship education (EE) has encountered confusing ontological and methodological issues, such as definitional controversy, gaps between research and practice, and lack of theoretical foundations. These are factors holding back the further development of the research and practice in this field. This paper presents a whole…

Complementing Lecturing as Teaching Pedagogy and Students' Learning Styles in Universities in Tanzania: State of Issues

ERIC Educational Resources Information Center

Mbalamula, Yazidu Saidi

2017-01-01

Lecturing remains a popular and predominant teaching pedagogy in Higher Education Institutions and Tanzanian universities are no exception. However, due to increase in enrollments, lecturing encounters serious challenges as burgeoning diverse nature of students' learning needs associated with physiological, psychological, professional and…

Engineering Encounters: An Engineering Design Process for Early Childhood

ERIC Educational Resources Information Center

Lottero-Perdue, Pamela; Bowditch, Michelle; Kagan, Michelle; Robinson-Cheek, Linda; Webb, Tedra; Meller, Megan; Nosek, Theresa

2016-01-01

This column presents ideas and techniques to enhance your science teaching. This month's issue shares information about trying (again) to engineer an egg package. Engineering is an essential part of science education, as emphasized in the "Next Generation Science Standards" (NGSS Lead States 2013). Engineering practices and performance…

Methodological and Ethical Considerations in a Life History Study of Teacher Thinking.

ERIC Educational Resources Information Center

Muchmore, James A.

This paper discusses some of the methodological and ethical issues that one educational researcher encountered throughout his work, focusing on the importance of understanding teachers' thinking from their perspective (an insider looking out rather than an outsider looking in). It highlights a collaborative research relationship that the…

Mathematics & Economics: Connections for Life, Grades 6-8.

ERIC Educational Resources Information Center

Hoff, Jody; McCorkle, Sarapage; Suiter, Mary; Bettendorf, James; Breidenbach, Lisa; Cornwell, Pamela

This book contains a set of 12 lessons for middle school students that demonstrate how mathematical processes and concepts may be applied to the study of economics and personal finance. Mathematics educators can find lessons connecting mathematics instruction to practical problems and issues that students encounter throughout their life. The…

Designing for Learner Engagement with Computer Based Testing

ERIC Educational Resources Information Center

Walker, Richard; Handley, Zoe

2016-01-01

The issues influencing student engagement with high-stakes computer-based exams were investigated, drawing on feedback from two cohorts of international MA Education students encountering this assessment method for the first time. Qualitative data from surveys and focus groups on the students' examination experience were analysed, leading to the…

Enabling Integration in Sports for Adolescents with Intellectual Disabilities

ERIC Educational Resources Information Center

Grandisson, Marie; Tetreault, Sylvie; Freeman, Andrew R.

2012-01-01

Background: Promoting the health and social participation of adolescents with intellectual disability is important as they are particularly vulnerable to encountering difficulties in those areas. Integration of these individuals in integrated sports is one strategy to address this issue. Methods: The main objective of this study was to gain a…

Confronting Globalisation: Learning from Intercontinental Collaboration

ERIC Educational Resources Information Center

Larsson, Staffan; Boud, David; Dahlgren, Madeleine Abrandt; Walters, Shirley; Sork, Tom

2005-01-01

Higher education institutions are responding to globalisation in various ways. This study describes and analyses challenges encountered in a recent case of global collaboration between four universities on different continents in developing a web-based master's program. The key issue was how to develop programs in a way that is fair for the…

Five Approaches to Avoid When Managing the Middle School Classroom

ERIC Educational Resources Information Center

Englehart, Joshua M.

2013-01-01

Too often, teachers encountering difficulties with classroom management focus only on the students rather than critically examining the influence of their own approaches on student behavior. Given the particular challenges that middle school students present, certain practices and expectations exacerbate management issues, and a lack of awareness…

Disrupting Qualitative Inquiry: Possibilities and Tensions in Educational Research. Critical Qualitative Research. Volume 10

ERIC Educational Resources Information Center

Brown, Ruth Nicole, Ed.; Carducci, Rozana, Ed.; Kuby, Candace R., Ed.

2014-01-01

"Disrupting Qualitative Inquiry" is an edited volume that examines the possibilities and tensions encountered by scholars who adopt disruptive qualitative approaches to the study of educational contexts, issues, and phenomena. It presents a collection of innovative and intellectually stimulating chapters which illustrate the potential…

School Reentry for the Child with Chronic Illness.

ERIC Educational Resources Information Center

Sexson, Sandra B.; Madan-Swain, Avi

1993-01-01

This article focuses on the issues of reintegrating the chronically ill child into the school setting, the types of school problems encountered, the process of school reentry, (including a successful school reentry plan), and the implications for the school and the family of returning the chronically ill child to school. (DB)

Ethical Challenges in the Teaching of Multicultural Course Work

ERIC Educational Resources Information Center

Fier, Elizabeth Boyer; Ramsey, MaryLou

2005-01-01

The authors explore the ethical issues and challenges frequently encountered by counselor educators of multicultural course work. Existing ethics codes are examined, and the need for greater specificity with regard to teaching courses of multicultural content is addressed. Options for revising existing codes to better address the challenges of…

Impact of Military Deployment and Distance Learning on Soldier-Students

ERIC Educational Resources Information Center

Murray, August T.

2013-01-01

Soldiers face complex challenges, issues, and decisions when pursuing distance learning while deployed. These challenges are encountered frequently while completing undergraduate and graduate degree programs on active duty overseas. Many learning programs and benefits are available and utilized by military online learners in a war zone. Education…

Poststructuralist Readings of the Pedagogical Encounter. Eruptions, Volume 14.

ERIC Educational Resources Information Center

Palermo, James

This book uses leading poststructuralist thinkers to expose the mechanisms that U.S. public schools employ to form subjectivity. Political issues that inform pedagogy such as cultural pluralism, the Deweyan legacy, and feminist classroom strategies are read applying constructs taken from philosophers such as Barthes, Derrida, Foucault, and…

Creating Education That is Multicultural in Preschool and Kindergarten Settings.

ERIC Educational Resources Information Center

Swadener, Elizabeth Blue; Jackson, Mollie M.

