The Structural Features of Sports and Race Betting Inducements: Issues for Harm Minimisation and Consumer Protection.

PubMed

Hing, Nerilee; Sproston, Kerry; Brook, Kate; Brading, Richard

2017-06-01

Minimal research has been published about inducements for sports and race betting, despite their ready availability and aggressive advertising. This paper aimed to document the range and structural features of these inducements, and analyse their alignment with the harm minimisation and consumer protection goals of responsible gambling. A scan of all inducements offered on the websites of 30 major race and sports betting brands located 223 separate inducements which we categorised into 15 generic types, all offering financial incentives to purchase. These comprised sign-up offers, refer-a-friend offers, happy hours, mobile betting bonuses, multi-bet offers, refund/stake-back offers, matching stakes/deposits, winnings paid for 'close calls', bonus or better odds, bonus or better winnings, competitions, reduced commission, free bets to selected punters, cash rebates and other free bets. All inducements were subject to numerous terms and conditions which were complex, difficult to find, and obscured by legalistic language. Play-through conditions of bonus bets were particularly difficult to interpret and failed basic requirements for informed choice. Website advertisements for inducements were prominently promoted but few contained a responsible gambling message. The results were analysed to generate 12 research propositions considered worthy of empirical research to inform much needed regulatory reform in this area.

Use of application containers and workflows for genomic data analysis.

PubMed

Schulz, Wade L; Durant, Thomas J S; Siddon, Alexa J; Torres, Richard

2016-01-01

The rapid acquisition of biological data and development of computationally intensive analyses has led to a need for novel approaches to software deployment. In particular, the complexity of common analytic tools for genomics makes them difficult to deploy and decreases the reproducibility of computational experiments. Recent technologies that allow for application virtualization, such as Docker, allow developers and bioinformaticians to isolate these applications and deploy secure, scalable platforms that have the potential to dramatically increase the efficiency of big data processing. While limitations exist, this study demonstrates a successful implementation of a pipeline with several discrete software applications for the analysis of next-generation sequencing (NGS) data. With this approach, we significantly reduced the amount of time needed to perform clonal analysis from NGS data in acute myeloid leukemia.

A novel approach for modelling vegetation distributions and analysing vegetation sensitivity through trait-climate relationships in China

PubMed Central

Yang, Yanzheng; Zhu, Qiuan; Peng, Changhui; Wang, Han; Xue, Wei; Lin, Guanghui; Wen, Zhongming; Chang, Jie; Wang, Meng; Liu, Guobin; Li, Shiqing

2016-01-01

Increasing evidence indicates that current dynamic global vegetation models (DGVMs) have suffered from insufficient realism and are difficult to improve, particularly because they are built on plant functional type (PFT) schemes. Therefore, new approaches, such as plant trait-based methods, are urgently needed to replace PFT schemes when predicting the distribution of vegetation and investigating vegetation sensitivity. As an important direction towards constructing next-generation DGVMs based on plant functional traits, we propose a novel approach for modelling vegetation distributions and analysing vegetation sensitivity through trait-climate relationships in China. The results demonstrated that a Gaussian mixture model (GMM) trained with a LMA-Nmass-LAI data combination yielded an accuracy of 72.82% in simulating vegetation distribution, providing more detailed parameter information regarding community structures and ecosystem functions. The new approach also performed well in analyses of vegetation sensitivity to different climatic scenarios. Although the trait-climate relationship is not the only candidate useful for predicting vegetation distributions and analysing climatic sensitivity, it sheds new light on the development of next-generation trait-based DGVMs. PMID:27052108

Laboratory Protocol for Genetic Gut Content Analyses of Aquatic Macroinvertebrates Using Group-specific rDNA Primers.

PubMed

Koester, Meike; Gergs, René

2017-10-05

Analyzing food webs is essential for a better understanding of ecosystems. For example, food web interactions can undergo severe changes caused by the invasion of non-indigenous species. However, an exact identification of field predator-prey interactions is difficult in many cases. These analyses are often based on a visual evaluation of gut content or the analysis of stable isotope ratios (δ 15 N and δ 13 C). Such methods require comprehensive knowledge about, respectively, morphologic diversity or isotopic signature from individual prey organisms, leading to obstacles in the exact identification of prey organisms. Visual gut content analyses especially underestimate soft bodied prey organisms, because maceration, ingestion and digestion of prey organisms make identification of specific species difficult. Hence, polymerase chain reaction (PCR) based strategies, for example the use of group-specific primer sets, provide a powerful tool for the investigation of food web interactions. Here, we describe detailed protocols to investigate the gut contents of macroinvertebrate consumers from the field using group-specific primer sets for nuclear ribosomal deoxyribonucleic acid (rDNA). DNA can be extracted either from whole specimens (in the case of small taxa) or out of gut contents of specimens collected in the field. Presence and functional efficiency of the DNA templates need to be confirmed directly from the tested individual using universal primer sets targeting the respective subunit of DNA. We also demonstrate that consumed prey can be determined further down to species level via PCR with unmodified group-specific primers combined with subsequent single strand conformation polymorphism (SSCP) analyses using polyacrylamide gels. Furthermore, we show that the use of different fluorescent dyes as labels enables parallel screening for DNA fragments of different prey groups from multiple gut content samples via automated fragment analysis.

Spatiotemporal analysis of changes in lode mining claims around the McDermitt Caldera, northern Nevada and southern Oregon

USGS Publications Warehouse

Coyan, Joshua; Zientek, Michael L.; Mihalasky, Mark J.

2017-01-01

Resource managers and agencies involved with planning for future federal land needs are required to complete an assessment of and forecast for future land use every ten years. Predicting mining activities on federal lands is difficult as current regulations do not require disclosure of exploration results. In these cases, historic mining claims may serve as a useful proxy for determining where mining-related activities may occur. We assess the utility of using a space–time cube (STC) and associated analyses to evaluate and characterize mining claim activities around the McDermitt Caldera in northern Nevada and southern Oregon. The most significant advantage of arranging the mining claim data into a STC is the ability to visualize and compare the data, which allows scientists to better understand patterns and results. Additional analyses of the STC (i.e., Trend, Emerging Hot Spot, Hot Spot, and Cluster and Outlier Analyses) provide extra insights into the data and may aid in predicting future mining claim activities.

Random sampling of constrained phylogenies: conducting phylogenetic analyses when the phylogeny is partially known.

PubMed

Housworth, E A; Martins, E P

2001-01-01

Statistical randomization tests in evolutionary biology often require a set of random, computer-generated trees. For example, earlier studies have shown how large numbers of computer-generated trees can be used to conduct phylogenetic comparative analyses even when the phylogeny is uncertain or unknown. These methods were limited, however, in that (in the absence of molecular sequence or other data) they allowed users to assume that no phylogenetic information was available or that all possible trees were known. Intermediate situations where only a taxonomy or other limited phylogenetic information (e.g., polytomies) are available are technically more difficult. The current study describes a procedure for generating random samples of phylogenies while incorporating limited phylogenetic information (e.g., four taxa belong together in a subclade). The procedure can be used to conduct comparative analyses when the phylogeny is only partially resolved or can be used in other randomization tests in which large numbers of possible phylogenies are needed.

Familiar Technology Promotes Academic Success for Students with Exceptional Learning Needs

ERIC Educational Resources Information Center

Wilson, Carolyn H.; Brice, Costeena; Carter, Emanuel I.; Fleming, Jeffery C.; Hay, Dontia D.; Hicks, John D.; Picot, Ebony; Taylor, Aashja M.; Weaver, Jessica

2011-01-01

Children with exceptional learning needs find it very difficult to retain content information from the regular curriculum. Many content teachers also find it difficult to adapt curriculum to the learning needs of these exception children within the confines of the classroom and without any assistance. Although many schools are equipped with…

It's not all about moral reasoning: Understanding the content of Moral Case Deliberation.

PubMed

Svantesson, Mia; Silén, Marit; James, Inger

2018-03-01

Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain. To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces. A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority. Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation. Other than 'moral reasoning' (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of 'reflections on the psychosocial work environment' to a varying extent (md: 29%). Additional content comprised 'assumptions about the patient's psychosocial situation' (md: 6%), 'facts about the patient's situation' (md: 5%), 'concrete problem-solving' (md: 6%) and 'process' (md: 3%). The findings suggest that a restorative function of staff's wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants' own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation.

Managing the Difficult Child.

ERIC Educational Resources Information Center

Murphy, Linda; Della Corte, Suzanne

1990-01-01

This newsletter issue focuses on ways parents can manage the difficult child with special needs. Characteristics of the difficult child are listed including poor listening skills, irritableness, impulsivity, and tendency to have tantrums. Typical reactions to the difficult child by parents, siblings, other relatives, neighbors, the school, and…

Use of application containers and workflows for genomic data analysis

PubMed Central

Schulz, Wade L.; Durant, Thomas J. S.; Siddon, Alexa J.; Torres, Richard

2016-01-01

Background: The rapid acquisition of biological data and development of computationally intensive analyses has led to a need for novel approaches to software deployment. In particular, the complexity of common analytic tools for genomics makes them difficult to deploy and decreases the reproducibility of computational experiments. Methods: Recent technologies that allow for application virtualization, such as Docker, allow developers and bioinformaticians to isolate these applications and deploy secure, scalable platforms that have the potential to dramatically increase the efficiency of big data processing. Results: While limitations exist, this study demonstrates a successful implementation of a pipeline with several discrete software applications for the analysis of next-generation sequencing (NGS) data. Conclusions: With this approach, we significantly reduced the amount of time needed to perform clonal analysis from NGS data in acute myeloid leukemia. PMID:28163975

Was the tragedy of Tovia Laufau caused by an absence of trust?

PubMed

Gray, Ben; Gillett, Grant

2014-06-01

The case of Tovia Laufau concerned a Samoan boy who died of osteosarcoma of the leg. He was diagnosed after a delay and eventually died after his parents did not present him for the treatment recommended for his condition. His parents were given a suspended sentence under s 152 of the New Zealand Crimes Act for failing to provide a child with necessary medical treatment. The case is analysed in terms of the need to enter into a conversation in which trust is the underpinning of a constructive discussion of the possibilities of treatment and the formulation of mutually acceptable regimens of care for difficult and uncertain treatments. This need is heightened when there are cultural barriers to be overcome and a significant divergence in understandings of an illness and value commitments between parents, or patients, and their caregivers.

Access to difficult airway equipment and training for rural GP-anaesthetists in Australia: results of a 2012 survey.

PubMed

Leeuwenburg, Tim J

2012-01-01

In rural Australia, general practitioners (GPs) form the frontline for provision of medical services. Besides responsibilities for primary care via private practice, rural doctors often provide emergency and inpatient services for rural hospitals. The aim of this study was to determine access to difficult airway equipment and training among the GP-anaesthetist cadre in rural Australia. an online survey regarding availability of difficult airway equipment, access to ongoing training and inviting comments on rural anaesthesia in general. a questionnaire was distributed to rural doctors in January 2012 via membership databases of the Rural Doctors Association of Australia and state-based Rural Doctor Workforce Agencies. 293 participants identified as a GP-anaesthetist working in rural Australia (65% response rate). Of these 83% were male, 17% female with the percentage of respondents from each state concordant with the distributions indicated by the 2010 Rural Health Workforce National Minimum Dataset. closed-ended questions were quantified and open-ended questions analysed to determine issues relevant to GP-anaesthetists. Only 53% of GP-anaesthetists reported access to a difficult airway trolley or box in their facility. Lack of availability of certain airway equipment was reported among GP-anaesthetists, with very few having access to advanced intubation aids such as videolaryngoscopes or fibreoptic devices (flexible fibrescopes and/or malleable fibreoptic stylets). Open-ended questions suggested that GP-anaesthetists desired such aids to manage difficult airways. Only 79% had access to surgical airway or paediatric airway equipment. Of the respondents, 58% reported involvement in prehospital medicine but only 12% had received training in this challenging environment. A formal arrangement for prehospital responses existed for only 7% of respondents. Despite the existence of well-publicised algorithms for difficult airway management and the need for specific equipment to manage the difficult airway, Australian GP-anaesthetists report difficulty accessing essential equipment for these infrequent but life-threatening events. This is surprising in the light of recommendations from the Australian and New Zealand College of Anaesthetists. The consequences of difficulty in airway management can be catastrophic. Equipment needs must be balanced against important considerations including ease of use, initial and ongoing training, and cost. Suggestions for affordable equipment and ongoing training for rural GP-anaesthetists are made. The involvement of GP-anaesthetists in prehospital responses occurs in the absence of formal arrangements and with a dearth of training. There is scope to improve rural prehospital responses in Australia, utilising the advanced skills of GP-anaesthetists in resuscitation and airway management.

Filling of orbital fluid management systems

NASA Technical Reports Server (NTRS)

Merino, F.; Blatt, M. H.; Thies, N. C.

1978-01-01

A study was performed with three objectives: (1) analyze fluid management system fill under orbital conditions; (2) determine what experimentation is needed; and (3) develop an experimental program. The fluid management system was a 1.06m (41.7 in) diameter pressure vessel with screen channel device. Analyses were conducted using liquid hydrogen and N2O4. The influence of helium and autogenous pressurization systems was considered. Analyses showed that fluid management system fill will be more difficult with a cryogen than with an earth storable. The key to a successful fill with cryogens is in devising techniques for filling without vent liquid, and removing trapped vapor from the screen device at tank fill completion. This will be accomplished with prechill, fill, and vapor condensation processes. Refill will require a vent and purge process, to dilute the residual helium, prior to introducing liquid. Neither prechill, chill, nor purge processes will be required for earth storables.

Strategic Analysis for the MER Cape Verde Approach

NASA Technical Reports Server (NTRS)

Gaines, Daniel; Belluta, Paolo; Herman, Jennifer; Hwang, Pauline; Mukai, Ryan; Porter, Dan; Jones, Byron; Wood, Eric; Grotzinger, John; Edgar, Lauren;

Continuous improvement in the Industrial and Management Systems Engineering programme at Kuwait University

NASA Astrophysics Data System (ADS)

Aldowaisan, Tariq; Allahverdi, Ali

2016-07-01

This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been applied to the results of four assessment tools and other data sources to improve performance. Important improvements include the need to reconsider two student outcomes as they were difficult to implement in courses. In addition, through benchmarking and the engagement of Alumni and Employers, key decisions were made to improve the curriculum and enhance employability.

2010 drug packaging review: identifying problems to prevent errors.

PubMed

2011-06-01

Prescrire's analyses showed that the quality of drug packaging in 2010 still left much to be desired. Potentially dangerous packaging remains a significant problem: unclear labelling is source of medication errors; dosing devices for some psychotropic drugs create a risk of overdose; child-proof caps are often lacking; and too many patient information leaflets are misleading or difficult to understand. Everything that is needed for safe drug packaging is available; it is now up to regulatory agencies and drug companies to act responsibly. In the meantime, health professionals can help their patients by learning to identify the pitfalls of drug packaging and providing safe information to help prevent medication errors.

Differentiation of histoplasma and cryptococcus in cytology smears: a diagnostic dilemma in severely necrotic cases.

PubMed

Ranjan, R; Jain, D; Singh, L; Iyer, V K; Sharma, M C; Mathur, S R

2015-08-01

The correct identification of fungal organisms is important for the appropriate clinical management of patients. It becomes difficult in necrotic smears when the tissue response is not clearly discernible. It is difficult to distinguish between histoplasma and cryptococcus in severely necrotic cases, where both appear as variably sized clear refractile haloes. Four cases of adrenal necrotic histoplasma infection were studied and the morphology was compared with that of non-necrotic histoplasmosis and cases of cryptococcal infection. Eleven cases were analysed in fine needle aspiration cytology (FNAC) smears. Ziehl-Neelsen (ZN) stain was performed to exclude tuberculosis in necrotic smears. A clinical and serology correlation was performed where available. Necrotic cases of histoplasma infection revealed negative refractile clear haloes similar to those of cryptococcus. Histoplasma showed methylene blue-stained organisms in ZN stains, whereas the cryptococcus cases were negative. Similar methylene blue-stained organisms were seen in non-necrotic histoplasma infection. As a result of morphological overlap between cryptococcus and histoplasma, the distinction between the two fungi can be difficult in many cases. ZN staining appears to have a role in the differentiation of these fungi in severely necrotic cases. This observation needs to be validated on a larger number of cases with complete correlation with clinical, serology and treatment records. © 2014 John Wiley & Sons Ltd.

Generational differences in factors influencing job turnover among Japanese nurses: an exploratory comparative design.

PubMed

Takase, Miyuki; Oba, Keiko; Yamashita, Noriko

2009-07-01

Although nurse turnover is a serious problem, the fact that each nurse has different work-related needs/values, and leaves their job for different reasons makes it difficult for organisations to develop effective countermeasures against it. Understanding nurses' needs and the reasons for job turnover by the generation in which they were born may provide some feasible solutions. The purpose of the study was to identify specific work-related needs and values of nurses in three generations (born in 1946-1959, 1960-1974, 1975-present). The study also aimed to explore generation-specific reasons that might make nurses consider leaving the jobs. The study was conducted in three public hospitals in Japan. A convenience sample of 315 registered nurses participated in the study. A survey method was used to collect quantitative and qualitative data. Quantitative data were analysed by ANOVA, and qualitative data were analysed by content analysis. Nurses born between 1960 and 1974 embraced high needs and values in professional privileges such as autonomy and recognition, while those born after 1975 expressed low needs and values in the opportunities for clinical challenge. For nurses born between 1960 and 1974, the imbalance between their jobs and personal life made them consider leaving their jobs. For those born after 1975, losing the confidence to care made them consider turning over. Nurses born after 1960 tended to value economic return and job security more highly compared to those born between 1946 and 1959. Nurses in different generations have different sets of needs/values and reasons for job turnover. Understanding generation-specific needs and values of nurses may enable organisations and Nurse Managers to develop feasible and effective countermeasures to reduce nurse turnover.

Standardizing economic analysis in prevention will require substantial effort.

PubMed

Guyll, Max

2014-12-01

It is exceedingly difficult to compare results of economic analyses across studies due to variations in assumptions, methodology, and outcome measures, a fact which surely decreases the impact and usefulness of prevention-related economic research. Therefore, Crowley et al. (Prevention Science, 2013) are precisely correct in their call for increased standardization and have usefully highlighted the issues that must be addressed. However, having made the need clear, the questions become what form the solution should take, and how should it be implemented. The present discussion outlines the rudiments of a comprehensive framework for promoting standardized methodology in the estimation of economic outcomes, as encouraged by Crowley et al. In short, a single, standard, reference case approach should be clearly articulated, and all economic research should be encouraged to apply that standard approach, with results from compliant analyses being reported in a central archive. Properly done, the process would increase the ability of those without specialized training to contribute to the body of economic research pertaining to prevention, and the most difficult tasks of predicting and monetizing distal outcomes would be readily completed through predetermined models. These recommendations might be viewed as somewhat forcible, insomuch as they advocate for prescribing the details of a standard methodology and establishing a means of verifying compliance. However, it is unclear that the best practices proposed by Crowley et al. will be widely adopted in the absence of a strong and determined approach.

Recognition of depression in people of different cultures: a qualitative study.

PubMed

Lehti, Arja; Hammarström, Anne; Mattsson, Bengt

2009-07-27

Many minority group patients who attend primary health care are depressed. To identify a depressive state when GPs see patients from other cultures than their own can be difficult because of cultural and gender differences in expressions and problems of communication. The aim of this study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive features. The data were collected in focus groups and through individual interviews with GPs in northern Sweden and analysed by qualitative content analysis. In the analysis three themes, based on various categories, emerged; "Realizing the background", "Struggling for clarity" and "Optimizing management". Patients' early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in the meetings were sometimes confused. GPs based their judgement mainly on clinical intuition and the established classification of depressive disorders was discussed. Tools for management and adequate action were diffuse. Dialogue about patients' illness narratives and social context are crucial. There is a need for tools for multicultural, general practice care in the depressive spectrum. It is also essential to be aware of GPs' own conceptions in order to avoid stereotypes and not to under- or overestimate the occurrence of depressive symptoms.

Organizational Behavior: Coping with Difficult Co-Workers.

ERIC Educational Resources Information Center

Arnold, Vanessa D.; Roach, Terry D.

1992-01-01

Discusses the need for students to learn to recognize and cope with difficult co-workers. Describes a few types of personalities that exhibit difficult or disturbed behavior and offers suggestions for coping with these personalities. (JOW)

Unmet care needs in people living with advanced cancer: a systematic review.

PubMed

Moghaddam, Nima; Coxon, Helen; Nabarro, Sally; Hardy, Beth; Cox, Karen

2016-08-01

The support needs of cancer patients vary according to the phase of their cancer journey. Recent developments in healthcare are such that the advanced cancer phase is increasingly experienced as a chronic illness phase, with consequent changes in patient support needs. Understanding these needs, and identifying areas of unmet need, can enable us to develop services that are more adequate to the task of supporting this population. We conducted a systematic search of four electronic databases to identify studies examining the unmet needs of people living with advanced cancer. Relevant data were extracted and synthesised; meta-analyses were conducted to obtain pooled estimates for prevalence of needs. We identified 23 studies (4 qualitative) for inclusion. Unmet needs were identified across a broad range of domains, with greatest prevalence in informational (30-55 %), psychological (18-42 %), physical (17-48 %), and functional (17-37 %) domains. There was considerable heterogeneity amongst studies in terms of methods of assessment, coding and reporting of needs, respondent characteristics, and appraised study quality. Heterogeneity made it difficult to compare across studies and inflated confidence intervals for pooled estimates of prevalence-we need standardised and comprehensive approaches to assessment and reporting of unmet needs to further our understanding. Nonetheless, the review identified prominent needs across a range of (interacting) experiential domains. Moreover, by focussing on unmet needs for support, we were able to extrapolate potential implications for service development.

Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study.

PubMed

Ellis, Scott Michael; Varley, Martin; Howell, Stuart; Trochsler, Markus; Maddern, Guy; Hewett, Peter; Runge, Tina; Mees, Soeren Torge

2016-08-01

Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills. Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion. 92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P < 0.0001) and precision cutting (P < 0.0001) were significantly more difficult. Males performed significantly better than females (P < 0.005). For LS, a deterioration of skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A-C) (P < 0.05). Our data reveal that complex laparoscopic tasks (cutting) and techniques (SILS) are more difficult to learn and acquired skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.

Traditional and emerging molecular markers in neuroblastoma prognosis: the good, the bad and the ugly.

PubMed

Poremba, C; Hero, B; Goertz, H G; Scheel, C; Wai, D; Schaefer, K L; Christiansen, H; Berthold, F; Juergens, H; Boecker, W; Dockhorn-Dworniczak, B

2001-01-01

Neuroblastomas (NB) are a heterogeneous group of childhood tumours with a wide range of likelihood for tumour progression. As traditional parameters do not ensure completely accurate prognostic grouping, new molecular markers are needed for assessing the individual patient's prognosis more precisely. 133 NB of all stages were analysed in blind-trial fashion for telomerase activity (TA), expression of surviving, and MYCN status. These data were correlated with other traditional prognostic indicators and disease outcome. TA is a powerful independent prognostic marker for all stages and is capable of differentiating between good and poor outcome in putative "favourable" clinical or biological subgroups of NB patients. High surviving expression is associated with an adverse outcome, but is more difficult to interprete than TA because survivin expression needs to be accurately quantified to be of predictive value. We propose an extended progression model for NB including emerging prognostic markers, with emphasis on telomerase activity.

Fourier Transform Mass Spectrometry: The Transformation of Modern Environmental Analyses

PubMed Central

Lim, Lucy; Yan, Fangzhi; Bach, Stephen; Pihakari, Katianna; Klein, David

2016-01-01

Unknown compounds in environmental samples are difficult to identify using standard mass spectrometric methods. Fourier transform mass spectrometry (FTMS) has revolutionized how environmental analyses are performed. With its unsurpassed mass accuracy, high resolution and sensitivity, researchers now have a tool for difficult and complex environmental analyses. Two features of FTMS are responsible for changing the face of how complex analyses are accomplished. First is the ability to quickly and with high mass accuracy determine the presence of unknown chemical residues in samples. For years, the field has been limited by mass spectrometric methods that were based on knowing what compounds of interest were. Secondly, by utilizing the high resolution capabilities coupled with the low detection limits of FTMS, analysts also could dilute the sample sufficiently to minimize the ionization changes from varied matrices. PMID:26784175

The parent magma of the Nakhla (SNC) meteorite: Reconciliation of composition estimates from magmatic inclusions and element partitioning

NASA Technical Reports Server (NTRS)

Treiman, A. H.

1993-01-01

The composition of the parent magma of the Nakhla meteorite was difficult to determine, because it is accumulate rock, enriched in olivine and augite relative to a basalt magma. A parent magma composition is estimated from electron microprobe area analyses of magmatic inclusions in olivine. This composition is consistent with an independent estimate based on the same inclusions, and with chemical equilibria with the cores of Nakhla's augites. This composition reconciles most of the previous estimates of Nakhla's magma composition, and obviates the need for complex magmatic processes. Inconsistency between this composition and those calculated previously suggests that magma flowed through and crystallized into Nakhla as it cooled.

Digital imaging biomarkers feed machine learning for melanoma screening.

PubMed

Gareau, Daniel S; Correa da Rosa, Joel; Yagerman, Sarah; Carucci, John A; Gulati, Nicholas; Hueto, Ferran; DeFazio, Jennifer L; Suárez-Fariñas, Mayte; Marghoob, Ashfaq; Krueger, James G

2017-07-01

We developed an automated approach for generating quantitative image analysis metrics (imaging biomarkers) that are then analysed with a set of 13 machine learning algorithms to generate an overall risk score that is called a Q-score. These methods were applied to a set of 120 "difficult" dermoscopy images of dysplastic nevi and melanomas that were subsequently excised/classified. This approach yielded 98% sensitivity and 36% specificity for melanoma detection, approaching sensitivity/specificity of expert lesion evaluation. Importantly, we found strong spectral dependence of many imaging biomarkers in blue or red colour channels, suggesting the need to optimize spectral evaluation of pigmented lesions. © 2016 The Authors. Experimental Dermatology Published by John Wiley & Sons Ltd.

Strategic analysis for the MER Cape Verde approach

USGS Publications Warehouse

Gaines, D.; Belluta, P.; Herman, J.; Hwang, P.; Mukai, R.; Porter, D.; Jones, B.; Wood, E.; Grotzinger, J.; Edgar, L.; Hayes, A.; Hare, T.; Squyres, S.

2009-01-01

The Mars Exploration Rover Opportunity has recently completed a two year campaign studying Victoria Crater. The campaign culminated in a close approach of Cape Verde in order to acquire high resolution imagery of the exposed stratigraphy in the cliff face. The close approach to Cape Verde provided significant challenges for every subsystem of the rover as the rover needed to traverse difficult, uncharacterised terrain and approach a cliff face with the potential of blocking out solar energy and communications with Earth. In this paper we describe the strategic analyses performed by the science and engineering teams so that we could successfully achieve the science objectives while keeping the rover safe. ??2009 IEEE.

Changing trends in barriers to cataract surgery in India.

PubMed

Vaidyanathan, K; Limburg, H; Foster, A; Pandey, R M

1999-01-01

Cataract is a major cause of blindness in Asia. Efforts in India to provide cataract surgical services have had limited success in reaching the cataract-blind population. Earlier studies identified the major barriers to cataract surgery as poverty, lack of transportation or felt need, or sex related; and the critical barriers in rural areas as lack of awareness, difficult access, and cost. Compared with these earlier data, the results of the present study in Karnataka State indicate a shift in the character of the barriers. They now appear to be more related to case selection and service provision. These shifts are analysed and alternative strategies to increase the uptake to cataract surgery are recommended.

Using spatial capture–recapture to elucidate population processes and space-use in herpetological studies

USGS Publications Warehouse

Muñoz, David J.; Miller, David A.W.; Sutherland, Chris; Grant, Evan H. Campbell

2016-01-01

The cryptic behavior and ecology of herpetofauna make estimating the impacts of environmental change on demography difficult; yet, the ability to measure demographic relationships is essential for elucidating mechanisms leading to the population declines reported for herpetofauna worldwide. Recently developed spatial capture–recapture (SCR) methods are well suited to standard herpetofauna monitoring approaches. Individually identifying animals and their locations allows accurate estimates of population densities and survival. Spatial capture–recapture methods also allow estimation of parameters describing space-use and movement, which generally are expensive or difficult to obtain using other methods. In this paper, we discuss the basic components of SCR models, the available software for conducting analyses, and the experimental designs based on common herpetological survey methods. We then apply SCR models to Red-backed Salamander (Plethodon cinereus), to determine differences in density, survival, dispersal, and space-use between adult male and female salamanders. By highlighting the capabilities of SCR, and its advantages compared to traditional methods, we hope to give herpetologists the resource they need to apply SCR in their own systems.

Data Mining and Analysis

NASA Technical Reports Server (NTRS)

Samms, Kevin O.

2015-01-01

The Data Mining project seeks to bring the capability of data visualization to NASA anomaly and problem reporting systems for the purpose of improving data trending, evaluations, and analyses. Currently NASA systems are tailored to meet the specific needs of its organizations. This tailoring has led to a variety of nomenclatures and levels of annotation for procedures, parts, and anomalies making difficult the realization of the common causes for anomalies. Making significant observations and realizing the connection between these causes without a common way to view large data sets is difficult to impossible. In the first phase of the Data Mining project a portal was created to present a common visualization of normalized sensitive data to customers with the appropriate security access. The tool of the visualization itself was also developed and fine-tuned. In the second phase of the project we took on the difficult task of searching and analyzing the target data set for common causes between anomalies. In the final part of the second phase we have learned more about how much of the analysis work will be the job of the Data Mining team, how to perform that work, and how that work may be used by different customers in different ways. In this paper I detail how our perspective has changed after gaining more insight into how the customers wish to interact with the output and how that has changed the product.

Readability of American online patient education materials in urologic oncology: a need for simple communication.

PubMed

Pruthi, Amanda; Nielsen, Matthew E; Raynor, Mathew C; Woods, Michael E; Wallen, Eric M; Smith, Angela B

2015-02-01

To determine the readability levels of reputable cancer and urologic Web sites addressing bladder, prostate, kidney, and testicular cancers. Online patient education materials (PEMs) for bladder, prostate, kidney, and testicular malignancies were evaluated from the American Cancer Society, American Society of Clinical Oncology, National Cancer Institute, Urology Care Foundation, Bladder Cancer Advocacy Network, Prostate Cancer Foundation, Kidney Cancer Association, and Testicular Cancer Resource Center. Grade level was determined using several readability indices, and analyses were performed on the basis of cancer type, Web site, and content area (general, causes, risk factors and prevention, diagnosis and staging, treatment, and post-treatment). Estimated grade level of online PEMs ranged from 9.2 to 14.2 with an overall mean of 11.7. Web sites for kidney cancer had the least difficult readability (11.3) and prostate cancer had the most difficult readability (12.1). Among specific Web sites, the most difficult readability levels were noted for the Urology Care Foundation Web site for bladder and prostate cancer and the Kidney Cancer Association and Testicular Cancer Resource Center for kidney and testes cancer. Readability levels within content areas varied on the basis of the disease and Web site. Online PEMs in urologic oncology are written at a level above the average American reader. Simplification of these resources is necessary to improve patient understanding of urologic malignancy. Copyright © 2015 Elsevier Inc. All rights reserved.

HIPPI: highly accurate protein family classification with ensembles of HMMs.

PubMed

Nguyen, Nam-Phuong; Nute, Michael; Mirarab, Siavash; Warnow, Tandy

2016-11-11

Given a new biological sequence, detecting membership in a known family is a basic step in many bioinformatics analyses, with applications to protein structure and function prediction and metagenomic taxon identification and abundance profiling, among others. Yet family identification of sequences that are distantly related to sequences in public databases or that are fragmentary remains one of the more difficult analytical problems in bioinformatics. We present a new technique for family identification called HIPPI (Hierarchical Profile Hidden Markov Models for Protein family Identification). HIPPI uses a novel technique to represent a multiple sequence alignment for a given protein family or superfamily by an ensemble of profile hidden Markov models computed using HMMER. An evaluation of HIPPI on the Pfam database shows that HIPPI has better overall precision and recall than blastp, HMMER, and pipelines based on HHsearch, and maintains good accuracy even for fragmentary query sequences and for protein families with low average pairwise sequence identity, both conditions where other methods degrade in accuracy. HIPPI provides accurate protein family identification and is robust to difficult model conditions. Our results, combined with observations from previous studies, show that ensembles of profile Hidden Markov models can better represent multiple sequence alignments than a single profile Hidden Markov model, and thus can improve downstream analyses for various bioinformatic tasks. Further research is needed to determine the best practices for building the ensemble of profile Hidden Markov models. HIPPI is available on GitHub at https://github.com/smirarab/sepp .

Software agents for the dissemination of remote terrestrial sensing data

NASA Technical Reports Server (NTRS)

Toomey, Christopher N.; Simoudis, Evangelos; Johnson, Raymond W.; Mark, William S.

1994-01-01

Remote terrestrial sensing (RTS) data is constantly being collected from a variety of space-based and earth-based sensors. The collected data, and especially 'value-added' analyses of the data, are finding growing application for commercial, government, and scientific purposes. The scale of this data collection and analysis is truly enormous; e.g., by 1995, the amount of data available in just one sector, NASA space science, will reach 5 petabytes. Moreover, the amount of data, and the value of analyzing the data, are expected to increase dramatically as new satellites and sensors become available (e.g., NASA's Earth Observing System satellites). Lockheed and other companies are beginning to provide data and analysis commercially. A critical issue for the exploitation of collected data is the dissemination of data and value-added analyses to a diverse and widely distributed customer base. Customers must be able to use their computational environment (eventually the National Information Infrastructure) to obtain timely and complete information, without having to know the details of where the relevant data resides and how it is accessed. Customers must be able to routinely use standard, widely available (and, therefore, low cost) analyses, while also being able to readily create on demand highly customized analyses to make crucial decisions. The diversity of user needs creates a difficult software problem: how can users easily state their needs, while the computational environment assumes the responsibility of finding (or creating) relevant information, and then delivering the results in a form that users understand? A software agent is a self-contained, active software module that contains an explicit representation of its operational knowledge. This explicit representation allows agents to examine their own capabilities in order to modify their goals to meet changing needs and to take advantage of dynamic opportunities. In addition, the explicit representation allows agents to advertize their capabilities and results to other agents, thereby allowing the collection of agents to reuse each others work.

Challenges for IT-supported shared care: a qualitative analyses of two shared care initiatives for diabetes treatment in Denmark “I'll never use it” (GP5).

PubMed Central

Granlien, Maren Fich; Simonsen, Jesper

2007-01-01

Purpose To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion The two cases faced the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general practitioners which hinder bridging the primary sector (general practitioners) and the secondary sector (hospitals and outpatient clinics). Especially the needs associated with the primary sector were not being satisfied. We discovered three main challenges related to bridging the gap between the two sectors: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must recognise the underlying and significant differences between the primary and secondary care sectors: If IT-supported shared care does not meet the needs of the general practitioners as well as the needs of the secondary care sector the initiative will fail. PMID:17627300

General health in Timor-Leste: self-assessed health in a large household survey.

PubMed

Earnest, Jaya; Finger, Robert P

2009-08-01

Timor-Leste is one of the world's newest nations and became a democracy in 2002. Ranked 150 out of 177 in the 2007 UNDP Human Development Index, the country has the worst health indicators in the Asia-Pacific region. The objective of this study was to collect and analyse data on subjectively assessed general health, health service use, migration and mobility patterns. The data collection involved recording self-reported status of general health using a structured questionnaire. The survey was administered to 1,213 Timorese households in six districts using a multi-stage random cluster sampling procedure. Basic descriptive statistical analyses were performed on all variables with SPSS version 13. More than a quarter (27%) of respondents reported a health problem at the time of the survey. Only approximately half of respondents assessed their health to be good (53%) or average (38%). Barriers reported in the uptake of healthcare services were no felt needed; difficulty in accessing services and unavailability of service. Results reveal that Timor-Leste needs a more decentralised provision of healthcare through primary healthcare centres or integrated health services. Trained traditional healers, who are familiar with the difficult terrain and understand cultural contexts and barriers, can be used to improve uptake of public health services. An adult literacy and community health education program is needed to further improve the extremely poor health indicators in the country. Key lessons that emerged were the importance of understanding cultural mechanisms in areas of protracted conflict and the need for integrated health services in communities.

Patterns and Correlates of Serostatus Disclosure to Sexual Partners by Perinatally-Infected Adolescents and Young Adults.

PubMed

Weintraub, Amy; Mellins, Claude A; Warne, Patricia; Dolezal, Curtis; Elkington, Katherine; Bucek, Amelia; Leu, Cheng-Shiun; Bamji, Mahrukh; Wiznia, Andrew; Abrams, Elaine J

2017-01-01

Similar to same-age peers, perinatally HIV-infected (PHIV+) youth in the US are engaging in sex, including condomless sex. Understanding decisions about serostatus disclosure to sexual partners is important to domestic and global HIV prevention efforts, since large numbers of PHIV+ children are entering adolescence and becoming sexually active. Using Social Action Theory (SAT) to inform variable selection, we examined correlates of disclosure among 98 PHIV+ adolescents/young adults in New York City. Over half of these youth reported not disclosing to any casual partners (59 %) or to any partners when using condoms (55 %). In bivariate analyses, increased disclosure was associated with older age; being female; earlier age of learning one's serostatus; and increased STD knowledge, disclosure intentions, and parent-child communication. Multiple regression analyses revealed a strong fit with the SAT model. As with adults, disclosure to sexual partners is difficult for PHIV+ youth and challenges prevention efforts. Effective interventions that help youth with disclosure decisions are needed to curb the epidemic.

Maximizing beneficence and autonomy. Ethical support for the use of nonpharmacological methods for managing dental anxiety.

PubMed

Donate-Bartfield, Evelyn; Spellecy, Ryan; Shane, Nicholas J

2010-01-01

This article examines advantages associated with nonpharmacological behavioral management techniques and suggests that there are benefits to their use (such as achieving a more lasting solution to the problem of dental anxiety) that are not realized with medication-based interventions. Analyses that use Kantian and existential viewpoints for exploring the use of medication versus behavioral interventions for managing life problems yield parallel conclusions: there are advantages gained by using behavioral interventions that are not always associated with medication-based interventions. These analyses, taken together with an understanding of the psychology of dental anxiety management, suggest that using nonpharmacological techniques for the management of dental anxiety can maximize adherence to the ethical principles of beneficence and patient autonomy. The authors discuss the barriers that make nonpharmacological interventions for anxiety management difficult for dentists to routinely use, and suggest that additional training in these methods and increased collaboration with mental health professionals are needed for dentists.

Engineering and fabrication cost considerations for cryogenic wind tunnel models

NASA Technical Reports Server (NTRS)

Boykin, R. M., Jr.; Davenport, J. B., Jr.

1983-01-01

Design and fabrication cost drivers for cryogenic transonic wind tunnel models are defined. The major cost factors for wind tunnel models are model complexity, tolerances, surface finishes, materials, material validation, and model inspection. The cryogenic temperatures require the use of materials with relatively high fracture toughness but at the same time high strength. Some of these materials are very difficult to machine, requiring extensive machine hours which can add significantly to the manufacturing costs. Some additional engineering costs are incurred to certify the materials through mechanical tests and nondestructive evaluation techniques, which are not normally required with conventional models. When instrumentation such as accelerometers and electronically scanned pressure modules is required, temperature control of these devices needs to be incorporated into the design, which requires added effort. Additional thermal analyses and subsystem tests may be necessary, which also adds to the design costs. The largest driver to the design costs is potentially the additional static and dynamic analyses required to insure structural integrity of the model and support system.

Markov Chain Monte Carlo: an introduction for epidemiologists

PubMed Central

Hamra, Ghassan; MacLehose, Richard; Richardson, David

2013-01-01

Markov Chain Monte Carlo (MCMC) methods are increasingly popular among epidemiologists. The reason for this may in part be that MCMC offers an appealing approach to handling some difficult types of analyses. Additionally, MCMC methods are those most commonly used for Bayesian analysis. However, epidemiologists are still largely unfamiliar with MCMC. They may lack familiarity either with he implementation of MCMC or with interpretation of the resultant output. As with tutorials outlining the calculus behind maximum likelihood in previous decades, a simple description of the machinery of MCMC is needed. We provide an introduction to conducting analyses with MCMC, and show that, given the same data and under certain model specifications, the results of an MCMC simulation match those of methods based on standard maximum-likelihood estimation (MLE). In addition, we highlight examples of instances in which MCMC approaches to data analysis provide a clear advantage over MLE. We hope that this brief tutorial will encourage epidemiologists to consider MCMC approaches as part of their analytic tool-kit. PMID:23569196

How a submarine returns to periscope depth: analysing complex socio-technical systems using Cognitive Work Analysis.

PubMed

Stanton, Neville A; Bessell, Kevin

2014-01-01

This paper presents the application of Cognitive Work Analysis to the description of the functions, situations, activities, decisions, strategies, and competencies of a Trafalgar class submarine when performing the function of returning to periscope depth. All five phases of Cognitive Work Analysis are presented, namely: Work Domain Analysis, Control Task Analysis, Strategies Analysis, Social Organisation and Cooperation Analysis, and Worker Competencies Analysis. Complex socio-technical systems are difficult to analyse but Cognitive Work Analysis offers an integrated way of analysing complex systems with the core of functional means-ends analysis underlying all of the other representations. The joined-up analysis offers a coherent framework for understanding how socio-technical systems work. Data were collected through observation and interviews at different sites across the UK. The resultant representations present a statement of how the work domain and current activities are configured in this complex socio-technical system. This is intended to provide a baseline, from which all future conceptions of the domain may be compared. The strength of the analysis is in the multiple representations from which the constraints acting on the work may be analysed. Future research needs to challenge the assumptions behind these constraints in order to develop new ways of working. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Infant temperament moderates relations between maternal parenting in early childhood and children's adjustment in first grade.

PubMed

Stright, Anne Dopkins; Gallagher, Kathleen Cranley; Kelley, Ken

2008-01-01

A differential susceptibility hypothesis proposes that children may differ in the degree to which parenting qualities affect aspects of child development. Infants with difficult temperaments may be more susceptible to the effects of parenting than infants with less difficult temperaments. Using latent change curve analyses to analyze data from the National Institute of Child Health and Human Development Study of Early Child Care, the current study found that temperament moderated associations between maternal parenting styles during early childhood and children's first-grade academic competence, social skills, and relationships with teachers and peers. Relations between parenting and first-grade outcomes were stronger for difficult than for less difficult infants. Infants with difficult temperaments had better adjustment than less difficult infants when parenting quality was high and poorer adjustment when parenting quality was lower.

Sustainable Lifestyle Change-Participatory Design of Support Together with Persons with Obesity in the Third Age.

PubMed

Wiklund Axelsson, Sarianne; Wikberg-Nilsson, Åsa; Melander Wikman, Anita

2016-12-16

Sustainable lifestyle changes due to obesity are difficult to achieve regardless methods used. We need to know more about the lived experience of obesity and older persons' needs for support to make a sustainable change. This paper focuses on the need-finding process in designing support for a sustainable lifestyle change. Multistage focus group interviews were conducted with persons aged 61-72 living in Northern Sweden. A participatory and appreciative reflection and action (PAAR) approach was used in the group-sessions. Probes were used to increase reflections and achieve a deeper knowledge about the participants' needs of support. Data were analysed using qualitative thematic content analysis. Our findings revealed that to be able to succeed with a lifestyle change a focus has to be on a converted way of thinking, managing vulnerability, and achieving an emotional balance. To achieve a sustainable lifestyle change due to obesity in the third age the focus has to be on a health identity instead of a weight identity. Personalised support with enjoyable physical activities should be designed and developed. Strategies for emotional balance based on autonomy and self-empowerment must be included. This knowledge is important when designing support for sustainable change.

Dealing with Institutional Racism on Campus: Initiating Difficult Dialogues and Social Justice Advocacy Interventions

ERIC Educational Resources Information Center

D'Andrea, Michael; Daniels, Judy

2007-01-01

The authors describe social justice advocacy interventions to initiate difficult discussions at the university where they are employed. They emphasize the need to foster difficult dialogues about the problem of institutional racism among students, faculty members, and administrators where they work. The Privileged Identity Exploration (PIE) model…

A decoy chain deployment method based on SDN and NFV against penetration attack

PubMed Central

Zhao, Qi; Zhang, Chuanhao

2017-01-01

Penetration attacks are one of the most serious network security threats. However, existing network defense technologies do not have the ability to entirely block the penetration behavior of intruders. Therefore, the network needs additional defenses. In this paper, a decoy chain deployment (DCD) method based on SDN+NFV is proposed to address this problem. This method considers about the security status of networks, and deploys decoy chains with the resource constraints. DCD changes the attack surface of the network and makes it difficult for intruders to discern the current state of the network. Simulation experiments and analyses show that DCD can effectively resist penetration attacks by increasing the time cost and complexity of a penetration attack. PMID:29216257

A decoy chain deployment method based on SDN and NFV against penetration attack.

PubMed

Zhao, Qi; Zhang, Chuanhao; Zhao, Zheng

2017-01-01

Penetration attacks are one of the most serious network security threats. However, existing network defense technologies do not have the ability to entirely block the penetration behavior of intruders. Therefore, the network needs additional defenses. In this paper, a decoy chain deployment (DCD) method based on SDN+NFV is proposed to address this problem. This method considers about the security status of networks, and deploys decoy chains with the resource constraints. DCD changes the attack surface of the network and makes it difficult for intruders to discern the current state of the network. Simulation experiments and analyses show that DCD can effectively resist penetration attacks by increasing the time cost and complexity of a penetration attack.

Infant Temperament Moderates Relations between Maternal Parenting in Early Childhood and Children's Adjustment in First Grade

ERIC Educational Resources Information Center

Stright, Anne Dopkins; Gallagher, Kathleen Cranley; Kelley, Ken

2008-01-01

A differential susceptibility hypothesis proposes that children may differ in the degree to which parenting qualities affect aspects of child development. Infants with difficult temperaments may be more susceptible to the effects of parenting than infants with less difficult temperaments. Using latent change curve analyses to analyze data from the…

Associations between neighbourhood support and financial burden with unmet needs of head and neck cancer survivors.

PubMed

O'Brien, Katie M; Timmons, Aileen; Butow, Phyllis; Gooberman-Hill, Rachael; O'Sullivan, Eleanor; Balfe, Myles; Sharp, Linda

2017-02-01

To assess the unmet needs of head and neck cancer survivors and investigate associated factors. In particular, to explore whether social support (family/friends and neighbours) and financial burden are associated with unmet needs of head and neck cancer (HNC) survivors. This was a cross-sectional study of HNC survivors, with 583 respondents included in the analysis. Information was collected on unmet supportive care needs as measured by the Supportive Care Needs Survey (SCNS-SF34). Poisson regression with robust standard errors was used to examine factors associated with having one or more needs in each of the five domains (physical; psychological; sexuality; patient care and support; and health system and information). The mean age of respondents was 62.9years (standard deviation 11.3years) and one third of respondents were female. The top ten unmet needs was composed exclusively of items from the physical and psychological domains. Financial strain due to cancer and finding it difficult to obtain practical help from a neighbour were both associated with unmet needs in each of the five domains, in the adjusted analyses. Whilst in each domain, a minority of respondents have unmet needs, approximately half of respondents reported at least one unmet need, with the commonest unmet needs in the psychological domain. Providing services to people with these needs should be a priority for healthcare providers. We suggest that studies, which identify risk factors for unmet needs, could be used to develop screening tools or aid in the targeting of support. Copyright © 2016 Elsevier Ltd. All rights reserved.

Understanding patient requirements for technology systems that support pain management in palliative care services: A qualitative study.

PubMed

Allsop, Matthew J; Taylor, Sally; Bennett, Michael I; Bewick, Bridgette M

2017-11-01

Approaches to pain management using electronic systems are being developed for use in palliative care. This article explores palliative care patients' perspectives on managing and talking about pain, the role of technology in their lives and how technology could support pain management. Face-to-face interviews were used to understand patient needs and concerns to inform how electronic systems are developed. A total of 13 interviews took place with a convenience sample of community-based patients with advanced cancer receiving palliative care through a hospice. Data were analysed using framework analysis. Four meta-themes emerged: Technology could be part of my care; I'm trying to understand what is going on; My pain is ever-changing and difficult to control; and I'm selective about who to tell about pain. Patients described technology as peripheral to existing processes of care. To be relevant, systems may need to take account of the complexity of a patient's pain experience alongside existing relationships with health professionals.

Healthy imaginations: a social history of the epidemiology of Aboriginal and Torres Strait Islander health.

PubMed

Brough, M

2001-01-01

It is difficult to imagine Aboriginal and Torres Strait Islander health without the powerful descriptors of epidemiology. The statistical imagery of numerical tables, pie charts, and bar graphs have become a key element in the public presentation of Indigenous public health issues. Such quantitative measurements of health draw on the authority of neutral, objective science and are thus rarely questioned in terms of their social meaning. This paper traces the history of this imagery through the 20th century, providing a social account of epidemiological description. Historical notions such as social Darwinism, assimilation, and dangerous other are all seen to be woven into the epidemiological text. The enormous rise in the epidemiological description of Indigenous health problems in recent years needs to be analyzed as a social phenomenon and, in particular, as an aspect of emerging forms of governmentality. Finally, it is argued that such analyses are needed in order to promote an anthropology of epidemiology and to avoid limiting medical anthropology to applications within epidemiology.

Biliary access in technically difficult biliary cannulation: the mucosal bridge technique

PubMed Central

Thomas, Rebecca; Shah, Suhaila Rizal; Worthley, Christopher S

2009-01-01

Background: The use of precut sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) facilitates selective bile duct access in difficult procedures. However, it is also associated with high rates of complications. Several techniques for precut sphincterotomy have been described in the literature. This paper reports our experience with a non-needle-knife technique for precut sphincterotomy, namely, the mucosal bridge technique. Methods: We analysed the experience of a single surgical endoscopist at our centre in performing precut sphincterotomies by retrospectively examining information in the database for January 2002 to February 2008, which had been stored prospectively using Endoscribe. Results: The mucosal bridge technique was performed in 16 (3.19%) of 501 patients. Success rates were 75% and 100% after first and second ERCPs, respectively. The failure of initial procedures was caused by bleeding, tissue oedema, poorly visualized papilla or a poorly distensible duodenum and oedematous papilla. There were four cases of complications, which included periductular extravasation of contrast, bleeding, and sepsis in two patients. However, these complications were not a direct consequence of the precut sphincterotomy. Conclusions: The mucosal bridge technique can be used to increase the likelihood of successful bile duct cannulation, thus preventing the need for a second intervention. PMID:19590645

[Instrumental studies in laboratories dedicated to the examination of disk overload in health workers].

PubMed

Frigo, C

1999-01-01

The main factors to be considered when applying movement analysis techniques to complex situations are analysed. In particular, when the mechanical interactions of the operator with an object to be handled are not easily measurable, as in the case of lifting a patient in a nursery, an approach in which the ground reaction forces are measured through a force platform is more convenient. In these situations the posture and the movement of the subject, that are also difficult to track, do not need to be analysed. The only information needed is the position and orientation of the intervertebral disk and some estimation of the anthropometric parameters of the part of the body which is below the vertebral level of interest. This can be achieved by a relatively simple approach and a few reasonable assumptions. In addition, the method can enable us to analyse forces and moments in 3-D. The results presented refer to several kinds of operations that are usually performed with hospital patients. They include bed to wheelchair transfer, assistance with standing up from a chair, repositioning the patient in bed. It is shown that the compression loads (1810 N to 5110 N) are comparable to those already reported in the literature. In addition, the transversal components (anterior (260 N-707 N) and lateral (5 N-200 N) shear) are of considerable interest. It is also shown how the use of appropriate ergonomical devices to help patient lifting and handling can considerably reduce the loads on the spine: in fact the compression loads are between 991 N and 1644 N.

When Your Child Is Difficult: Solve Your Toughest Child-Raising Problems with a Four-Step Plan That Works.

ERIC Educational Resources Information Center

Silberman, Mel

Written for parents, this book discusses four steps for dealing with children's difficult behavior. The book is divided into two parts. Part 1, "The Building Blocks," discusses baseline perspectives parents need to establish in order to effectively deal with difficult behavior. Topics covered include: (1) parents' dual roles as caregivers and…

Use of METEOSAT images for Tracking Severe Weather Conditions: Application to the Extreme Event of 24 October 2007 in Rio de Janeiro

NASA Astrophysics Data System (ADS)

Barbosa, Humberto

Previous studies on severe storms and related flash foods over large urban areas of Southeastern Brazil have proceeded through the analyses of specific individual case studies. These urban areas, especially in austral summer, are prone to severe convective rainfall that affects targets that are difficult to protect, such as vulnerable communities. The synoptic case on 24 October 2007 showed severe thunderstorms with heavy rains produced widespread street flooding and major damage across the Rio de Janeiro metropolitan area and surrounding locations. The suspected cause determining heavy rains were associated with the intrusion of the cold front towards this urban area, and the interaction that occurred between it and the tropical moist air mass moved from the Amazon deep convection. In this context, METEOSAT Second Generation is an important tool to monitoring the dynamical evolution of cloud structures. This event presented the need to explore possible applications of METEOSAT-9 image analyses in this particular location to account for the possibility of tracking the weather disturbances. One way of supporting the exploratory analyses was by applying the RGB air masses and IR 10.8 images. The results showed that both the RGB air masses and IR 10.8 analyses attain clear and good approach in monitoring and evaluating severe storms that can cause widespread daily rains over the large urban areas located at Southeastern Brazil.

Open and scalable analytics of large Earth observation datasets: From scenes to multidimensional arrays using SciDB and GDAL

NASA Astrophysics Data System (ADS)

Appel, Marius; Lahn, Florian; Buytaert, Wouter; Pebesma, Edzer

2018-04-01

Earth observation (EO) datasets are commonly provided as collection of scenes, where individual scenes represent a temporal snapshot and cover a particular region on the Earth's surface. Using these data in complex spatiotemporal modeling becomes difficult as soon as data volumes exceed a certain capacity or analyses include many scenes, which may spatially overlap and may have been recorded at different dates. In order to facilitate analytics on large EO datasets, we combine and extend the geospatial data abstraction library (GDAL) and the array-based data management and analytics system SciDB. We present an approach to automatically convert collections of scenes to multidimensional arrays and use SciDB to scale computationally intensive analytics. We evaluate the approach in three study cases on national scale land use change monitoring with Landsat imagery, global empirical orthogonal function analysis of daily precipitation, and combining historical climate model projections with satellite-based observations. Results indicate that the approach can be used to represent various EO datasets and that analyses in SciDB scale well with available computational resources. To simplify analyses of higher-dimensional datasets as from climate model output, however, a generalization of the GDAL data model might be needed. All parts of this work have been implemented as open-source software and we discuss how this may facilitate open and reproducible EO analyses.

Quantitative trait loci analyses and RNA-seq identify genes affecting stress response in rainbow trout

USDA-ARS?s Scientific Manuscript database

Genomic analyses have the potential to impact aquaculture production traits by identifying markers as proxies for traits which are expensive or difficult to measure and characterizing genetic variation and biochemical mechanisms underlying phenotypic variation. One such trait is the response of rai...

Exploration of Heterogeneity in Distributed Research Network Drug Safety Analyses

ERIC Educational Resources Information Center

Hansen, Richard A.; Zeng, Peng; Ryan, Patrick; Gao, Juan; Sonawane, Kalyani; Teeter, Benjamin; Westrich, Kimberly; Dubois, Robert W.

2014-01-01

Distributed data networks representing large diverse populations are an expanding focus of drug safety research. However, interpreting results is difficult when treatment effect estimates vary across datasets (i.e., heterogeneity). In a previous study, risk estimates were generated for selected drugs and potential adverse outcomes. Analyses were…

Poetry and Prose as Pedagogical Tools for Addressing Difficult Knowledges: Translocational Positionality and Issues of Collective Political Agency

ERIC Educational Resources Information Center

Keddie, Amanda

2012-01-01

In this paper the focus is on the possibilities that poetry and prose offer as pedagogical tools that can both accommodate and address difficult and painful knowledges. The paper presents and analyses poems and prose written by students at a non-traditional secondary school for disadvantaged girls (many of whom identify as Indigenous Australian).…

A framework for streamlining research workflow in neuroscience and psychology

PubMed Central

Kubilius, Jonas

2014-01-01

Successful accumulation of knowledge is critically dependent on the ability to verify and replicate every part of scientific conduct. However, such principles are difficult to enact when researchers continue to resort on ad-hoc workflows and with poorly maintained code base. In this paper I examine the needs of neuroscience and psychology community, and introduce psychopy_ext, a unifying framework that seamlessly integrates popular experiment building, analysis and manuscript preparation tools by choosing reasonable defaults and implementing relatively rigid patterns of workflow. This structure allows for automation of multiple tasks, such as generated user interfaces, unit testing, control analyses of stimuli, single-command access to descriptive statistics, and publication quality plotting. Taken together, psychopy_ext opens an exciting possibility for a faster, more robust code development and collaboration for researchers. PMID:24478691

Modification of gDNA extraction from soil for PCR designed for the routine examination of soil samples contaminated with Toxocara spp. eggs.

PubMed

Borecka, A; Gawor, J

2008-06-01

A modification of gDNA extraction was developed for the polymerase chain reaction (PCR) technique, intended for the detection and differentiation of Toxocara spp. eggs in soil or sediments. Sand samples from sandpits confirmed as being contaminated with Toxocara spp. eggs by the flotation technique were analysed by PCR. The use of proteinase K made it possible to obtain genomic DNA from the sample without needing to isolate eggs using flotation or to inactivate PCR inhibitors present in the sand. Specific primers in the PCR reaction allowed discrimination between T. canis and T. cati eggs. The modification simplified the procedure, thanks to eliminating the step of gDNA isolation from eggs, which is both laborious and difficult.

Quantifying the Global Fresh Water Budget: Capabilities from Current and Future Satellite Sensors

NASA Technical Reports Server (NTRS)

Hildebrand, Peter; Zaitchik, Benjamin

2007-01-01

The global water cycle is complex and its components are difficult to measure, particularly at the global scales and with the precision needed for assessing climate impacts. Recent advances in satellite observational capabilities, however, are greatly improving our knowledge of the key terms in the fresh water flux budget. Many components of the of the global water budget, e.g. precipitation, atmospheric moisture profiles, soil moisture, snow cover, sea ice are now routinely measured globally using instruments on satellites such as TRMM, AQUA, TERRA, GRACE, and ICESat, as well as on operational satellites. New techniques, many using data assimilation approaches, are providing pathways toward measuring snow water equivalent, evapotranspiration, ground water, ice mass, as well as improving the measurement quality for other components of the global water budget. This paper evaluates these current and developing satellite capabilities to observe the global fresh water budget, then looks forward to evaluate the potential for improvements that may result from future space missions as detailed by the US Decadal Survey, and operational plans. Based on these analyses, and on the goal of improved knowledge of the global fresh water budget under the effects of climate change, we suggest some priorities for the future, based on new approaches that may provide the improved measurements and the analyses needed to understand and observe the potential speed-up of the global water cycle under the effects of climate change.

Practical integration: The art of balancing values, institutions and knowledge - lessons from the History of British Public Health and Town Planning.

PubMed

De Grandis, Giovanni

2016-04-01

The paper uses two historical examples, public health (1840-1880) and town planning (1945-1975) in Britain, to analyse the challenges faced by goal-driven research, an increasingly important trend in science policy, as exemplified by the prominence of calls for addressing Grand Challenges. Two key points are argued. (1) Given that the aim of research addressing social or global problems is to contribute to improving things, this research should include all the steps necessary to bring science and technology to fruition. This need is captured by the idea of practical integration, which brings this type of research under the umbrella of collective practical reason rather than under the aegis of science. Achieving practical integration is difficult for many reasons: the complexity of social needs, the plurality of values at stake, the limitation of our knowledge, the elusive nature of the skills needed to deal with uncertainty, incomplete information and asymmetries of power. Nevertheless, drawing from the lessons of the case studies, it is argued that (2) practical integration needs a proper balance between values, institutions and knowledge: i.e. a combination of mutual support and mutual limitation. Pursuing such a balance provides a flexible strategy for approximating practical integration. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patterns and correlates of serostatus disclosure to sexual partners by perinatally-infected adolescents and young adults

PubMed Central

Weintraub, Amy; Mellins, Claude; Warne, Patricia; Dolezal, Curtis; Elkington, Katherine; Bucek, Amelia; Leu, Cheng-Shiun; Bamji, Mahrukh; Wiznia, Andrew; Abrams, Elaine J

2017-01-01

Similar to same-age peers, perinatally HIV-infected (PHIV+) youth in the US are engaging in sex, including condomless sex. Understanding decisions about serostatus disclosure to sexual partners is important to domestic and global HIV prevention efforts, since large numbers of PHIV+ children are entering adolescence and becoming sexually active. Using Social Action Theory (SAT) to inform variable selection, we examined correlates of disclosure among 98 PHIV+ adolescents/young adults in New York City. Over half of these youth reported not disclosing to any casual partners (59%) and to any partners when using condoms (55%). In simple regression analyses, increased disclosure was associated with older age; being female; earlier age of learning one’s serostatus; and increased STD knowledge, disclosure intentions, and parent-child communication. Multiple regression analyses revealed a strong fit with the SAT model. As with adults, disclosure to sexual partners is difficult for PHIV+ youth and challenges prevention efforts. Effective interventions that help youth with disclosure decisions are needed to curb the epidemic. PMID:26874846

Negotiating the (bio)medical gaze - Experiences of trans-specific healthcare in Sweden.

PubMed

Linander, Ida; Alm, Erika; Hammarström, Anne; Harryson, Lisa

2017-02-01

In Sweden as well as in other western countries persons with trans experiences have to go through a clinical evaluation in order to get access to gender-confirming medical procedures. The aim of this study is to analyse care-users' experiences of navigating and negotiating access to gender-confirming medical procedures in Sweden. Biomedicalisation is used as a theoretical framework in order to analyse how technoscientific and neoliberal developments are parts of constructing specific experiences within trans-specific care. Constructivist grounded theory was used to analyse 14 interviews with persons having experiences of, or considering seeking, trans-specific healthcare. The participants experienced trans-specific healthcare as difficult to navigate because of waiting times, lack of support, provider ignorance and relationships of dependency between healthcare-users and providers. These barriers pushed the users to take responsibility for the care process themselves, through ordering hormones from abroad, acquiring medical knowledge and finding alternative support. Based on the participants' experiences, it can be argued that the shift of responsibility from care-providers to users is connected to a lack of resources within trans-specific care, to neoliberal developments within the Swedish healthcare system, but also to discourses that frame taking charge of the care process as an indicator that a person is in need of or ready for care. Thus, access to gender-confirming medical procedures is stratified, based on the ability and opportunity to adopt a charge-taking role and on economic and geographic conditions. Based on the results and discussion, we conclude that trans-specific care ought to focus on supporting the care-seekers throughout the medical process, instead of the current focus on verifying the need for care. There is also a need for increased knowledge and financial resources. A separation between legal and medical gender reassignment could contribute to a better relationship between care-providers and care-users and increase the quality of care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Information and decision support needs of parents considering amniocentesis: interviews with pregnant women and health professionals.

PubMed

Durand, Marie-Anne; Stiel, Mareike; Boivin, Jacky; Elwyn, Glyn

2010-06-01

Our aim was to clarify and categorize information and decision support needs of pregnant women deciding about amniocentesis. Prenatal screening for Down's syndrome (implemented in routine practice) generates a quantifiable risk of chromosome abnormality. To increase certainty, chromosomal material needs to be obtained through amniocentesis or other diagnostic test. Amniocentesis carries risks of pregnancy loss. Semi-structured interviews were conducted with health professionals and pregnant women who had considered amniocentesis. The data were qualitatively analysed using a two-step thematic content analysis. A sample of 17 health professionals and 17 pregnant women were interviewed. Professionals demonstrated little consensus regarding the miscarriage rate, the potential consequences of amniocentesis testing and the uncertainty associated with the tests. Furthermore, methods employed to communicate risks varied between professionals. Pregnant women reported heightened stress and anxiety. Twelve out of 17 women described the decision as complex and difficult to make while five participants were satisfied with the information and support provided. Women would have liked more information about the risks involved, the results, the consequences of an amniocentesis and associated emotional difficulties. Women highlighted the need for personalized information, presented in multiple ways, while remaining simple and unbiased. There is variation in the provision of information related to amniocentesis testing. The majority of pregnant women reported difficulties making a decision and identified dimensions of information and decision support where improvements were needed.

Beyond the specific child. What is 'a child's case' in general practice?

PubMed

Hølge-Hazelton, Bibi; Tulinius, Charlotte

2010-01-01

Too many abused and neglected children are being overlooked by GPs and other professionals who are in contact with the families. Some suggestions for a definition of 'a child in need' have been given, but the functionality of these definitions has not been tested in general practice. To describe the problems presented by GPs as cases with children in need during supervision, and from here to suggest an empirically-based definition of a child in need in general practice. A mixed-method evaluation design was used. Twenty-one GPs, in Denmark, participated in supervision groups concerning cases with children in need in general practice. The data were analysed via field notes and video recordings; case categorisation into sex, ethnicity, and developmental stages; thematically using the GPs' own descriptions; and a theoretically supported style. Analysis of the data led to the suggested definition of a case concerning 'a child in need' in general practice as one that directly or indirectly involves problems with a specific child, an as-yet unborn child, or one or both parents of a family currently or potentially threatening the wellbeing of the family or the child. Based on this analysis, one suggestion as to why some abused and neglected children are overlooked in general practice is that GPs often have to navigate in difficult indirect consultations, where there is a high risk of losing the overview.

The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters.

PubMed

Shapiro, Johanna; Rakhra, Pavandeep; Wong, Adrianne

2016-10-01

Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.

Advanced Simulation & Computing FY15 Implementation Plan Volume 2, Rev. 0.5

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

McCoy, Michel; Archer, Bill; Matzen, M. Keith

2014-09-16

The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities andmore » computational resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resource, including technical staff, hardware, simulation software, and computer science solutions. As the program approaches the end of its second decade, ASC is intently focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), quantify critical margins and uncertainties, and resolve increasingly difficult analyses needed for the SSP. Where possible, the program also enables the use of high-performance simulation and computing tools to address broader national security needs, such as foreign nuclear weapon assessments and counternuclear terrorism.« less

Predicting nurses' well-being from job demands and resources: a cross-sectional study of emotional labour.

PubMed

Chou, Huei Yin; Hecker, Rob; Martin, Angela

2012-05-01

The aim of the present study was to investigate the effects of job demands and resources as well as emotional labour on job satisfaction and emotional exhaustion among nurses. While emotional labour is a construct that has considerable significance in health care as nurses often need to express organizationally desired emotions, little research has investigated the relationships between emotional labour, job demands and resources in the prediction of nurses' well-being. The questionnaire was distributed to 450 registered nurses (RN) working in a teaching hospital in Taiwan during February 2007, of which 240 valid questionnaires were returned and analysed (53.33% response rate). In addition to descriptive statistics and correlation, structural equation modelling (LISREL 8.8) was conducted. The findings showed that the frequency of interacting with difficult patients positively related to surface acting. Perceived organizational support (POS) positively related to deep acting and negatively to surface acting. The results also showed that surface acting related negatively, and deep acting related positively, to job satisfaction. The frequency of interactions with difficult patients related positively to emotional exhaustion, and negatively to job satisfaction. Perceived organizational support related negatively to emotional exhaustion and positively to job satisfaction. The results suggest that job demands, resources and emotional labour can predict nurses' well-being. The results of the present study indicate that nurses' well-being can be predicted by job demands, resources and emotional labour. There is a need to address organizational support and training programmes to enhance job satisfaction and reduce emotional exhaustion among nurses. © 2011 Blackwell Publishing Ltd.

Information and communication in society.

PubMed

Sandberg, Helena

2005-06-01

In late modernity, the media is one of the most important social institutions in influencing people's knowledge, perceptions and actions. The media supply citizens with health-related messages and contribute thereby to their health development. The abundant flow of health-related messages, however, makes it difficult for the individual to separate good and reliable information from information of poor quality. The prevalence of overweight and obesity is rising each year in Sweden as well as in other countries. The future scenario is troublesome. The presented study deals with two questions: (1) How is overweight represented in the media? (2) What consequences do these representations have on public perceptions of overweight? A multidisciplinary approach has been chosen for the study. Theories and concepts are derived from four areas of research: consumption, bodily issues, risks and media & journalism. The aim was to describe, analyse and problematize how overweight is presented quantitatively and qualitatively in the media. The method used is content analysis. The study is limited to media content in Swedish daily newspapers, 1997-2001. In all, 1925 articles from four different papers have been analysed. The ideals of journalism are easy to accept but too often difficult to realize. Reporters as well as physicians and scientists must make more of an effort to communicate comprehensible and useful information about overweight and obesity to their audiences. Still we know little about the amount, the quality and the utility of health information in the media. There is a need for further research in this field if we want to understand what chances people have in making informed health-related decisions and how they make sense of and use the health information at their disposal.

Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis.

PubMed

Johnson, Judith; Panagioti, Maria

2018-06-05

To assess the effectiveness of news delivery interventions to improve observer-rated skills, physician confidence, and patient-reported depression/anxiety. MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 5, 2016 (updated February 2017). Eligible studies included randomized controlled trials (RCTs), non-RCTs, and controlled before-after studies of interventions to improve the communication of bad or difficult news by physicians, medical students, and residents/interns. The EPOC risk of bias tool was used to conduct a risk of bias assessment. Main and secondary meta-analyses examined the effectiveness of the identified interventions for improving observer-rated news delivery skills and for improving physician confidence in delivering news and patient-reported depression/anxiety, respectively. Seventeen studies were included in the systematic review and meta-analysis, including 19 independent comparisons on 1,322 participants and 9 independent comparisons on 985 participants for the main and secondary (physician confidence) analyses (mean [SD] age = 35 [7] years; 46% male), respectively. Interventions were associated with large, significant improvements in observer-rated news delivery skills (19 comparisons: standardized mean difference [SMD] = 0.74, 95% CI = 0.47-1.01) and moderate, significant improvements in physician confidence (9 comparisons: SMD = 0.60, 95% CI = 0.26-0.95). One study reported intervention effects on patient-reported depression/anxiety. The risk of bias findings did not influence the significance of the results. Interventions are effective for improving news delivery and physician confidence. Further research is needed to test the impact of interventions on patient outcomes and determine optimal components and length.

Quantifying Forest Soil Physical Variables Potentially Important for Site Growth Analyses

Treesearch

John S. Kush; Douglas G. Pitt; Phillip J. Craul; William D. Boyer

2004-01-01

Accurate mean plot values of forest soil factors are required for use as independent variables in site-growth analyses. Adequate accuracy is often difficult to attain because soils are inherently widely variable. Estimates of the variability of appropriate soil factors influencing growth can be used to determine the sampling intensity required to secure accurate mean...

The use of exploratory analyses within the National Institute for Health and Care Excellence single technology appraisal process: an evaluation and qualitative analysis.

PubMed

Kaltenthaler, Eva; Carroll, Christopher; Hill-McManus, Daniel; Scope, Alison; Holmes, Michael; Rice, Stephen; Rose, Micah; Tappenden, Paul; Woolacott, Nerys

2016-04-01

As part of the National Institute for Health and Care Excellence (NICE) single technology appraisal (STA) process, independent Evidence Review Groups (ERGs) critically appraise the company submission. During the critical appraisal process the ERG may undertake analyses to explore uncertainties around the company's model and their implications for decision-making. The ERG reports are a central component of the evidence considered by the NICE Technology Appraisal Committees (ACs) in their deliberations. The aim of this research was to develop an understanding of the number and type of exploratory analyses undertaken by the ERGs within the STA process and to understand how these analyses are used by the NICE ACs in their decision-making. The 100 most recently completed STAs with published guidance were selected for inclusion in the analysis. The documents considered were ERG reports, clarification letters, the first appraisal consultation document and the final appraisal determination. Over 400 documents were assessed in this study. The categories of types of exploratory analyses included fixing errors, fixing violations, addressing matters of judgement and the ERG-preferred base case. A content analysis of documents (documentary analysis) was undertaken to identify and extract relevant data, and narrative synthesis was then used to rationalise and present these data. The level and type of detail in ERG reports and clarification letters varied considerably. The vast majority (93%) of ERG reports reported one or more exploratory analyses. The most frequently reported type of analysis in these 93 ERG reports related to the category 'matters of judgement', which was reported in 83 (89%) reports. The category 'ERG base-case/preferred analysis' was reported in 45 (48%) reports, the category 'fixing errors' was reported in 33 (35%) reports and the category 'fixing violations' was reported in 17 (18%) reports. The exploratory analyses performed were the result of issues raised by an ERG in its critique of the submitted economic evidence. These analyses had more influence on recommendations earlier in the STA process than later on in the process. The descriptions of analyses undertaken were often highly specific to a particular STA and could be inconsistent across ERG reports and thus difficult to interpret. Evidence Review Groups frequently conduct exploratory analyses to test or improve the economic evaluations submitted by companies as part of the STA process. ERG exploratory analyses often have an influence on the recommendations produced by the ACs. More in-depth analysis is needed to understand how ERGs make decisions regarding which exploratory analyses should be undertaken. More research is also needed to fully understand which types of exploratory analyses are most useful to ACs in their decision-making. The National Institute for Health Research Health Technology Assessment programme.

Family Life

MedlinePlus

... that is often difficult for both parents and children. Learn more about caring for a parent with cancer . Balancing your needs and your children’s needs. Being a parent while living with cancer ...

Contemporary Spaces of Memory - Towards Transdisciplinarity in Architecture

NASA Astrophysics Data System (ADS)

Kabrońska, Joanna

2017-10-01

The paper explores new phenomena in the contemporary practice of commemoration implemented through architecture. Architectural objects related to memory can be a place where new trends and phenomena appear earlier than in other architectural objects. The text is an attempt to prove that these new spaces of memory are a kind of laboratory where new ideas taking place in architecture and related disciplines are being tested. Research focuses on the bond between the complex and difficult problem of memory and the issue of transdisciplinarity in architecture. Over the last few decades architecture has been - in comparison to other areas - a relatively closed domain of knowledge. Contemporary places of memory - different from the traditional - may be the evidence of changes. On the basis of theoretical approaches, interdisciplinary surveys, in-field analyses and case studies the paper give insight into the relationships between architecture and other areas, emerging in the recently created spaces of memory of different types. The text indicates that today both the study and the design of such places is difficult without going beyond the field of architecture. There is a need for further extensive research, but the paper confirms the potential of this research direction. Spaces of memory offer the opportunity to capture the transformation of the discipline at the moment when the process begins.