In recent years, strategies for multicultural education and human relations have been applied to progressively younger preschool children. This paper identifies five approaches to multicultural education, then goes on to discuss the strengths and weaknesses of the predominant human relations approach. Challenging issues encountered in applying…

Broadband for Public Libraries: Importance, Issues, and Research Needs

ERIC Educational Resources Information Center

Mandel, Lauren H.; Bishop, Bradley Wade; McClure, Charles R.; Bertot, John Carlo; Jaeger, Paul T.

2010-01-01

U.S. public libraries provide free public internet services to the communities that they serve, but require robust, high-speed broadband internet connections to continue meeting public demands. The 2008-2009 "Public Library Funding & Technology Access Study" ("PLFTAS") illustrates challenges that public libraries encounter in achieving broadband…

Encountering Complexity: Native Musics in the Curriculum.

ERIC Educational Resources Information Center

Boyea, Andrea

1999-01-01

Describes Native American musics, focusing on issues such as music and the experience of time, metaphor and metaphorical aspects, and spirituality and sounds from nature. Discusses Native American metaphysics and its reflection in the musics. States that an effective curriculum would provide a new receptivity to Native American musics. (CMK)

Interpersonal Skills Training in a Dental Setting: A Group Interaction Approach.

ERIC Educational Resources Information Center

Eigenbrode, Charles R.

1983-01-01

General curriculum emphases on behavioral science in the first- and second-year dental curriculum culminate in a course on doctor-patient relationships, preparatory to clinic activity. The course includes discussion and essay quizzes about videotape recordings of typical doctor-patient encounters. Topics and issues included are outlined. (MSE)

Engineering Encounters: Reverse Engineering

ERIC Educational Resources Information Center

McGowan, Veronica Cassone; Ventura, Marcia; Bell, Philip

2017-01-01

This column presents ideas and techniques to enhance your science teaching. This month's issue shares information on how students' everyday experiences can support science learning through engineering design. In this article, the authors outline a reverse-engineering model of instruction and describe one example of how it looked in our fifth-grade…

HIV-Positive Athletes. When Medicine Meets the Law.

ERIC Educational Resources Information Center

Mitten, Matthew, J.

1994-01-01

Though the risk of HIV transmission in sports is slight, physicians who treat active patients can encounter weighty legal issues. Mandatory testing, exclusion of HIV-positive athletes, and breaching of patient confidentiality can lead to lawsuits. Knowing the possible consequences can help physicians in setting effective, legal prevention…

Cloning, expression, and purification of a sesquiterpene cyclase from geosmin-producing Oscillatoria splendida

USDA-ARS?s Scientific Manuscript database

The aquaculture industry is a growing part of agriculture worldwide. Many of these systems, primarily closed ones, encounter serious issues with off-flavors. Cyanobacteria are the main producers of the two dominant off-flavor compounds, geosmin and 2-methylisoborneol. In an effort to begin to und...

Ethics in an Online Environment

ERIC Educational Resources Information Center

Mitchell, Regina L. Garza

2009-01-01

The blending of technology and education introduces ethical issues for colleges. In particular, those involved with online education may encounter unique dilemmas that have collegewide implications. In order for ethical decisions to be made in regard to online education, colleges must cultivate a culture of trust, define clearly the correct and…

Teaching Listening Skills to JFL Students in Australia.

ERIC Educational Resources Information Center

Danaher, Mike

1996-01-01

Examines issues affecting the teaching and learning of listening skills within the study of Japanese as a Foreign Language. Listening within foreign-language learning is a complex skill, and students encounter several difficulties in learning to listen for comprehension. Teachers face concerns ranging from resource availability to how to teach…

English Intonation and Computerized Speech Synthesis. Technical Report No. 287.

ERIC Educational Resources Information Center

Levine, Arvin

This work treats some of the important issues encountered in an attempt to synthesize natural sounding English speech from arbitrary written text. Details of the systems that interact in producing speech are described. The principal systems dealt with are phonology (intonation), phonetics, syntax, semantics, and text-view (discourse). Technical…

Helping the Grieving Child in School. Fastback 460.

ERIC Educational Resources Information Center

Goldman, Linda

This booklet provides short treatment options for educators, counselors and others on grief issues that today's youth often face. Children may encounter the trauma of fatal illness, accidents, suicide, homicide, and terrorism that they experience either directly or indirectly through the media. They can also face abuse, divorce, multiple moves,…

Encountering Student Texts: Interpretive Issues in Reading Student Writing.

ERIC Educational Resources Information Center

Lawson, Bruce, Ed.; And Others

Designed to raise the full range of hermeneutic concerns regarding evaluation of student writing, and to spur further research and discussion, this collection of essays focuses on a reconsideration of the interpretation and evaluation practices of writing teachers. Essays include: "A Reflective Conversation: 'Tempos of Meaning'"…

Counseling Older Women: Curriculum Guidelines and Strategies.

ERIC Educational Resources Information Center

Cavallaro, Marion L.

Since the population of older persons is predominantly female, counselor educators need to incorporate into their curriculum topics related to the unique issues faced by older women. Most counselors in their practice will be encountering at some point the problems of older women. Therefore, the preparation of counselors needs to incorporate…

Taking Flight: Using a Wind Tunnel to Teach Aeronautic Principles

ERIC Educational Resources Information Center

Zembal-Saul, Carla; Huckans, John H.; Walker, Dean C.; Hershberger, Kimber; Kurz, Nathan A.; Reed, Diane; Cole, Milton W.

2007-01-01

Several teachers from State College (Pennsylvania) Area School District became intrigued with helping their students better understand the science associated with a unit on air and aviation. In particular, they observed that students often encountered difficulty with abstract flight concepts, such as lift, thrust, and drag. Content issues became…

Get a Lawyer Before It's Too Late.

ERIC Educational Resources Information Center

Variety Club School, Honolulu, HI.

Lawyers are needed by schools for many more purposes than merely to execute legal documents. This set of notes for a conference presentation considers lawyers' roles in advising on the legal issues involved in the following: (1) business transactions typically encountered by schools (state contract review, state lease, pool lease, nonprofit…

Psychometric Issues in Organizational Stressor Research: A Review and Implications for Sport Psychology

ERIC Educational Resources Information Center

Arnold, Rachel; Fletcher, David

2012-01-01

Organizational stressors can potentially elicit a number of undesirable consequences for sport performers. It is, therefore, imperative that psychologists better understand the demands that athletes encounter via their exploration and assessment. However, although researchers have identified a wide range of organizational stressors in competitive…

An Introduction to Cost Sharing: Why Good Deeds Do Not Go Unpunished.

ERIC Educational Resources Information Center

Seligman, Richard P.

2000-01-01

Examines the concept of cost sharing between grantor agencies and grantee institutions and identifies problems encountered, including use of cost sharing to leverage funds by both funding agencies and grantee institutions; and various grantee institution costing, accounting, and auditing issues, such as effort reporting, the Cost Accounting…

A Constructivist Perspective for Integrating Spirituality into Counselor Training

ERIC Educational Resources Information Center

Shaw, Brian M.; Bayne, Hannah; Lorelle, Sonya

2012-01-01

Significant efforts have been made in recent years to integrate training in spirituality and religion into counselor training programs. This article highlights issues that may be encountered by some trainees and suggests that constructivist teaching principles be used to mitigate these concerns. The authors present recommendations and activities…

Applying Mediationist Theory to Communication about Terrorism and War.

ERIC Educational Resources Information Center

Coufal, Kathy L.

2002-01-01

This introductory article to a forum on contemporary issues discusses the importance of communication in the transmission of social values and attitudes and applies mediation theory to the role of parents and teachers in assisting children to understand the images and rhetoric they encounter. (Contains 3 references.) (Author/DB)

Phytophthora ramorum tissue colonization studied with fluorescense microscopy

Treesearch

M. Riedel; S. Wagner; M. Gotz; L. Belbahri; F. Lefort; S. Werres

2009-01-01

The proceeding worldwide spread and the expanding host spectrum of P. ramorum has become a serious threat to natural plant communities. To encounter this threat detailed knowledge about infection pathways and tissue colonization is essential. To analyze these issues, histological studies of infected tissue with epifluorescence microscopy have been...

Proactive Strategies to Safeguard Young Adolescents in the Cyberage

ERIC Educational Resources Information Center

Miller, Nicole C.; Thompson, Nicole L.; Franz, Dana Pomykal

2009-01-01

Schools should be proactive rather than reactive to issues of technology safety, and this requires careful planning and policy implementation. In this article, the authors provide information and recommendations that will help middle grades educators, students, and parents to safely and successfully manage the many technologies they encounter and…

Working with Nonsuicidal Self-Injurious Adolescents

ERIC Educational Resources Information Center

Nelson, Mark D.; Piccin, Rian

2016-01-01

Nonsuicidal self-injury (NSSI) has evolved into a serious issue for adolescents, and is encountered in school systems across the United States. The ability of school counselors and other professionals working in the school environment to understand and assist students who exhibit signs of NSSI is critically important. Research remains minimal on…

Case Studies in Wilderness Medicine.

ERIC Educational Resources Information Center

Gray, Melissa; Tarter, Shana Lee

Five case studies explore issues in wilderness medicine, with emphasis on evacuation decision making. The cases describe medical problems encountered during wilderness trips involving college or high school students. In each case, the situation and facts of the case are outlined, including the patient's medical history and vital signs, and at…

Determination of Bioethical Perceptions of Gifted Students

ERIC Educational Resources Information Center

Ceylan, Özge; Topsakal, Ünsal Umdu

2018-01-01

This research was carried out to reveal the bioethical values that special, talented students have about the socioscientific issues that they may encounter in everyday life. Scanning model was used in the research from quantitative research methods. The study's working group is composed of special talented fifth, sixth, seventh, eighth, ninth, and…

Bilingual Medical Phrase Book (In English and Vietnamese).

ERIC Educational Resources Information Center

Thuy, Vuong G.

This guide offers Vietnamese refugees and immigrants with limited English proficiency a short-cut, word-for-word bilingual reference tool for dealing with medical problems and situations in English-language environments. Seven chapters deal with different issues of the medical encounter and five appendixes present specialized terms and…

Bilingual Medical Phrase Book (In English and Laotian).

ERIC Educational Resources Information Center

Thuy, Vuong G.

This phrase book offers Laotian refugees and immigrants with limited English proficiency a short-cut, word-for-word bilingual reference tool for dealing with medical problems and situations in English-language environments. Seven chapters deal with different issues of the medical encounter and five appendixes present specialized terms and…

Bilingual Medical Phrase Book (In English and Cambodian (Khmer)).

ERIC Educational Resources Information Center

Thuy, Vuong G.

This guide offers Cambodian refugees and immigrants with limited English proficiency a short-cut, word-for-word bilingual reference tool for dealing with medical problems and situations in English-language environments. Seven chapters deal with different issues of the medical encounter and five appendixes present specialized terms and…

Students' Meaning Making in Classroom Discussions: The Importance of Peer Interaction

ERIC Educational Resources Information Center

Rudsberg, Karin; Östman, Leif; Aaro Östman, Elisabeth

2017-01-01

The aim is to investigate how encounters with peers affect an individual's meaning making in argumentation about socio-scientific issues, and how the individual's meaning making influences the argumentation at the collective level. The analysis is conducted using the analytical method "transactional argumentation analysis" (TAA) which…

Choosing and using a lawyer. What every medical practice administrator needs to know.

PubMed

Crow, N R

1994-01-01

Attorney Nancy Crow, J.D., L.L.M., writes about some of the legal issues encountered by medical groups, such as business law, real estate and land use, taxes and employee benefits, among many others, and what types of attorneys are more appropriate for particular concerns.

Foiling Cyberbullies in the New Wild West

ERIC Educational Resources Information Center

Franek, Mark

2006-01-01

The explosion of technology available to schools--and specifically, the ways in which students can misuse technology--has caught many educators off guard. School leaders are now being asked to protect students against potential harmful material they may encounter in cyberspace. The issue of cyberbullying--using technology to harass, intimidate,…

COMBINING EVIDENCE ON AIR POLLUTION AND DAILY MORTALITY FROM 20 LARGEST U.S. CITIES: A HIERARCHICAL MODELING STRATEGY

EPA Science Inventory

Environmental science and management are fed by individual studies of pollution effects, often focused on single locations. Data are encountered data, typically from multiple sources and on different time and spatial scales. Statistical issues including publication bias and m...