SolarTherm: A flexible Modelica-based simulator for CSP systems

NASA Astrophysics Data System (ADS)

Scott, Paul; Alonso, Alberto de la Calle; Hinkley, James T.; Pye, John

2017-06-01

Annual performance simulations provide a valuable tool for analysing the viability and overall impact of different concentrating solar power (CSP) component and system designs. However, existing tools work best with conventional systems and are difficult or impossible to adapt when novel components, configurations and operating strategies are of interest. SolarTherm is a new open source simulation tool that fulfils this need for the solar community. It includes a simulation framework and a library of flexible CSP components and control strategies that can be adapted or replaced with new designs to meet the special needs of end users. This paper provides an introduction to SolarTherm and a comparison of models for an energy-based trough system and a physical tower system to those in the well-established and widely-used simulator SAM. Differences were found in some components where the inner workings of SAM are undocumented or not well understood, while the other parts show strong agreement. These results help to validate the fundamentals of SolarTherm and demonstrate that, while at an early stage of development, it is already a useful tool for performing annual simulations.

Translational medicine: science or wishful thinking?

PubMed Central

Wehling, Martin

2008-01-01

"Translational medicine" as a fashionable term is being increasingly used to describe the wish of biomedical researchers to ultimately help patients. Despite increased efforts and investments into R&D, the output of novel medicines has been declining dramatically over the past years. Improvement of translation is thought to become a remedy as one of the reasons for this widening gap between input and output is the difficult transition between preclinical ("basic") and clinical stages in the R&D process. Animal experiments, test tube analyses and early human trials do simply not reflect the patient situation well enough to reliably predict efficacy and safety of a novel compound or device. This goal, however, can only be achieved if the translational processes are scientifically backed up by robust methods some of which still need to be developed. This mainly relates to biomarker development and predictivity assessment, biostatistical methods, smart and accelerated early human study designs and decision algorithms among other features. It is therefore claimed that a new science needs to be developed called 'translational science in medicine'. PMID:18559092

An audit of the statistics and the comparison with the parameter in the population

NASA Astrophysics Data System (ADS)

Bujang, Mohamad Adam; Sa'at, Nadiah; Joys, A. Reena; Ali, Mariana Mohamad

2015-10-01

The sufficient sample size that is needed to closely estimate the statistics for particular parameters are use to be an issue. Although sample size might had been calculated referring to objective of the study, however, it is difficult to confirm whether the statistics are closed with the parameter for a particular population. All these while, guideline that uses a p-value less than 0.05 is widely used as inferential evidence. Therefore, this study had audited results that were analyzed from various sub sample and statistical analyses and had compared the results with the parameters in three different populations. Eight types of statistical analysis and eight sub samples for each statistical analysis were analyzed. Results found that the statistics were consistent and were closed to the parameters when the sample study covered at least 15% to 35% of population. Larger sample size is needed to estimate parameter that involve with categorical variables compared with numerical variables. Sample sizes with 300 to 500 are sufficient to estimate the parameters for medium size of population.

Citations in Life Science Patents to Publicly Funded Research at Academic Medical Centers.

PubMed

Sampat, Bhaven N; Pincus, Harold Alan

2015-12-01

The contributions of Academic Medical Centers (AMCs) to biomedical innovation have been difficult to measure because of the challenges involved in tracing knowledge flows from their origin to their uses. The authors examined patent citation linkages between AMC research funded by the National Institutes of Health (NIH) and patents. In prospective analyses, they examine the extent to which articles resulting from NIH grants to AMCs awarded between 1990 and 1995 were cited in drug and medical patents. The authors then examine the extent to which these patents are associated with marketed drugs. In retrospective analyses, they examine the share of drugs approved between 2000 and 2009 that have citation links to NIH-funded AMC research. The prospective analyses show over a third of AMC grants resulted in publications that were cited in patents. Most the patents are drug and biotechnology patents, and are assigned to private firms. Patents citing NIH-funded AMC publications were associated with 106 new FDA approved drugs, half of which are new molecular entities and a quarter of which are priority NMEs. The retrospective analyses showed that about half of the new molecular entities approved over the 2000-2009 period had citations links to NIH-funded AMC research. There are strong links between articles from NIH-funded AMC research and private sector medical patenting, including drugs. More research is needed to better understand the types of links the citations represent and their implications for public policy. © 2015 Wiley Periodicals, Inc.

The economics of health information technology in medication management: a systematic review of economic evaluations.

PubMed

O'Reilly, Daria; Tarride, Jean-Eric; Goeree, Ron; Lokker, Cynthia; McKibbon, K Ann

2012-01-01

To conduct a systematic review and synthesis of the evidence surrounding the cost-effectiveness of health information technology (HIT) in the medication process. Peer-reviewed electronic databases and gray literature were searched to identify studies on HIT used to assist in the medication management process. Articles including an economic component were reviewed for further screening. For this review, full cost-effectiveness analyses, cost-utility analyses and cost-benefit analyses, as well as cost analyses, were eligible for inclusion and synthesis. The 31 studies included were heterogeneous with respect to the HIT evaluated, setting, and economic methods used. Thus the data could not be synthesized, and a narrative review was conducted. Most studies evaluated computer decision support systems in hospital settings in the USA, and only five of the studied performed full economic evaluations. Most studies merely provided cost data; however, useful economic data involves far more input. A full economic evaluation includes a full enumeration of the costs, synthesized with the outcomes of the intervention. The quality of the economic literature in this area is poor. A few studies found that HIT may offer cost advantages despite their increased acquisition costs. However, given the uncertainty that surrounds the costs and outcomes data, and limited study designs, it is difficult to reach any definitive conclusion as to whether the additional costs and benefits represent value for money. Sophisticated concurrent prospective economic evaluations need to be conducted to address whether HIT interventions in the medication management process are cost-effective.

In-depth analyses of paleolithic pigments in cave climatic conditions

NASA Astrophysics Data System (ADS)

Touron, Stéphanie; Trichereau, Barbara; Syvilay, Delphine

2017-07-01

Painted caves are a specific environment which preservation needs multidisciplinary studies carried out within the different actors. The actions set-up must follow national and European ethics and treaties and be as less invasive as possible to preserve the integrity of the site. Studying colorants in caves should meet these expectations and take into account on-field conditions: high humidity rate, reduced access to electricity, etc. Therefore, non-invasive analyses should be preferred. However, their limits restrict the field of application and sometimes sampling and laboratory analyses must be used to answer the problematic. It is especially true when the pigment is covered by calcite. For this purpose, the Laser-Induced Breakdown Spectroscopy (LIBS) has been assessed to identify the composition with stratigraphic analyses. This study carries out in-depth profile on laboratory samples in conditions close to the ones meet in caves. Samples were prepared on a calcareous substrate using three pigments: red ochre, manganese black and carbon black and two binding media: water and saliva. All samples have been covered by calcite. Four sets of measurements have then been done using the LIBS instrument. The in-depth profiles were obtained using the Standard Normal Variate (SNV) normalization. For all the samples, the pigment layer was identified in the second or third shot, the calcite layer being quite thin. However, the results remain promising with the carbon black pigment but not really conclusive, the carbon being generally quite difficult to quantify.

ESP Needs Washback and the Fine Tuning of Driving Instruction

ERIC Educational Resources Information Center

Freiermuth, Mark R.

2007-01-01

Workplace needs are often difficult for English for Specific Purposes (ESP) teachers to assess due to a variety of obstacles that can restrict opportunities to analyze the existing needs. Nevertheless, the workers' needs may be recognized by employing techniques aimed at extracting information from the workers themselves. Japanese university…

Medical student resilience and stressful clinical events during clinical training.

PubMed

Houpy, Jennifer C; Lee, Wei Wei; Woodruff, James N; Pincavage, Amber T

2017-01-01

Medical students face numerous stressors during their clinical years, including difficult clinical events. Fostering resilience is a promising way to mitigate negative effects of stressors, prevent burnout, and help students thrive after difficult experiences. However, little is known about medical student resilience. To characterize medical student resilience and responses to difficult clinical events during clinical training. Sixty-two third-year (MS3) and 55 fourth-year (MS4) University of Chicago medical students completed surveys in 2016 assessing resilience (Connor Davidson Resilience Scale, CD-RISC 10), symptoms of burnout, need for resilience training, and responses to difficult clinical events. Medical student mean resilience was lower than in a general population sample. Resilience was higher in males, MS4s, those without burnout symptoms, and students who felt able to cope with difficult clinical events. When students experienced difficult events in the clinical setting, the majority identified poor team dynamics among the most stressful, and agreed their wellbeing was affected by difficult clinical events. A majority also would prefer to discuss these events with their team later that day. Students discussed events with peers more than with attendings or residents. Students comfortable discussing stress and burnout with peers had higher resilience. Most students believed resilience training would be helpful and most beneficial during MS3 year. Clinical medical student resilience was lower than in the general population but higher in MS4s and students reporting no burnout. Students had some insight into their resilience and most thought resilience training would be helpful. Students discussed difficult clinical events most often with peers. More curricula promoting medical student resilience are needed.

Professional Support for Families in Difficult Life Situations

ERIC Educational Resources Information Center

Zakirova, Venera G.; Gaysina, Guzel I.; Raykova, Elena

2016-01-01

Relevance of the problem stated in the article is determined by the presence of a significant number of families in difficult life situations who need in professional support and socio-psychological assistance. The article aims to substantiate the effectiveness of the structural-functional model of professional supporting for families in difficult…

Effective communication during difficult conversations.

PubMed

Polito, Jacquelyn M

2013-06-01

A strong interest and need exist in the workplace today to master the skills of conducting difficult conversations. Theories and strategies abound, yet none seem to have found the magic formula with universal appeal and success. If it is such an uncomfortable skill to master is it better to avoid or initiate such conversations with employees? Best practices and evidence-based management guide us to the decision that quality improvement dictates effective communication, even when difficult. This brief paper will offer some suggestions for strategies to manage difficult conversations with employees. Mastering the skills of conducting difficult conversations is clearly important to keeping lines of communication open and productive. Successful communication skills may actually help to avert confrontation through employee engagement, commitment and appropriate corresponding behavior

Variable Renewable Energy in Long-Term Planning Models: A Multi-Model Perspective

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

Cole, Wesley J.; Frew, Bethany A.; Mai, Trieu T.

Long-term capacity expansion models of the U.S. electricity sector have long been used to inform electric sector stakeholders and decision makers. With the recent surge in variable renewable energy (VRE) generators - primarily wind and solar photovoltaics - the need to appropriately represent VRE generators in these long-term models has increased. VRE generators are especially difficult to represent for a variety of reasons, including their variability, uncertainty, and spatial diversity. To assess current best practices, share methods and data, and identify future research needs for VRE representation in capacity expansion models, four capacity expansion modeling teams from the Electric Powermore » Research Institute, the U.S. Energy Information Administration, the U.S. Environmental Protection Agency, and the National Renewable Energy Laboratory conducted two workshops of VRE modeling for national-scale capacity expansion models. The workshops covered a wide range of VRE topics, including transmission and VRE resource data, VRE capacity value, dispatch and operational modeling, distributed generation, and temporal and spatial resolution. The objectives of the workshops were both to better understand these topics and to improve the representation of VRE across the suite of models. Given these goals, each team incorporated model updates and performed additional analyses between the first and second workshops. This report summarizes the analyses and model 'experiments' that were conducted as part of these workshops as well as the various methods for treating VRE among the four modeling teams. The report also reviews the findings and learnings from the two workshops. We emphasize the areas where there is still need for additional research and development on analysis tools to incorporate VRE into long-term planning and decision-making.« less

[Difficult teenagers: the challenges of interdisciplinarity].

PubMed

Saint-Andrté, Stéphane; Botbola, Michel

2013-01-01

The adolescents in great distress, because of ruptures in the course of their lives and of their chaotic family environment, need educational and social actions. The consensual point of view is that responding to the needs of the so called "difficult adolescents" implies the involvement of educational, therapeutic and judicial services. Nevertheless, the usual tendency to categorize the users with the idea it will permit to guide them to the appropriate skill field and the transgressive characteristic of these adolescents' behaviours lead all these services to reject them and send them to the two other services.

Specific needs of families of young adults with profound intellectual disability during and after transition to adulthood: What are we missing?

PubMed

Gauthier-Boudreault, Camille; Gallagher, Frances; Couture, Mélanie

2017-07-01

At the age of 21, the trajectory of services offered to youth with profound intellectual disability (ID) change significantly since access to specialised services is more limited. Despite the desire of parents to avoid any impact on their child, several factors can influence the course of this transition. However, there is little research on facilitators and obstacles to the transition to adulthood, and impacts on people with a profound ID. It is therefore difficult to provide solutions that meet their specific needs. The study aimed to document the needs of parents and young adults with profound ID during and after the transition to adulthood by exploring their transitioning experience and factors that influenced it. Using a descriptive qualitative design, two individual semi-structured interviews were conducted with fourteen (14) parents of young adults aged between 18 and 26 with a profound ID. At this point, many material, informative, cognitive and emotional needs of young adults and their parents are not met. Obstacles, mainly organisational, persist and result in a particularly difficult transition to adulthood experience. By knowing the specific needs of these families, it is possible to develop and implement solutions tailored to their reality. WHAT THE PAPERS ADDS?: The transition to adulthood is a critical period for families with young adults with an intellectual disability (ID), a reality observed internationally. Current literature on all levels of ID suggests some barriers to transition that lead to negative impacts on both parents and young adults with ID. However, presently, very little research exists on the reality of families of young adults with profound ID and factors influencing transition to adult life. Most of studies target people with mild to moderate ID. Considering the significant disabilities of people with profound ID, it is possible to imagine that their experience of transition will be even more difficult and they will present specific needs. The lack of understanding of these needs makes it difficult to introduce solutions tailored to their reality. The results of this current study suggest that many needs of young adults with profound ID and their parents are not met despite existent transition planning services. Transition to adulthood seems particularly difficult for these families who face many challenges. Parents in this study proposed different obstacles during transition to adulthood that could be improved for creation of future solutions adapted to their reality. Copyright © 2017. Published by Elsevier Ltd.

Special school teachers require more goal-oriented collaboration with psychiatric professionals in Northern Finland.

PubMed

Pönkkö, Maija-Leena; Taanila, Anja; Ebeling, Hanna

2003-03-01

The problems of children and adolescents have increased in number and severity during the last years. The purpose of this study was to elicit the views of special school teachers in the Oulu Province in Finland concerning their pupils' problems and the need, use and adequacy of relevant psychiatric services. The information was collected from the Northern Ostrobothnia Hospital District in 1998 in Finland and responses were obtained from the 37 (97.4%) special schools. The data were analysed using the content analysis method. Special-needs pupils had various behavioural and emotional problems that made it difficult for them to learn and for the teachers to teach. According to the teachers, the major obstacles in the process of helping special-needs pupils were the delayed admission for treatment and the lack of information necessary for the pupils' school work and goal-oriented aftercare, although there were also favourable experiences of functional co-operation and availability of useful information. Some schools lacked a reliable network for helping pupilsand supporting teachers. The Finnish legislation on basic education obliges the providers of education to provide rehabilitation in connection with special education and to arrange relevant development, counselling and support services. The rehabilitation of special-need pupils and the collaboration between school and mental health authorities is not optimally realised in spite of the legislation.

Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace?

PubMed

Balfe, Myles; Brugha, Ruairi; Smith, Diarmuid; Sreenan, Seamus; Doyle, Frank; Conroy, Ronan

2014-03-01

This article explores how and why workplace environments impact diabetes management for adults people with Type 1 diabetes, 23-30 years of age. Interviews were conducted with 35 young adults, 29 women and 6 men. The majority of these interviewees worked in sectors such as banking, technology and administration. Young adults found it difficult to manage diabetes in the workplace for two main reasons: work-related time pressures and the non-routine nature of interviewees' work and working environment. Young adults also found it difficult to get the time to exercise both inside and outside of work. Young adults with Type 1 diabetes need to be provided with the tools and technologies that they need to manage diabetes in modern flexible workplaces. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Language for Specifying Compiler Optimizations for Generic Software

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

Willcock, Jeremiah J.

2007-01-01

Compiler optimization is important to software performance, and modern processor architectures make optimization even more critical. However, many modern software applications use libraries providing high levels of abstraction. Such libraries often hinder effective optimization — the libraries are difficult to analyze using current compiler technology. For example, high-level libraries often use dynamic memory allocation and indirectly expressed control structures, such as iteratorbased loops. Programs using these libraries often cannot achieve an optimal level of performance. On the other hand, software libraries have also been recognized as potentially aiding in program optimization. One proposed implementation of library-based optimization is to allowmore » the library author, or a library user, to define custom analyses and optimizations. Only limited systems have been created to take advantage of this potential, however. One problem in creating a framework for defining new optimizations and analyses is how users are to specify them: implementing them by hand inside a compiler is difficult and prone to errors. Thus, a domain-specific language for librarybased compiler optimizations would be beneficial. Many optimization specification languages have appeared in the literature, but they tend to be either limited in power or unnecessarily difficult to use. Therefore, I have designed, implemented, and evaluated the Pavilion language for specifying program analyses and optimizations, designed for library authors and users. These analyses and optimizations can be based on the implementation of a particular library, its use in a specific program, or on the properties of a broad range of types, expressed through concepts. The new system is intended to provide a high level of expressiveness, even though the intended users are unlikely to be compiler experts.« less

Online maritime health information: an overview of the situation.

PubMed

Guitton, Matthieu J

2015-01-01

Due to their working conditions, seafarers often don't benefit from the same medical coverage than the onshore population. Therefore, seafarers and their relatives often need to locate health information by themselves. While the rise of the Internet has drastically transformed the way people can gather information, the availability of specific maritime health information online still need to be evaluated scientifically. We aim here to document of the characteristic of maritime health-related online information. A web survey was performed, articulated on two complementary analyses. First, an overall analysis of websites related to maritime health compared to websites related to two other health areas relevant for the general population (dental health and otorhinolaryngology) used as control. Second, an analysis of the understandability and actionability of a series of Wikipedia articles related to pathologies relevant for seafarers using the Patient Education Materials Assessment Tool (PEMAT). Online resources associated with maritime health were sparse and difficult to locate. When compared to other medical fields, maritime health websites were extremely poor in displaying useful information for seafarers. Available online resources regarding specific diseases affecting seafarers were mainly not adapted for a general audience and scored poorly both in terms of understandability and of actionability. This study provides a general overview of the degree of adaption of online material related to maritime health to seafarers' potential needs. Considerably more efforts need to be made in order to provide controlled online materials to answer the health information needs of the seafarers and their relatives.

The need for cost-effectiveness analyses of antimicrobial stewardship programmes: A structured review.

PubMed

Coulter, Sonali; Merollini, Katharina; Roberts, Jason A; Graves, Nicholas; Halton, Kate

2015-08-01

The cost effectiveness of antimicrobial stewardship (AMS) programmes was reviewed in hospital settings of Organisation for Economic Co-operation and Development (OECD) countries, and limited to adult patient populations. In each of the 36 studies, the type of AMS strategy and the clinical and cost outcomes were evaluated. The main AMS strategy implemented was prospective audit with intervention and feedback (PAIF), followed by the use of rapid technology, including rapid polymerase chain reaction (PCR)-based methods and matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) technology, for the treatment of bloodstream infections. All but one of the 36 studies reported that AMS resulted in a reduction in pharmacy expenditure. Among 27 studies measuring changes to health outcomes, either no change was reported post-AMS, or the additional benefits achieved from these outcomes were not quantified. Only two studies performed a full economic evaluation: one on a PAIF-based AMS intervention; and the other on use of rapid technology for the selection of appropriate treatment for serious Staphylococcus aureus infections. Both studies found the interventions to be cost effective. AMS programmes achieved a reduction in pharmacy expenditure, but there was a lack of consistency in the reported cost outcomes making it difficult to compare between interventions. A failure to capture complete costs in terms of resource use makes it difficult to determine the true cost of these interventions. There is an urgent need for full economic evaluations that compare relative changes both in clinical and cost outcomes to enable identification of the most cost-effective AMS strategies in hospitals. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Media Exposure in Low-Income Preschool-Aged Children Is Associated with Multiple Measures of Self-Regulatory Behavior.

PubMed

Munzer, Tiffany G; Miller, Alison L; Peterson, Karen E; Brophy-Herb, Holly E; Horodynski, Mildred A; Contreras, Dawn; Sturza, Julie; Lumeng, Julie C; Radesky, Jenny

2018-05-01

Excessive screen media exposure in childhood is associated with parent-reported self-regulation difficulties. No studies have used laboratory-based or teacher-reported measures of child self-regulatory behaviors. This study examines cross-sectional associations between preschooler screen media exposure and multiple measures of self-regulatory behaviors. Preintervention data were used from 541 preschoolers in the Growing Healthy study, an obesity prevention trial (2011-2015). Screen media exposure was measured by daily screen media exposure (hr/d), television (TV) in the bedroom, frequency of background TV, and TV with meals (1 = rarely/never, 4 = frequently). Child self-regulatory behaviors were measured by the following: child ability to delay gratification, a standardized waiting paradigm; teacher-reported Social Competence and Behavior Evaluation; and parent-reported difficult temperament on the Child Behavior Questionnaire (CBQ). Multivariate regression analyses modeled screen media exposure predicting each self-regulatory measure, adjusting for child age, sex, parent age, education, marital status, income-to-needs ratio, number of adults in household, parent depressive symptoms, and sensitivity. Children were aged 4.1 years (SD = 0.5), parents were aged 29.6 years (SD = 6.8), 48% had high school education or less, and 67% were married. Daily screen media exposure and background TV were associated with weaker observed self-regulation (β: -10.30 seconds for each hr/d media, -12.63 seconds for 1-point increase, respectively). Background TV and TV with meals were associated with greater parent-reported difficult temperament (β: 0.04 and 0.05 CBQ, respectively, for 1-point increase). Greater screen media exposure had small but significant associations with weaker observed and parent-reported, but not teacher-reported, self-regulatory behaviors. Longitudinal studies are needed to determine the directionality of associations.

A public health approach to cervical cancer control: considerations of screening and vaccination strategies.

PubMed

Goldie, Sue

2006-11-01

Cervical cancer remains a leading cause of cancer death among women living in low-resource settings. In the last 3 decades, cytologic screening has -in theory -been available and yet more than 6 million women have died of this preventable disease. The necessary resources, infrastructure, and technological expertise, together with the need for repeated screenings at regular intervals, make cytologic screening difficult to implement in poor countries. As noncytologic approaches for the detection of HPV, simple visual screening methods for anogenital lesions caused by HPV, and the availability of an HPV-16/18 vaccine will enhance the linkage between screening and treatment, multiple factors will need to be considered when designing new, or modifying existing prevention strategies. Countryspecific decisions regarding the best strategy for cervical cancer control will need to rely on data from many sources and take into account complex epidemiologic, economic, social, political, and cultural factors, and be made despite uncertainty and incomplete information. A rigorous decision analytic approach using computerbased modeling methods enables linkage of the knowledge gained from empirical studies to real-world situations. This chapter provides an introduction to these methods, reviews lessons learned from cost-effectiveness analyses of cervical cancer screening in developed and developing countries, and emphasizes important qualitative themes to consider in designing cervical cancer prevention policies.

Active Pixel Sensors: Are CCD's Dinosaurs?

NASA Technical Reports Server (NTRS)

Fossum, Eric R.

1993-01-01

Charge-coupled devices (CCD's) are presently the technology of choice for most imaging applications. In the 23 years since their invention in 1970, they have evolved to a sophisticated level of performance. However, as with all technologies, we can be certain that they will be supplanted someday. In this paper, the Active Pixel Sensor (APS) technology is explored as a possible successor to the CCD. An active pixel is defined as a detector array technology that has at least one active transistor within the pixel unit cell. The APS eliminates the need for nearly perfect charge transfer -- the Achilles' heel of CCDs. This perfect charge transfer makes CCD's radiation 'soft,' difficult to use under low light conditions, difficult to manufacture in large array sizes, difficult to integrate with on-chip electronics, difficult to use at low temperatures, difficult to use at high frame rates, and difficult to manufacture in non-silicon materials that extend wavelength response.

Learning Your Kids: An Action Research Approach to Home Visits and Teacher Practice

ERIC Educational Resources Information Center

Polson, Bilal

2013-01-01

Due to demographic shifts suburban schools are having difficulty meeting the needs of students of immigrant, poor and working class families. Schools are forced with the difficult task of closing learning gaps with students who may have difficult circumstances. Literature indicates fostering a healthy home/school connection by conducting…

Rugged passively cooled high power laser fiber optic connectors and methods of use

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

Rinzler, Charles C.; Gray, William C.; Fraze, Jason D.

2016-06-07

There are provided high power laser connectors and couplers and methods that are capable of providing high laser power without the need for active cooling to remote, harsh and difficult to access locations and under difficult and harsh conditions and to manage and mitigate the adverse effects of back reflections.

Classroom Techniques to Illustrate Water Transport in Plants

ERIC Educational Resources Information Center

Lakrim, Mohamed

2013-01-01

The transport of water in plants is among the most difficult and challenging concepts to explain to students. It is even more difficult for students enrolled in an introductory general biology course. An easy approach is needed to demonstrate this complex concept. I describe visual and pedagogical examples that can be performed quickly and easily…

Providing Dental Services for People with Disabilities: Why Is It So Difficult?

ERIC Educational Resources Information Center

Waldman, H. Barry; Perlman, Steven P.

2002-01-01

This article examines why it is difficult for individuals with disabilities to obtain dental services. It discusses inadequate preparation of dentists, cultural norms that create social, attitudinal, economic, and environmental barriers, and limited participation in the Medicaid dental program. The need for changes in dental school curricula is…

When I Whisper, Nobody Listens: Helping Young People Write about Difficult Issues.

ERIC Educational Resources Information Center

Frost, Helen

This book offers guidance on how teachers can help their students write about sensitive topics or provide pragmatic suggestions for developing the skill and sensitivity necessary to venture into such difficult terrain. The book addresses students' need to articulate their thoughts and feelings about violence, anger, drug use, peer pressure, and…

Therapeutic patient education in heart failure: do studies provide sufficient information about the educational programme?

PubMed

Albano, Maria Grazia; Jourdain, Patrick; De Andrade, Vincent; Domenke, Aukse; Desnos, Michel; d'Ivernois, Jean-François

2014-05-01

Therapeutic patient education programmes on heart failure have been widely proposed for many years for heart failure patients, but their efficiency remains questionable, partly because most articles lack a precise programme description, which makes comparative analysis of the studies difficult. To analyse the degree of precision in describing therapeutic patient education programmes in recent randomized controlled trials. Three major recent recommendations on therapeutic patient education in heart failure inspired us to compile a list of 23 relevant items that an 'ideal' description of a therapeutic patient education programme should contain. To discover the extent to which recent studies into therapeutic patient education in heart failure included these items, we analysed 19 randomized controlled trials among 448 articles published in this field from 2005 to 2012. The major elements required to describe a therapeutic patient education programme were present, but some other very important pieces of information were missing in most of the studies we analysed: the patient's educational needs, health literacy, projects, expectations regarding therapeutic patient education and psychosocial status; the educational methodology used; outcomes evaluation; and follow-up strategies. Research into how therapeutic patient education can help heart failure patients will be improved if more precise descriptions of patients, educational methodology and evaluation protocols are given by authors, ideally in a standardized format. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Financial hardship and drug use among men who have sex with men.

PubMed

Park, Su Hyun; Al-Ajlouni, Yazan; Palamar, Joseph J; Goedel, William C; Estreet, Anthony; Elbel, Brian; Sherman, Scott E; Duncan, Dustin T

2018-05-24

Little is known about the role of financial hardship as it relates to drug use, especially among men who have sex with men (MSM). As such, this study aimed to investigate potential associations between financial hardship status and drug use among MSM. We conducted a cross-sectional survey of 580 MSM in Paris recruited using a popular geosocial-networking smartphone application (GSN apps). Descriptive analyses and multivariate analyses were performed. A modified Poisson model was used to assess associations between financial hardship status and use of drugs (any drugs, tobacco, alcohol, marijuana, inhalant nitrites, and club drugs). In our sample, 45.5% reported that it was somewhat, very, or extremely difficult to meet monthly payments of bills (high financial hardship). In multivariate analyses, a high level of financial hardship was significantly associated with an increased likelihood of reporting use of any substance use (adjusted risk ratio [aRR] = 1.15; 95% CI = 1.05-1.27), as well as use of tobacco (aRR = 1.45; 95% CI = 1.19-1.78), marijuana (aRR = 1.48; 95% CI =1.03-2.13), and inhalant nitrites (aRR = 1.24; 95% CI = 1.03-1.50). Financial hardship was associated with drug use among MSM, suggesting the need for interventions to reduce the burden of financial hardship in this population.

ReportingTools: an automated result processing and presentation toolkit for high-throughput genomic analyses.

PubMed

Huntley, Melanie A; Larson, Jessica L; Chaivorapol, Christina; Becker, Gabriel; Lawrence, Michael; Hackney, Jason A; Kaminker, Joshua S

2013-12-15

It is common for computational analyses to generate large amounts of complex data that are difficult to process and share with collaborators. Standard methods are needed to transform such data into a more useful and intuitive format. We present ReportingTools, a Bioconductor package, that automatically recognizes and transforms the output of many common Bioconductor packages into rich, interactive, HTML-based reports. Reports are not generic, but have been individually designed to reflect content specific to the result type detected. Tabular output included in reports is sortable, filterable and searchable and contains context-relevant hyperlinks to external databases. Additionally, in-line graphics have been developed for specific analysis types and are embedded by default within table rows, providing a useful visual summary of underlying raw data. ReportingTools is highly flexible and reports can be easily customized for specific applications using the well-defined API. The ReportingTools package is implemented in R and available from Bioconductor (version ≥ 2.11) at the URL: http://bioconductor.org/packages/release/bioc/html/ReportingTools.html. Installation instructions and usage documentation can also be found at the above URL.

Interlaboratory comparison measurements of aspheres

NASA Astrophysics Data System (ADS)

Schachtschneider, R.; Fortmeier, I.; Stavridis, M.; Asfour, J.; Berger, G.; Bergmann, R. B.; Beutler, A.; Blümel, T.; Klawitter, H.; Kubo, K.; Liebl, J.; Löffler, F.; Meeß, R.; Pruss, C.; Ramm, D.; Sandner, M.; Schneider, G.; Wendel, M.; Widdershoven, I.; Schulz, M.; Elster, C.

2018-05-01

The need for high-quality aspheres is rapidly growing, necessitating increased accuracy in their measurement. A reliable uncertainty assessment of asphere form measurement techniques is difficult due to their complexity. In order to explore the accuracy of current asphere form measurement techniques, an interlaboratory comparison was carried out in which four aspheres were measured by eight laboratories using tactile measurements, optical point measurements, and optical areal measurements. Altogether, 12 different devices were employed. The measurement results were analysed after subtracting the design topography and subsequently a best-fit sphere from the measurements. The surface reduced in this way was compared to a reference topography that was obtained by taking the pointwise median across the ensemble of reduced topographies on a 1000 × 1000 Cartesian grid. The deviations of the reduced topographies from the reference topography were analysed in terms of several characteristics including peak-to-valley and root-mean-square deviations. Root-mean-square deviations of the reduced topographies from the reference topographies were found to be on the order of some tens of nanometres up to 89 nm, with most of the deviations being smaller than 20 nm. Our results give an indication of the accuracy that can currently be expected in form measurements of aspheres.

Oxidative status of human milk and its variations during cold storage.

PubMed

Miranda, María; Muriach, María; Almansa, Inmaculada; Jareño, Enrique; Bosch-Morell, Francisco; Romero, Francisco J; Silvestre, Dolores

2004-01-01

Breastfeeding and human milk are widely accepted as optimal for human infants' nutrition. Nowadays lifestyle often makes it difficult to maintain or even initiate human lactation. This situation is mostly related to the workload of women away from home. New approaches are needed to enable maternal lactation under these circumstances. Human breastmilk storage for differed use is one possibility. The aim of this study was to assess changes in glutathione peroxidase (GPx) activity and in the concentration of the lipid peroxidation marker, malondialdehyde (MDA), when human milk was kept refrigerated or frozen. Thirty-two human milk samples were assayed for GPx activity and MDA concentration. Samples were divided in three aliquot portions, the first to be immediately analysed, the second to be refrigerated at 4 degrees C and analysed 24 h thereafter, and the third to be frozen at -20 degrees C and assayed after 10 days. GPx activity was significantly decreased in refrigerated and in frozen milk, when compared to their control samples. MDA was increased only in refrigerated milk but not in frozen samples. Thus, freezing seems better than refrigeration in order to prevent lipid peroxidation in stored human milk samples.

Optimization of large animal MI models; a systematic analysis of control groups from preclinical studies.

PubMed

Zwetsloot, P P; Kouwenberg, L H J A; Sena, E S; Eding, J E; den Ruijter, H M; Sluijter, J P G; Pasterkamp, G; Doevendans, P A; Hoefer, I E; Chamuleau, S A J; van Hout, G P J; Jansen Of Lorkeers, S J

2017-10-27

Large animal models are essential for the development of novel therapeutics for myocardial infarction. To optimize translation, we need to assess the effect of experimental design on disease outcome and model experimental design to resemble the clinical course of MI. The aim of this study is therefore to systematically investigate how experimental decisions affect outcome measurements in large animal MI models. We used control animal-data from two independent meta-analyses of large animal MI models. All variables of interest were pre-defined. We performed univariable and multivariable meta-regression to analyze whether these variables influenced infarct size and ejection fraction. Our analyses incorporated 246 relevant studies. Multivariable meta-regression revealed that infarct size and cardiac function were influenced independently by choice of species, sex, co-medication, occlusion type, occluded vessel, quantification method, ischemia duration and follow-up duration. We provide strong systematic evidence that commonly used endpoints significantly depend on study design and biological variation. This makes direct comparison of different study-results difficult and calls for standardized models. Researchers should take this into account when designing large animal studies to most closely mimic the clinical course of MI and enable translational success.

RESPONSIVENESS, LANGUAGE, AND ALIGNMENT: REFLECTIONS ON SOME CHALLENGES FOR HEALTH TECHNOLOGY ASSESSMENT.

PubMed

Dillon, Andrew

2015-01-01

Health systems around the world cope with the challenge of difficult economic times, and the value of health technology assessment (HTA) is increasing. Making the right choices, with limited resources, in the face of increasingly complex technologies requires decisions informed by data and analyses that help us to manage the risks involved. Those who undertake and use HTA can play a greater role in helping decision makers meet these challenges; they need to think how to define innovation and respond to it, how to communicate their analyses, and, critically, how to align their work with the ambitions of their health systems. HTA can become a key health system enabler without compromising its objectivity or independence. It can say that it is too early to determine the value of a new technology when the data simply will not support a safe decision. However, it can also be bold and recommend the managed introduction of new technologies, even when the when the data is immature, provided that the health system understands the risks and there is a plausible case for believing that further research will support the value proposition. The goal for HTA is to be able confidently to do both.

Investigation into the use of satellite remote sensing data products as part of a multi-modal marine environmental monitoring network

NASA Astrophysics Data System (ADS)

O'Connor, Edel; Smeaton, Alan F.; O'Connor, Noel E.; Regan, Fiona

2012-09-01

In this paper it is investigated how conventional in-situ sensor networks can be complemented by the satellite data streams available through numerous platforms orbiting the earth and the combined analyses products available through services such as MyOcean. Despite the numerous benefits associated with the use of satellite remote sensing data products, there are a number of limitations with their use in coastal zones. Here the ability of these data sources to provide contextual awareness, redundancy and increased efficiency to an in-situ sensor network is investigated. The potential use of a variety of chlorophyll and SST data products as additional data sources in the SmartBay monitoring network in Galway Bay, Ireland is analysed. The ultimate goal is to investigate the ability of these products to create a smarter marine monitoring network with increased efficiency. Overall it was found that while care needs to be taken in choosing these products, there was extremely promising performance from a number of these products that would be suitable in the context of a number of applications especially in relation to SST. It was more difficult to come to conclusive results for the chlorophyll analysis.

Current and anticipated uses of the thermal hydraulics codes at the NRC

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

Caruso, R.