The Brown University Child and Adolescent Behavior Letter, 1996.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1996-01-01

These 12 monthly newsletters from 1996 explore the many problems encountered by children and adolescents as they grow up. Regular departments in the newsletter issues include "Keep Your Eye On...," which briefly presents results of research into childhood and adolescent problems; "What's New in Research," summarizing research…

Teaching Controversial Materials: Teaching about the Nuclear Issue.

ERIC Educational Resources Information Center

Wall, Joseph

1986-01-01

Describes difficulties encountered in presenting a college course on nuclear weapons and disarmament. Maintains that such courses must strive for a fuller historical account of the arms race, in addition to stressing the humanistic and ethical questions involved. Warns that controversy will arise and concludes that even blind anger is preferable…

Learning to Understand Others through Relationally Oriented Reading

ERIC Educational Resources Information Center

Lysaker, Judith; Tonge, Clare

2013-01-01

Children with reading difficulties often face social and emotional challenges as well. These struggles may be particularly taxing for these children as classrooms increase in diversity and they encounter fewer people like themselves. In response to these issues, we developed an approach to teaching reading called Relationally Oriented Reading…

The Brown University Child and Adolescent Behavior Letter, 1995.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1995-01-01

These 12 monthly newsletters from 1995 explore the myriad problems encountered by children and adolescents as they grow up. Regular departments in the newsletter issues include "Keep Your Eye On...," which briefly presents results of research into childhood and adolescent problems; "New Research," summarizing research from recent publications and…

MMS Encounters with Reconnection Diffusion Regions in the Earth's Magnetotail

NASA Astrophysics Data System (ADS)

Torbert, R. B.; Burch, J. L.; Argall, M. R.; Farrugia, C. J.; Alm, L.; Dors, I.; Payne, D.; Rogers, A. J.; Strangeway, R. J.; Phan, T.; Ergun, R.; Goodrich, K.; Lindqvist, P. A.; Khotyaintsev, Y. V.; Giles, B. L.; Rager, A. C.; Gershman, D. J.; Kletzing, C.

2017-12-01

The Magnetospheric Multiscale (MMS) fleet of four spacecraft traversed the Earth's magnetotail in May through August of 2017 with an apogee of 25 Re, and encountered diffusion regions characteristic of symmetric reconnection. This presentation will describe in-situ measurements of large electric fields, strong electron cross-tail and Hall currents, and electron velocity distributions (frequently crescent-shaped) that are commonly observed in these regions. Positive electromagnetic energy conversion is also typical. The characteristics of symmetric reconnection observations will be contrasted with those of asymmetric reconnection that MMS observed previously at the dayside magnetopause.

Glaucoma in juvenile xanthogranuloma.

PubMed

Vendal, Zarmeena; Walton, David; Chen, Teresa

2006-01-01

Juvenile xanthogranuloma (JXG) is a benign histiocytic skin disorder mainly encountered during infancy. Approximately 10% of cases exhibit ocular manifestations leading to serious complications. Specifically, secondary glaucoma can result in severe and blinding eye disease. We present a case of a two-month-old female with JXG related glaucoma in order to demonstrate the classic presentation and the problems commonly encountered in treating this disease. The natural history, pathogenesis, and treatment of the condition are then discussed and the pertinent literature reviewed. JXG should be considered in any case of unilateral glaucoma that presents in infancy.

Evaluation of PCR Systems for Field Screening of Bacillus anthracis

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

Ozanich, Richard M.; Colburn, Heather A.; Victry, Kristin D.

There is little published data on the performance of hand-portable polymerase chain reaction (PCR) instruments that could be used by first responders to determine if a suspicious powder contains a potential biothreat agent. We evaluated five commercially available hand-portable PCR instruments for detection of Bacillus anthracis (Ba). We designed a cost-effective, statistically-based test plan that allows instruments to be evaluated at performance levels ranging from 0.85-0.95 lower confidence bound (LCB) on the probability of detection (POD) at confidence levels of 80-95%. We assessed specificity using purified genomic DNA from 13 Ba strains and 18 Bacillus near neighbors, interference with 22more » common hoax powders encountered in the field, and PCR inhibition when Ba spores were spiked into these powders. Our results indicated that three of the five instruments achieved >0.95 LCB on the POD with 95% confidence at test concentrations of 2,000 genome equivalents/mL (comparable to 2,000 spores/mL), displaying more than sufficient sensitivity for screening suspicious powders. These instruments exhibited no false positive results or PCR inhibition with common hoax powders, and reliably detected Ba spores spiked into common hoax powders, though some issues with instrument controls were observed. Our testing approach enables efficient instrument performance testing to a statistically rigorous and cost-effective test plan to generate performance data that will allow users to make informed decisions regarding the purchase and use of biodetection equipment in the field.« less

Common dental and periodontal diseases: evaluation and management.

PubMed

Laudenbach, Joel M; Simon, Ziv

2014-11-01

Physicians may encounter patients with dental and periodontal diseases in the context of outpatient medical practice. It is important for physicians to be aware of common dental and periodontal conditions and be able to assess for the presence and severity of these diseases. This article reviews common dental and periodontal conditions, their cardinal signs and symptoms, outpatient-setting assessment techniques, as well as common methods of treatment. Physicians detecting gross abnormalities on clinical examination should refer the patient to a dentist for further evaluation and management. Copyright © 2014 Elsevier Inc. All rights reserved.