1997-07-01

The focus of Thermal-Hydraulic computer code usage in nuclear regulatory organizations has undergone a considerable shift since the codes were originally conceived. Less work is being done in the area of {open_quotes}Design Basis Accidents,{close_quotes}, and much more emphasis is being placed on analysis of operational events, probabalistic risk/safety assessment, and maintenance practices. All of these areas need support from Thermal-Hydraulic computer codes to model the behavior of plant fluid systems, and they all need the ability to perform large numbers of analyses quickly. It is therefore important for the T/H codes of the future to be able to support thesemore » needs, by providing robust, easy-to-use, tools that produce easy-to understand results for a wider community of nuclear professionals. These tools need to take advantage of the great advances that have occurred recently in computer software, by providing users with graphical user interfaces for both input and output. In addition, reduced costs of computer memory and other hardware have removed the need for excessively complex data structures and numerical schemes, which make the codes more difficult and expensive to modify, maintain, and debug, and which increase problem run-times. Future versions of the T/H codes should also be structured in a modular fashion, to allow for the easy incorporation of new correlations, models, or features, and to simplify maintenance and testing. Finally, it is important that future T/H code developers work closely with the code user community, to ensure that the code meet the needs of those users.« less

Ethical challenges related to elder care. High level decision-makers' experiences

PubMed Central

Mamhidir, Anna-Greta; Kihlgren, Mona; Sorlie, Venke

2007-01-01

Background Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. Methods A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Results Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Conclusion Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet. PMID:17419880

Ethical challenges related to elder care. High level decision-makers' experiences.

PubMed

Mamhidir, Anna-Greta; Kihlgren, Mona; Sorlie, Venke

2007-04-10

Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet.

Ontogeny of Foraging Competence in Capuchin Monkeys (Cebus capucinus) for Easy versus Difficult to Acquire Fruits: A Test of the Needing to Learn Hypothesis.

PubMed

Eadie, Elizabeth Christine

2015-01-01

Which factors select for long juvenile periods in some species is not well understood. One potential reason to delay the onset of reproduction is slow food acquisition rates, either due to competition (part of the ecological risk avoidance hypothesis), or due to a decreased foraging efficiency (a version of the needing to learn hypothesis). Capuchins provide a useful genus to test the needing to learn hypothesis because they are known for having long juvenile periods and a difficult-to-acquire diet. Generalized, linear, mixed models with data from 609 fruit forage focal follows on 49, habituated, wild Cebus capucinus were used to test two predictions from the needing-to-learn hypothesis as it applies to fruit foraging skills: 1) capuchin monkeys do not achieve adult foraging return rates for difficult-to-acquire fruits before late in the juvenile period; and 2) variance in return rates for these fruits is at least partially associated with differences in foraging skill. In support of the first prediction, adults, compared with all younger age classes, had significantly higher foraging return rates when foraging for fruits that were ranked as difficult-to-acquire (return rates relative to adults: 0.30-0.41, p-value range 0.008-0.016), indicating that the individuals in the group who have the most foraging experience also achieve the highest return rates. In contrast, and in support of the second prediction, there were no significant differences between age classes for fruits that were ranked as easy to acquire (return rates relative to adults: 0.97-1.42, p-value range 0.086-0.896), indicating that strength and/or skill are likely to affect return rates. In addition, fruits that were difficult to acquire were foraged at nearly identical rates by adult males and significantly smaller (and presumably weaker) adult females (males relative to females: 1.01, p = 0.978), while subadult females had much lower foraging efficiency than the similarly-sized but more experienced adult females (subadults relative to adults: 0.34, p = 0.052), indicating that skill, specifically, is likely to have an effect on return rates. These results are consistent with the needing to learn hypothesis and indicate that long juvenile periods in capuchins may be the result of selection for more time to learn foraging skills for difficult-to-acquire fruits.

Swyer Syndrome With Gonadoblastoma: A Clinicoradiological Approach.

PubMed

Agarwal, Arjit; Agarwal, Shubhra

2017-01-01

Primary amenorrhea is a common diagnostic challenge in the gynecology department, wherein there are numerous causes that need to be approached in a systematic manner. However, when a case with a pelvic lump or a solid pelvic mass presents to a gynecologist or a radiologist, the approach becomes difficult to justify amenorrhea and pelvic mass as a single entity. We present the case of a 36-year-old female with the complaints of primary amenorrhea with a pelvic mass. The case was approached keeping in view the diagnostic possibilities and applying the role of clinical, radiological, and laboratory analyses. The final diagnosis of Swyer syndrome with gonadoblastoma was made, and she was further subjected to operative resection and hormonal therapy. This study stresses on the approach to a case, wherein the diagnosis was based only on the clinician's acumen and the radiologist's expertise, providing a way to simplify the protocol in the evaluation of such types of cases.

Argumentation: A Methodology to Facilitate Critical Thinking.

PubMed

Makhene, Agnes

2017-06-20

Caring is a difficult nursing activity that involves a complex nature of a human being in need of complex decision-making and problem solving through the critical thinking process. It is mandatory that critical thinking is facilitated in general and in nursing education particularly in order to render care in diverse multicultural patient care settings. This paper aims to describe how argumentation can be used to facilitate critical thinking in learners. A qualitative, exploratory and descriptive design that is contextual was used. Purposive sampling method was used to draw a sample and Miles and Huberman methodology of qualitative analysis was used to analyse data. Lincoln and Guba's strategies were employed to ensure trustworthiness, while Dhai and McQuoid-Mason's principles of ethical consideration were used. Following data analysis the findings were integrated within literature which culminated into the formulation of guidelines that can be followed when using argumentation as a methodology to facilitate critical thinking.

The complex system of environmental monitoring (CSEM). An analysis of concept

NASA Astrophysics Data System (ADS)

Kazatsev, Yury I.; Mitchenkov, Igor G.

2018-01-01

Researches of ecological processes in Russia testify to rather difficult and adverse situation. It is quite obviously that we need a reasonable concept of an exit from the situation. It could become the strategic program for the solution of ecological tasks at the same time. In this regard, it is obviously necessary not just to develop new scientific and technological mechanisms to overcome of critical situations, but to offer a new research platform which will be able to give ideas to predict tendencies of ecological development and to analyses the consequences of their embodiment. Our offer for it is “the composite system of environmental monitoring” (CSEM) of the territory or region. We use a method of the conceptual analysis. Also, we will try to show how definition of the term influences to contents of social practicing, namely, environmental monitoring of the region.

[The importance of psychosocial care].

PubMed

Menyhért, Mónika; Csikós, Agnes; Radványi, Ildikó; Busa, Csilla

2014-09-14

Psychosocial support is very important for cancer patients, because it affects the quality of life of the patients and the course of the disease. It helps the family to deal with difficult situations and prepare for future challenges. The aim of this study was to analyse the psychosocial care in the Pécs-Baranyai Hospice Foundation and answer the following questions: what are the characteristics of psychosocial care and how many people receive this support. It was a retrospective study. During the 8 years examined, 36% of the patients (273 persons) asked or proposed by anyone psychosocial support for the family. However, meeting between the patient and expert evolved only in 49% of the 273 patients and, thus, only 18% of the patients received psychosocial support. In the Pécs-Baranya Hospice Foundation less patients received psychosocial support, than those who would need it. Psychosocial care is not yet an integral part of hospice care in practice.

Systemic Analysis Approaches for Air Transportation

NASA Technical Reports Server (NTRS)

Conway, Sheila

2005-01-01

Air transportation system designers have had only limited success using traditional operations research and parametric modeling approaches in their analyses of innovations. They need a systemic methodology for modeling of safety-critical infrastructure that is comprehensive, objective, and sufficiently concrete, yet simple enough to be used with reasonable investment. The methodology must also be amenable to quantitative analysis so issues of system safety and stability can be rigorously addressed. However, air transportation has proven itself an extensive, complex system whose behavior is difficult to describe, no less predict. There is a wide range of system analysis techniques available, but some are more appropriate for certain applications than others. Specifically in the area of complex system analysis, the literature suggests that both agent-based models and network analysis techniques may be useful. This paper discusses the theoretical basis for each approach in these applications, and explores their historic and potential further use for air transportation analysis.

Virtues and humanitarian ethics.

PubMed

Löfquist, Lars

2017-01-01

This paper analyses the contribution of virtue ethics, the study of good character traits, to the humanitarian context. It argues that a virtue ethics perspective paints a realistic picture of the use of ethical standards in morally complex circumstances. Virtuous relief workers can employ standards in their thinking, but they are also committed to professional excellence that goes beyond any formal code. The concept of virtue ethics places a stress on moral development, which can be facilitated by role models that impart modest and feasible ideals. However, virtue ethics cannot provide simple guidelines on how to resolve difficult situations. It is possible that two virtuous persons can disagree on what should be done in a particular instance. In addition, a virtue ethics perspective emphasises the need for both individuals and organisations to discuss the actual purpose of relief work in order to pinpoint the virtues of a good relief professional. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.

Extraction and Analysis of Display Data

NASA Technical Reports Server (NTRS)

Land, Chris; Moye, Kathryn

2008-01-01

The Display Audit Suite is an integrated package of software tools that partly automates the detection of Portable Computer System (PCS) Display errors. [PCS is a lap top computer used onboard the International Space Station (ISS).] The need for automation stems from the large quantity of PCS displays (6,000+, with 1,000,000+ lines of command and telemetry data). The Display Audit Suite includes data-extraction tools, automatic error detection tools, and database tools for generating analysis spread sheets. These spread sheets allow engineers to more easily identify many different kinds of possible errors. The Suite supports over 40 independent analyses, 16 NASA Tech Briefs, November 2008 and complements formal testing by being comprehensive (all displays can be checked) and by revealing errors that are difficult to detect via test. In addition, the Suite can be run early in the development cycle to find and correct errors in advance of testing.

Curriculum as Conversation: Vulnerability, Violence, and Pedagogy in Prison

ERIC Educational Resources Information Center

O'Donnell, Aislinn

2015-01-01

It is difficult to respond creatively to humiliation, affliction, degradation, or shame, just as it is difficult to respond creatively to the experience of undergoing or inflicting violence. In this article Aislinn O'Donnell argues that if we are to think about how to address gun violence--including mass shootings- in schools, then we need to talk…

Collegiate Connections: Music Education Budget Crisis

ERIC Educational Resources Information Center

Slaton, Emily Dawn

2012-01-01

Due to the current recession, the American economy within the last few years has taken a nosedive, making it difficult for national, state, and local governments to support all the programs they currently have in place. There are difficult choices that need to be made about where to make sacrifices in their budgets so things can still run…

The Professionalization of Management: Aims, Obstacles, and Prospects

ERIC Educational Resources Information Center

Moskovskaia, A. A.

2012-01-01

Management in Russia is as difficult to define as a profession as it is in other countries, and the question of what education is appropriate for a future manager is also difficult to define. Business schools in Russia need to think more carefully about their curriculums and about what they should be preparing their students for. (Contains 6…

Families as Decision-Makers: When Researchers and Advocates Work Together

ERIC Educational Resources Information Center

Fields-Smith, Cheryl; Neuharth-Pritchett, Stacey

2009-01-01

Families across the United States must routinely make difficult choices about child care arrangements because of the need to resume a job, continue an education or training program, or care for other family members. Leaving children in the care of others for the first time can be difficult (Sayer, Bianchi, & Robinson, 2004; Van Horn, Ramey,…

Effective Inclusion Strategies for Professionals Working with Students with Disabilities

ERIC Educational Resources Information Center

Hogan, Kathleen A.; Lohmann, Marla; Champion, Rose

2013-01-01

Inclusive classrooms are now the norm in many K-12 public schools across the United States. General education teachers have a difficult job making sure all their students are meeting state standards. With the addition of special education students in the classroom, their job becomes even more difficult due to meeting the needs of the general…

The economics of health information technology in medication management: a systematic review of economic evaluations

PubMed Central

Tarride, Jean-Eric; Goeree, Ron; Lokker, Cynthia; McKibbon, K Ann

2011-01-01

Objective To conduct a systematic review and synthesis of the evidence surrounding the cost-effectiveness of health information technology (HIT) in the medication process. Materials and methods Peer-reviewed electronic databases and gray literature were searched to identify studies on HIT used to assist in the medication management process. Articles including an economic component were reviewed for further screening. For this review, full cost-effectiveness analyses, cost-utility analyses and cost-benefit analyses, as well as cost analyses, were eligible for inclusion and synthesis. Results The 31 studies included were heterogeneous with respect to the HIT evaluated, setting, and economic methods used. Thus the data could not be synthesized, and a narrative review was conducted. Most studies evaluated computer decision support systems in hospital settings in the USA, and only five of the studied performed full economic evaluations. Discussion Most studies merely provided cost data; however, useful economic data involves far more input. A full economic evaluation includes a full enumeration of the costs, synthesized with the outcomes of the intervention. Conclusion The quality of the economic literature in this area is poor. A few studies found that HIT may offer cost advantages despite their increased acquisition costs. However, given the uncertainty that surrounds the costs and outcomes data, and limited study designs, it is difficult to reach any definitive conclusion as to whether the additional costs and benefits represent value for money. Sophisticated concurrent prospective economic evaluations need to be conducted to address whether HIT interventions in the medication management process are cost-effective. PMID:21984590

Primary care physicians' educational needs and learning preferences in end of life care: A focus group study in the UK.

PubMed

Selman, Lucy Ellen; Brighton, Lisa Jane; Robinson, Vicky; George, Rob; Khan, Shaheen A; Burman, Rachel; Koffman, Jonathan

2017-03-09

Primary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC). However, many lack confidence in this area, and the quality of EoLC by GPs can be problematic. Evidence regarding educational needs, learning preferences and the acceptability of evaluation methods is needed to inform the development and testing of EoLC education. This study therefore aimed to explore GPs' EoLC educational needs and preferences for learning and evaluation. A qualitative focus group study was conducted with qualified GPs and GP trainees in the UK. Audio recordings were transcribed and analysed thematically. Expert review of the coding frame and dual coding of transcripts maximised rigour. Twenty-eight GPs (10 fully qualified, 18 trainees) participated in five focus groups. Four major themes emerged: (1) why education is needed, (2) perceived educational needs, (3) learning preferences, and (4) evaluation preferences. EoLC was perceived as emotionally and clinically challenging. Educational needs included: identifying patients for palliative care; responsibilities and teamwork; out-of-hours care; having difficult conversations; symptom management; non-malignant conditions; and paediatric palliative care. Participants preferred learning through experience, working alongside specialist palliative care staff, and discussion of real cases, to didactic methods and e-learning. 360° appraisals and behavioural assessment using videoing or simulated interactions were considered problematic. Self-assessment questionnaires and patient and family outcome measures were acceptable, if used and interpreted correctly. GPs require education and support in EoLC, particularly the management of complex clinical care and counselling. GPs value mentoring, peer-support, and experiential learning alongside EoLC specialists over formal training.

An Approximate Dissipation Function for Large Strain Rubber Thermo-Mechanical Analyses

NASA Technical Reports Server (NTRS)

Johnson, Arthur R.; Chen, Tzi-Kang

2003-01-01

Mechanically induced viscoelastic dissipation is difficult to compute. When the constitutive model is defined by history integrals, the formula for dissipation is a double convolution integral. Since double convolution integrals are difficult to approximate, coupled thermo-mechanical analyses of highly viscous rubber-like materials cannot be made with most commercial finite element software. In this study, we present a method to approximate the dissipation for history integral constitutive models that represent Maxwell-like materials without approximating the double convolution integral. The method requires that the total stress can be separated into elastic and viscous components, and that the relaxation form of the constitutive law is defined with a Prony series. Numerical data is provided to demonstrate the limitations of this approximate method for determining dissipation. Rubber cylinders with imbedded steel disks and with an imbedded steel ball are dynamically loaded, and the nonuniform heating within the cylinders is computed.

The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews

PubMed Central

2012-01-01

Background Co-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology. Methods PubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed. Results Of the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety. Conclusions Based on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components. PMID:23067573

Airway physical examination tests for detection of difficult airway management in apparently normal adult patients.

PubMed

Roth, Dominik; Pace, Nathan L; Lee, Anna; Hovhannisyan, Karen; Warenits, Alexandra-Maria; Arrich, Jasmin; Herkner, Harald

2018-05-15

The unanticipated difficult airway is a potentially life-threatening event during anaesthesia or acute conditions. An unsuccessfully managed upper airway is associated with serious morbidity and mortality. Several bedside screening tests are used in clinical practice to identify those at high risk of difficult airway. Their accuracy and benefit however, remains unclear. The objective of this review was to characterize and compare the diagnostic accuracy of the Mallampati classification and other commonly used airway examination tests for assessing the physical status of the airway in adult patients with no apparent anatomical airway abnormalities. We performed this individually for each of the four descriptors of the difficult airway: difficult face mask ventilation, difficult laryngoscopy, difficult tracheal intubation, and failed intubation. We searched major electronic databases including CENTRAL, MEDLINE, Embase, ISI Web of Science, CINAHL, as well as regional, subject specific, and dissertation and theses databases from inception to 16 December 2016, without language restrictions. In addition, we searched the Science Citation Index and checked the references of all the relevant studies. We also handsearched selected journals, conference proceedings, and relevant guidelines. We updated this search in March 2018, but we have not yet incorporated these results. We considered full-text diagnostic test accuracy studies of any individual index test, or a combination of tests, against a reference standard. Participants were adults without obvious airway abnormalities, who were having laryngoscopy performed with a standard laryngoscope and the trachea intubated with a standard tracheal tube. Index tests included the Mallampati test, modified Mallampati test, Wilson risk score, thyromental distance, sternomental distance, mouth opening test, upper lip bite test, or any combination of these. The target condition was difficult airway, with one of the following reference standards: difficult face mask ventilation, difficult laryngoscopy, difficult tracheal intubation, and failed intubation. We performed screening and selection of the studies, data extraction and assessment of methodological quality (using QUADAS-2) independently and in duplicate. We designed a Microsoft Access database for data collection and used Review Manager 5 and R for data analysis. For each index test and each reference standard, we assessed sensitivity and specificity. We produced forest plots and summary receiver operating characteristic (ROC) plots to summarize the data. Where possible, we performed meta-analyses to calculate pooled estimates and compare test accuracy indirectly using bivariate models. We investigated heterogeneity and performed sensitivity analyses. We included 133 (127 cohort type and 6 case-control) studies involving 844,206 participants. We evaluated a total of seven different prespecified index tests in the 133 studies, as well as 69 non-prespecified, and 32 combinations. For the prespecified index tests, we found six studies for the Mallampati test, 105 for the modified Mallampati test, six for the Wilson risk score, 52 for thyromental distance, 18 for sternomental distance, 34 for the mouth opening test, and 30 for the upper lip bite test. Difficult face mask ventilation was the reference standard in seven studies, difficult laryngoscopy in 92 studies, difficult tracheal intubation in 50 studies, and failed intubation in two studies. Across all studies, we judged the risk of bias to be variable for the different domains; we mostly observed low risk of bias for patient selection, flow and timing, and unclear risk of bias for reference standard and index test. Applicability concerns were generally low for all domains. For difficult laryngoscopy, the summary sensitivity ranged from 0.22 (95% confidence interval (CI) 0.13 to 0.33; mouth opening test) to 0.67 (95% CI 0.45 to 0.83; upper lip bite test) and the summary specificity ranged from 0.80 (95% CI 0.74 to 0.85; modified Mallampati test) to 0.95 (95% CI 0.88 to 0.98; Wilson risk score). The upper lip bite test for diagnosing difficult laryngoscopy provided the highest sensitivity compared to the other tests (P < 0.001). For difficult tracheal intubation, summary sensitivity ranged from 0.24 (95% CI 0.12 to 0.43; thyromental distance) to 0.51 (95% CI 0.40 to 0.61; modified Mallampati test) and the summary specificity ranged from 0.87 (95% CI 0.82 to 0.91; modified Mallampati test) to 0.93 (0.87 to 0.96; mouth opening test). The modified Mallampati test had the highest sensitivity for diagnosing difficult tracheal intubation compared to the other tests (P < 0.001). For difficult face mask ventilation, we could only estimate summary sensitivity (0.17, 95% CI 0.06 to 0.39) and specificity (0.90, 95% CI 0.81 to 0.95) for the modified Mallampati test. Bedside airway examination tests, for assessing the physical status of the airway in adults with no apparent anatomical airway abnormalities, are designed as screening tests. Screening tests are expected to have high sensitivities. We found that all investigated index tests had relatively low sensitivities with high variability. In contrast, specificities were consistently and markedly higher than sensitivities across all tests. The standard bedside airway examination tests should be interpreted with caution, as they do not appear to be good screening tests. Among the tests we examined, the upper lip bite test showed the most favourable diagnostic test accuracy properties. Given the paucity of available data, future research is needed to develop tests with high sensitivities to make them useful, and to consider their use for screening difficult face mask ventilation and failed intubation. The 27 studies in 'Studies awaiting classification' may alter the conclusions of the review, once we have assessed them.

Collections Care in Southeast Asia: Conservation and the Need for the Creation of Micro-Environments.

ERIC Educational Resources Information Center

Dean, John F.

For a variety of reasons, collection care in Southeast Asia, especially in the northern regions, is fraught with many difficult challenges. Climates that are unfriendly to paper-based materials, poor economies, war, and civil unrest, are just a few of the reasons that librarians and archivists find it extremely difficult to ensure the survival of…

Little Known, Much Needed: Addressing the Cocurricular Needs of LGBTQ Students

ERIC Educational Resources Information Center

Ivory, Brian T.

2012-01-01

Due to the invisible nature of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) undergraduate population, it is difficult for student affairs professionals at community colleges to identify and address the needs of sexual minority students on campus. Given the lack of literature regarding LGBTQ students at community colleges, student…

"We need to talk!" Barriers to GPs' communication about the option of physician-assisted suicide and their ethical implications: results from a qualitative study.

PubMed

Otte, Ina C; Jung, Corinna; Elger, Bernice; Bally, Klaus

2017-06-01

GPs usually care for their patients for an extended period of time, therefore, requests to not only discontinue a patient's treatment but to assist a patient in a suicide are likely to create intensely stressful situations for physicians. However, in order to ensure the best patient care possible, the competent communication about the option of physician assisted suicide (PAS) as well as the assessment of the origin and sincerity of the request are very important. This is especially true, since patients' requests for PAS can also be an indicator for unmet needs or concerns. Twenty-three qualitative semi-structured interviews were conducted to in-depth explore this multifaceted, complex topic while enabling GPs to express possible difficulties when being asked for assistance. The analysis of the gathered data shows three main themes why GPs may find it difficult to professionally communicate about PAS: concerns for their own psychological well-being, conflicting personal values or their understanding of their professional role. In the discussion part of this paper we re-assess these different themes in order to ethically discuss and analyse how potential barriers to professional communication concerning PAS could be overcome.

A comparison of barriers to mental health support-seeking among farming and non-farming adults in rural South Australia.

PubMed

Hull, Melissa J; Fennell, Kate M; Vallury, Kari; Jones, Martin; Dollman, James

2017-12-01

To assess the differences between farming and non-farming rural adults in perceived barriers to mental health service use. A cross-sectional survey, modified from the Barriers to Help-Seeking Scale (BHSS), was conducted using a computer-assisted telephone interview. Respondents (age 52.6 ± 11.6 years) were recruited from three rural regions of South Australia. Approximately, 78 non-farmers and 45 farmers were included in analyses. 78 retired and two unemployed participants were excluded from the analyses. Farmers and non-farmers were compared on domain scores and individual item responses from the adapted BHSS that represent 'agrarian' attitudes to support-seeking for mental health: stoicism, self-reliance, minimisation of the problem, stigma and distrust of health professionals. In the analysis of domain scores, 'Need for Control and Self-Reliance' was a stronger barrier for farmers than non-farmers (P = 0.009) with a trend (P = 0.07) towards stronger barriers among farmers in the 'Minimising Problem and Resignation' domain. In the analysis of item-level responses, there was a difference (P = 0.03) between farmers and non-farmers in responses to 'I find it difficult to understand my doctor/health professional', with 24.4% of the farmers agreeing that this is a barrier compared with 15.3% of the non-farmers. Long-held stereotypes of stoicism and self-reliance among farmers were somewhat supported, in the context of mental health. Mental health services and professionals in rural Australia might need to adapt their practices to successfully engage this population. © 2017 National Rural Health Alliance Inc.

A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure.

PubMed

Fliess-Douer, Osnat; Vanlandewijck, Yves C; Lubel Manor, Galia; Van Der Woude, Lucas H V

2010-10-01

To review, analyse, evaluate and critically appraise available wheelchair skill tests in the international literature and to determine the need for a standardized measurement tool of manual wheeled mobility in those with spinal cord injury. A systematic review of literature (databases PubMed, Web of Science and Cochrane Library (1970-December 2009). Hand rim wheelchair users, mainly those with spinal cord injury. Studies' content and methodology were analysed qualitatively. Study quality was assessed using the scale of Gardner and Altman. Thirteen studies fell within the inclusion criteria and were critically reviewed. The 13 studies covered 11 tests, which involved 14 different skills. These 14 skills were categorized into: wheelchair manoeuvring and basic daily living skills; obstacle-negotiating skills; wheelie tasks; and transfers. The Wheelchair Skills Test version 2.4 (WST-2.4) and Wheelchair Circuit tests scored best on the Gardner and Altman scale, the Obstacle Course Assessment of Wheelchair User Performances (OCAWUP) test was found to be the most relevant for daily needs in a wheelchair. The different tests used different measurement scales, varying from binary to ordinal and continuous. Comparison of outcomes between tests was not possible because of differences in skills assessed, measurement scales, environment and equipment selected for each test. A lack of information regarding protocols as well as differences in terminology was also detected. This systematic review revealed large inconsistencies among the current available wheelchair skill tests. This makes it difficult to compare study results and to create norms and standards for wheelchair skill performance.

[Pruritus in Germany-a Google search engine analysis].

PubMed

Zink, A; Rüth, M; Schuster, B; Darsow, U; Biedermann, T; Ständer, S

2018-06-06

Because affected persons often do not visit a doctor, the prevalence of chronic and acute pruritus in the general population is difficult to determine. The aim of this study is to estimate the frequency and the most common locations of pruritus in German internet users, who-with 62.4 million persons-represent a large majority of the German population, by analysing the Google search volume. Relevant keywords for the subject "pruritus" were identified and analysed using the Google AdWords Keyword Planner. The assessment period was January 2015 to December 2016. In total the Google AdWords Keyword Planner identified 701 keywords for the topic "Juckreiz" (German lay word for pruritus), resulting in 7,531,890 pruritus-related Google searches during the assessment period. Most common search terms were the German lay term for atopic eczema ("Neurodermitis", 23.7%), the German lay term for psoriasis ("Schuppenflechte", 17.8%) and "psoriasis" (13%). The German lay term for pruritus ("Juckreiz") was only the sixth most searched term (3%). Most searches (72%) focused on influencing factors for pruritus, especially on skin diseases and skin conditions. The most commonly searched location was pruritus on the whole body, followed by anal pruritus. Analysis of the temporal course showed a higher monthly search volume during winter. With its unconventional methodology, a Google search engine analysis, this study allows a rough estimation of the medical need of pruritus in the German general population, which seems to be higher than expected. Especially pruritus in the anal area was identified as an unmet medical need.

Assessment of the storz video Macintosh laryngoscope for use in difficult airways: A human simulator study.

PubMed

Bair, Aaron E; Olmsted, Kalani; Brown, Calvin A; Barker, Tobias; Pallin, Daniel; Walls, Ron M

2010-10-01

Video laryngoscopy has been shown to improve glottic exposure when compared to direct laryngoscopy in operating room studies. However, its utility in the hands of emergency physicians (EPs) remains undefined. A simulated difficult airway was used to determine if intubation by EPs using a video Macintosh system resulted in an improved glottic view, was easier, was faster, or was more successful than conventional direct laryngoscopy. Emergency medicine (EM) residents and attending physicians at two academic institutions performed endotracheal intubation in one normal and two identical difficult airway scenarios. With the difficult scenarios, the participants used video laryngoscopy during the second case. Intubations were performed on a medium-fidelity human simulator. The difficult scenario was created by limiting cervical spine mobility and inducing trismus. The primary outcome was the proportion of direct versus video intubations with a grade I or II Cormack-Lehane glottic view. Ease of intubation (self-reported via 10-cm visual analog scale [VAS]), time to intubation, and success rate were also recorded. Descriptive statistics as well as medians with interquartile ranges (IQRs) are reported where appropriate. The Wilcoxon matched pairs signed-rank test was used for comparison testing of nonparametric data. Participants (n = 39) were residents (59%) and faculty. All had human intubation experience; 51% reported more than 100 prior intubations. On difficult laryngoscopy, a Cormack-Lehane grade I or II view was obtained in 20 (51%) direct laryngoscopies versus 38 (97%) of the video-assisted laryngoscopies (p < 0.01). The median VAS score for difficult airways was 50 mm (IQR = 28–73 mm) for direct versus 18 mm (IQR = 9–50 mm) for video (p < 0.01). The median time to intubation in difficult airways was 25 seconds (IQR = 16–44 seconds) for direct versus 20 seconds (IQR = 12–35 seconds) for video laryngoscopy (p < 0.01). All intubations were successful without need for an invasive airway. In this simulation, video laryngoscopy was associated with improved glottic exposure, was perceived as easier, and was slightly faster than conventional direct laryngoscopy in a simulated difficult airway. Absence of secretions and blood limits the generalizability of our findings; human studies are needed.

Information and Decision-Making Needs Among People with Anxiety Disorders: Results of an Online Survey.

PubMed

Liebherz, Sarah; Härter, Martin; Dirmaier, Jörg; Tlach, Lisa

2015-12-01

People with anxiety disorders are faced with treatment decisions considerably affecting their life. Patient decision aids are aimed at enabling patients to deliberate treatment options based on individual values and to participate in medical decisions. This is the first study to determine patients' information and decision-making needs as a pre-requisite for the development of patient decision aids for anxiety disorders. An online cross-sectional survey was conducted between January and April 2013 on the e-health portal http://www.psychenet.de by using a self-administered questionnaire with items on internet use, online health information needs, role in decision making and important treatment decisions. Descriptive and inferential statistical as well as qualitative data analyses were performed. A total of 60 people with anxiety disorders with a mean age of 33.3 years (SD 10.5) participated in the survey. The most prevalent reasons for online health information search were the need for general information on anxiety disorders, the search for a physician or psychiatrist and the insufficiency of information given by the healthcare provider. Respondents experienced less shared and more autonomous decisions than they preferred. They assessed decisions on psychotherapy, medication, and treatment setting (inpatient or outpatient) as the most difficult decisions. Our results confirm the importance of offering patient decision aids for people with anxiety disorders that encourage patients to participate in decision making by providing information about the pros and cons of evidence-based treatment options.

Maintaining family life balance while facing a child's imminent death-A mixed methods study.

PubMed

Eskola, Katri; Bergstraesser, Eva; Zimmermann, Karin; Cignacco, Eva

2017-10-01

To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision. A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home. Concurrent embedded mixed methods design. This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012. We extracted quantitative data from patients' medical charts and obtained information via parental questionnaire and then compared parents whose child died at home or in hospital by computing generalized estimation equations. We thematically analysed interviews with parents who provided EOL care at home. Parents created an intimate lifeworld and a sense of normality for the child at home. They constantly balanced the family's lifeworld with the requirements and challenges posed by the outside world. This work exhausted parents. Parental 'readiness' and social support drove EOL care for children at home. Parents needed practical help with housekeeping and had negative experiences when dealing with insurance. In only 34.8% of cases was a child's EOL home care supported by paediatric palliative care team. Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents' needs could be better met. © 2017 John Wiley & Sons Ltd.

The concept of research utilization as understood by Swedish nurses: demarcations of instrumental, conceptual, and persuasive research utilization.

PubMed

Strandberg, Elisabeth; Catrine Eldh, Ann; Forsman, Henrietta; Rudman, Ann; Gustavsson, Petter; Wallin, Lars

2014-02-01

The literature implies research utilization (RU) to be a multifaceted and complex phenomenon, difficult to trace in clinical practice. A deeper understanding of the concept of RU in a nursing context is needed, in particular, for the development of instruments for measuring nurses' RU, which could facilitate the evaluation of interventions to support the implementation of evidence-based practice. In this paper, we explored nurses' demarcation of instrumental RU (IRU), conceptual RU (CRU), and persuasive RU (PRU) using an item pool proposed to measure IRU, CRU, and PRU. The item pool (12 items) was presented to two samples: one of practicing registered nurses (n = 890) in Sweden 4 years after graduating and one of recognized content experts (n = 7). Correlation analyses and content validity index (CVI) calculations were used together with qualitative content analysis, in a mixed methods design. According to the item and factor analyses, CRU and PRU could not be distinguished, whereas IRU could. Analyses also revealed problems in linking the CRU items to the external criteria. The CVIs, however, showed excellent or good results for the IRU, CRU, and PRU items as well as at the scale level. The qualitative data indicated that IRU was the least problematic for the experts to categorize, whereas CRU and PRU were harder to demarcate. Our findings illustrate a difficulty in explicitly demarcating between CRU and PRU in clinical nursing. We suggest this overlap is related to conceptual incoherence, indicating a need for further studies. The findings constitute new knowledge about the RU concepts in a clinical nursing context, and highlight differences in how the concepts can be understood by RNs in clinical practice and experts within the field. We suggest that the findings are useful for defining RU in nursing and further development of measures of RU. © 2013 Sigma Theta Tau International.

Assessing the effect of elevated carbon dioxide on soil carbon: a comparison of four meta-analyses.

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

Hungate, B. A.; van Groenigen, K.; Six, J.

2009-08-01

Soil is the largest reservoir of organic carbon (C) in the terrestrial biosphere and soil C has a relatively long mean residence time. Rising atmospheric carbon dioxide (CO{sub 2}) concentrations generally increase plant growth and C input to soil, suggesting that soil might help mitigate atmospheric CO{sub 2} rise and global warming. But to what extent mitigation will occur is unclear. The large size of the soil C pool not only makes it a potential buffer against rising atmospheric CO{sub 2}, but also makes it difficult to measure changes amid the existing background. Meta-analysis is one tool that can overcomemore » the limited power of single studies. Four recent meta-analyses addressed this issue but reached somewhat different conclusions about the effect of elevated CO{sub 2} on soil C accumulation, especially regarding the role of nitrogen (N) inputs. Here, we assess the extent of differences between these conclusions and propose a new analysis of the data. The four meta-analyses included different studies, derived different effect size estimates from common studies, used different weighting functions and metrics of effect size, and used different approaches to address nonindependence of effect sizes. Although all factors influenced the mean effect size estimates and subsequent inferences, the approach to independence had the largest influence. We recommend that meta-analysts critically assess and report choices about effect size metrics and weighting functions, and criteria for study selection and independence. Such decisions need to be justified carefully because they affect the basis for inference. Our new analysis, with a combined data set, confirms that the effect of elevated CO{sub 2} on net soil C accumulation increases with the addition of N fertilizers. Although the effect at low N inputs was not significant, statistical power to detect biogeochemically important effect sizes at low N is limited, even with meta-analysis, suggesting the continued need for long-term experiments.« less

Methods for detecting, quantifying, and adjusting for dissemination bias in meta-analysis are described.

PubMed

Mueller, Katharina Felicitas; Meerpohl, Joerg J; Briel, Matthias; Antes, Gerd; von Elm, Erik; Lang, Britta; Motschall, Edith; Schwarzer, Guido; Bassler, Dirk

2016-12-01

To systematically review methodological articles which focus on nonpublication of studies and to describe methods of detecting and/or quantifying and/or adjusting for dissemination in meta-analyses. To evaluate whether the methods have been applied to an empirical data set for which one can be reasonably confident that all studies conducted have been included. We systematically searched Medline, the Cochrane Library, and Web of Science, for methodological articles that describe at least one method of detecting and/or quantifying and/or adjusting for dissemination bias in meta-analyses. The literature search retrieved 2,224 records, of which we finally included 150 full-text articles. A great variety of methods to detect, quantify, or adjust for dissemination bias were described. Methods included graphical methods mainly based on funnel plot approaches, statistical methods, such as regression tests, selection models, sensitivity analyses, and a great number of more recent statistical approaches. Only few methods have been validated in empirical evaluations using unpublished studies obtained from regulators (Food and Drug Administration, European Medicines Agency). We present an overview of existing methods to detect, quantify, or adjust for dissemination bias. It remains difficult to advise which method should be used as they are all limited and their validity has rarely been assessed. Therefore, a thorough literature search remains crucial in systematic reviews, and further steps to increase the availability of all research results need to be taken. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality of websites with patient information about spinal cord injury in Spanish.

PubMed

Bea-Muñoz, M; Medina-Sánchez, M; Flórez-García, M T

2016-07-01

Descriptive, cross-sectional analysis of websites with information on spinal cord injury (SCI) in Spanish. To assess the quality, readability and presence of quality labels on web pages with information about SCI in Spanish. The Internet. An Internet search was conducted on Google with the keywords 'lesión medular' (spinal cord injury), 'paraplejia' (paraplegia) and 'tetraplejia' (tetraplegia). The first 50 results of each search were included. The quality of websites was assessed with the LIDA tool while the readability was assessed with the Flesch-Szigriszt index and the INFLESZ scale. We also checked the presence of any quality label. After excluding duplicated and irrelevant results, 33 websites were analysed. Only four of them had a quality label. The mean score of the LIDA tool was 61.12% (medium quality), and the worst results were those referring to the reliability of the information. The readability of the web pages was somewhat difficult, with a mean of 48.22 in the Flesch-Szigriszt index. Only eight of the websites showed normal readability. We observed no differences in either the quality or the readability of the websites according to their origin or the presence of quality labels. The websites analysed present a medium quality. Mainly, they should improve the reliability of their contents and their readability, including more quality labels. For SCI information in Spanish to be understandable and to provide valuable content, websites analysed in our study need to improve the quality parameters.

Understanding why veterans are reluctant to access help for alcohol problems: Considerations for nurse education.