Disrespect, harassment, and abuse

PubMed Central

Miedema, Baukje; Easley, Julie; Fortin, Pierrette; Hamilton, Ryan; Tatemichi, Sue

2009-01-01

ABSTRACT OBJECTIVE To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. DESIGN Qualitative case study using semistructured interviews. SETTING Province of New Brunswick. PARTICIPANTS Forty-eight family physicians from across the province. METHODS A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick’s physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. MAIN FINDINGS Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters—young, female, rural physicians appeared to experience such encounters most often. CONCLUSION Abusive encounters in the workplace are concerning. It is essential to address these issues of workplace harassment and abuse in order to protect physician safety and avoid workplace dissatisfaction. Abusive encounters might push family physicians to leave clinical practice prematurely or refuse to work in higher-risk environments, such as emergency departments or rural areas. PMID:19282539

Religion, Spirituality, and Medicine: Psychiatrists’ and Other Physicians’ Differing Observations, Interpretations, and Clinical Approaches

PubMed Central

Curlin, Farr A.; Lawrence, Ryan E.; Odell, Shaun; Chin, Marshall H.; Lantos, John D.; Koenig, Harold G.; Meador, Keith G.

2010-01-01

Objective This study compared the ways in which psychiatrists and nonpsychiatrists interpret the relationship between religion/spirituality and health and address religion/spirituality issues in the clinical encounter. Method The authors mailed a survey to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. The authors asked the physicians about their beliefs and observations regarding the relationship between religion/spirituality and patient health and about the ways in which they address religion/spirituality in the clinical setting. Results A total of 1,144 physicians completed the survey. Psychiatrists generally endorse positive influences of religion/spirituality on health, but they are more likely than other physicians to note that religion/spirituality sometimes causes negative emotions that lead to increased patient suffering (82% versus 44%). Compared to other physicians, psychiatrists are more likely to encounter religion/spirituality issues in clinical settings (92% versus 74% report their patients sometimes or often mention religion/spirituality issues), and they are more open to addressing religion/spirituality issues with patients (93% versus 53% say that it is usually or always appropriate to inquire about religion/spirituality). Conclusions This study suggests that the vast majority of psychiatrists appreciate the importance of religion and/or spirituality at least at a functional level. Compared to other physicians, psychiatrists also appear to be more comfortable, and have more experience, addressing religion/spirituality concerns in the clinical setting. PMID:18056237

Male Escorts' and Male Clients' Sexual Behavior During Their Last Commercial Sexual Encounter: Comparing and Contrasting Findings from Two Online Studies.

PubMed

Grov, Christian; Rodríguez-Díaz, Carlos E; Jovet-Toledo, Gerardo G

2016-05-01

Much of what is known about commercial sexual encounters between men is based on data gathered from escorts. With few exceptions, studies have not compared male clients' reports of behavior during commercial sexual encounters with male escorts'. The present study draws from two datasets, a 2012 survey of clients (n = 495) and a 2013 survey of escorts (n = 387)--both used virtually identical measures of sexual behavior during the most recent commercial sexual encounter. For clients and escorts, the majority eschewed having sex without a condom, and kissing and oral sex were among the most common behaviors reported. Using logistic regression, both samples were compared across 15 sexual behaviors, finding significant differences in six--the escort sample had greater odds of reporting their last commercial sexual encounter involved watching the client masturbate, viewing porn, role play (dad/son, dominant/submissive), and having prior sexual experience with their commercial partner. The escort sample had lower odds of reporting that the client watched the escort masturbate, and being told partner's HIV status. In multivariable modeling, both samples did not significantly differ in reports of condomless anal sex. Male-male commercial sexual encounters appear to be involved in a wide range of sexual behaviors, many of which convey low-to-no risk of HIV transmission.

Stereotype threat and racial differences in citizens' experiences of police encounters.

PubMed

Najdowski, Cynthia J; Bottoms, Bette L; Goff, Phillip Atiba

2015-10-01

We conducted 2 studies to investigate how cultural stereotypes that depict Blacks as criminals affect the way Blacks experience encounters with police officers, expecting that such encounters induce Blacks to feel stereotype threat (i.e., concern about being judged and treated unfairly by police because of the stereotype). In Study 1, we asked Black and White participants to report how they feel when interacting with police officers in general. As predicted, Blacks, but not Whites, reported concern that police officers stereotype them as criminals simply because of their race. In addition, this effect was found for Black men but not Black women. In Study 2, we asked Black and White men to imagine a specific police encounter and assessed potential downstream consequences of stereotype threat. Consistent with Study 1, Black but not White men anticipated feeling stereotype threat in the hypothetical police encounter. Further, racial differences in anticipated threat translated into racial differences in anticipated anxiety, self-regulatory efforts, and behavior that is commonly perceived as suspicious by police officers. By demonstrating that Blacks might expect to be judged and treated unfairly by police because of the negative stereotype of Black criminality, this research extends stereotype threat theory to the new domain of criminal justice encounters. It also has practical implications for understanding how the stereotype could ironically contribute to bias-based policing and racial disparities in the justice system. (c) 2015 APA, all rights reserved).

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 ...

Resource-driven encounters among consumers and implications for the spread of infectious disease

PubMed Central

Flynn, Jason M.

2017-01-01

Animals share a variety of common resources, which can be a major driver of conspecific encounter rates. In this work, we implement a spatially explicit mathematical model for resource visitation behaviour in order to examine how changes in resource availability can influence the rate of encounters among consumers. Using simulations and asymptotic analysis, we demonstrate that, under a reasonable set of assumptions, the relationship between resource availability and consumer conspecific encounters is not monotonic. We characterize how the maximum encounter rate and associated critical resource density depend on system parameters like consumer density and the maximum distance from which consumers can detect and respond to resources. The assumptions underlying our theoretical model and analysis are motivated by observations of large aggregations of black-backed jackals at carcasses generated by seasonal outbreaks of anthrax among herbivores in Etosha National Park, Namibia. As non-obligate scavengers, black-backed jackals use carcasses as a supplemental food resource when they are available. While jackals do not appear to acquire disease from ingesting anthrax carcasses, changes in their movement patterns in response to changes in carcass abundance do alter jackals' conspecific encounter rate in ways that may affect the transmission dynamics of other diseases, such as rabies. Our theoretical results provide a method to quantify and analyse the hypothesis that the outbreak of a fatal disease among herbivores can potentially facilitate outbreaks of an entirely different disease among jackals. By analysing carcass visitation data, we find support for our model's prediction that the number of conspecific encounters at resource sites decreases with additional increases in resource availability. Whether or not this site-dependent effect translates to an overall decrease in encounters depends, unexpectedly, on the relationship between the maximum distance of detection and the resource density. PMID:29021163

Encountering a bait is necessary but insufficient to explain individual variability in vulnerability to angling in two freshwater benthivorous fish in the wild

PubMed Central

Monk, Christopher Thomas; Arlinghaus, Robert

2017-01-01

Fish personality traits, such as swimming activity, or personality related emergent behavioural properties, such as the degree of space use shown by an individual fish, should affect encounter rates between individual fish and fishing gear. Increased encounters should in turn drive vulnerability to capture by passively operated gears. However, empirical evidence documenting a relationship between activity-based behaviours and vulnerability to capture by passive fishing gear in the wild is limited. Using whole-lake acoustic telemetry, we first documented significant repeatabilities over several months in a suite of encounter rate-associated behaviours (swimming distance, activity space size, time on baited feeding sites, switching frequency among baited feeding sites, distance to the lake bottom) in two recreationally important benthivorous cyprinid species, the common carp (Cyprinus carpio) and tench (Tinca tinca). We then experimentally targeted both species using stationary angling on baited feeding sites. Individual fish regularly visited the angling sites, documenting that the fishes encountered the angling baits. When attempting to explain individual variation in vulnerability as a function of repeatable behavioural traits, we found no evidence of a significant relationship among various encounter-based behaviours and vulnerability to angling for both species. There was also no evidence for size selection or for energetically less conditioned fish to be more vulnerable. The data cumulatively suggest that fine-scale behaviours after encountering a bait (e.g., frequency of bait intake) may be ultimately decisive for determining vulnerability to angling in benthivorous fish. Based on our work, fishing-induced selection on encounter-based behaviours in recreational angling for benthivorous fish in the wild appears unlikely. PMID:28301558

Intercultural differences and communication at the end of life.

PubMed

Hallenbeck, J L

2001-06-01

Cross-cultural encounters at the end of life are common and can result in misunderstandings and conflicts. The primary care physician is ideally suited to facilitate communication that can promote understanding and conflict resolution.

2016 Annual Report of the University of Kansas Health System Poison Control Center.

PubMed

Thornton, Stephen L; Oller, Lisa; Coons, Doyle M

2018-05-01

This is the 2016 Annual Report of the University of Kansas Health System Poison Control Center (PCC). The PCC is one of 55 certified poison control centers in the United States and serves the state of Kansas 24-hours a day, 365 days a year, with certified specialists in poison information and medical toxicologists. The PCC receives calls from the public, law enforcement, health care professionals, and public health agencies. All calls to the PCC are recorded electronically in the Toxicall® data management system and uploaded in near real-time to the National Poison Data System (NPDS), which is the data repository for all poison control centers in the United States. All encounters reported to the PCC from January 1, 2016 to December 31, 2016 were analyzed. Data recorded for each exposure includes caller location, age, weight, gender, substance exposed to, nature of exposure, route of exposure, interventions, medical outcome, disposition and location of care. Encounters were classified further as human exposure, animal exposure, confirmed non-exposure, or information call (no exposure reported). The PCC logged 21,965 total encounters in 2016, including 20,713 human exposure cases. The PCC received calls from every county in Kansas. The majority of human exposure cases (50.4%, n = 10,174) were female. Approximately 67% (n = 13,903) of human exposures involved a child (defined as age 19 years or less). Most encounters occurred at a residence (94.0%, n = 19,476) and most calls (72.3%, n = 14,964) originated from a residence. The majority of human exposures (n = 18,233) were acute cases (exposures occurring over eight hours or less). Ingestion was the most common route of exposure documented (86.3%, n = 17,882). The most common reported substance in pediatric encounters was cosmetics/personal care products (n = 1,362), followed by household cleaning product (n = 1,301). For adult encounters, sedatives/hypnotics/antipsychotics (n = 1,130) and analgesics (n = 1,103) were the most frequently involved substances. Unintentional exposures were the most common reason for exposures (81.3%, n = 16,836). Most encounters (71.1%, n = 14,732) were managed in a non-healthcare facility (i.e., a residence). Among human exposures, 14,679 involved exposures to pharmaceutical agents while 10,176 involved exposure to non-pharmaceuticals. Medical outcomes were 32% (n = 6,582) no effect, 19% (n = 3,911) minor effect, 8% (n = 1,623) moderate effect, and 2% (n = 348) major effects. There were 15 deaths in 2016 reported to the PCC. Number of exposures, calls from healthcare facilities, cases with moderate or major medical outcomes, and deaths all increased in 2016 compared to 2015. The results of the 2016 University of Kansas Health System Poison Control annual report demonstrates that the center receives calls from the entire state of Kansas totaling over 20,000 human exposures per year. While pediatric exposures remain the most common, there is an increasing number of calls from healthcare facilities and for cases with serious outcomes. The experience of the PCC is similar to national data. This report supports the continued value of the PCC to both public and acute health care in the state of Kansas.

2016 Annual Report of the University of Kansas Health System Poison Control Center

PubMed Central

Thornton, Stephen L.; Oller, Lisa; Coons, Doyle M.