PubMed

Kiernan, Matthew D; Moran, Sandra; Hill, Mick

2016-12-01

To effectively engage veterans with substance misuse services, nurses need to understand their unique needs and the potential barriers that prevent them from accessing care. Nurses need to have an understanding and awareness of the cultural sensitivities associated with having been a member of the armed forces. The aim of this study was to investigate the perceived barriers to care amongst those planning, commissioning and delivering services for veterans with substance misuse problems, and to identify and explore subject areas which nurse educators should consider for inclusion in nursing and health education programmes. The findings reported in this paper come from one phase of a larger three phase research project and used an applied qualitative research approached based on methods developed for applied social policy research. The study was undertaken in the north-east of England. The study consisted of a purposive sample of planners, commissioners of services, and service providers in the North East of England. Data was collected using a semi-structured interview schedule. Framework analysis was used to analyse the data. Complexity of services and care, complexity of need and a lack of understanding of veterans were identified as factors that made accessing substance misuse care difficult. To help nurses better understand the unique needs of veterans three educational topics were identified for consideration in pre-registration nurse education: understanding military and veteran culture and the nature of modern warfare, the military 'veteran as institutionalised' hypothesis and stigma. Health and social services can struggle to truly understand the unique needs and experiences of the veteran community. We have identified three broad subject areas that should be considered as the theoretical basis for a veteran specific education programme within pre and post-registration nurse education. Copyright © 2016 Elsevier Ltd. All rights reserved.

What type of leader am I?: a training needs analysis of health library and information managers.

PubMed

Sutton, Anthea; Booth, Andrew

2012-03-01

Leadership is a necessary facet of professional practice for health library and information managers (HLIMs). Several training needs analyses (TNA) in the health library and information services field have been conducted in recent years, all identifying a need for professional development in leadership skills. However, these previous TNAs have not focused on specific elements of leadership skills required by health library and information managers. The National Library for Health (NLH) commissioned the School of Health and Related Research (ScHARR) at the University of Sheffield to conduct a TNA where HLIMs assess their current leadership skills and identify any future development needs in this area. The results would inform a programme of influencing skills workshops. HLIMs in the UK were invited to complete a self-assessment online questionnaire. The questionnaire utilised items from Manning and Robertson's Influencing Skills Style Profile (ISSP). This allowed the results to be characterised by influencing 'style'. HLIMs considered themselves to have strengths in the leadership areas of influencing, negotiating, managing change and delivering presentations to decision-makers. They identified significant development needs in communicating with stakeholders, conflict resolution, using body language and being assertive. Most HLIMs demonstrated two collaborative styles identified by the ISSP, namely strategic collaborator and opportunistic collaborator. In difficult times, HLIMs may need to adapt to more of an 'opportunistic-battler' influencing style. It is important that HLIMs not only assess their own leadership skills but also that they take opportunities to employ 360(°) feedback, comprising assessment from subordinates, peers and supervisors. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

Mental health care needs and preferences for mothers of children with a disability.

PubMed

Gilson, K-M; Davis, E; Johnson, S; Gains, J; Reddihough, D; Williams, K

2018-05-01

Mothers of children with a disability are at increased risk of poor mental health compared with mothers of typically developing children. The aim of the study was to describe the mental health care needs and preferences for support of mothers of children and young people aged 0-25 years with a disability. A cross-sectional study was used, using an online survey with 294 mothers of children with a disability. Questions were asked about mental health, perceived need for support, barriers to accessing mental health care, and preferences for support. Descriptive and chi-squared analyses were performed. High rates of mental ill health were self-identified in the previous 12 months, with reported clinically significant depression (44%), anxiety (42%), and suicidality (22%). Nearly half (48%) of the mothers reported high to very high psychological distress. Although 75% of mothers perceived a need for professional support, only 58% attempted to access this. Key barriers to accessing support were caregiving duties making it difficult to schedule appointments (45%) and not perceiving the mental health problem as serious enough to require help (36%). Individual counselling was the preferred type of support (66%) followed by professionally guided relaxation (49%) and education about mental health (47%). Support was considered most critical at the time of diagnosis and during medical intervention for their child. Although mental health problems were common and mothers perceived the need for professional help, several key barriers were preventing mothers from accessing help. Our study suggests that improving mothers' knowledge of when and where to seek help (mental health literacy) may encourage their access to support. There also needs to be more accessible treatment to mothers given the high care demands that are placed upon them. © 2018 John Wiley & Sons Ltd.

High-throughput sequencing reveals unprecedented diversities of Aspergillus species in outdoor air.

PubMed

Lee, S; An, C; Xu, S; Lee, S; Yamamoto, N

2016-09-01

This study used the Illumina MiSeq to analyse compositions and diversities of Aspergillus species in outdoor air. The seasonal air samplings were performed at two locations in Seoul, South Korea. The results showed the relative abundances of all Aspergillus species combined ranging from 0·20 to 18% and from 0·19 to 21% based on the number of the internal transcribed spacer 1 (ITS1) and β-tubulin (BenA) gene sequences respectively. Aspergillus fumigatus was the most dominant species with the mean relative abundances of 1·2 and 5·5% based on the number of the ITS1 and BenA sequences respectively. A total of 29 Aspergillus species were detected and identified down to the species rank, among which nine species were known opportunistic pathogens. Remarkably, eight of the nine pathogenic species were detected by either one of the two markers, suggesting the need of using multiple markers and/or primer pairs when the assessments are made based on the high-throughput sequencing. Due to diversity of species within the genus Aspergillus, the high-throughput sequencing was useful to characterize their compositions and diversities in outdoor air, which are thought to be difficult to be accurately characterized by conventional culture and/or Sanger sequencing-based techniques. Aspergillus is a diverse genus of fungi with more than 300 species reported in literature. Aspergillus is important since some species are known allergens and opportunistic human pathogens. Traditionally, growth-dependent methods have been used to detect Aspergillus species in air. However, these methods are limited in the number of isolates that can be analysed for their identities, resulting in inaccurate characterizations of Aspergillus diversities. This study used the high-throughput sequencing to explore Aspergillus diversities in outdoor, which are thought to be difficult to be accurately characterized by traditional growth-dependent techniques. © 2016 The Society for Applied Microbiology.

Getting England to be more physically active: are the Public Health Responsibility Deal's physical activity pledges the answer?

PubMed

Knai, C; Petticrew, M; Scott, C; Durand, M A; Eastmure, E; James, L; Mehrotra, A; Mays, N

2015-09-18

The Public Health Responsibility Deal (RD) in England is a public-private partnership involving voluntary pledges between government, industry, and other organisations to improve public health by addressing alcohol, food, health at work, and physical activity. This paper analyses the RD physical activity (PA) pledges in terms of the evidence of their potential effectiveness, and the likelihood that they have motivated actions among organisations that would not otherwise have taken place. We systematically reviewed evidence of the effectiveness of interventions proposed in four PA pledges of the RD, namely, those on physical activity in the community; physical activity guidelines; active travel; and physical activity in the workplace. We then analysed publically available data on RD signatory organisations' plans and progress towards achieving the physical activity pledges, and assessed the extent to which activities among organisations could be attributed to the RD. Where combined with environmental approaches, interventions such as mass media campaigns to communicate the benefits of physical activity, active travel in children and adults, and workplace-related interventions could in principle be effective, if fully implemented. However, most activities proposed by each PA pledge involved providing information or enabling choice, which has limited effectiveness. Moreover, it was difficult to establish the extent of implementation of pledges within organisations, given that progress reports were mostly unavailable, and, where provided, it was difficult to ascertain their relevance to the RD pledges. Finally, 15 % of interventions listed in organisations' delivery plans were judged to be the result of participation in the RD, meaning that most actions taken by organisations were likely already under way, regardless of the RD. Irrespective of the nature of a public health policy to encourage physical activity, targets need to be evidence-based, well-defined, measurable and encourage organisations to go beyond business as usual. RD physical activity targets do not adequately fulfill these criteria.

CHAPTER 10 A public health approach to cervical cancer control: Considerations of screening and vaccination strategies.

PubMed

Goldie, Sue

2006-11-01

Cervical cancer remains a leading cause of cancer death among women living in low-resource settings. In the last 3 decades, cytologic screening has -in theory -been available and yet more than 6 million women have died of this preventable disease. The necessary resources, infrastructure, and technological expertise, together with the need for repeated screenings at regular intervals, make cytologic screening difficult to implement in poor countries. As noncytologic approaches for the detection of HPV, simple visual screening methods for anogenital lesions caused by HPV, and the availability of an HPV-16/18 vaccine will enhance the linkage between screening and treatment, multiple factors will need to be considered when designing new, or modifying existing prevention strategies. Countryspecific decisions regarding the best strategy for cervical cancer control will need to rely on data from many sources and take into account complex epidemiologic, economic, social, political, and cultural factors, and be made despite uncertainty and incomplete information. A rigorous decision analytic approach using computerbased modeling methods enables linkage of the knowledge gained from empirical studies to real-world situations. This chapter provides an introduction to these methods, reviews lessons learned from cost-effectiveness analyses of cervical cancer screening in developed and developing countries, and emphasizes important qualitative themes to consider in designing cervical cancer prevention policies. © 2006 International Federation of Gynecology and Obstetrics.

Outcomes of reintervention after failed urethroplasty.

PubMed

Ekerhult, Teresa Olsen; Lindqvist, Klas; Peeker, Ralph; Grenabo, Lars

2017-02-01

Urethroplasty is a procedure that has a high success rate. However, there exists a small subgroup of patients who require multiple procedures to achieve an acceptable result. This study analyses the outcomes of a series of patients with failed urethroplasty. This is a retrospective review of 82 failures out of 407 patients who underwent urethroplasty due to urethral stricture during the period 1999-2013. Failure was defined as the need for an additional surgical procedure. Of the failures, 26 patients had penile strictures and 56 had bulbar strictures. Meatal strictures were not included. The redo procedures included one or multiple direct vision internal urethrotomies, dilatations or new urethroplasties, all with a long follow-up time. The patients underwent one to seven redo surgeries (mean 2.4 procedures per patient). In the present series of patients, endourological procedures cured 34% (28/82) of the patients. Ten patients underwent multiple redo urethroplasties until a satisfactory outcome was achieved; the penile strictures were the most difficult to cure. In patients with bulbar strictures, excision with anastomosis and substitution urethroplasty were equally successful. Nevertheless, 18 patients were defined as treatment failures. Of these patients, nine ended up with clean intermittent self-dilatation as a final solution, five had perineal urethrostomy and four are awaiting a new reintervention. Complicated cases need centralized professional care. Despite the possibility of needing multiple reinterventions, the majority of patients undergoing urethroplasty have a good chance of successful treatment.

Translation and cross-cultural adaptation of a family booklet on comfort care in dementia: sensitive topics revised before implementation.

PubMed

van der Steen, Jenny T; Hertogh, Cees M P M; de Graas, Tjomme; Nakanishi, Miharu; Toscani, Franco; Arcand, Marcel

2013-02-01

Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Three themes emerged: (1) relationships among patient, physician and other professionals-the authority of the physician was more explicit in adapted versions; (2) patient rights and family position-adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia.

Dual Powerpoint Presentation Approach for Students with Special Educational Needs and Note-Takers

ERIC Educational Resources Information Center

Naik, Nitin

2017-01-01

In higher education, supporting students with special educational needs (SEN) necessitates an understanding of these needs, additional teaching aids and innovative ideas. The teacher must be an integral part of this support process, and this is difficult for the majority of teachers, due to their lack of core understanding of SEN. However,…

Navigating Negotiations in Uncharted Waters

ERIC Educational Resources Information Center

Jaeger, Kurt

2012-01-01

It is the best of times because there has never been a greater need for quality school business officials, but it is the worst of times because it has never been more difficult to "be" a school business official. One needs the wisdom of Solomon to balance the foolishness of greed with need. A poorly equipped negotiating team can quickly sink the…

Patterns of Awareness in Children's Understanding of Disabilities.

ERIC Educational Resources Information Center

Conant, Susan; Budoff, Milton

1983-01-01

Nondisabled children and adults (n=103) were interviewed about their conceptions of blindness, deafness, orthopedic disabilities, mental retardation, and psychological disturbance. In the Guttman scalogram analyses, psychological disturbance was the "most difficult" disability, then mental retardation, then orthopedic disabilities, then…

Neck circumference to inter-incisor gap ratio: a new predictor of difficult laryngoscopy in cervical spondylosis patients.

PubMed

Han, Yong-Zheng; Tian, Yang; Xu, Mao; Ni, Cheng; Li, Min; Wang, Jun; Guo, Xiang-Yang

2017-04-04

Preoperative airway assessment help anticipate a difficult airway. We hypothesized that a close association existed between difficult laryngoscopy and the neck circumference/inter-incisor gap ratio (RNIIG). Our aim was to determine its utility in predicting difficult laryngoscopy in cervical spondylosis patients. Two hundred thirteen consecutive patients, aged 20-70 years, scheduled to undergo cervical spine surgery under general anesthesia, were recruited. Preoperative assessments included inter-incisor gap (IIG), thyromental distance (TMD), neck circumference (NC), NC/IIG ratio (RNIIG), NC/TMD ratio (RNTMD) and modified Mallampati test (MMT). Cormack-Lehane scales were assessed during intubation. The anesthesiologist was blinded to the airway assessments. RNIIG's ability to predict difficult laryngoscopy was compared with that of established predictors. Difficult laryngoscopy incidence was 16.4%. Univariate analysis showed that male gender, increased age, weight, NC, RNIIG and RNTMD, decreased IIG and TMD, and MMT 3 and 4 were associated with difficult laryngoscopy. Binary multivariate logistic regression analyses identified only one factor that was independently associated with difficult laryngoscopy: RNIIG. The odds ratio and 95% confidence interval (95% CI) were 1.932 (1.504-2.482). RNIIG (≥9.5) exhibited the largest area under the curve (0.80; 95% CI 0.73-0.86) and the highest sensitivity (88.6%; 95% CI 78.1-99.1) and negative predictive value (96.6%; 95% CI 94.0-99.2), confirming its better predictive ability. RNIIG is a new and simple predictor with a higher level of efficacy, and could help anesthetists plan for difficult laryngoscopy management in cervical spondylosis patients. ChiCTR-OON-16008320 (April 19th, 2016).

Can You Hack It? Validating Predictors for IT Boot Camps

NASA Astrophysics Data System (ADS)

Gear, Courtney C.

Given the large number of information technology jobs open and lack of qualified individuals to fill them, coding boot camps have sprung up in response to this skill gap by offering a specialized training program in an accelerated format. This fast growth has created a need to measure these training programs and understand their effectiveness. In the present study, a series of analyses examined whether specific or combinations of predictors were valid for training performance in this coding academy. Self-rated, daily efficacy scores were used as outcome variables of training success and correlation results showed a positive relationship with efficacy scores and the logic test score as a predictor. Exploratory analyses indicated a Dunning-Kruger effect where students with lower education levels experience higher overall mood during the training program. Limitations of the study included small sample size, severe range restriction in predictor scores, lack of variance in predictor scores, and low variability in training program success. These limitations made identifying jumps between training stages difficult to identify. By identifying which predictors matter most for each stage of skill acquisition, further research should consider more objective variables such as instructor scores which can serve as a guideline to better asses what stage learners join at and how to design curriculum and assignments accordingly (Honken, 2013).

Host-based identification is not supported by morphometrics in natural populations of Gyrodactylus salaris and G. thymalli (Platyhelminthes, Monogenea).

PubMed

Olstad, K; Shinn, A P; Bachmann, L; Bakke, T A

2007-12-01

Gyrodactylus salaris is a serious pest of wild pre-smolt Atlantic salmon (Salmo salar) in Norway. The closely related G. thymalli, originally described from grayling (Thymallus thymallus), is assumed harmless to both grayling and salmon. The 2 species are difficult to distinguish using traditional, morphometric methods or molecular approaches. The aim of this study was to explore whether there is a consistent pattern of morphometrical variation between G. salaris and G. thymalli and to analyse the morphometric variation in the context of 'diagnostic realism' (in natural populations). Specimens from the type-material for the 2 species are also included. In total, 27 point-to-point measurements from the opisthaptoral hard parts were used and analysed by digital image processing and uni- and multivariate morphometry. All populations most closely resembled its respective type material, as expected from host species, with the exception of G. thymalli from the Norwegian river Trysilelva. We, therefore, did not find clear support in the morphometrical variation among G. salaris and G. thymalli for an a priori species delineation based on host. The present study also indicates an urgent need for more detailed knowledge on the influence of environmental factors on the phenotype of gyrodactylid populations.

Economic and environmental review of Waste-to-Energy systems for municipal solid waste management in medium and small municipalities.

PubMed

Fernández-González, J M; Grindlay, A L; Serrano-Bernardo, F; Rodríguez-Rojas, M I; Zamorano, M

2017-09-01

The application of Directive 2008/98/CE on Municipal Solid Waste (MSW) implies the need to introduce technologies to generate energy from waste. Incineration, the most widely used method, is difficult to implement in low populated areas because it requires a large amount of waste to be viable (100,000 tons per year). This paper analyses the economic and environmental costs of different MSW-to-Energy technologies (WtE) in an area comprising of 13 municipalities in southern Spain. We analyse anaerobic digestion (Biomethanization), the production of solid recovered fuel (SRF) and gasification, and compare these approaches to the present Biological Mechanical Treatment (BMT) with elimination of the reject in landfill, and incineration with energy recovery. From an economic standpoint the implementation of WtE systems reduces the cost of running present BMT systems and incineration; gasification presents the lowest value. From the environmental standpoint, Life Cycle Assessment shows that any WtE alternatives, including incineration, present important advantages for the environment when compared to BMT. Finally, in order to select the best alternative, a multi-criteria method is applied, showing that anaerobic digestion is the optimal solution for the area studied. Copyright © 2017 Elsevier Ltd. All rights reserved.

Mature students' experiences of undergraduate nurse education programmes: the Irish experience.

PubMed

O'Brien, Frances; Keogh, Brian; Neenan, Kathleen

2009-08-01

In recent years mature students have been encouraged into nurse education for the valuable qualities they are known to possess, along with their ability to assist in providing a sustainable solution to the current health care crisis. Unfortunately corresponding resources and support structures have not accompanied this widening of access and mature students are expected to fit into structures that already exist, structures that were formulated with eighteen year olds in mind. This qualitative study explores the experiences of mature students in nurse education. Three discipline specific focus group interviews were used as a means of gathering data from 28 mature students. Data were analysed using thematic content analysis as described by Burnard [Burnard, P., 1991. A method of analysing interview transcripts in qualitative research. Nurse Education Today 11, 461-466]. Findings revealed that students continue to struggle with the academic component of the course. They also found it difficult to balance the home and university divide. Greater challenges were identified by female participants as they maintained their previous roles. Males on the other hand were provided with greater freedom to pursue their studies. There is a need for curricular changes to be implemented in order to provide a greater flexibility and supportive experience for mature students. Further research is advocated in this area.

Impact Of Health Care Delivery System Innovations On Total Cost Of Care.

PubMed

Smith, Kevin W; Bir, Anupa; Freeman, Nikki L B; Koethe, Benjamin C; Cohen, Julia; Day, Timothy J

2017-03-01

Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings. Project HOPE—The People-to-People Health Foundation, Inc.

Thermomagnetic Analyses to Test Concrete Stability

NASA Astrophysics Data System (ADS)

Geiss, C. E.; Gourley, J. R.

2017-12-01

Over the past decades pyrrhotite-containing aggregate has been used in concrete to build basements and foundations in central Connecticut. The sulphur in the pyrrhotite reacts to several secondary minerals, and associated changes in volume lead to a loss of structural integrity. As a result hundreds of homes have been rendered worthless as remediation costs often exceed the value of the homes and the value of many other homes constructed during the same time period is in question as concrete provenance and potential future structural issues are unknown. While minor abundances of pyrrhotite are difficult to detect or quantify by traditional means, the mineral is easily identified through its magnetic properties. All concrete samples from affected homes show a clear increase in magnetic susceptibility above 220°C due to the γ - transition of Fe9S10 [1] and a clearly defined Curie-temperature near 320°C for Fe7S8. X-ray analyses confirm the presence of pyrrhotite and ettringite in these samples. Synthetic mixtures of commercially available concrete and pyrrhotite show that the method is semiquantitative but needs to be calibrated for specific pyrrhotite mineralogies. 1. Schwarz, E.J., Magnetic properties of pyrrhotite and their use in applied geology and geophysics. 1975, Geological Survey of Canada : Ottawa, ON, Canada: Canada.

Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study.

PubMed

Macey, Kat; Gregory, Angela; Nunns, David; das Nair, Roshan

2015-06-20

Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes 'performance-based' sexuality which may be detrimental. Despite this, little has been done to seek women's views about their treatment. This study set out to explore women's experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. Four superordinate themes were elicited and used to draft 'better treatment' guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous 'Journey into treatment', including difficulties asking for help, undergoing physical investigations and negotiating 'the system' of medical referrals. It also describes the sometimes demoralising process of 'being in treatment', which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to 'partner support'. 'Professional support' comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. 'Peer support/helping each other' describes the importance of supportive vaginimus networks and sharing tips with other women. Accessing effective treatment for vaginal penetration difficulties is difficult. The practical and emotional demands of using vaginal trainers may be underestimated by professionals, resulting in inadequate provision of support and information in practice. At times vaginal trainers may be prescribed to women who are unlikely to benefit from this treatment in isolation. Core communication skills like non-judgemental listening are important for supporting women through treatment. However professionals also need greater specialist knowledge, which in turn requires more detailed research. New ways to disseminate specialist knowledge and suggestions for further research are discussed.

Disaster waste characteristics and radiation distribution as a result of the Great East Japan Earthquake.

PubMed

Shibata, Tomoyuki; Solo-Gabriele, Helena; Hata, Toshimitsu

2012-04-03

The compounded impacts of the catastrophes that resulted from the Great East Japan Earthquake have emphasized the need to develop strategies to respond to multiple types and sources of contamination. In Japan, earthquake and tsunami-generated waste were found to have elevated levels of metals/metalloids (e.g., mercury, arsenic, and lead) with separation and sorting more difficult for tsunami-generated waste as opposed to earthquake-generated waste. Radiation contamination superimposed on these disaster wastes has made it particularly difficult to manage the ultimate disposal resulting in delays in waste management. Work is needed to develop policies a priori for handling wastes from combined catastrophes such as those recently observed in Japan.

Clinical management and outcome of refractory asthma in the UK from the British Thoracic Society Difficult Asthma Registry.

PubMed

Sweeney, Joan; Brightling, Chris E; Menzies-Gow, Andrew; Niven, Robert; Patterson, Chris C; Heaney, Liam G

2012-08-01

Refractory asthma represents a significant unmet clinical need. Data from a national online registry audited clinical outcome in 349 adults with refractory asthma from four UK specialist centres in the British Thoracic Society Difficult Asthma Network. At follow-up, lung function improved, with a reduction in important healthcare outcomes, specifically hospital admission, unscheduled healthcare visits and rescue courses of oral steroids. The most frequent therapeutic intervention was maintenance oral corticosteroids and most steroid sparing agents (apart from omalizumab) demonstrated minimal steroid sparing benefit. A significant unmet clinical need remains in this group, specifically a requirement for therapies which reduce systemic steroid exposure.

Systematic review of the economic evidence on home visitation programmes for vulnerable pregnant women.

PubMed

Stamuli, Eugena; Richardson, Gerry; Duffy, Steven; Robling, Michael; Hood, Kerry

2015-09-01

A systematic review of the economic evidence on home visitation programmes for young or vulnerable pregnant women was undertaken to provide a summary of the existing literature of these interventions. Relevant studies were identified from a number of sources including large databases, free text search on Google Scholar as well as hand-searching of the obtained references. The search yielded a large number of papers, of which 12 were considered appropriate to be included in the review. These were either full or partial economic evaluations: four studies were cost-benefit analyses, three were cost-effectiveness analyses and the remaining were costing studies. The review highlighted the paucity of good quality economic evaluations in the area of home visiting programmes for young or vulnerable pregnant women. Methods varied substantially between the studies spanning from differing data sources (e.g. single randomized trials or meta-analyses) to different perspectives taken, cost items and outcomes included in the analysis. It is difficult to establish a coherent body of economic evidence for these interventions and draw a firm conclusion on their value for money. Home visiting programmes are complex interventions, with impact on the lives of mothers and their children. The funding of such interventions should be based on rigorous effectiveness and economic evidence. There is a need for well-designed economic evaluations which will follow the appropriate methodological guidelines and also take into account the complexity of such interventions. These analyses should preferably consider multiple perspectives and allow for the fact that the majority of the benefits accrue in the long-term future. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Helping Children in Times of Need: Grief, Loss, Separation & Divorce. A Handbook for Parents Assisting Children through Grief and Loss.

ERIC Educational Resources Information Center

Parker, Judith A.

Although a world of uncertainty and continual change is difficult to explain to children, by exploring and discussing the process of grief, parents can begin to understand the significance and necessity of the grief process and help their children to cope with difficult events. This booklet offers parents advice on how to talk with children about…

Evaluation and management of the patient with difficult-to-control or resistant hypertension.

PubMed

Viera, Anthony J; Hinderliter, Alan L

2009-05-15

High blood pressure is often difficult to control. Resistant hypertension is blood pressure above goal despite adherence to a combination of at least three antihypertensive medications of different classes, optimally dosed and usually including a diuretic. The approach to blood pressure that is apparently difficult to control begins with an assessment of the patient's adherence to the management plan, including lifestyle modifications and medications. White-coat hypertension may need to be ruled out. Suboptimal therapy is the most common reason for failure to reach the blood pressure goal. Once-daily fixed-dose combination pills may improve control through the synergism of antihypertensive agents from different classes and improved adherence. Truly drug-resistant hypertension is commonly caused by chronic kidney disease, obstructive sleep apnea, or hyperaldosteronism, all of which can lead to fluid retention. Higher doses of diuretics (or a change to a loop diuretic) are usually needed. Other strategies include adding an alpha blocker, alpha-beta blocker, clonidine, or an aldosterone antagonist (e.g., spironolactone). Particularly in patients with diabetes or renal disease, combining a long-acting nondihydropyridine with a dihydropyridine calcium channel . blocker can also be considered. Obesity, heavy alcohol intake, high levels of dietary sodium, and interfering substances (especially nonsteroidal anti-inflammatory drugs) contribute to hypertension that is resistant or difficult to control.

Learning Computer Science: Perceptions, Actions and Roles

ERIC Educational Resources Information Center

Berglund, Anders; Eckerdal, Anna; Pears, Arnold; East, Philip; Kinnunen, Paivi; Malmi, Lauri; McCartney, Robert; Mostrom, Jan-Erik; Murphy, Laurie; Ratcliffe, Mark; Schulte, Carsten; Simon, Beth; Stamouli, Ioanna; Thomas, Lynda

2009-01-01

This phenomenographic study opens the classroom door to investigate teachers' experiences of students learning difficult computing topics. Three distinct themes are identified and analysed. "Why" do students succeed or fail to learn these concepts? "What" actions do teachers perceive will ameliorate the difficulties facing…

Identifying genes affectng stress response in rainbow trout

USDA-ARS?s Scientific Manuscript database

Genomic analyses have the potential to impact aquaculture production traits by identifying markers as proxies for traits which are expensive or difficult to measure and characterizing genetic variation and biochemical mechanisms underlying phenotypic variation. One such set of traits are the respon...

The Reluctant Professor: Implications for University Management

ERIC Educational Resources Information Center

Schein, Edgar H.

1973-01-01

Stating the belief that most analyses of the university fail to deal realistically with the role of the professor, the author's purpose is to show why it is difficult and possible undesirable to involve professors deeply in issues of university government. (Author/JB)

The economic and operational value of using drones to transport vaccines.

PubMed

Haidari, Leila A; Brown, Shawn T; Ferguson, Marie; Bancroft, Emily; Spiker, Marie; Wilcox, Allen; Ambikapathi, Ramya; Sampath, Vidya; Connor, Diana L; Lee, Bruce Y

2016-07-25

Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40L) than the currently assumed UAV payload of 1.5L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled. Copyright © 2016. Published by Elsevier Ltd.

The economic and operational value of using drones to transport vaccines

PubMed Central

Haidari, Leila A.; Brown, Shawn T.; Ferguson, Marie; Bancroft, Emily; Spiker, Marie; Wilcox, Allen; Ambikapathi, Ramya; Sampath, Vidya; Connor, Diana L.; Lee, Bruce Y.

2017-01-01

Background Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. Methods Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). Results Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40 L) than the currently assumed UAV payload of 1.5 L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. Conclusion Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled. PMID:27340098

Putting the Pieces Together for Queer Youth: A Model of Integrated Assessment of Need and Program Planning

ERIC Educational Resources Information Center

Berberet, Heather M.

2006-01-01

Needs assessments require staff with the necessary expertise to design the study, collect the data, analyze the data, and present results. They require money, time, and persistence, because the people one wishes to assess often are difficult to access. This article argues for the centrality of a well-done needs assessment when developing services…

Sleep and Your Child with Special Needs: What Parents Need to Know

ERIC Educational Resources Information Center

Leadley, Lauri

2011-01-01

Getting a good night's sleep is important to good health for all, but for children with special needs, getting that good night's sleep can be especially difficult. According to a National Sleep Foundation study, more than two-thirds of children experience one or more sleep problems at least a few nights a week. However, studies show that children…

Homeland Biological Warfare Consequence Management: Capabilities and Needs Assessment

DTIC Science & Technology

2001-04-01

AU/ACSC/105/2001-04 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY HOMELAND BIOLOGICAL WARFARE CONSEQUENCE MANAGEMENT: CAPABILITIES AND NEEDS...Dates Covered (from... to) - Title and Subtitle Homeland biological Warfare Consequence Management: Capabilities and Needs Assessment Contract...FEMA, DoJ, DoD, HHS, etc.) make a comprehensive, organized solution to the problem difficult. Focusing on the consequence management functions

Use of an Airway Exchange Catheter-Assisted Extubation With Continuous End-Tidal Carbon Dioxide Monitoring in a Pediatric Patient With a Known Difficult Airway: A Case Report.

PubMed

Yegian, Courtney C; Volz, Lana M; Galgon, Richard E

2018-05-11

Tracheal extubation in children with known difficult airways is associated with an increased risk of adverse events. Currently, there is no reliable measure to predict the need for emergent reintubation due to airway inadequacy. Airway exchange catheter-assisted extubation has been shown to be a useful adjunct in decreasing the risk of adverse events due to failed extubation. We report a case of using an airway exchange catheter-assisted extubation with continuous end-tidal carbon dioxide monitoring for a pediatric patient with a known difficult airway.

"Vulnerable Families": Reflections on a Difficult Category

ERIC Educational Resources Information Center

Bauer, Petra; Wiezorek, Christine

2016-01-01

The term "vulnerable families" refers to familial living situations that are considered problematic, with a particular need for socially responsible, professionally provided support. This means of categorising families is extremely ambivalent, indicating not only a need for society to support forms of family life and family achievements,…

Difficult relationships between parents and physicians of children with cancer: A qualitative study of parent and physician perspectives.

PubMed

Mack, Jennifer W; Ilowite, Maya; Taddei, Sarah

2017-02-15

Previous work on difficult relationships between patients and physicians has largely focused on the adult primary care setting and has typically held patients responsible for challenges. Little is known about experiences in pediatrics and more serious illness; therefore, we examined difficult relationships between parents and physicians of children with cancer. This was a cross-sectional, semistructured interview study of parents and physicians of children with cancer at the Dana-Farber Cancer Institute and Boston Children's Hospital (Boston, Mass) in longitudinal primary oncology relationships in which the parent, physician, or both considered the relationship difficult. Interviews were audiotaped, transcribed, and subjected to a content analysis. Dyadic parent and physician interviews were performed for 29 relationships. Twenty were experienced as difficult by both parents and physicians; 1 was experienced as difficult by the parent only; and 8 were experienced as difficult by the physician only. Parent experiences of difficult relationships were characterized by an impaired therapeutic alliance with physicians; physicians experienced difficult relationships as demanding. Core underlying issues included problems of connection and understanding (n = 8), confrontational parental advocacy (n = 16), mental health issues (n = 2), and structural challenges to care (n = 3). Although problems of connection and understanding often improved over time, problems of confrontational advocacy tended to solidify. Parents and physicians both experienced difficult relationships as highly distressing. Although prior conceptions of difficult relationships have held patients responsible for challenges, this study has found that difficult relationships follow several patterns. Some challenges, such as problems of connection and understanding, offer an opportunity for healing. However, confrontational advocacy appears especially refractory to repair; special consideration of these relationships and avenues for repairing them are needed. Cancer 2017;123:675-681. © 2016 American Cancer Society. © 2016 American Cancer Society.

A hierarchy of distress and invariant item ordering in the General Health Questionnaire-12.

PubMed

Doyle, F; Watson, R; Morgan, K; McBride, O

2012-06-01

Invariant item ordering (IIO) is defined as the extent to which items have the same ordering (in terms of item difficulty/severity - i.e. demonstrating whether items are difficult [rare] or less difficult [common]) for each respondent who completes a scale. IIO is therefore crucial for establishing a scale hierarchy that is replicable across samples, but no research has demonstrated IIO in scales of psychological distress. We aimed to determine if a hierarchy of distress with IIO exists in a large general population sample who completed a scale measuring distress. Data from 4107 participants who completed the 12-item General Health Questionnaire (GHQ-12) from the Northern Ireland Health and Social Wellbeing Survey 2005-6 were analysed. Mokken scaling was used to determine the dimensionality and hierarchy of the GHQ-12, and items were investigated for IIO. All items of the GHQ-12 formed a single, strong unidimensional scale (H=0.58). IIO was found for six of the 12 items (H-trans=0.55), and these symptoms reflected the following hierarchy: anhedonia, concentration, participation, coping, decision-making and worthlessness. The cross-sectional analysis needs replication. The GHQ-12 showed a hierarchy of distress, but IIO is only demonstrated for six of the items, and the scale could therefore be shortened. Adopting brief, hierarchical scales with IIO may be beneficial in both clinical and research contexts. Copyright © 2011 Elsevier B.V. All rights reserved.

QTL affecting stress response to crowding in a rainbow trout broodstock population

USDA-ARS?s Scientific Manuscript database

Background Genomic analyses have the potential to impact selective breeding programs by identifying markers that serve as proxies for traits which are expensive or difficult to measure. Also, identifying genes affecting traits of interest enhances our understanding of their underlying biochemical ...

New Partnerships for Learning: Meeting Professional Information Needs

ERIC Educational Resources Information Center

Gannon-Leary, Pat; Carr, James

2010-01-01

This paper has been prompted by the challenges created by recent proposed reforms to social care services in the UK services which are being "modernised", a term ubiquitous in policy documents but difficult to define with confidence. Government modernisation and e-government programmes highlight with renewed urgency the need for social…

Parenting, Pressures and Policies.

ERIC Educational Resources Information Center

Chance, Graham W.

2000-01-01

In the 1990s, parenting became a difficult effort to balance work demands with children's needs. However, Canadian and U.S. government policies have not met changing family needs for child care, other services, paid parental leave, and work flexibility. Canada's long-awaited National Children's Agenda has the potential to modernize family policy…

Textile Recycling, Convenience, and the Older Adult.

ERIC Educational Resources Information Center

Domina, Tanya; Koch, Kathryn

2001-01-01

Results of a study to examine the recycling practices and needs of older adults (n=217) indicated that older adults do recycle traditional materials, but need accommodations for physical limitations. They report textile recycling as time consuming and difficult and used donations to religious organizations as their principal means of textile…

Wraparound Milwaukee: Aiding Youth with Mental Health Needs.

ERIC Educational Resources Information Center

Kamradt, Bruce

2000-01-01

Finding effective treatment models for youth in the juvenile justice system with serious emotional, mental health, and behavioral needs can be difficult. The traditional categorical approach that the juvenile justice, child welfare, and mental health systems often use places youth in a "one-size-fits-all" program, regardless of the…

Instructional Strategies for the Inclusive Music Classroom

ERIC Educational Resources Information Center

Darrow, Alice-Ann; Adamek, Mary

2018-01-01

While inclusive education is an admirable ideal, it is often difficult to implement. Successful educators have found that employing certain instructional strategies can help meet the needs of students with varying abilities. Inclusive teaching strategies refer to any number of teaching approaches that address the needs of students with a variety…

Resilience Strategies for New Teachers in High-Needs Areas

ERIC Educational Resources Information Center

Castro, Antonio J.; Kelly, John; Shih, Minyi

2010-01-01

This qualitative study investigates strategies of resilience exhibited by fifteen novice teachers employed in high-needs areas, such as in urban and rural contexts and in special education. Findings indicated that teachers utilised a variety of strategies, including help-seeking, problem-solving, managing difficult relationships, and seeking…

What English Teachers Need to Know about Grammar.

ERIC Educational Resources Information Center

Murdick, William

1996-01-01

Suggests that English teachers need to know that grammar is a difficult subject; know what children know about grammar; know that grammatical error is complex; and know more about language than just grammar. Concludes with the advice of Noam Chomsky--that grammar should be taught for its own intrinsic interest. (RS)

Leadership and Work-Life Balance.

PubMed

Mattock, Sarah L

2015-01-01

Simply stated, work-life balance is something that is both difficult to define and difficult to achieve. Leaders, throughout the continuum of trauma care, need to have a sound understanding of what work-life balance means and set an example of a healthy work-life balance for those they lead. This article offers strategies for enhancing work-life balance and challenges individuals to use self-reflection as a means to furthering their personal and professional growth.

Modelling the spatial distribution of five natural hazards in the context of the WHO/EMRO Atlas of Disaster Risk as a step towards the reduction of the health impact related to disasters

PubMed Central

El Morjani, Zine El Abidine; Ebener, Steeve; Boos, John; Abdel Ghaffar, Eman; Musani, Altaf

2007-01-01

Background Reducing the potential for large scale loss of life, large numbers of casualties, and widespread displacement of populations that can result from natural disasters is a difficult challenge for the individuals, communities and governments that need to respond to such events. While it is extremely difficult, if not impossible, to predict the occurrence of most natural hazards; it is possible to take action before emergency events happen to plan for their occurrence when possible and to mitigate their potential effects. In this context, an Atlas of Disaster Risk is under development for the 21 Member States that constitute the World Health Organization's (WHO) Eastern Mediterranean (EM) Region and the West Bank and Gaza Strip territory. Methods and Results This paper describes the Geographic Information System (GIS) based methods that have been used in order to create the first volume of the Atlas which looks at the spatial distribution of 5 natural hazards (flood, landslide, wind speed, heat and seismic hazard). It also presents the results obtained through the application of these methods on a set of countries part of the EM Region before illustrating how this type of information can be aggregated for decision making. Discussion and Conclusion The methods presented in this paper aim at providing a new set of tools for GIS practitioners to refine their analytical capabilities when examining natural hazards, and at the same time allowing users to create more specific and meaningful local analyses. The maps resulting from the application of these methods provides decision makers with information to strengthen their disaster management capacity. It also represents the basis for the reflection that needs to take place regarding populations' vulnerability towards natural hazards from a health perspective. PMID:17343733

Comprehensive Genomic Profiling Aids in Distinguishing Metastatic Recurrence from Second Primary Cancers

PubMed Central

Weinberg, Benjamin A.; Gowen, Kyle; Lee, Thomas K.; Ou, Sai‐Hong Ignatius; Bristow, Robert; Krill, Lauren; Almira‐Suarez, M. Isabel; Ali, Siraj M.; Miller, Vincent A.; Liu, Stephen V.

2017-01-01

Abstract Background. Metastatic recurrence after treatment for locoregional cancer is a major cause of morbidity and cancer‐specific mortality. Distinguishing metastatic recurrence from the development of a second primary cancer has important prognostic and therapeutic value and represents a difficult clinical scenario. Advances beyond histopathological comparison are needed. We sought to interrogate the ability of comprehensive genomic profiling (CGP) to aid in distinguishing between these clinical scenarios. Materials and Methods. We identified three prospective cases of recurrent tumors in patients previously treated for localized cancers in which histologic analyses suggested subsequent development of a distinct second primary. Paired samples from the original primary and recurrent tumor were subjected to hybrid capture next‐generation sequencing‐based CGP to identify base pair substitutions, insertions, deletions, copy number alterations (CNA), and chromosomal rearrangements. Genomic profiles between paired samples were compared using previously established statistical clonality assessment software to gauge relatedness beyond global CGP similarities. Results. A high degree of similarity was observed among genomic profiles from morphologically distinct primary and recurrent tumors. Genomic information suggested reclassification as recurrent metastatic disease, and patients received therapy for metastatic disease based on the molecular determination. Conclusions. Our cases demonstrate an important adjunct role for CGP technologies in separating metastatic recurrence from development of a second primary cancer. Larger series are needed to confirm our observations, but comparative CGP may be considered in patients for whom distinguishing metastatic recurrence from a second primary would alter the therapeutic approach. Implications for Practice. Distinguishing a metastatic recurrence from a second primary cancer can represent a difficult clinicopathologic problem but has important prognostic and therapeutic implications. Approaches to aid histologic analysis may improve clinician and pathologist confidence in this increasingly common clinical scenario. Our series provides early support for incorporating paired comprehensive genomic profiling in clinical situations in which determination of metastatic recurrence versus a distinct second primary cancer would influence patient management. PMID:28193735

"I didn't think we'd be dealing with stuff like this": A qualitative study of volunteer support for very disadvantaged pregnant women and new mothers.

PubMed

McLeish, Jenny; Redshaw, Maggie

2017-02-01

to identify the particular issues associated with volunteer support for very disadvantaged mothers (who were young, had insecure immigration status, were recent migrants whose English was poor,misused drugs or alcohol, or were involved in crime), from the perspective of the volunteers. a qualitative descriptive study, informed by phenomenological social psychology. Semi-structured qualitative interviews were carried out between July 2013 and March 2015. Interview transcripts were analysed using inductive thematic analysis. nine volunteer support projects for pregnant women and new mothers, run by third sector organisations in England. 38 volunteer supporters. three key themes were identified: 'Meeting challenges', 'Needing support' and 'Identifying successes'. 'Meeting challenges' contained the subthemes 'making the relationship of trust','remaining non-judgemental', 'maintaining boundaries' and 'dealing with child protection'. 'Needing support' contained the subthemes 'feeling prepared', 'feeling supported' and 'staying safe'. 'Identifying successes' contained the subthemes 'celebrating the small wins', 'validation as a mother', and 'supporting access to services'. volunteers were able to build strong, empowering relationships with some very disadvantaged women during pregnancy and afterwards, including where the mothers did not readily engage with professionals. However, supporting women with complex needs is emotionally challenging and volunteers need to be carefully selected, realistically trained and robustly supervised and supported during their volunteering. third sector organisations offering volunteer support for pregnant women and new mothers can be valuable partners in reaching very disadvantaged women who may find it difficult to engage with services. Volunteers can build up a relationship of trust with vulnerable mothers over time, but need to be well supported to do this safely and effectively. Copyright © 2016 Elsevier Ltd. All rights reserved.

Massive processing of pyro-chromatogram mass spectra (py-GCMS) of soil samples using the PARAFAC2 algorithm

NASA Astrophysics Data System (ADS)

Cécillon, Lauric; Quénéa, Katell; Anquetil, Christelle; Barré, Pierre

2015-04-01

Due to its large heterogeneity at all scales (from soil core to the globe), several measurements are often mandatory to get a meaningful value of a measured soil property. A large number of measurements can therefore be needed to study a soil property whatever the scale of the study. Moreover, several soil investigation techniques produce large and complex datasets, such as pyrolysis-gas chromatography-mass spectrometry (Py-GC-MS) which produces complex 3-way data. In this context, straightforward methods designed to speed up data treatments are needed to deal with large datasets. GC-MS pyrolysis (py-GCMS) is a powerful and frequently used tool to characterize soil organic matter (SOM). However, the treatment of the results of a py-GCMS analysis of soil sample is time consuming (number of peaks, co-elution, etc.) and the treatment of large data set of py-GCMS results is rather laborious. Moreover, peak position shifts and baseline drifts between analyses make the automation of GCMS programs data treatment difficult. These problems can be fixed using the Parallel Factor Analysis 2 (PARAFAC 2, Kiers et al., 1999; Bro et al., 1999). This algorithm has been applied frequently on chromatography data but has never been applied to analyses of SOM. We developed a Matlab routine based on existing Matlab packages dedicated to the simultaneous treatment of dozens of pyro-chromatograms mass spectra. We applied this routine on 40 soil samples. The benefits and expected improvements of our method will be discussed in our poster. References Kiers et al. (1999) PARAFAC2 - PartI. A direct fitting algorithm for the PARAFAC2 model. Journal of Chemometrics, 13: 275-294. Bro et al. (1999) PARAFAC2 - PartII. Modeling chromatographic data with retention time shifts. Journal of Chemometrics, 13: 295-309.

Online patient information on Vagus Nerve Stimulation: How reliable is it for facilitating shared decision making?

PubMed

Ved, Ronak; Cobbold, Naomi; Igbagiri, Kueni; Willis, Mark; Leach, Paul; Zaben, Malik

2017-08-01

This study evaluates the quality of information available on the internet for carers of children with epilepsy considering treatment with Vagus Nerve Stimulation (VNS). Selected key phrases were entered into two popular search engines (Google™, Yahoo™). These phrases were: "Vagus nerve stimulator", alone and in combination with "childhood epilepsy", "paediatric epilepsy" and "epilepsy in childhood"; "VNS", and "VNS epilepsy". The first 50 hits per search were then screened. Of 600 identified sites, duplicated (262), irrelevant (230) and inaccessible (15) results were excluded. 93 websites were identified for evaluation using the DISCERN instrument, an online validation tool for patient information websites. The mean DISCERN score of all analysed websites was 39/80 (49%; SD 13.5). This equates to Fair to borderline Poor global quality, (Excellent=80-63; Good=62-51; Fair=50-39; Poor=38-27; Very poor=26-15). None of the analysed sites obtained an Excellent quality rating. 13% (12) obtained a Good score, 40% (37) obtained an Average score, 35% (33) obtained a Poor score, and 12% (11) obtained a Very poor score. The cohort of websites scored particularly poorly on assessment of whether reliable, holistic information was presented, for instance provision of reliable sources, (28%, SD 18) and discussion of alternative treatments, (30%, SD 14). To facilitate patient-centred shared decision-making, high quality information needs to be available for patients and families considering VNS. This study identifies that such information is difficult to locate on the internet. There is a need to develop focussed and reliable online patient resources for VNS. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Difficult incidents and tutor interventions in problem-based learning tutorials.

PubMed

Kindler, Pawel; Grant, Christopher; Kulla, Steven; Poole, Gary; Godolphin, William

2009-09-01

Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors. The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses. Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure. The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective < 50% of the time) by response (i), but with moderate success by response (ii) and successfully (> 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully. Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.

The Plant Phenology Ontology: A New Informatics Resource for Large-Scale Integration of Plant Phenology Data.

PubMed

Stucky, Brian J; Guralnick, Rob; Deck, John; Denny, Ellen G; Bolmgren, Kjell; Walls, Ramona

2018-01-01

Plant phenology - the timing of plant life-cycle events, such as flowering or leafing out - plays a fundamental role in the functioning of terrestrial ecosystems, including human agricultural systems. Because plant phenology is often linked with climatic variables, there is widespread interest in developing a deeper understanding of global plant phenology patterns and trends. Although phenology data from around the world are currently available, truly global analyses of plant phenology have so far been difficult because the organizations producing large-scale phenology data are using non-standardized terminologies and metrics during data collection and data processing. To address this problem, we have developed the Plant Phenology Ontology (PPO). The PPO provides the standardized vocabulary and semantic framework that is needed for large-scale integration of heterogeneous plant phenology data. Here, we describe the PPO, and we also report preliminary results of using the PPO and a new data processing pipeline to build a large dataset of phenology information from North America and Europe.

[Predictive value of Hodgkin's lymphoma tumor burden in present].

PubMed

Kulyova, S A; Karitsky, A P

2014-01-01

Today approximately 70% of patients with Hodgkin lymphoma can be cured with the combined-modality therapy. Tumor burden, the importance of which was demonstrated 15 years ago for the first time, is a powerful prognostic factor. Data of literature of representations on predictive value of Hodgkin's lymphoma tumor burden are shown in the article. The difficult immunological relations between tumor cells and reactive ones lead to development of the main symptoms. Nevertheless, the collective sign of tumor burden shows the greatest influence on survival and on probability of resistance, which relative risk can be predicted on this variable and treatment program. Patients with bulky disease need escalated therapy with high-dose chemotherapy. Integration into predictive models of the variable will change an expected contribution of clinical and laboratory parameters in the regression analyses constructed on patients with Hodgkin's lymphoma. Today the role of diagnostic functional methods, in particular a positron emission tomography, for metabolic active measurement is conducted which allows excluding a reactive component.

BioSMACK: a linux live CD for genome-wide association analyses.

PubMed

Hong, Chang Bum; Kim, Young Jin; Moon, Sanghoon; Shin, Young-Ah; Go, Min Jin; Kim, Dong-Joon; Lee, Jong-Young; Cho, Yoon Shin

2012-01-01

Recent advances in high-throughput genotyping technologies have enabled us to conduct a genome-wide association study (GWAS) on a large cohort. However, analyzing millions of single nucleotide polymorphisms (SNPs) is still a difficult task for researchers conducting a GWAS. Several difficulties such as compatibilities and dependencies are often encountered by researchers using analytical tools, during the installation of software. This is a huge obstacle to any research institute without computing facilities and specialists. Therefore, a proper research environment is an urgent need for researchers working on GWAS. We developed BioSMACK to provide a research environment for GWAS that requires no configuration and is easy to use. BioSMACK is based on the Ubuntu Live CD that offers a complete Linux-based operating system environment without installation. Moreover, we provide users with a GWAS manual consisting of a series of guidelines for GWAS and useful examples. BioSMACK is freely available at http://ksnp.cdc. go.kr/biosmack.

Methodology for determining toxicity of pesticides to wild vertebrates

USGS Publications Warehouse

DeWitt, James B.; Moore, N.W.

1966-01-01

The effects of pesticidal contamination of wildlife habitats may be expected to be proportional to the toxicity of the compounds, the rate and manner of application, persistence of the basic chemical and/or any toxic metabolites, and the extent to which these substances are stored in animal tissues or concentrated by successive elements of wildlife food chains. Measurement of these effects under field conditions is difficult, but the need for field studies may be reduced or eliminated by controlled laboratory tests. Representatives of the birds, mammals and aquatic animals in treated areas should be examined at all stages in the life cycle. Suitable species include laboratory rats, rabbits, dogs, bobwhite or coturnix quail, ringneck pheasant, trout, sunfish, oysters. The quantity of pesticide (ppm in diet or environment; mg/kg consumed) should be determined which produces acute or chronic poisoning or which shows measurable sublethal effects on growth or reproduction. Tissues (including gonads and eggs) should be analysed at each degree of exposure.

Using Multicriteria Analysis in Issues Concerning Adaptation of Historic Facilities for the Needs of Public Utility Buildings with a Function of a Theatre

NASA Astrophysics Data System (ADS)

Obracaj, Piotr; Fabianowski, Dariusz

2017-10-01

Implementations concerning adaptation of historic facilities for public utility objects are associated with the necessity of solving many complex, often conflicting expectations of future users. This mainly concerns the function that includes construction, technology and aesthetic issues. The list of issues is completed with proper protection of historic values, different in each case. The procedure leading to obtaining the expected solution is a multicriteria procedure, usually difficult to accurately define and requiring designer’s large experience. An innovative approach has been used for the analysis, namely - the modified EA FAHP (Extent Analysis Fuzzy Analytic Hierarchy Process) Chang’s method of a multicriteria analysis for the assessment of complex functional and spatial issues. Selection of optimal spatial form of an adapted historic building intended for the multi-functional public utility facility was analysed. The assumed functional flexibility was determined in the scope of: education, conference, and chamber spectacles, such as drama, concerts, in different stage-audience layouts.

Geographic variation in the relationship between human Lyme disease incidence and density of infected host-seeking Ixodes scapularis nymphs in the Eastern United States.

PubMed

Pepin, Kim M; Eisen, Rebecca J; Mead, Paul S; Piesman, Joseph; Fish, Durland; Hoen, Anne G; Barbour, Alan G; Hamer, Sarah; Diuk-Wasser, Maria A

2012-06-01

Prevention and control of Lyme disease is difficult because of the complex biology of the pathogen's (Borrelia burgdorferi) vector (Ixodes scapularis) and multiple reservoir hosts with varying degrees of competence. Cost-effective implementation of tick- and host-targeted control methods requires an understanding of the relationship between pathogen prevalence in nymphs, nymph abundance, and incidence of human cases of Lyme disease. We quantified the relationship between estimated acarological risk and human incidence using county-level human case data and nymphal prevalence data from field-derived estimates in 36 eastern states. The estimated density of infected nymphs (mDIN) was significantly correlated with human incidence (r = 0.69). The relationship was strongest in high-prevalence areas, but it varied by region and state, partly because of the distribution of B. burgdorferi genotypes. More information is needed in several high-prevalence states before DIN can be used for cost-effectiveness analyses.

'One size does not fit all': Perspectives on diversity in community aged care.

PubMed

Meyer, Claudia; Appannah, Arti; McMillan, Sally; Browning, Colette; Ogrin, Rajna

2018-05-13

Typically, older people are viewed via a single health condition, yet health outcomes are likely impacted by the intersection of many individual characteristics. Promoting inclusive health care is underpinned by reducing bias, respectful communication and supporting individual needs and preferences. This study explores perspectives of community aged care workers on diversity training and implementing training into practice. Ninety community aged care workers were telephone-interviewed three months after a one-day diversity training workshop. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Five themes emerged: 'raising awareness'; 'reserving judgement'; 'confidence and empowerment to embed diversity into practice'; 'communicating effectively'; and 'thinking about change … but'. Diversity concepts were positively received, but applying diversity principles into practice is more difficult. Recommendations to promote inclusive health care included raising awareness of bias, communicating with inclusive language and embedding diversity concepts into community aged care practice by addressing individual, organisational and wider system constraints. © 2018 AJA Inc.

Information technologies for Marine Corps combat medicine.

PubMed

Carey, N B; Rattelman, C R; Nguyen, H Q

1998-09-01

Future Marine Corps warfighting concepts will make it more difficult to locate casualties, which will complicate casualty evacuation, lengthen casualty wait times, and require infantrymen or corpsmen to provide more extensive treatment. In these future scenarios, information flow and communications will be critical to medical functions. We asked, for Navy medical support to the Marines, what information will future combat medicine require and what technologies should supply those information needs? Based on analyses of patient data streams, focus groups of Navy medical personnel, and our estimates of the cost and feasibility of communications systems, we recommend the following: (1) increase medical training for some fraction of Marines, especially in hemorrhage control; (2) augment corpsmen's training; (3) furnish data systems for evacuation and supply that would provide in-transit visibility and simplify requests; (4) provide all ground medical personnel with access to treatment information systems and limited voice communications; and (5) exploit e-mail systems to reduce reliance on voice communications. Implementation time frames are discussed.

Eating out in Spain: Motivations, sociability and consumer contexts.

PubMed

Díaz-Méndez, Cecilia; García-Espejo, Isabel

2017-12-01

Eating out is a consumer practice which is difficult to define. The study of this practice has traditionally been based on the work/leisure dichotomy. However, in Spain this is not so clear. If we analyse profiles, motivations, places and relationships, we discover an eating-out food model which is specific to Spain and in which food is not limited by this dual link with work and leisure. Eating linked to work does not respond only to instrumental needs. Leisure eating is not always a choice based on preference. Both contain a strong element of sociability which acts as a motivator and are linked to the familisme of Spanish society, whilst at the same time de-routinizing daily life, both at home and at work. This study is based on a national survey carried out in 2014 and helps to understand this consumer practice and those elements which are specific to Spain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Neural Responses to Partner Rejection Cues

PubMed Central

Zayas, Vivian; Shoda, Yuichi; Mischel, Walter; Osterhout, Lee; Takahashi, Melissa

2009-01-01

Little is known about neural responses in the early automatic-stage processing of rejection cues from a partner. Event-related potentials (ERPs) offer a window to study processes that may be difficult to detect via behavioral methods. We focused on the N400 ERP component, which reflects the amount of semantic processing prompted by a target. When participants were primed by attachment-related contexts (“If I need help from my partner, my partner will be …”), rejection-related words (e.g., dismissing) elicited greater N400 amplitudes than acceptance-related words (e.g., supporting). Analyses of results for nonattachment primes suggest that these findings were not simply caused by target valence; the brain responds differentially to cues of partner rejection versus acceptance in under 300 ms. Moreover, these early-stage neurophysiological responses were heightened or dampened as a function of individuals’ adult attachment; women characterized by high anxiety and low avoidance showed the greatest N400 responses to cues of partner rejection (vs. acceptance). PMID:19493321

Service Approaches to Young People with Complex Needs Leaving Out-of-Home Care

ERIC Educational Resources Information Center

Malvaso, Catia; Delfabbro, Paul; Hackett, Louisa; Mills, Hayley

2016-01-01

Although leaving statutory out-of-home care can be a challenging time for many young people, it is recognised that young people who have multiple or complex needs find this transition particularly difficult. This study aims to gain a deeper understanding of the challenges faced by care leavers who have complex needs, as well as to identify some of…

Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

PubMed

Paolini, Jean-Baptiste; Donati, François; Drolet, Pierre

2013-02-01

An adequate airway management plan is essential for patient safety. Recently, new tools have been developed as alternatives to direct laryngoscopy and intubation. Among these, video-laryngoscopy has enjoyed a rapid increase in popularity and is now considered by many as the first-line technique in airway management. This paradigm shift may have an impact on patient safety. Studies show that video-laryngoscopes are associated with better glottic visualization, a higher success rate for difficult airways, and a faster learning curve, resulting in a higher success rate for intubations by novice physicians. Thus, unanticipated difficult intubations may be less frequent if video-laryngoscopy is used as the first-line approach. In addition, on-screen viewing by the operator creates a new dynamic interaction during airway management. The entire operating room team can assess progress in real time, which enhances communication and improves teaching. However, if video-laryngoscopes become standard tools for tracheal intubation, these more costly devices will need to be widely available in all locations where airway management is conducted. Furthermore, algorithms for difficult intubation will require modification, and the question of selecting alternate devices will arise. If the incidence of difficult intubation decreases, the lack of motivation to teach and learn the use of alternative devices might adversely impact patient safety. The greater effectiveness of video-laryngoscopes associated with multi-person visualization could enhance overall patient safety during airway management. However, the routine use of video-laryngoscopy also introduces some issues that need to be addressed to avoid potentially dangerous pitfalls.

Measurement of turbulent spatial structure and kinetic energy spectrum by exact temporal-to-spatial mapping

NASA Astrophysics Data System (ADS)

Buchhave, Preben; Velte, Clara M.

2017-08-01

We present a method for converting a time record of turbulent velocity measured at a point in a flow to a spatial velocity record consisting of consecutive convection elements. The spatial record allows computation of dynamic statistical moments such as turbulent kinetic wavenumber spectra and spatial structure functions in a way that completely bypasses the need for Taylor's hypothesis. The spatial statistics agree with the classical counterparts, such as the total kinetic energy spectrum, at least for spatial extents up to the Taylor microscale. The requirements for applying the method are access to the instantaneous velocity magnitude, in addition to the desired flow quantity, and a high temporal resolution in comparison to the relevant time scales of the flow. We map, without distortion and bias, notoriously difficult developing turbulent high intensity flows using three main aspects that distinguish these measurements from previous work in the field: (1) The measurements are conducted using laser Doppler anemometry and are therefore not contaminated by directional ambiguity (in contrast to, e.g., frequently employed hot-wire anemometers); (2) the measurement data are extracted using a correctly and transparently functioning processor and are analysed using methods derived from first principles to provide unbiased estimates of the velocity statistics; (3) the exact mapping proposed herein has been applied to the high turbulence intensity flows investigated to avoid the significant distortions caused by Taylor's hypothesis. The method is first confirmed to produce the correct statistics using computer simulations and later applied to measurements in some of the most difficult regions of a round turbulent jet—the non-equilibrium developing region and the outermost parts of the developed jet. The proposed mapping is successfully validated using corresponding directly measured spatial statistics in the fully developed jet, even in the difficult outer regions of the jet where the average convection velocity is negligible and turbulence intensities increase dramatically. The measurements in the developing region reveal interesting features of an incomplete Richardson-Kolmogorov cascade under development.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 4: clinical factor.

PubMed

Alexander, G; Hopcraft, M S; Tyas, M J; Wong, Rhk

2017-09-01

The Minamata Convention embodies a worldwide reduction in the production and use of mercury and mercury-containing products and processes, including a phase-down of dental amalgam. This will change the approach to the use of direct restorative materials in the near future. There is little research as to the influence of clinical factors on dentists' decision-making which may be of use when determining the impact of any change. An online survey relating to aspects of and attitudes to the use of direct restorative materials was distributed to all dentists who were members of the Australian Dental Association and/or members or fellows of the Royal Australasian College of Dental Surgeons. Data were statistically analysed. There were 408 respondents to the survey. Eighty-seven per cent of respondents (strongly) disagreed that amalgam was a technically more difficult material to place compared with resin composite, 82% (strongly) disagreed that placement time for amalgam was longer than that for resin composite and 69% (strongly) disagreed that amalgam was more difficult to finish than resin composite. Eighty-three per cent of respondents stated they were confident in their ability to place amalgam restorations. Where physical properties were of importance, indirect restorations were preferred (e.g. parafunction) 54%. The factors considered most important when choosing a direct restorative material included moisture control and aesthetics; least important factors were cost and time to place. There is consensus that amalgam is not more technically difficult to use, place or finish than resin composite and vice versa. There is recognition that both amalgam and resin composite have limitations in terms of physical properties. When choosing a direct restorative material, clinical factors considered to be of greatest importance are moisture control, aesthetics and the need to apply minimally invasive approaches. There is little difference in the opinions of users and non-users of amalgam with respect to these findings. © 2017 Australian Dental Association.

Cerebral blood flow relationships associated with a difficult tone recognition task in trained normal volunteers.

PubMed

Holcomb, H H; Medoff, D R; Caudill, P J; Zhao, Z; Lahti, A C; Dannals, R F; Tamminga, C A

1998-09-01

Tone recognition is partially subserved by neural activity in the right frontal and primary auditory cortices. First we determined the brain areas associated with tone perception and recognition. This study then examined how regional cerebral blood flow (rCBF) in these and other brain regions correlates with the behavioral characteristics of a difficult tone recognition task. rCBF changes were assessed using H2(15)O positron emission tomography. Subtraction procedures were used to localize significant change regions and correlational analyses were applied to determine how response times (RT) predicted rCBF patterns. Twelve trained normal volunteers were studied in three conditions: REST, sensory motor control (SMC) and decision (DEC). The SMC-REST contrast revealed bilateral activation of primary auditory cortices, cerebellum and bilateral inferior frontal gyri. DEC-SMC produced significant clusters in the right middle and inferior frontal gyri, insula and claustrum; the anterior cingulate gyrus and supplementary motor area; the left insula/claustrum; and the left cerebellum. Correlational analyses, RT versus rCBF from DEC scans, showed a positive correlation in right inferior and middle frontal cortex; rCBF in bilateral auditory cortices and cerebellum exhibited significant negative correlations with RT These changes suggest that neural activity in the right frontal, superior temporal and cerebellar regions shifts back and forth in magnitude depending on whether tone recognition RT is relatively fast or slow, during a difficult, accurate assessment.

Maintenance: organizational modes, activities and health and safety. Use of a French national survey and in-situ analyses.

PubMed

Grusenmeyer, Corinne

2014-12-01

Maintenance activities are identified as critical both to operator safety and to systems safety and reliability. However, it is still difficult to identify maintenance workers in French occupational accident and disease statistics. Moreover, few analyses of these activities and of organizational changes in this field have been conducted. This paper presents two different approaches to this same issue. Analyses were aimed firstly at identifying the occupational exposures of these operators and at comparing them with occupational exposures of production staff and, secondly at developing understanding of normal real maintenance activities, i.e. maintenance activities that are normally actually carried out, while taking into account the socio-technical system and maintenance organization within which they lie. The use of the French SUMER 2003 survey shows that occupational exposures of maintenance staff to various constraints are more frequent than occupational exposures of their production colleagues. However, maintenance staff appear to have greater independence. Analyses were also conducted in a subcontracting urban public transport company, who outsources some maintenance work. Those analyses highlight a complex network of companies involved in maintenance activities, a substantial number of work interruptions and a significant fragmentation of the internal technicians' activities that can be cognitively costly, reduce anticipation possibilities and lead to incidents or accidents. Above all they underline internal technicians' contributions to the completion of outsourced interventions and interdependent relationships between the activities of the internal and the external technicians. Outsourcing maintenance interventions thus raises the question of risks associated with the interdependence of actual work activities undertaken by the different types of staff, since they contribute to the same maintenance intervention. This study therefore pinpoints the need to integrate inter-organizational interactions in order to understand the variability of maintenance activities and its relationships with reliability and safety. In this respect, some suggestions are provided with a prevention aim. Copyright © 2014 Elsevier Ltd. All rights reserved.

Soil physical property estimation from soil strength and apparent electrical conductivity sensor data

USDA-ARS?s Scientific Manuscript database

Quantification of soil physical properties through soil sampling and laboratory analyses is time-, cost-, and labor-consuming, making it difficult to obtain the spatially-dense data required for precision agriculture. Proximal soil sensing is an attractive alternative, but many currently available s...

BioQueue: a novel pipeline framework to accelerate bioinformatics analysis.

PubMed

Yao, Li; Wang, Heming; Song, Yuanyuan; Sui, Guangchao

2017-10-15

With the rapid development of Next-Generation Sequencing, a large amount of data is now available for bioinformatics research. Meanwhile, the presence of many pipeline frameworks makes it possible to analyse these data. However, these tools concentrate mainly on their syntax and design paradigms, and dispatch jobs based on users' experience about the resources needed by the execution of a certain step in a protocol. As a result, it is difficult for these tools to maximize the potential of computing resources, and avoid errors caused by overload, such as memory overflow. Here, we have developed BioQueue, a web-based framework that contains a checkpoint before each step to automatically estimate the system resources (CPU, memory and disk) needed by the step and then dispatch jobs accordingly. BioQueue possesses a shell command-like syntax instead of implementing a new script language, which means most biologists without computer programming background can access the efficient queue system with ease. BioQueue is freely available at https://github.com/liyao001/BioQueue. The extensive documentation can be found at http://bioqueue.readthedocs.io. li_yao@outlook.com or gcsui@nefu.edu.cn. Supplementary data are available at Bioinformatics online. © The Author (2017). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Variable Renewable Energy in Long-Term Planning Models: A Multi-Model Perspective

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

Cole, Wesley; Frew, Bethany; Mai, Trieu

Long-term capacity expansion models of the U.S. electricity sector have long been used to inform electric sector stakeholders and decision-makers. With the recent surge in variable renewable energy (VRE) generators — primarily wind and solar photovoltaics — the need to appropriately represent VRE generators in these long-term models has increased. VRE generators are especially difficult to represent for a variety of reasons, including their variability, uncertainty, and spatial diversity. This report summarizes the analyses and model experiments that were conducted as part of two workshops on modeling VRE for national-scale capacity expansion models. It discusses the various methods for treatingmore » VRE among four modeling teams from the Electric Power Research Institute (EPRI), the U.S. Energy Information Administration (EIA), the U.S. Environmental Protection Agency (EPA), and the National Renewable Energy Laboratory (NREL). The report reviews the findings from the two workshops and emphasizes the areas where there is still need for additional research and development on analysis tools to incorporate VRE into long-term planning and decision-making. This research is intended to inform the energy modeling community on the modeling of variable renewable resources, and is not intended to advocate for or against any particular energy technologies, resources, or policies.« less

Self-management for breathlessness in COPD: the role of pulmonary rehabilitation.

PubMed

Gysels, M H; Higginson, I J

2009-01-01

Most of the effort of controlling breathlessness happens at home. Therefore, it is important to explore how patients and carers respond to breathlessness, what their self-care entails and what they experience as helpful. Data were collected from a purposive sample of 18 chronic obstructive pulmonary disease patients through participant observation during outpatient consultations and in-depth interviews at a large hospital and in the community in London. Data were analysed with the Grounded Theory approach. As information regarding the management of breathlessness was lacking and access to treatment was difficult, patients reverted to alternative strategies. Some patients developed considerable expertise and managed their symptoms competently within the limits of current care. Patients who coped successfully were involved in pulmonary rehabilitation and had adopted this as a way of life. Benefits and challenges to participation in these programmes were identified. Those patients who self-manage maintain an acceptable quality of life through self-acquired expertise relating to symptoms, medication and help-seeking. Well-being needs to be understood not as the end point, but as a precarious balance needing skillful maintenance and hard work. The findings have implications for notions such as adherence, patient involvement and responsibility in the management of chronic obstructive pulmonary disease.

A perspective on nonstationarity and water management

USGS Publications Warehouse

Hirsch, R.M.

2011-01-01

This essay offers some perspectives on climate-related nonstationarity and water resources. Hydrologists must not lose sight of the many sources of nonstationarity, recognizing that many of them may be of much greater magnitude than those that may arise from climate change. It is paradoxical that statistical and deterministic approaches give us better insights about changes in mean conditions than about the tails of probability distributions, and yet the tails are very important to water management. Another paradox is that it is difficult to distinguish between long-term hydrologic persistence and trend. Using very long hydrologic records is helpful in mitigating this problem, but does not guarantee success. Empirical approaches, using long-term hydrologic records, should be an important part of the portfolio of research being applied to understand the hydrologic response to climate change. An example presented here shows very mixed results for trends in the size of the annual floods, with some strong clusters of positive trends and a strong cluster of negative trends. The potential for nonstationarity highlights the importance of the continuity of hydrologic records, the need for repeated analysis of the data as the time series grow, and the need for a well-trained cadre of scientists and engineers, ready to interpret the data and use those analyses to help adjust the management of our water resources.

Detecting fossil fuel emissions patterns from subcontinental regions using North American in situ CO2 measurements.

PubMed

Shiga, Yoichi P; Michalak, Anna M; Gourdji, Sharon M; Mueller, Kim L; Yadav, Vineet

2014-06-28

The ability to monitor fossil fuel carbon dioxide (FFCO 2 ) emissions from subcontinental regions using atmospheric CO 2 observations remains an important but unrealized goal. Here we explore a necessary but not sufficient component of this goal, namely, the basic question of the detectability of FFCO 2 emissions from subcontinental regions. Detectability is evaluated by examining the degree to which FFCO 2 emissions patterns from specific regions are needed to explain the variability observed in high-frequency atmospheric CO 2 observations. Analyses using a CO 2 monitoring network of 35 continuous measurement towers over North America show that FFCO 2 emissions are difficult to detect during nonwinter months. We find that the compounding effects of the seasonality of atmospheric transport patterns and the biospheric CO 2 flux signal dramatically hamper the detectability of FFCO 2 emissions. Results from several synthetic data case studies highlight the need for advancements in data coverage and transport model accuracy if the goal of atmospheric measurement-based FFCO 2 emissions detection and estimation is to be achieved beyond urban scales. Poor detectability of fossil fuel CO 2 emissions from subcontinental regionsDetectability assessed via attribution of emissions patterns in atmospheric dataLoss in detectability due to transport modeling errors and biospheric signal.

Developing an analytical toxicology service: principles and guidance.

PubMed

Flanagan, Robert J

2004-01-01

Many acutely poisoned patients are treated with no laboratory help other than general clinical chemistry and haematology. Emergency toxicological analyses (24-hour availability) that could influence immediate patient management such as iron, lithium and paracetamol (acetaminophen), are relatively few in number and are remarkably similar worldwide. These assays should be provided at hospitals with large accident and emergency departments. More complex, less frequently needed clinical toxicological assays that can often be offered on a less urgent basis are usually provided from regional or national centres because of the need to make best use of resources. Recommendations as to the assays that should be provided locally and at regional centres are available for the UK and US, and are generally applicable. Regional centres normally diversify into specialised therapeutic drug monitoring, urine screening for drugs of abuse, metals analysis and sometimes forensic work in order to widen the repertoire of tests available and to increase funding. Whatever the type and quantity of work undertaken and the instrumentation used, guidelines are now available delineating staff training, method validation, assay operation, quality control/quality assurance, and indeed virtually all other aspects of laboratory operation. These considerations notwithstanding, clinical interpretation of analytical results remains a difficult area and is the responsibility of the reporting laboratory, at least in the first instance.

Caring for a patient with delirium in an acute hospital: The lived experience of cardiology, elderly care, renal, and respiratory nurses.

PubMed

Brooke, Joanne; Manneh, Claire

2018-03-12

To explore the lived experience of caring for a patient during an acute episode of delirium by nurses working in cardiology, elderly care, renal, or respiratory specialities. A missed or delayed diagnosis of delirium in an acute hospital setting adversely impacts on patient outcomes. Nurses are the best placed health care professionals to identify a change in patient's cognitive status but struggle to do so. Inductive interpretative phenomenology. Semi-structured interviews with nurses working in an acute hospital in England between November 2016 and March 2017 (n = 23). Interviews were transcribed verbatim and analysed using thematic analysis. Three themes were identified: (i) "sometimes delirium is confusing", difficultly in differentiating between delirium and dementia; (ii) "everyone in the ward was looking after him", a need for collaborative working to provide harm free care; and (iii) "he was aggressive with us, but after treatment he was a gentleman", acceptance and tolerance of aggression. The need for education across specialities, with a combination of classroom and simulation teaching. Alongside, the development of structures to support the development of nursing teamwork and reporting of near miss incidents that occur with patients during an episode of delirium. © 2018 John Wiley & Sons Australia, Ltd.

Domestic violence during pregnancy: Midwives׳ experiences.