2018-01-01

Introduction This is the 2016 Annual Report of the University of Kansas Health System Poison Control Center (PCC). The PCC is one of 55 certified poison control centers in the United States and serves the state of Kansas 24-hours a day, 365 days a year, with certified specialists in poison information and medical toxicologists. The PCC receives calls from the public, law enforcement, health care professionals, and public health agencies. All calls to the PCC are recorded electronically in the Toxicall® data management system and uploaded in near real-time to the National Poison Data System (NPDS), which is the data repository for all poison control centers in the United States. Methods All encounters reported to the PCC from January 1, 2016 to December 31, 2016 were analyzed. Data recorded for each exposure includes caller location, age, weight, gender, substance exposed to, nature of exposure, route of exposure, interventions, medical outcome, disposition and location of care. Encounters were classified further as human exposure, animal exposure, confirmed non-exposure, or information call (no exposure reported). Results The PCC logged 21,965 total encounters in 2016, including 20,713 human exposure cases. The PCC received calls from every county in Kansas. The majority of human exposure cases (50.4%, n = 10,174) were female. Approximately 67% (n = 13,903) of human exposures involved a child (defined as age 19 years or less). Most encounters occurred at a residence (94.0%, n = 19,476) and most calls (72.3%, n = 14,964) originated from a residence. The majority of human exposures (n = 18,233) were acute cases (exposures occurring over eight hours or less). Ingestion was the most common route of exposure documented (86.3%, n = 17,882). The most common reported substance in pediatric encounters was cosmetics/personal care products (n = 1,362), followed by household cleaning product (n = 1,301). For adult encounters, sedatives/hypnotics/antipsychotics (n = 1,130) and analgesics (n = 1,103) were the most frequently involved substances. Unintentional exposures were the most common reason for exposures (81.3%, n = 16,836). Most encounters (71.1%, n = 14,732) were managed in a non-healthcare facility (i.e., a residence). Among human exposures, 14,679 involved exposures to pharmaceutical agents while 10,176 involved exposure to non-pharmaceuticals. Medical outcomes were 32% (n = 6,582) no effect, 19% (n = 3,911) minor effect, 8% (n = 1,623) moderate effect, and 2% (n = 348) major effects. There were 15 deaths in 2016 reported to the PCC. Number of exposures, calls from healthcare facilities, cases with moderate or major medical outcomes, and deaths all increased in 2016 compared to 2015. Conclusion The results of the 2016 University of Kansas Health System Poison Control annual report demonstrates that the center receives calls from the entire state of Kansas totaling over 20,000 human exposures per year. While pediatric exposures remain the most common, there is an increasing number of calls from healthcare facilities and for cases with serious outcomes. The experience of the PCC is similar to national data. This report supports the continued value of the PCC to both public and acute health care in the state of Kansas. PMID:29796151

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.

Moving Beyond the Theoretical: Medical Students' Desire for Practical, Role-Specific Ethics Training.

PubMed

Stites, Shana D; Clapp, Justin; Gallagher, Stefanie; Fiester, Autumn

2018-05-04

Background It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this most U.S. medical schools include ethics curricula in their undergraduate programs. However, the content of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.

Nurses' use of qualitative research approaches to investigate tobacco use and control.

PubMed

Schultz, Annette S H; Bottorff, Joan L; McKeown, Stephanie Barclay

2009-01-01

Qualitative research methods are increasingly used by nurse scientists to explore a wide variety of topics relevant to practice and/or health policy issues. The purpose of this chapter is to review the contributions of nurse scientists to the field of tobacco control through the use of qualitative research methods. A systematic literature search strategy was used to identify 51 articles published between 1980 and 2008. The majority (84%) of reviewed articles were authored by North American nurse scientists. Cessation was the most commonly (85%) studied aspect of tobacco control. Six qualitative research approaches were used: qualitative descriptive (55%), narrative analysis (8%), phenomenology (6%), grounded theory (14%), ethnography (12%), and case study (6%). Qualitative descriptive methods were primarily one-off studies to address practical problems or issues encountered in practice, and often validated current understandings related to tobacco. Researchers who used other types of qualitative methods and who conducted qualitative studies as part of programs of research were more likely to make more substantive contributions to the evolving field of tobacco control. These contributions related to how smoking intertwines with personal and social identities, the influence of social context on tobacco use, and nurses' involvement in tobacco control (both of their own tobacco use and in assisting others). Nurse scientists interested in exploring tobacco-related issues are encouraged to consider the full range of qualitative research approaches. Qualitative research methods contribute to our understanding of tobacco use arising from nursing practice, health care and policy, along with the field of tobacco control in general.

Official Positions for FRAX® Bone Mineral Density and FRAX® simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

PubMed

Lewiecki, E Michael; Compston, Juliet E; Miller, Paul D; Adachi, Jonathan D; Adams, Judith E; Leslie, William D; Kanis, John A; Moayyeri, Alireza; Adler, Robert A; Hans, Didier B; Kendler, David L; Diez-Perez, Adolfo; Krieg, Marc-Antoine; Masri, Basel K; Lorenc, Roman R; Bauer, Douglas C; Blake, Glen M; Josse, Robert G; Clark, Patricia; Khan, Aliya A

2011-01-01

Tools to predict fracture risk are useful for selecting patients for pharmacological therapy in order to reduce fracture risk and redirect limited healthcare resources to those who are most likely to benefit. FRAX® is a World Health Organization fracture risk assessment algorithm for estimating the 10-year probability of hip fracture and major osteoporotic fracture. Effective application of FRAX® in clinical practice requires a thorough understanding of its limitations as well as its utility. For some patients, FRAX® may underestimate or overestimate fracture risk. In order to address some of the common issues encountered with the use of FRAX® for individual patients, the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) assigned task forces to review the medical evidence and make recommendations for optimal use of FRAX® in clinical practice. Among the issues addressed were the use of bone mineral density (BMD) measurements at skeletal sites other than the femoral neck, the use of technologies other than dual-energy X-ray absorptiometry, the use of FRAX® without BMD input, the use of FRAX® to monitor treatment, and the addition of the rate of bone loss as a clinical risk factor for FRAX®. The evidence and recommendations were presented to a panel of experts at the Joint ISCD-IOF FRAX® Position Development Conference, resulting in the development of Joint ISCD-IOF Official Positions addressing FRAX®-related issues. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Chest Trauma in Athletic Medicine.

PubMed

Phillips, Nicholas R; Kunz, Derek E

2018-03-01

While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Sports medicine providers must be prepared to encounter a wide range of traumatic conditions relating to the torso, varying from the benign chest wall contusion to the life-threatening tension pneumothorax. Basic field-side management should be rapid and focused, using the standardized approach of Advanced Traumatic Life Support protocol. Early and appropriate diagnosis and management can help allow safe and enjoyable sports participation.

[The heuristics of reaching a diagnosis].

PubMed

Wainstein, Eduardo

2009-12-01

Making a diagnosis in medicine is a complex process in which many cognitive and psychological issues are involved. After the first encounter with the patient, an unconscious process ensues to suspect the presence of a particular disease. Usually, complementary tests are requested to confirm the clinical suspicion. The interpretation of requested tests can be biased by the clinical diagnosis that was considered in the first encounter with the patient. The awareness of these sources of error is essential in the interpretation of the findings that will eventually lead to a final diagnosis. This article discusses some aspects of the heuristics involved in the adjudication of priory probabilities and provides a brief review of current concepts of the reasoning process.

Jewish physicians' beliefs and practices regarding religion/spirituality in the clinical encounter.

PubMed

Stern, Robert M; Rasinski, Kenneth A; Curlin, Farr A

2011-12-01

We used data from a 2003 survey of US physicians to examine differences between Jewish and other religiously affiliated physicians on 4-D of physicians' beliefs and practices regarding religion and spirituality (R/S) in the clinical encounter. On each dimension, Jewish physicians ascribed less importance to the effect of R/S on health and a lesser role for physicians in addressing R/S issues. These effects were partially mediated by lower levels of religiosity among Jewish physicians and by differences in demographic and practice-level characteristics. The study provides a salient example of how religious affiliation can be an important independent predictor of physicians' clinically-relevant beliefs and practices.

Jewish Physicians' Beliefs and Practices Regarding Religion/Spirituality in the Clinical Encounter

PubMed Central

Stern, Robert M.; Rasinski, Kenneth A.; Curlin, Farr A.

2013-01-01

We used data from a 2003 survey of US physicians to examine differences between Jewish and other religiously affiliated physicians on 4-D of physicians' beliefs and practices regarding religion and spirituality (R/S) in the clinical encounter. On each dimension, Jewish physicians ascribed less importance to the effect of R/S on health and a lesser role for physicians in addressing R/S issues. These effects were partially mediated by lower levels of religiosity among Jewish physicians and by differences in demographic and practice-level characteristics. The study provides a salient example of how religious affiliation can be an important independent predictor of physicians' clinically-relevant beliefs and practices. PMID:21706257

What happens when the doctor denies a patient’s request? A qualitative interview study among general practitioners in Norway

PubMed Central

Nilsen, Stein; Malterud, Kirsti

2017-01-01

Objective To explore general practitioners (GPs’) experiences from consultations when a patient’s request is denied, and outcomes of such incidents. Design and participants We conducted a qualitative study with semi-structured individual interviews with six GPs in Norway. We asked them to tell about experiences from specific encounters where they had refused a patient’s request. The texts were analysed with Systematic Text Condensation, a method for thematic cross-case analysis. Main outcome measures Accounts of experiences from consultations when GPs refused their patients’ requests. Results Subjects of dispute included clinical topics like investigation and treatment, certification regarding welfare benefits and medico-legal issues, and administrative matters. The arguments took different paths, sometimes settled by reaching common ground but more often as unresolved disagreement with anger or irritation from the patient, sometimes with open hostility and violence. The aftermath and outcomes of these disputes lead to strong emotional impact where the doctors reflected upon the incidents and sometimes regretted their handling of the consultation. Some long-standing and close patient–doctor relationships were injured or came to an end. Conclusions The price for denying a patient’s request may be high, and GPs find themselves uncomfortable in such encounters. Skills pertaining to this particular challenge could be improved though education and training, drawing attention to negotiation of potential conflicts. Also, the notion that doctors have a professional commitment to his or her own autonomy and to society should be restored, through increased emphasis on core professional ethics in medical education at all levels. PMID:28581878

Emergency department care for patients with hemophilia and von Willebrand disease.

PubMed

Singleton, Tammuella; Kruse-Jarres, Rebecca; Leissinger, Cindy

2010-08-01

Patients with bleeding disorders such as hemophilia A, hemophilia B, and von Willebrand disease (VWD) are routinely treated at home, with their care managed in specialized centers. In emergency situations, these patients often present to their local emergency department (ED), where their management can represent a challenge to the emergency physicians and staff who rarely encounter them. Delays in diagnosis and administration of replacement therapy are the factors most commonly identified as predictive of death. Patients and family members are often very well educated in the disease and its management, which can significantly reduce morbidity and mortality. Children with bleeding disorders confer different challenges to the emergency physician and staff: they may present with no obvious signs of trauma or they may present with bruises consistent with non-accidental injury. All possible causes of bruising/bleeding should be investigated, although treatment should be administered promptly. The initial presentation of a bleeding disorder in the pediatric population is often made in the ED. Treatment of hemophilia A and B requires rapid replacement of the deficient clotting factor, with the desired factor level and dosage dependent on the product used and the hemorrhagic situation encountered. In patients with VWD, the main treatments are desmopressin or intravenous infusion of plasma-derived concentrates containing factor VIII and von Willebrand factor. The aim of this review is to outline some of the issues facing emergency physicians and the options available for the treatment of patients with hemophilia A, hemophilia B, and VWD. Copyright 2010. Published by Elsevier Inc.

The most common nonconformities encountered during the assessments of medical laboratories in Hong Kong using ISO 15189 as accreditation criteria

PubMed Central

Ho, Bella; Ho, Eric

2012-01-01

Introduction: ISO 15189 was a new standard published in 2003 for accrediting medical laboratories. We believe that some requirements of the ISO 15189 standard are especially difficult to meet for majority of laboratories. The aim of this article was to present the frequency of nonconformities to requirements of the ISO 15189 accreditation standard, encountered during the assessments of medical laboratories in Hong Kong, during 2004 to 2009. Materials and methods: Nonconformities reported in assessments based on ISO 15189 were analyzed in two periods – from 2004 to 2006 and in 2009. They are categorized according to the ISO 15189 clause numbers. The performance of 27 laboratories initially assessed between 2004 and 2006 was compared to their performance in the second reassessment in 2009. Results: For management requirements, nonconformities were most frequently reported against quality management system, quality and technical records and document control; whereas for technical requirements, they were reported against examination procedures, equipment, and assuring quality of examination procedures. There was no major difference in types of common nonconformities reported in the two study periods. The total number of nonconformities reported in the second reassessment of 27 laboratories in 2009 was almost halved compared to their initial assessments. The number of significant nonconformities per laboratory significantly decreased (P = 0.023). Conclusion: Similar nonconformities were reported in the two study periods though the frequency encountered decreased. The significant decrease in number of significant nonconformities encountered in the same group of laboratories in the two periods substantiated that ISO15189 contributed to quality improvement of accredited laboratories. PMID:22838190