PubMed

Mauri, Elisa Marta; Nespoli, Antonella; Persico, Giuseppina; Zobbi, Virna Franca

2015-05-01

the aim of this qualitative study was to explore midwives׳ knowledge and clinical experience of domestic violence among pregnant women, with particular emphasis on their perceptions of their professional role. the data collected for this phenomenological-hermeneutical qualitative study were collected using semi-structured interviews, and analysed according to Denzin and Lincoln (2011). fifteen hospital and community midwives working in the local health district of Monza and Brianza in northern Italy were recruited between July and October 2012. three main themes emerged: 'it is difficult to recognise domestic violence' because of a limited knowledge of the most common signs and symptoms of violence, a lack of training, cultural taboos, and the women׳s unwillingness to disclose abuse; 'we have a certain number of means of identifying violence', such as relationships with the woman, specific professional training and screening tools, which have advantages and disadvantages; 'the professionals involved' in identifying and managing family violence highlight the importance of a interdisciplinary approach. midwives acknowledge their crucial role in identifying and managing domestic violence but are still unprepared to do so and indicate various barriers that need to be overcome. There is a need to implement basic university education on the subject and provide specific professional training. Copyright © 2015 Elsevier Ltd. All rights reserved.

Web-based documentation system with exchange of DICOM RT for multicenter clinical studies in particle therapy

NASA Astrophysics Data System (ADS)

Kessel, Kerstin A.; Bougatf, Nina; Bohn, Christian; Engelmann, Uwe; Oetzel, Dieter; Bendl, Rolf; Debus, Jürgen; Combs, Stephanie E.

2012-02-01

Conducting clinical studies is rather difficult because of the large variety of voluminous datasets, different documentation styles, and various information systems, especially in radiation oncology. In this paper, we describe our development of a web-based documentation system with first approaches of automatic statistical analyses for transnational and multicenter clinical studies in particle therapy. It is possible to have immediate access to all patient information and exchange, store, process, and visualize text data, all types of DICOM images, especially DICOM RT, and any other multimedia data. Accessing the documentation system and submitting clinical data is possible for internal and external users (e.g. referring physicians from abroad, who are seeking the new technique of particle therapy for their patients). Thereby, security and privacy protection is ensured with the encrypted https protocol, client certificates, and an application gateway. Furthermore, all data can be pseudonymized. Integrated into the existing hospital environment, patient data is imported via various interfaces over HL7-messages and DICOM. Several further features replace manual input wherever possible and ensure data quality and entirety. With a form generator, studies can be individually designed to fit specific needs. By including all treated patients (also non-study patients), we gain the possibility for overall large-scale, retrospective analyses. Having recently begun documentation of our first six clinical studies, it has become apparent that the benefits lie in the simplification of research work, better study analyses quality and ultimately, the improvement of treatment concepts by evaluating the effectiveness of particle therapy.

When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guide with flowcharts.

PubMed

Jakobsen, Janus Christian; Gluud, Christian; Wetterslev, Jørn; Winkel, Per

2017-12-06

Missing data may seriously compromise inferences from randomised clinical trials, especially if missing data are not handled appropriately. The potential bias due to missing data depends on the mechanism causing the data to be missing, and the analytical methods applied to amend the missingness. Therefore, the analysis of trial data with missing values requires careful planning and attention. The authors had several meetings and discussions considering optimal ways of handling missing data to minimise the bias potential. We also searched PubMed (key words: missing data; randomi*; statistical analysis) and reference lists of known studies for papers (theoretical papers; empirical studies; simulation studies; etc.) on how to deal with missing data when analysing randomised clinical trials. Handling missing data is an important, yet difficult and complex task when analysing results of randomised clinical trials. We consider how to optimise the handling of missing data during the planning stage of a randomised clinical trial and recommend analytical approaches which may prevent bias caused by unavoidable missing data. We consider the strengths and limitations of using of best-worst and worst-best sensitivity analyses, multiple imputation, and full information maximum likelihood. We also present practical flowcharts on how to deal with missing data and an overview of the steps that always need to be considered during the analysis stage of a trial. We present a practical guide and flowcharts describing when and how multiple imputation should be used to handle missing data in randomised clinical.

An evaluation system for electronic retrospective analyses in radiation oncology: implemented exemplarily for pancreatic cancer

NASA Astrophysics Data System (ADS)

Kessel, Kerstin A.; Jäger, Andreas; Bohn, Christian; Habermehl, Daniel; Zhang, Lanlan; Engelmann, Uwe; Bougatf, Nina; Bendl, Rolf; Debus, Jürgen; Combs, Stephanie E.

2013-03-01

To date, conducting retrospective clinical analyses is rather difficult and time consuming. Especially in radiation oncology, handling voluminous datasets from various information systems and different documentation styles efficiently is crucial for patient care and research. With the example of patients with pancreatic cancer treated with radio-chemotherapy, we performed a therapy evaluation by using analysis tools connected with a documentation system. A total number of 783 patients have been documented into a professional, web-based documentation system. Information about radiation therapy, diagnostic images and dose distributions have been imported. For patients with disease progression after neoadjuvant chemoradiation, we designed and established an analysis workflow. After automatic registration of the radiation plans with the follow-up images, the recurrence volumes are segmented manually. Based on these volumes the DVH (dose-volume histogram) statistic is calculated, followed by the determination of the dose applied to the region of recurrence. All results are stored in the database and included in statistical calculations. The main goal of using an automatic evaluation system is to reduce time and effort conducting clinical analyses, especially with large patient groups. We showed a first approach and use of some existing tools, however manual interaction is still necessary. Further steps need to be taken to enhance automation. Already, it has become apparent that the benefits of digital data management and analysis lie in the central storage of data and reusability of the results. Therefore, we intend to adapt the evaluation system to other types of tumors in radiation oncology.

Molecular phylogenetics and character evolution of morphologically diverse groups, Dendrobium section Dendrobium and allies

PubMed Central

Takamiya, Tomoko; Wongsawad, Pheravut; Sathapattayanon, Apirada; Tajima, Natsuko; Suzuki, Shunichiro; Kitamura, Saki; Shioda, Nao; Handa, Takashi; Kitanaka, Susumu; Iijima, Hiroshi; Yukawa, Tomohisa

2014-01-01

It is always difficult to construct coherent classification systems for plant lineages having diverse morphological characters. The genus Dendrobium, one of the largest genera in the Orchidaceae, includes ∼1100 species, and enormous morphological diversification has hindered the establishment of consistent classification systems covering all major groups of this genus. Given the particular importance of species in Dendrobium section Dendrobium and allied groups as floriculture and crude drug genetic resources, there is an urgent need to establish a stable classification system. To clarify phylogenetic relationships in Dendrobium section Dendrobium and allied groups, we analysed the macromolecular characters of the group. Phylogenetic analyses of 210 taxa of Dendrobium were conducted on DNA sequences of internal transcribed spacer (ITS) regions of 18S–26S nuclear ribosomal DNA and the maturase-coding gene (matK) located in an intron of the plastid gene trnK using maximum parsimony and Bayesian methods. The parsimony and Bayesian analyses revealed 13 distinct clades in the group comprising section Dendrobium and its allied groups. Results also showed paraphyly or polyphyly of sections Amblyanthus, Aporum, Breviflores, Calcarifera, Crumenata, Dendrobium, Densiflora, Distichophyllae, Dolichocentrum, Holochrysa, Oxyglossum and Pedilonum. On the other hand, the monophyly of section Stachyobium was well supported. It was found that many of the morphological characters that have been believed to reflect phylogenetic relationships are, in fact, the result of convergence. As such, many of the sections that have been recognized up to this point were found to not be monophyletic, so recircumscription of sections is required. PMID:25107672

[Diagnosis and treatment guidelines for difficult-to-control asthma in children].

PubMed

Navarro Merino, M; Andrés Martín, A; Asensio de la Cruz, O; García García, M L; Liñán Cortes, S; Villa Asensi, J R

2009-12-01

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier.

Sensitivity based coupling strengths in complex engineering systems

NASA Technical Reports Server (NTRS)

Bloebaum, C. L.; Sobieszczanski-Sobieski, J.

1993-01-01

The iterative design scheme necessary for complex engineering systems is generally time consuming and difficult to implement. Although a decomposition approach results in a more tractable problem, the inherent couplings make establishing the interdependencies of the various subsystems difficult. Another difficulty lies in identifying the most efficient order of execution for the subsystem analyses. The paper describes an approach for determining the dependencies that could be suspended during the system analysis with minimal accuracy losses, thereby reducing the system complexity. A new multidisciplinary testbed is presented, involving the interaction of structures, aerodynamics, and performance disciplines. Results are presented to demonstrate the effectiveness of the system reduction scheme.

End-of-life issues: difficult decisions and dealing with grief.

PubMed

Loomis, Beth

2009-06-01

People face many challenging psychosocial and spiritual issues as they approach the end of their lives, and caregivers need advice on how to help them. Choosing among treatment options, handling grief, addressing unfinished business, and coping with loss of self-sufficiency are difficult for the dying person, and caregivers must deal with surrogate decision making, raw emotions in the patient and in family members, and the caregivers' own grief. Listening and coping skills are discussed.

Students with Specialized Health Care Needs. ERIC Digest #458.

ERIC Educational Resources Information Center

Sirvis, Barbara

Students with specialized health care needs require specialized technological health care procedures for life support and/or health support during the school day. They may or may not require special education. These children were previously unserved in educational settings. Estimation of their numbers is difficult, but as many as 100,000 infants…

Discovering Reliable Sources of Biochemical Thermodynamic Data to Aid Students' Understanding

ERIC Educational Resources Information Center

Me´ndez, Eduardo; Cerda´, María F.

2016-01-01

Students of physical chemistry in biochemical disciplines need biochemical examples to capture the need, not always understood, of a difficult area in their studies. The use of thermodynamic data in the chemical reference state may lead to incorrect interpretations in the analysis of biochemical examples when the analysis does not include relevant…

New thinking needed for emergency services.

PubMed

Wankhade, Paresh

2017-07-13

Recent events in London and Manchester have highlighted the difficult and challenging role played by the emergency services. Their swift and professional response has drawn universal praise, but also raised concerns about reduced funding levels and job cuts against a heightened security threat. Transformational reforms are needed to improve our emergency services in a time of austerity.

Refocusing the Vision: The Future of Instructional Technology

ERIC Educational Resources Information Center

Pence, Harry E.; McIntosh, Steven

2011-01-01

Two decades ago, many campuses mobilized a major effort to deal with a clear problem; faculty and students needed access to desktop computing technologies. Now the situation is much more complex. Responding to the current challenges, like mobile computing and social networking, will be ore difficult but equally important. There is a clear need for…

Machine Shop. Instructor Key. Supplementary Units.

ERIC Educational Resources Information Center

Walden, Charles; Cole, Phyllis

These supplementary units are designed to help students with special needs learn and apply machine shop skills. Nine competencies that are difficult for special needs students to grasp or that would help them get a future job in the field were chosen from the regular machine shop curriculum. Specific objectives for these competencies are listed at…

Italian In-Field EST Users Self-Assess Their Macro- and Micro-Level Needs: A Case Study.

ERIC Educational Resources Information Center

Tarantino, Maria

1988-01-01

Presents and discusses results of study on the specific linguistics needs of Italian scientists who must use English for science and technology for study and work purposes. Writing and listening were considered to be the most difficult skills to master. Questionnaire appears in Appendix. (LMO)

The difficult mountain: enriched composition in adjective–noun phrases

PubMed Central

Pickering, Martin J.; McElree, Brian

2012-01-01

When readers need to go beyond the straightforward compositional meaning of a sentence (i.e., when enriched composition is required), costly additional processing is the norm. However, this conclusion is based entirely on research that has looked at enriched composition between two phrases or within the verb phrase (e.g., the verb and its complement in … started the book …) where there is a discrepancy between the semantic expectations of the verb and the semantics of the noun. We carried out an eye-tracking experiment investigating enriched composition within a single noun phrase, as in the difficult mountain. As compared with adjective–noun phrases that allow a straightforward compositional interpretation (the difficult exercise), the coerced phrases were more difficult to process. These results indicate that coercion effects can be found in the absence of a typing violation and within a single noun phrase. PMID:21826403

Growing the IBCLC Workforce: A Florida Needs Assessment.

PubMed

Eden, Aimee R; Anstey, Erica H; Orriola, Deidre

2018-02-01

Florida has fewer International Board Certified Lactation Consultants (IBCLCs) per 1,000 live births than the national average. An important strategy to support breastfeeding entails creating opportunities to prepare and train IBCLCs from underrepresented groups. However, it can be difficult for individuals to access lactation education and gain clinical experience necessary to become an IBCLC. Research aim: The Building a Better Breastfeeding Network project was a needs assessment designed to assess the interest in an IBCLC training program in Florida and perceived barriers and facilitators to completing such a program. An online survey was distributed via email to non-IBCLC students and maternal and child healthcare workers in Florida. Microsoft Excel was used to complete descriptive analyses. Surveys were initiated by 1,939 eligible individuals from diverse racial and ethnic backgrounds across the state, 86% of whom responded that they would be possibly to very interested in an IBCLC training program. For those interested, cost was perceived as a potential barrier to enrolling in a program, but flexible course schedules and scholarship or financial aid availability would further attract participants. More than half were interested in working with underserved populations or in low-resource settings, but Black and Hispanic participants were significantly more likely to express interest in working in those settings. Due to the high level of interest in an IBCLC training program in Florida, a formal lactation training program may be successful in attracting diverse students, particularly if funding and program flexibility needs are met.

Parenting Outside the Box, Part One: Our Path to a Diagnosis | Poster

Cancer.gov

Editor’s note: This article is the first in a series describing one NCI at Frederick parent’s perspective on special needs parenting. By Melissa Porter, Staff Writer My husband and I find calling ourselves “special needs parents” difficult. Yes, we do have a child who has autism, and yes, we approach each day differently, but I have never thought of that as special needs parenting.

Parenting Outside the Box, Part One: Our Path to a Diagnosis | Poster

Cancer.gov

Editor’s note: This article is the first in a series describing one NCI at Frederick parent’s perspective on special needs parenting. By Melissa Porter, Staff Writer My husband and I find calling ourselves “special needs parents” difficult. Yes, we do have a child who has autism, and yes, we approach each day differently, but I have never thought of that as special needs

Applying a Mixed Methods Framework to Differential Item Function Analyses

ERIC Educational Resources Information Center

Hitchcock, John H.; Johanson, George A.

2015-01-01

Understanding the reason(s) for Differential Item Functioning (DIF) in the context of measurement is difficult. Although identifying potential DIF items is typically a statistical endeavor, understanding the reasons for DIF (and item repair or replacement) might require investigations that can be informed by qualitative work. Such work is…

Calculating the Financial Impact of Population Growth on Education.

ERIC Educational Resources Information Center

Cline, Daniel H.

It is particularly difficult to make accurate enrollment projections for areas that are experiencing a rapid expansion in their population. The traditional method of calculating cohort survival ratios must be modified and supplemented with additional information to ensure accuracy; cost projection methods require detailed analyses of current costs…

Virtual Reference, Real Money: Modeling Costs in Virtual Reference Services

ERIC Educational Resources Information Center

Eakin, Lori; Pomerantz, Jeffrey

2009-01-01

Libraries nationwide are in yet another phase of belt tightening. Without an understanding of the economic factors that influence library operations, however, controlling costs and performing cost-benefit analyses on services is difficult. This paper describes a project to develop a cost model for collaborative virtual reference services. This…

Identification and characterization of plasmids from Xylella fastidiosa using next generation sequencing analyses

USDA-ARS?s Scientific Manuscript database

Xylella fastidiosa causes diseases in many economically important crops, e.g. Pierce’s disease (PD) of grapevines and blueberry bacterial leaf scorch (BBLS) disease in the U.S. Biological research on X. fastidiosa has been difficult due to its nutritional fastidiousness. Genomic research provides a ...

Organisational Legitimacy of the Singapore Ministry of Education

ERIC Educational Resources Information Center

Tan, Cheng Yong

2013-01-01

This paper analyses the perceived organisational legitimacy of the Singapore Ministry of Education (MOE) in preparing the population for work in the knowledge-based economy (KBE). It is argued that challenges to MOE's legitimacy are emerging with ramifications that are difficult to ignore. These challenges relate to equipping the population with…

Short Answers to Deep Questions: Supporting Teachers in Large-Class Settings

ERIC Educational Resources Information Center

McDonald, J.; Bird, R. J.; Zouaq, A.; Moskal, A. C. M.

2017-01-01

In large class settings, individualized student-teacher interaction is difficult. However, teaching interactions (e.g., formative feedback) are central to encouraging deep approaches to learning. While there has been progress in automatic short-answer grading, analysing student responses to support formative feedback at scale is arguably some way…

Thermogravimetric and differential thermal analysis of potassium bicarbonate contaminated cellulose

Treesearch

A. Broido

1966-01-01

When samples undergo a complicated set of simultaneous and sequential reactions, as cellulose does on heating, results of thermogravimetric and differential thermal analyses are difficult to interpret. Nevertheless, careful comparison of pure and contaminated samples, pyrolyzed under identical conditions, can yield useful information. In these experiments TGA and DTA...

Earbuds: A Method for Analyzing Nasality in the Field

ERIC Educational Resources Information Center

Stewart, Jesse; Kohlberger, Martin

2017-01-01

Existing methods for collecting and analyzing nasality data are problematic for linguistic fieldworkers: aerodynamic equipment can be expensive and difficult to transport, and acoustic analyses require large amounts of optimally-recorded data. In this paper, a highly mobile and low-cost method is proposed. By connecting low impedance earbuds into…

Professional "Temps" in Today's Workforce.

ERIC Educational Resources Information Center

Millner, Guy W.

1989-01-01

With office technology becoming more sophisticated and skilled workers harder to find, meeting personnel needs is a difficult task. In many cases, professional temporaries may be just the answer. (Author)

Hurricane Katrina-related maternal stress, maternal mental health, and early infant temperament.

PubMed

Tees, Michael T; Harville, Emily W; Xiong, Xu; Buekens, Pierre; Pridjian, Gabriella; Elkind-Hirsch, Karen

2010-07-01

To investigate temperament in infants whose mothers were exposed to Hurricane Katrina and its aftermath, and to determine if high hurricane exposure is associated with difficult infant temperament. A prospective cohort study of women giving birth in New Orleans and Baton Rouge, LA (n = 288) in 2006-2007 was conducted. Questionnaires and interviews assessed the mother's experiences during the hurricane, living conditions, and psychological symptoms, 2 months and 12 months postpartum. Infant temperament characteristics were reported by the mother using the activity, adaptability, approach, intensity, and mood scales of the Early Infant and Toddler Temperament Questionnaires, and "difficult temperament" was defined as scoring in the top quartile for three or more of the scales. Logistic regression was used to examine the association between hurricane experience, mental health, and infant temperament. Serious experiences of the hurricane did not strongly increase the risk of difficult infant temperament (association with three or more serious experiences of the hurricane: adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 0.63-3.58 at 2 months; 0.58, 0.15-2.28 at 12 months). Maternal mental health was associated with report of difficult infant temperament, with women more likely to report having a difficult infant temperament at 1 year if they had screened positive for PTSD (aOR 1.82, 95% confidence interval (CI) 0.61-5.41), depression, (aOR 3.16, 95% CI 1.22-8.20) or hostility (aOR 2.17, 95% CI 0.81-5.82) at 2 months. Large associations between maternal stress due to a natural disaster and infant temperament were not seen, but maternal mental health was associated with reporting difficult temperament. Further research is needed to determine the effects of maternal exposure to disasters on child temperament, but in order to help babies born in the aftermath of disaster, the focus may need to be on the mother's mental health.

Hurricane Katrina-related maternal stress, maternal mental health, and early infant temperament

PubMed Central

Tees, Michael T.; Xiong, Xu; Buekens, Pierre; Pridjian, Gabriella; Elkind-Hirsch, Karen

2012-01-01

To investigate temperament in infants whose mothers were exposed to Hurricane Katrina and its aftermath, and to determine if high hurricane exposure is associated with difficult infant temperament. A prospective cohort study of women giving birth in New Orleans and Baton Rouge, LA (n=288) in 2006–2007 was conducted. Questionnaires and interviews assessed the mother’s experiences during the hurricane, living conditions, and psychological symptoms, two months and 12 months postpartum. Infant temperament characteristics were reported by the mother using the activity, adaptability, approach, intensity, and mood scales of the Early Infant and Toddler Temperament Questionnaires, and “difficult temperament” was defined as scoring in the top quartile for three or more of the scales. Logistic regression was used to examine the association between hurricane experience, mental health, and infant temperament. Serious experiences of the hurricane did not strongly increase the risk of difficult infant temperament (association with 3 or more serious experiences of the hurricane: adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 0.63–3.58 at 2 months; 0.58, 0.15–2.28 at 12 months). Maternal mental health was associated with report of difficult infant temperament, with women more likely to report having a difficult infant temperament at one year if they had screened positive for PTSD (aOR 1.82, 95% confidence interval (CI) 0.61–5.41), depression, (aOR 3.16, 95% CI 1.22–8.20) or hostility (aOR 2.17, 95% CI 0.81–5.82) at 2 months. Large associations between maternal stress due to a natural disaster and infant temperament were not seen, but maternal mental health was associated with reporting difficult temperament. Further research is needed to determine the effects of maternal exposure to disasters on child temperament, but in order to help babies born in the aftermath of disaster, the focus may need to be on the mother’s mental health. PMID:19554438

Creating single-subject design graphs in Microsoft Excel 2007.

PubMed

Dixon, Mark R; Jackson, James W; Small, Stacey L; Horner-King, Mollie J; Lik, Nicholas Mui Ker; Garcia, Yors; Rosales, Rocio

2009-01-01

Over 10 years have passed since the publication of Carr and Burkholder's (1998) technical article on how to construct single-subject graphs using Microsoft Excel. Over the course of the past decade, the Excel program has undergone a series of revisions that make the Carr and Burkholder paper somewhat difficult to follow with newer versions. The present article provides task analyses for constructing various types of commonly used single-subject design graphs in Microsoft Excel 2007. The task analyses were evaluated using a between-subjects design that compared the graphing skills of 22 behavior-analytic graduate students using Excel 2007 and either the Carr and Burkholder or newly developed task analyses. Results indicate that the new task analyses yielded more accurate and faster graph construction than the Carr and Burkholder instructions.

CREATING SINGLE-SUBJECT DESIGN GRAPHS IN MICROSOFT EXCELTM 2007

PubMed Central

Dixon, Mark R; Jackson, James W; Small, Stacey L; Horner-King, Mollie J; Lik, Nicholas Mui Ker; Garcia, Yors; Rosales, Rocio

2009-01-01

Over 10 years have passed since the publication of Carr and Burkholder's (1998) technical article on how to construct single-subject graphs using Microsoft Excel. Over the course of the past decade, the Excel program has undergone a series of revisions that make the Carr and Burkholder paper somewhat difficult to follow with newer versions. The present article provides task analyses for constructing various types of commonly used single-subject design graphs in Microsoft Excel 2007. The task analyses were evaluated using a between-subjects design that compared the graphing skills of 22 behavior-analytic graduate students using Excel 2007 and either the Carr and Burkholder or newly developed task analyses. Results indicate that the new task analyses yielded more accurate and faster graph construction than the Carr and Burkholder instructions. PMID:19949515

Marketing communications in nonbusiness situations or why it's so hard to sell brotherhood like soap.

PubMed

Rothschild, M L

1979-01-01

Marketing tools, techniques, and theories developed in the private sector can be applied in the public and nonprofit sectors; however, their limitations must be recognized. Nonbusiness communications campaigns should consider the involvedness (high or low) of the situation and the relevant segments, available positive and negative reinforcers, nonmonetary costs, the level of latent demand, and the wide range of communications alternatives. 5 hypotheses can be proposed regarding communications effectiveness outside of the private sector: 1) the lower the perceived personal value to the individual, relative to the cost, the more difficult the behavior change task and the lower the likelihood of success of marketing communications; 2) the lower the latent or pre-existing demand for the object, the more difficult the behavior change task and the lower the likelihood of marketing communications success; 3) the greater the involvement level of the object, situation, or issue, the more difficult the behavior change task and the lower the likelihood of marketing success; 4) the greater the past involvement level of the individual, the more difficult the behavior change task and the lower the likelihood of success; and 5) the greater the level of participation needed within the society, the more difficult the behavior change and the lower the likelihood of sucess of marketing communications. Many nonbusiness issues exist in either very high or very low involvement environments, calling for an enlarged set of communications strategies. More attention should be given to communications alternatives such as movies, television programs, and in-home and in-school educational communications, especially since it appears that public service spots are not very effective. Finally, more research is needed to generate and test the effectiveness of various marketing strategies aimed at overcoming inherent characteristics that suggest a low likelihood of success.

Characteristics of difficult-to-place youth in state custody: a profile of the Exceptional Care Pilot Project population.

PubMed

Armour, Marilyn P; Schwab, James

2007-01-01

This study examines the characteristics of Texas youth designated as 'most difficult to place' recipients of service under the "Exceptional Care Pilot Project" (N = 46). Findings include, among others, high levels of comorbid psychiatric disturbance (> 3 diagnostic groupings), physical (78.3%) and sexual (88%) maltreatment, and placement breakdowns (m = 4.8 therapeutic placements). This initial profile of the population provides a base for helping other states identify and plan for the needs of their most troubled youth.

Development of carbon plasma-coated multiwell plates for high-throughput mass spectrometric analysis of highly lipophilic fermentation products.

PubMed

Heinig, Uwe; Scholz, Susanne; Dahm, Pia; Grabowy, Udo; Jennewein, Stefan

2010-08-01

Classical approaches to strain improvement and metabolic engineering rely on rapid qualitative and quantitative analyses of the metabolites of interest. As an analytical tool, mass spectrometry (MS) has proven to be efficient and nearly universally applicable for timely screening of metabolites. Furthermore, gas chromatography (GC)/MS- and liquid chromatography (LC)/MS-based metabolite screens can often be adapted to high-throughput formats. We recently engineered a Saccharomyces cerevisiae strain to produce taxa-4(5),11(12)-diene, the first pathway-committing biosynthetic intermediate for the anticancer drug Taxol, through the heterologous and homologous expression of several genes related to isoprenoid biosynthesis. To date, GC/MS- and LC/MS-based high-throughput methods have been inherently difficult to adapt to the screening of isoprenoid-producing microbial strains due to the need for extensive sample preparation of these often highly lipophilic compounds. In the current work, we examined different approaches to the high-throughput analysis of taxa-4(5),11(12)-diene biosynthesizing yeast strains in a 96-deep-well format. Carbon plasma coating of standard 96-deep-well polypropylene plates allowed us to circumvent the inherent solvent instability of commonly used deep-well plates. In addition, efficient adsorption of the target isoprenoid product by the coated plates allowed rapid and simple qualitative and quantitative analyses of the individual cultures. Copyright 2010 Elsevier Inc. All rights reserved.

TaxI: a software tool for DNA barcoding using distance methods

PubMed Central

Steinke, Dirk; Vences, Miguel; Salzburger, Walter; Meyer, Axel

2005-01-01

DNA barcoding is a promising approach to the diagnosis of biological diversity in which DNA sequences serve as the primary key for information retrieval. Most existing software for evolutionary analysis of DNA sequences was designed for phylogenetic analyses and, hence, those algorithms do not offer appropriate solutions for the rapid, but precise analyses needed for DNA barcoding, and are also unable to process the often large comparative datasets. We developed a flexible software tool for DNA taxonomy, named TaxI. This program calculates sequence divergences between a query sequence (taxon to be barcoded) and each sequence of a dataset of reference sequences defined by the user. Because the analysis is based on separate pairwise alignments this software is also able to work with sequences characterized by multiple insertions and deletions that are difficult to align in large sequence sets (i.e. thousands of sequences) by multiple alignment algorithms because of computational restrictions. Here, we demonstrate the utility of this approach with two datasets of fish larvae and juveniles from Lake Constance and juvenile land snails under different models of sequence evolution. Sets of ribosomal 16S rRNA sequences, characterized by multiple indels, performed as good as or better than cox1 sequence sets in assigning sequences to species, demonstrating the suitability of rRNA genes for DNA barcoding. PMID:16214755

Ginkgo Biloba extract for angina pectoris: a systematic review.

PubMed

Sun, Tian; Wang, Xian; Xu, Hao

2015-07-01

To evaluate the efficacy and safety of Ginkgo Biloba extract for patients with angina pectoris according to the available evidence. Electronic databases were searched for all of the randomized controlled trials (RCTs) of angina pectoris treatments with Ginkgo Biloba extract, either alone or combined with routine Western medicine (RWM), and controlled by untreated, placebo, Chinese patent medicine, or RWM treatment. The RCTs were retrieved from the following electronic databases: PubMed/MEDLINE, ProQuest Health and Medical Complete, Springer, Elsevier, and ProQuest Dissertations and Theses, Wanfang Data, China National Knowledge Infrastructure (CNKI), VIP database, China Biology Medicine (CBM), Chinese Medical Citation Index (CMCI), from the earliest database records to December 2012. No language restriction was applied. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. RevMan 5.1.0 provided by Cochrane Collaboration The data were analysed by using. A total of 23 RCTs (involving 2,529 patients) were included and the methodological quality was evaluated as generally low. Ginkgo Biloba extract with RWM was more effective in angina relief and electrocardiogram improvement than RWM alone. Reported adverse events included epigastric discomfort, nausea, gastrointestinal reaction, and bitter taste. Ginkgo Biloba extract may have beneficial effects on patients with angina pectoris, although the low quality of existing trials makes it difficult to draw a satisfactory conclusion. More rigorous, high quality clinical trials are needed to provide conclusive evidence.

Update on work-related psychosocial factors and the development of ischemic heart disease: a systematic review.

PubMed

Pejtersen, Jan Hyld; Burr, Hermann; Hannerz, Harald; Fishta, Alba; Hurwitz Eller, Nanna

2015-01-01

The present review deals with the relationship between occupational psychosocial factors and the incidence of ischemic heart disease (IHD) with special regard to the statistical power of the findings. This review with 4 inclusion criteria is an update of a 2009 review of which the first 3 criteria were included in the original review: (1) STUDY: a prospective or case-control study if exposure was not self-reported (prognostic studies excluded); (2) OUTCOME: definite IHD determined externally; (3) EXPOSURE: psychosocial factors at work (excluding shift work, trauma, violence or accidents, and social capital); and (4) Statistical power: acceptable to detect a 20% increased risk in IHD. Eleven new papers met the inclusion criteria 1-3; a total of 44 papers were evaluated regarding inclusion criteria 4. Of 169 statistical analyses, only 10 analyses in 2 papers had acceptable statistical power. The results of the 2 papers pointed in the same direction, namely that only the control dimension of job strain explained the excess risk for myocardial infarction for job strain. The large number of underpowered studies and the focus on psychosocial models, such as the job strain models, make it difficult to determine to what extent psychosocial factors at work are risk factors of IHD. There is a need for considering statistical power when planning studies.

Legal Negligence and the Community Educator.

ERIC Educational Resources Information Center

Shoop, Robert J.

More and more educators are being charged with liability in court. Hence community educators need greater understanding of liability and need to know how to avoid being defendants in litigation. Ignorance of the law is no defense, even though it is often difficult to know what the law is. While there is a tension between protecting the rights of…

Professional Education and the Labor Market: Problems of Coordination

ERIC Educational Resources Information Center

Kochetov, A. N.

2012-01-01

The increasing desire to obtain a higher education in Russia is causing a growing disparity between educational qualifications and the needs of the labor market. Blue-collar jobs of varying levels are difficult to fill, and the demand for the qualification of those with degrees is not sufficient to avoid high levels of unemployment. Ways need to…

Analysis of Learning Behavior in a Flipped Programing Classroom Adopting Problem-Solving Strategies

ERIC Educational Resources Information Center

Chiang, Tosti Hsu-Cheng

2017-01-01

Programing is difficult for beginners because they need to learn the new language of computers. Developing software, especially complex software, is bound to result in problems, frustration, and the need to think in new ways. Identifying the learning behavior behind programing by way of empirical studies can help beginners learn more easily. In…

Meeting the Needs of the "Invisible University:" Identifying Information Needs of Postdoctoral Scholars in the Sciences

ERIC Educational Resources Information Center

Gunapala, Nirmala

2014-01-01

Academic libraries seek to play a central role in supporting the research enterprise on their campuses. Postdoctoral scholars ("postdocs") make substantial contributions to academic research and are an important group toward which services can be marketed. They are also difficult to find on many campuses, with some studies referring to…

Hear Me, Oh Hear Me! Are We Listening to Our Employees?

ERIC Educational Resources Information Center

Loy, Darcy

2011-01-01

Listening is one of the most crucial skills that leaders need to possess but is often the most difficult to master. It takes hard work, concentration, and specific skill sets to become an effective listener. Facilities leaders need to perfect the art of listening to their employees. Employees possess pertinent knowledge about day-to-day operations…

Early Childhood Special Education. Dental and Oral Hygiene Procedures for Young Children with Special Needs.

ERIC Educational Resources Information Center

Sluder, R. S.; Luder, Linda C.

1995-01-01

Notes that children with special needs often require specific considerations with regard to dental care. Discusses some of the physical disabilities and how they interfere with dental hygiene, and how child caregivers can modify daily routines and assist disabled children with areas of hygiene the children may find difficult. (HTH)

Encouraging Students to Think Strategically when Learning to Solve Linear Equations

ERIC Educational Resources Information Center

Robson, Daphne; Abell, Walt; Boustead, Therese

2012-01-01

Students who are preparing to study science and engineering need to understand equation solving but adult students returning to study can find this difficult. In this paper, the design of an online resource, Equations2go, for helping students learn to solve linear equations is investigated. Students learning to solve equations need to consider…

Development of a Mobile-Optimised Website to Support Students with Special Needs Transitioning from Primary to Secondary Settings

ERIC Educational Resources Information Center

Chambers, Dianne; Coffey, Anne

2013-01-01

With an increasing number of students with special needs being included in regular classroom environments, consideration of, and planning for, a smooth transition between different school settings is important for parents, classroom teachers and school administrators. The transition between primary and secondary school can be difficult for…

End of Life Issues

MedlinePlus

... difficult. But by deciding what end-of-life care best suits your needs when you are healthy, ... making choices about the following: The goals of care (for example, whether to use certain medicines during ...

Noticing Critical Incidents in a Mathematics Classroom

ERIC Educational Resources Information Center

Choy, Ban Heng

2014-01-01

What teachers attend to, how they make sense of, and respond to critical incidents in the classroom are important for improving teaching. However, seeing and understanding important features of critical incidents can be difficult. In this paper, I propose a notion of productive noticing, which I used to analyse a case study of what teachers…

Cross Validity of the Behavior Style Questionnaire and Child Personality Scale in Nursery School Children.

ERIC Educational Resources Information Center

Simonds, John F.; Simonds, M. Patricia

1982-01-01

Mothers of 182 nursery school children completed the Behavior Style Questionnaire (BSQ) and the Child Personality Scale (CPS). Intercorrelational analyses showed many significantly correlated items. Scores of the five CPS factors clearly distinguished between subjects in easy and difficult BSQ clusters. Found boys significantly more introverted…

Learning to Apply Models of Materials While Explaining Their Properties

ERIC Educational Resources Information Center

Karpin, Tiia; Juuti, Kalle; Lavonen, Jari

2014-01-01

Background: Applying structural models is important to chemistry education at the upper secondary level, but it is considered one of the most difficult topics to learn. Purpose: This study analyses to what extent in designed lessons students learned to apply structural models in explaining the properties and behaviours of various materials.…

Speaking and Listening through Drama 7 - 11

ERIC Educational Resources Information Center

Prendiville, Francis; Toye, Nigel

2007-01-01

Showing teachers how to use drama to promote speaking and listening for pupils, including those who find learning difficult, this book describes, analyses and teaches how to use role play effectively and looks at how to generate a productive dialogue between teachers and pupils that is both powerful and enabling. The authors present innovative…

Student Learning in an Electric Circuit Theory Course: Critical Aspects and Task Design

ERIC Educational Resources Information Center

Carstensen, Anna-Karin; Bernhard, Jonte

2009-01-01

Understanding time-dependent responses, such as transients, is important in electric circuit theory and other branches of engineering. However, transient response is considered difficult to learn since familiarity with advanced mathematical tools such as Laplace transforms is required. Here, we analyse and describe a novel learning environment…

Mining Information form a Coupled Air Quality Model to Examine the Impacts of Agricultural Management Practices on Air and Groundwater Quality

EPA Science Inventory

Attributing nitrogen (N) in the environment to emissions from agricultural management practices is difficult because of the complex and inter-related chemical and biological reactions associated with N and its cascading effects across land, air and water. Such analyses are criti...

Why Is It Difficult to Grasp the Impacts of the Portuguese Quality Assurance System?

ERIC Educational Resources Information Center

Veiga, Amélia; Rosa, Maria João; Dias, Diana; Amaral, Alberto

2013-01-01

This article analyses the impacts of the Portuguese quality assurance system on academic cultures, using the Cultural Theory proposed by Douglas (1970, 1982) and developed by Thompson, Ellis and Wildavsky (1990) as an explanatory framework for Portuguese academics' preference formation in relation to quality assessment. The Portuguese higher…

Genome sequence of cultivated Upland cotton (Gossypium hirsutum TM-1) provides insights into genome evolution

USDA-ARS?s Scientific Manuscript database

Genetic and genomic analyses of Upland cotton (Gossypium hirsutum) are difficult because it has a complex allotetraploid (AADD; 2n = 4x = 52) genome. Here we sequenced, assembled and analyzed the world's most important cultivated cotton genome with 246.2 gigabase (Gb) clean data obtained using whol...

Linear Response Laws and Causality in Electrodynamics

ERIC Educational Resources Information Center

Yuffa, Alex J.; Scales, John A.

2012-01-01

Linear response laws and causality (the effect cannot precede the cause) are of fundamental importance in physics. In the context of classical electrodynamics, students often have a difficult time grasping these concepts because the physics is obscured by the intermingling of the time and frequency domains. In this paper, we analyse the linear…

Regression Effects in Angoff Ratings: Examples from Credentialing Exams

ERIC Educational Resources Information Center

Wyse, Adam E.

2018-01-01

This article discusses regression effects that are commonly observed in Angoff ratings where panelists tend to think that hard items are easier than they are and easy items are more difficult than they are in comparison to estimated item difficulties. Analyses of data from two credentialing exams illustrate these regression effects and the…

Linguistic Skills Involved in Learning to Spell: An Australian Study

ERIC Educational Resources Information Center

Daffern, Tessa

2017-01-01

Being able to accurately spell in Standard English requires efficient coordination of multiple knowledge sources. Therefore, spelling is a word-formation problem-solving process that can be difficult to learn. The present study uses Triple Word Form Theory as a conceptual framework to analyse Standard English spelling performance levels of…

Understanding Producers' Intentions and Viewers' Learning Outcomes in a Science Museum Theater Play on Evolution

ERIC Educational Resources Information Center

Peleg, R.; Baram-Tsabari, A.

2016-01-01

Science museums often introduce plays to liven up exhibits, attract visitors to specific exhibitions, and help visitors to "digest" difficult content. Most previous research has concentrated on viewers' learning outcomes. This study uses performance and spectator analyses from the field of theater studies to explore the link between…

Summary for Forest health monitoring: 2005 national technical report

Treesearch

Mark J. Ambrose

2007-01-01

Forest Health Monitoring (FHM), together with cooperating researchers both in and outside of the U.S. Department of AgricultureForest Service, continues to investigate the variety of issues relating to forest health. This report provides a review of the latest analyses and results. The broad range of indicators presented alone demonstrates how difficult it...

Executive Leadership: Another Lever in the System?

ERIC Educational Resources Information Center

Harris, Alma; Brown, David; Abbott, Ian

2006-01-01

The leadership challenges facing most head teachers can at times be daunting but for those leading schools in difficulty, the challenges are acute. This article draws upon the personal experience of an executive leader in a school facing difficult circumstances. It will firstly, outline and analyse this model of leadership and secondly, look at…

Reliability Problems of the Datum: Solutions for Questionnaire Responses.

ERIC Educational Resources Information Center

Bastick, Tony

Questionnaires often ask for estimates, and these estimates are given with different reliabilities. It is difficult to know the different reliabilities of single estimates and to take these into account in subsequent analyses. This paper contains a practical example to show that not taking the reliability of different responses into account can…

Using a Coupled Modelling System to Examine the Impacts of Increased Corn Production on Groundwater Quality and Human Health

EPA Science Inventory

Attributing nitrogen (N) in the environment to emissions from agricultural management practices is difficult because of the complex and inter-related chemical and biological reactions associated with N and its cascading effects across land, air and water. Such analyses are critic...

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

McCoy, Michel; Archer, Bill; Hendrickson, Bruce

The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computationalmore » resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resource, including technical staff, hardware, simulation software, and computer science solutions. ASC is now focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), and quantifying critical margins and uncertainties. Resolving each issue requires increasingly difficult analyses because the aging process has progressively moved the stockpile further away from the original test base. Where possible, the program also enables the use of high performance computing (HPC) and simulation tools to address broader national security needs, such as foreign nuclear weapon assessments and counter nuclear terrorism.« less

SEX-DETector: A Probabilistic Approach to Study Sex Chromosomes in Non-Model Organisms

PubMed Central

Muyle, Aline; Käfer, Jos; Zemp, Niklaus; Mousset, Sylvain; Picard, Franck; Marais, Gabriel AB

2016-01-01

We propose a probabilistic framework to infer autosomal and sex-linked genes from RNA-seq data of a cross for any sex chromosome type (XY, ZW, and UV). Sex chromosomes (especially the non-recombining and repeat-dense Y, W, U, and V) are notoriously difficult to sequence. Strategies have been developed to obtain partially assembled sex chromosome sequences. Most of them remain difficult to apply to numerous non-model organisms, either because they require a reference genome, or because they are designed for evolutionarily old systems. Sequencing a cross (parents and progeny) by RNA-seq to study the segregation of alleles and infer sex-linked genes is a cost-efficient strategy, which also provides expression level estimates. However, the lack of a proper statistical framework has limited a broader application of this approach. Tests on empirical Silene data show that our method identifies 20–35% more sex-linked genes than existing pipelines, while making reliable inferences for downstream analyses. Approximately 12 individuals are needed for optimal results based on simulations. For species with an unknown sex-determination system, the method can assess the presence and type (XY vs. ZW) of sex chromosomes through a model comparison strategy. The method is particularly well optimized for sex chromosomes of young or intermediate age, which are expected in thousands of yet unstudied lineages. Any organisms, including non-model ones for which nothing is known a priori, that can be bred in the lab, are suitable for our method. SEX-DETector and its implementation in a Galaxy workflow are made freely available. PMID:27492231

Maternal complications in a geographically challenging and hard to reach district of Bangladesh: a qualitative study.

PubMed

Biswas, Animesh; Dalal, Koustuv; Abdullah, Abu Sayeed Md; Gifford, Mervyn; Halim, M A

2016-01-01

Background: Maternal complications contribute to maternal deaths in developing countries. Bangladesh still has a high prevalence of maternal mortality, which is often preventable. There are some geographically challenging and hard to reach rural districts in Bangladesh and it is difficult to get information about maternal complications in these areas. In this study, we examined the community lay knowledge of possible pregnancy complications. We also examined the common practices associated with complications and we discuss the challenges for the community. Methods: The study was conducted in Moulvibazar of north east Bangladesh, a geographically challenged, difficult to reach district. Qualitative methods were used to collect the information. Pregnant women, mothers who had recently delivered, their guardians and traditional birth attendants participated in focus group discussions. Additionally, in-depth interviews were conducted with the family members. Thematic analyses were performed. Results: The study revealed that there is a lack of knowledge of maternal complications. In the majority of cases, the mothers did not receive proper treatment for maternal complications.   There are significant challenges that these rural societies need to address: problems of ignorance, traditional myths and family restrictions on seeking better treatment. Moreover, traditional birth attendants and village doctors also have an important role in assuring appropriate, effective and timely treatment. Conclusions:  The rural community lacks adequate knowledge on maternal complications.  Reduction of the societal barriers including barriers within the family can improve overall practices. Moreover, dissemination of adequate information to the traditional birth attendant and village doctors may improve the overall situation, which would eventually help to reduce maternal deaths.

Emotional resistance building: how family members of loved ones undergoing chemotherapy treatment process their fear of emotional collapse.

PubMed

McCarthy, Bridie; Andrews, Tom; Hegarty, Josephine

2015-04-01

To explore family members' experiences when their loved one is undergoing chemotherapy treatment as an outpatient for newly diagnosed colorectal cancer and to develop an explanatory theory of how they process their main concern. Most individuals with cancer are now treated as outpatients and cared for by family members. International research highlights the many side effects of chemotherapy, which in the absence of specific information and/or experience can be difficult for family members to deal with. Unmet needs can have an impact on the health of both patients and family members. Classic grounded theory methodology was used for this study. Using classic grounded theory methodology, family members (n = 35) of patients undergoing chemotherapy treatment for cancer were interviewed (June 2010-July 2011). Data were analysed using the concurrent processes of constant comparative analysis, data collection, theoretical sampling and memo writing. The main concern that emerged for participants was fear of emotional collapse. This fear was dealt with through a process conceptualized as 'Emotional Resistance Building'. This is a basic social process with three phases: 'Figuring out', 'Getting on with it' and 'Uncertainty adjustment'. The phases are not linear, but interrelated as participants can be in any one or more of the phases at any one time. This theory has the potential to be used by healthcare professionals working in oncology to support family members of patients undergoing chemotherapy. New ways of supporting family members through this most difficult and challenging period are articulated within this theory. © 2014 John Wiley & Sons Ltd.

The use (or misuse) of microsatellite allelic distances in the context of inbreeding and conservation genetics.

PubMed

Hansson, Bengt

2010-03-01

In line with inbreeding theory, genetic diversity at a set of molecular markers may explain variation in fitness-associated traits in partially inbred populations, and such associations will appear as 'genotype-fitness correlations'. An individual genetic diversity index specifically used for microsatellites is 'mean d(2)', i.e. the mean squared distance between alleles. The original hypothesis for mean d(2)-fitness correlations assumes that mean d(2) captures fitness effects at both ends of the inbreeding-outbreeding spectrum. This hypothesis received strong criticism from work showing that even a plain diversity estimate such as multi-locus heterozygosity (MLH) outperforms mean d(2) as a predictor of the inbreeding coefficient and fitness in most realistic situations. Despite this critique, the mean d(2)-approach is still used frequently in ecological and evolutionary research, producing results suggesting that mean d(2) sometimes provides a stronger prediction of fitness than does MLH. In light of the critique, such results are unexpected, but potential explanations for them may exist (at least hypothetically), including scenarios based on close linkage and recent admixture. Nevertheless, a major caveat is that it is very difficult to predict a priori if mean d(2) will improve the genotype-fitness correlation, which in turn makes objective interpretations difficult. Mean d(2)-fitness associations are potentially interesting, but the fact that we cannot easily understand them is problematic and should be thoroughly addressed in each study. Therefore, instead of hastily reached interpretations of mean d(2)-fitness correlations, conclusions need support from complementary analyses, e.g. verifying admixture of genetically structured populations.

Persistent Identifiers for Improved Accessibility for Linked Data Querying

NASA Astrophysics Data System (ADS)

Shepherd, A.; Chandler, C. L.; Arko, R. A.; Fils, D.; Jones, M. B.; Krisnadhi, A.; Mecum, B.

2016-12-01

The adoption of linked open data principles within the geosciences has increased the amount of accessible information available on the Web. However, this data is difficult to consume for those who are unfamiliar with Semantic Web technologies such as Web Ontology Language (OWL), Resource Description Framework (RDF) and SPARQL - the RDF query language. Consumers would need to understand the structure of the data and how to efficiently query it. Furthermore, understanding how to query doesn't solve problems of poor precision and recall in search results. For consumers unfamiliar with the data, full-text searches are most accessible, but not ideal as they arrest the advantages of data disambiguation and co-reference resolution efforts. Conversely, URI searches across linked data can deliver improved search results, but knowledge of these exact URIs may remain difficult to obtain. The increased adoption of Persistent Identifiers (PIDs) can lead to improved linked data querying by a wide variety of consumers. Because PIDs resolve to a single entity, they are an excellent data point for disambiguating content. At the same time, PIDs are more accessible and prominent than a single data provider's linked data URI. When present in linked open datasets, PIDs provide balance between the technical and social hurdles of linked data querying as evidenced by the NSF EarthCube GeoLink project. The GeoLink project, funded by NSF's EarthCube initiative, have brought together data repositories include content from field expeditions, laboratory analyses, journal publications, conference presentations, theses/reports, and funding awards that span scientific studies from marine geology to marine ecosystems and biogeochemistry to paleoclimatology.

Physiotherapy management of joint hypermobility syndrome--a focus group study of patient and health professional perspectives.

PubMed

Palmer, S; Terry, R; Rimes, K A; Clark, C; Simmonds, J; Horwood, J

2016-03-01

To develop an understanding of patient and health professional views and experiences of physiotherapy to manage joint hypermobility syndrome (JHS). An explorative qualitative design. Seven focus groups were convened, audio recorded, fully transcribed and analysed using a constant comparative method to inductively derive a thematic account of the data. Four geographical areas of the U.K. 25 people with JHS and 16 health professionals (14 physiotherapists and two podiatrists). Both patients and health professionals recognised the chronic heterogeneous nature of JHS and reported a lack of awareness of the condition amongst health professionals, patients and wider society. Diagnosis and subsequent referral to physiotherapy services for JHS was often difficult and convoluted. Referral was often for acute single joint injury, failing to recognise the long-term multi-joint nature of the condition. Health professionals and patients felt that if left undiagnosed, JHS was more difficult to treat because of its chronic nature. When JHS was treated by health professionals with knowledge of the condition patients reported satisfactory outcomes. There was considerable agreement between health professionals and patients regarding an 'ideal' physiotherapy service. Education was reported as an overarching requirement for patients and health care professionals. Physiotherapy should be applied holistically to manage JHS as a long-term condition and should address injury prevention and symptom amelioration rather than cure. Education for health professionals and patients is needed to optimise physiotherapy provision. Further research is required to explore the specific therapeutic actions of physiotherapy for managing JHS. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Out of lab calibration of a rotating 2D scanner for 3D mapping

NASA Astrophysics Data System (ADS)

Koch, Rainer; Böttcher, Lena; Jahrsdörfer, Maximilian; Maier, Johannes; Trommer, Malte; May, Stefan; Nüchter, Andreas

2017-06-01

Mapping is an essential task in mobile robotics. To fulfil advanced navigation and manipulation tasks a 3D representation of the environment is required. Applying stereo cameras or Time-of-flight cameras (TOF cameras) are one way to archive this requirement. Unfortunately, they suffer from drawbacks which makes it difficult to map properly. Therefore, costly 3D laser scanners are applied. An inexpensive way to build a 3D representation is to use a 2D laser scanner and rotate the scan plane around an additional axis. A 3D point cloud acquired with such a custom device consists of multiple 2D line scans. Therefore the scanner pose of each line scan need to be determined as well as parameters resulting from a calibration to generate a 3D point cloud. Using external sensor systems are a common method to determine these calibration parameters. This is costly and difficult when the robot needs to be calibrated outside the lab. Thus, this work presents a calibration method applied on a rotating 2D laser scanner. It uses a hardware setup to identify the required parameters for calibration. This hardware setup is light, small, and easy to transport. Hence, an out of lab calibration is possible. Additional a theoretical model was created to test the algorithm and analyse impact of the scanner accuracy. The hardware components of the 3D scanner system are an HOKUYO UTM-30LX-EW 2D laser scanner, a Dynamixel servo-motor, and a control unit. The calibration system consists of an hemisphere. In the inner of the hemisphere a circular plate is mounted. The algorithm needs to be provided with a dataset of a single rotation from the laser scanner. To achieve a proper calibration result the scanner needs to be located in the middle of the hemisphere. By means of geometric formulas the algorithms determine the individual deviations of the placed laser scanner. In order to minimize errors, the algorithm solves the formulas in an iterative process. First, the calibration algorithm was tested with an ideal hemisphere model created in Matlab. Second, laser scanner was mounted differently, the scanner position and the rotation axis was modified. In doing so, every deviation, was compared with the algorithm results. Several measurement settings were tested repeatedly with the 3D scanner system and the calibration system. The results show that the length accuracy of the laser scanner is most critical. It influences the required size of the hemisphere and the calibration accuracy.

Ethical questions identified in a study of local and expatriate responders' perspectives of vulnerability in the 2010 Haiti earthquake.

PubMed

Durocher, Evelyne; Chung, Ryoa; Rochon, Christiane; Henrys, Jean-Hugues; Olivier, Catherine; Hunt, Matthew

2017-09-01

Situations of disaster that prompt international humanitarian responses are rife with ethical tensions. The 2010 Haiti earthquake caused great destruction and prompted a massive humanitarian response. The widespread needs experienced by the population and the scale of the response inevitably rendered priority-setting difficult, and gave rise to ethical challenges. This paper presents four ethical questions identified in the analysis of a study on vulnerability and equity in the humanitarian response to the 2010 Haiti earthquake. Using interpretive description methodology, the interdisciplinary research team analysed 24 semi-structured in-depth interviews conducted with expatriate and Haitian health workers and decision-makers involved in the response. Ethical questions identified through the analysis were: (1) How should limited resources be allocated in situations of widespread vulnerability and elevated needs? (2) At what point does it become ethically problematic to expend (considerable) resources to sustain expatriate disaster responders? (3) How ought rapid and reactive interventions be balanced with more deliberated and coordinated approaches? (4) What trade-offs are justified when interventions to address acute needs could contribute to long-term vulnerabilities? The questions arise in light of an immense gap between available resources and widespread and elevated needs. This gap is likely unavoidable in large-scale crises and may be a source of ethical distress for both local and international responders. The analysis of ethical questions associated with crisis response can advance discussions about how relief efforts can best be designed and implemented to minimise ethical distress and improve assistance to local populations. 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/.

Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients.

PubMed

Armenteros-Yeguas, Victoria; Gárate-Echenique, Lucía; Tomás-López, Maria Aranzazu; Cristóbal-Domínguez, Estíbaliz; Moreno-de Gusmão, Breno; Miranda-Serrano, Erika; Moraza-Dulanto, Maria Inmaculada

2017-12-01

To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. A cross-sectional study was conducted. 'Highly complex' patients (n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access. © 2017 John Wiley & Sons Ltd.

Deadlines at work and sleep quality. Cross-sectional and longitudinal findings among Danish knowledge workers.

PubMed

Rugulies, Reiner; Martin, Marie H T; Garde, Anne Helene; Persson, Roger; Albertsen, Karen

2012-03-01

Exposure to deadlines at work is increasing in several countries and may affect health. We aimed to investigate cross-sectional and longitudinal associations between frequency of difficult deadlines at work and sleep quality. Study participants were knowledge workers, drawn from a representative sample of Danish employees who responded to a baseline questionnaire in 2006 (n = 363) and a follow-up questionnaire in 2007 (n = 302). Frequency of difficult deadlines was measured by self-report and categorized into low, intermediate, and high. Sleep quality was measured with a Total Sleep Quality Score and two indexes (Awakening Index and Disturbed Sleep Index) derived from the Karolinska Sleep Questionnaire. Analyses on the association between frequency of deadlines and sleep quality scores were conducted with multiple linear regression models, adjusted for potential confounders. In addition, we used multiple logistic regression models to analyze whether frequency of deadlines at baseline predicted caseness of sleep problems at follow-up among participants free of sleep problems at baseline. Frequent deadlines were cross-sectionally and longitudinally associated with poorer sleep quality on all three sleep quality measures. Associations in the longitudinal analyses were greatly attenuated when we adjusted for baseline sleep quality. The logistic regression analyses showed that frequent deadlines at baseline were associated with elevated odds ratios for caseness of sleep problems at follow-up, however, confidence intervals were wide in these analyses. Frequent deadlines at work were associated with poorer sleep quality among Danish knowledge workers. We recommend investigating the relation between deadlines and health endpoints in large-scale epidemiologic studies. Copyright © 2011 Wiley Periodicals, Inc.

Analyzing the relationship between sequence divergence and nodal support using Bayesian phylogenetic analyses.

PubMed

Makowsky, Robert; Cox, Christian L; Roelke, Corey; Chippindale, Paul T

2010-11-01

Determining the appropriate gene for phylogeny reconstruction can be a difficult process. Rapidly evolving genes tend to resolve recent relationships, but suffer from alignment issues and increased homoplasy among distantly related species. Conversely, slowly evolving genes generally perform best for deeper relationships, but lack sufficient variation to resolve recent relationships. We determine the relationship between sequence divergence and Bayesian phylogenetic reconstruction ability using both natural and simulated datasets. The natural data are based on 28 well-supported relationships within the subphylum Vertebrata. Sequences of 12 genes were acquired and Bayesian analyses were used to determine phylogenetic support for correct relationships. Simulated datasets were designed to determine whether an optimal range of sequence divergence exists across extreme phylogenetic conditions. Across all genes we found that an optimal range of divergence for resolving the correct relationships does exist, although this level of divergence expectedly depends on the distance metric. Simulated datasets show that an optimal range of sequence divergence exists across diverse topologies and models of evolution. We determine that a simple to measure property of genetic sequences (genetic distance) is related to phylogenic reconstruction ability in Bayesian analyses. This information should be useful for selecting the most informative gene to resolve any relationships, especially those that are difficult to resolve, as well as minimizing both cost and confounding information during project design. Copyright © 2010. Published by Elsevier Inc.

Nuclear Regulatory Commission Semiannual Regulatory Agenda

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... identity and location of the general licensees, it would be difficult to enforce restrictions on the..., and that the immediate need for this rule has changed due to the shift in timing for reactor...

Medicare Hospice Benefits

MedlinePlus

... Choosing to start hospice care is a difficult decision. The information in this booklet and support from a doctor ... may need hospice care in all health care decisions. The information in this booklet describes the Medicare Program at ...

How Teachers Need to Deal with the Seen, the Unseen, the Improbable, and the Nearly Imponderable

ERIC Educational Resources Information Center

Gregory, Marshall

2010-01-01

In addition to dealing with the more or less obvious variables that affect classroom dynamics, teachers need to learn how to deal with the far more difficult issues related to learning, identity, selfhood, and autonomy. In this article, the author first discusses classroom issues that are most visible and vivid for teachers. Next, the author…

From Divergent Evolution to Witting Cross-Fertilisation: The Need for More Awareness of Potential Inter-Discursive Communication Regarding Students' Extended Historical Writing

ERIC Educational Resources Information Center

Carroll, James Edward

2017-01-01

History education stakeholders in England have consistently judged that some students find formal historical writing prohibitively difficult due to the demands of constructing an extended argument. While policy makers have agreed students need support in their historical writing, recurring themes in centralised resourcing have been wastage,…

Support for Self-Regulation in Learning Complex Topics from Multimedia Explanations: Do Learners Need Extensive or Minimal Support?

ERIC Educational Resources Information Center

Rodicio, Hector Garcia; Sanchez, Emilio; Acuna, Santiago R.

2013-01-01

Acquiring complex conceptual knowledge requires learners to self-regulate their learning by planning, monitoring, and adjusting the process but they find it difficult to do so. In one experiment, we examined whether learners need broad systems of support for self-regulation or whether they are also able to learn with more economical support…

Sharing the Focus: Engaging with Support Workers to Include People with Communication Needs in Research

ERIC Educational Resources Information Center

Lutz, Deborah; Fisher, Karen R.; Robinson, Sally

2016-01-01

Inclusive research is an increasing expectation to value and include people's voice in research and evaluations intended to benefit them. The active participation of people with communication support needs can be difficult due to the practical constraints of evaluations. One technique is to engage with workers who are familiar with the person, but…

The Importance of Psychological Needs for the Post Traumatic Stress Disorder (PTSD) and Displaced Children in Schools

ERIC Educational Resources Information Center

Uguak, Uget Apayo

2011-01-01

The study targets children in especially difficult circumstances from 8-14 years; and explores the importance of psychosocial needs for the PTSD and displaced children in schools. Out of 235 participants, descriptive statistics indicated that 63 children are traumatized. Based on ANOVA findings, the result revealed that there is significant effect…

Successes, shortcomings in using production wastes as raw material

NASA Astrophysics Data System (ADS)

Glushenkova, L.

1983-10-01

The economical and rational use of all forms of resources under modern conditions is a task of nationwide significance. Its urgency is caused by factors such as the progressively growing need for raw material, fuel, energy, and supplies, the limited and non-renewable nature of many minerals, and the difficult conditions of mining them and transporting them to where they are needed.

Evaluation of the status of laboratory practices and the need for continuing education in medical mycology.

PubMed

Rosner, Eunice R; Reiss, Errol; Warren, Nancy G; Shadomy, H Jean; Lipman, Harvey B

2002-08-01

A survey to determine the need for training in medical mycology was sent to 605 US laboratories. Training needs were determined by comparing actual laboratory mycology practices with recommended practices, documenting the extent of mycology training reported by employees, and asking respondents to specify the fungi they considered most difficult to identify. The response rate was 56.7% (with only 316 laboratories providing sufficient information). Results showed a large degree of interlaboratory variation in practices and suggested that more judicious practices could lower costs and improve clinical relevance. Only 55.6% of laboratories reported that at least 1 employee attended a formal mycology continuing education program in the 4 years before the survey. Species of dermatophytes, dematiaceous fungi, and non-Candida yeasts were the most difficult to identify. Training may be needed in basic isolation procedures and in advanced topics such as identification of problematic molds and yeasts and antifungal susceptibility testing. Educators should consider clinical relevance and cost-containment without sacrificing quality when designing courses. Support for additional mycology training may improve if hospital and laboratory administrators are alerted to potential dangers and costs involved in treating patients with invasive fungal infections.

"I wish he hadn't told me that": methodological and ethical issues in social trauma and conflict research.

PubMed

Chaitin, Julia

2003-10-01

Undertaking research on individuals who have experienced social traumas, such as being a victim or perpetrator of genocides and wars, presents difficult decisions for qualitative researchers. Deciding how to deal with these issues becomes more problematic when the researcher is a member of the society in conflict. To do this work, and to work collaboratively with researchers from the other side, sensitive ways to collect data have to be chosen. Interpretations of the materials can be no less difficult: Analyses often lead to information and understandings that may be difficult for the researcher to deal with from ethical, moral, and personal standpoints, especially when he or she is a member of the society and culture under study. In this keynote address, the author explores methodological and ethical issues connected to these topics. She brings examples from her work on the Palestinian-Israeli conflict and focuses on use of the life story methodology.

Effects of titanium surface topography on bone integration: a systematic review.

PubMed

Wennerberg, Ann; Albrektsson, Tomas

2009-09-01

To analyse possible effects of titanium surface topography on bone integration. Our analyses were centred on a PubMed search that identified 1184 publications of assumed relevance; of those, 1064 had to be disregarded because they did not accurately present in vivo data on bone response to surface topography. The remaining 120 papers were read and analysed, after removal of an additional 20 papers that mainly dealt with CaP-coated and Zr implants; 100 papers remained and formed the basis for this paper. The bone response to differently configurated surfaces was mainly evaluated by histomorphometry (bone-to-implant contact), removal torque and pushout/pullout tests. A huge number of the experimental investigations have demonstrated that the bone response was influenced by the implant surface topography; smooth (S(a)<0.5 microm) and minimally rough (S(a) 0.5-1 mum) surfaces showed less strong bone responses than rougher surfaces. Moderately rough (S(a)>1-2 microm) surfaces showed stronger bone responses than rough (S(a)>2 microm) in some studies. One limitation was that it was difficult to compare many studies because of the varying quality of surface evaluations; a surface termed 'rough' in one study was not uncommonly referred to as 'smooth' in another; many investigators falsely assumed that surface preparation per se identified the roughness of the implant; and many other studies used only qualitative techniques such as SEM. Furthermore, filtering techniques differed or only height parameters (S(a), R(a)) were reported. * Surface topography influences bone response at the micrometre level. * Some indications exist that surface topography influences bone response at the nanometre level. * The majority of published papers present an inadequate surface characterization. * Measurement and evaluation techniques need to be standardized. * Not only height descriptive parameters but also spatial and hybrid ones should be used.

Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies.

PubMed

Kuiper, Jisca S; Zuidersma, Marij; Zuidema, Sytse U; Burgerhof, Johannes Gm; Stolk, Ronald P; Oude Voshaar, Richard C; Smidt, Nynke

2016-08-01

Although poor social relationships are assumed to contribute to cognitive decline, meta-analytic approaches have not been applied. Individual study results are mixed and difficult to interpret due to heterogeneity in measures of social relationships. We conducted a systematic review and meta-analysis to investigate the relation between poor social relationships and cognitive decline. MEDLINE, Embase and PsycINFO were searched for longitudinal cohort studies examining various aspects of social relationships and cognitive decline in the general population. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random effects meta-analysis. Sources of heterogeneity were explored and likelihood of publication bias was assessed. We stratified analyses according to three aspects of social relationships: structural, functional and a combination of these. We identified 43 articles. Poor social relationships predicted cognitive decline; for structural (19 studies): pooled OR: 1.08 (95% CI: 1.05-1.11); functional (8 studies): pooled OR: 1.15 (95% CI: 1.00-1.32); and combined measures (7 studies): pooled OR: 1.12 (95% CI: 1.01-1.24). Meta-regression and subgroup analyses showed that the heterogeneity could be explained by the type of social relationship measurement and methodological quality of included studies. Despite heterogeneity in study design and measures, our meta-analyses show that multiple aspects of social relationships are associated with cognitive decline. As evidence for publication bias was found, the association might be overestimated and should therefore be interpreted with caution. Future studies are needed to better define the mechanisms underlying these associations. Potential causality of this prognostic association should be examined in future randomized controlled studies. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Economic Analyses in Squamous Cell Carcinoma of the Head and Neck: A Review of the Literature From a Clinical Perspective

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

Souza, Jonas A. de, E-mail: jdesouza@medicine.bsd.uchicago.edu; Santana, Iuri A.; Castro, Gilberto de

The purpose of this review was to describe cost-effectiveness and cost analysis studies across treatment modalities for squamous cell carcinoma of the head and neck (SCCHN), while placing their results in context of the current clinical practice. We performed a literature search in PubMed for English-language studies addressing economic analyses of treatment modalities for SCCHN published from January 2000 to March 2013. We also performed an additional search for related studies published by the National Institute for Health and Clinical Excellence in the United Kingdom. Identified articles were classified into 3 clinical approaches (organ preservation, radiation therapy modalities, and chemotherapy regimens)more » and into 2 types of economic studies (cost analysis and cost-effectiveness/cost-utility studies). All cost estimates were normalized to US dollars, year 2013 values. Our search yielded 23 articles: 13 related to organ preservation approaches, 5 to radiation therapy modalities, and 5 to chemotherapy regimens. In general, studies analyzed different questions and modalities, making it difficult to reach a conclusion. Even when restricted to comparisons of modalities within the same clinical approach, studies often yielded conflicting findings. The heterogeneity across economic studies of SCCHN should be carefully understood in light of the modeling assumptions and limitations of each study and placed in context with relevant settings of clinical practices and study perspectives. Furthermore, the scarcity of comparative effectiveness and quality-of-life data poses unique challenges for conducting economic analyses for a resource-intensive disease, such as SCCHN, that requires a multimodal care. Future research is needed to better understand how to compare the costs and cost-effectiveness of different modalities for SCCHN.« less

[Database supported electronic retrospective analyses in radiation oncology: establishing a workflow using the example of pancreatic cancer].

PubMed

Kessel, K A; Habermehl, D; Bohn, C; Jäger, A; Floca, R O; Zhang, L; Bougatf, N; Bendl, R; Debus, J; Combs, S E

2012-12-01

Especially in the field of radiation oncology, handling a large variety of voluminous datasets from various information systems in different documentation styles efficiently is crucial for patient care and research. To date, conducting retrospective clinical analyses is rather difficult and time consuming. With the example of patients with pancreatic cancer treated with radio-chemotherapy, we performed a therapy evaluation by using an analysis system connected with a documentation system. A total number of 783 patients have been documented into a professional, database-based documentation system. Information about radiation therapy, diagnostic images and dose distributions have been imported into the web-based system. For 36 patients with disease progression after neoadjuvant chemoradiation, we designed and established an analysis workflow. After an automatic registration of the radiation plans with the follow-up images, the recurrence volumes are segmented manually. Based on these volumes the DVH (dose volume histogram) statistic is calculated, followed by the determination of the dose applied to the region of recurrence. All results are saved in the database and included in statistical calculations. The main goal of using an automatic analysis tool is to reduce time and effort conducting clinical analyses, especially with large patient groups. We showed a first approach and use of some existing tools, however manual interaction is still necessary. Further steps need to be taken to enhance automation. Already, it has become apparent that the benefits of digital data management and analysis lie in the central storage of data and reusability of the results. Therefore, we intend to adapt the analysis system to other types of tumors in radiation oncology.

Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report.

PubMed

Tsujimura, Naoto; Takemoto, Hiroyoshi; Nakahara, Yujiro; Wakasugi, Masaki; Matsumoto, Takashi; Nishioka, Kiyonori; Takachi, Kou; Oshima, Satoshi; Yoshida, Kyotaro

2018-01-01

Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Preoperative confirmed diagnosis is very difficult, so most cases are diagnosed preoperatively as malignant tumors. We report a case of intraabdominal actinomycosis which was difficult to diagnose preoperatively. A woman, 60 years old, experienced discomfort in her lower right abdomen. She complained of nausea and anorexia and visited our hospital. Laboratory blood tests, abdominal CT, and abdominal MRI led to a diagnosis of a uterine sarcoma or primary intestinal mass, and she underwent surgery. Her histopathological diagnosis was intraabdominal actinomycosis. Actinomycosis is a chronic purulent granulomatous inflammation caused by Actinomyces israelii. No clinical symptoms or laboratory findings are characteristic of abdominal actinomycosis, so this disorder is very difficult to diagnose preoperatively. Therefore, many cases are diagnosed as malignant tumors and undergo surgery. After surgery, long-term antibiotic treatment (penicillin) is usually administered. We reported a case of intraabdominal actinomycosis that resulted in a difficult to diagnose intraperitoneal mass. When a large intraperitoneal mass is found, actinomycosis needs to be included as one of differential diagnoses. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Transitioning to an Intramedullary Lengthening and Compression Nail

PubMed Central

2017-01-01

Summary: The magnetic intramedullary lengthening nail is an innovative technology that allows for creative ways to treat difficult problems. The lengthening option has revolutionized femur fracture management with bone loss and malunion therapy. The compression version of this nail has provided a gradual method to compress nonunions and difficult fractures that may obviate the need for many current uses of external fixation. Three cases are presented in this manuscript demonstrating a new paradigm in the management of bone loss/shortening of the tibia and femur, and recalcitrant nonunions. PMID:28486284

An Extension of Holographic Moiré to Micromechanics

NASA Astrophysics Data System (ADS)

Sciammarella, C. A.; Sciammarella, F. M.

The electronic Holographic Moiré is an ideal tool for micromechanics studies. It does not require a modification of the surface by the introduction of a reference grating. This is of particular advantage when dealing with materials such as solid propellant grains whose chemical nature and surface finish makes the application of a reference grating very difficult. Traditional electronic Holographic Moiré presents some difficult problems when large magnifications are needed and large rigid body motion takes place. This paper presents developments that solves these problems and extends the application of the technique to micromechanics.

Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development.

PubMed

van der Steen, Jenny T; Lemos Dekker, Natashe; Gijsberts, Marie-José H E; Vermeulen, Laura H; Mahler, Margje M; The, B Anne-Mei

2017-04-28

When entering the dying phase, the nature of physical, psychosocial and spiritual care needs of people with dementia and their families may change. Our objective was to understand what needs to be in place to develop optimal palliative care services for the terminal phase in the face of a small evidence base. In 2015-2016, we performed a mixed-methods qualitative study in which we (1) analysed the domains and recommendations from the European Association for Palliative Care (EAPC) dementia white paper and identified those with particular relevance for the terminal phase; (2) performed a series of focus group discussions with Dutch family caregivers of people with dementia in variable stages; (3) conducted interviews with experts involved in 15 special forms of terminal care for people with dementia in five countries. The terminal phase was defined as dying but because of the difficulty predicting it, we included advanced dementia. We initially analysed the three parts separately, followed by an integrated analysis of (1)-(3) to inform service development. (1) The EAPC domain of "avoiding overly aggressive, burdensome, or futile treatment" was regarded of particular relevance in the terminal phase, along with a number of recommendations that refer to providing of comfort. (2) Families preferred continuity in care and living arrangements. Despite a recognition that this was a time when they had complex support needs, they found it difficult to accept involvement of a large team of unfamiliar (professional) caregivers. Mostly, terminal care was preferred at the place of residence. (3) The expert interviews identified preferred, successful models in which a representative of a well-trained team has the time, authority and necessary expertise to provide care and education of staff and family to where people are and which ensure continuity of relationships with and around the patient. A mobile team that specializes in palliative care in dementia and supports professional and family caregivers is a promising model. Compared to transfer to a hospice in the last weeks or days, it has the potential to address the priorities of families and patients for continuity of care, relationships and specialist expertise.

Gas chromatography/chemical ionization triple quadrupole mass spectrometry analysis of anabolic steroids: ionization and collision-induced dissociation behavior.

PubMed

Polet, Michael; Van Gansbeke, Wim; Van Eenoo, Peter; Deventer, Koen

2016-02-28

The detection of new anabolic steroid metabolites and new designer steroids is a challenging task in doping analysis. Switching from electron ionization gas chromatography triple quadrupole mass spectrometry (GC/EI-MS/MS) to chemical ionization (CI) has proven to be an efficient way to increase the sensitivity of GC/MS/MS analyses and facilitate the detection of anabolic steroids. CI also extends the possibilities of GC/MS/MS analyses as the molecular ion is retained in its protonated form due to the softer ionization. In EI it can be difficult to find previously unknown but expected metabolites due to the low abundance or absence of the molecular ion and the extensive (and to a large extent unpredictable) fragmentation. The main aim of this work was to study the CI and collision-induced dissociation (CID) behavior of a large number of anabolic androgenic steroids (AAS) as their trimethylsilyl derivatives in order to determine correlations between structures and CID fragmentation. Clarification of these correlations is needed for the elucidation of structures of unknown steroids and new metabolites. The ionization and CID behavior of 65 AAS have been studied using GC/CI-MS/MS with ammonia as the reagent gas. Glucuronidated AAS reference standards were first hydrolyzed to obtain their free forms. Afterwards, all the standards were derivatized to their trimethylsilyl forms. Full scan and product ion scan analyses were used to examine the ionization and CID behavior. Full scan and product ion scan analyses revealed clear correlations between AAS structure and the obtained mass spectra. These correlations were confirmed by analysis of multiple hydroxylated, methylated, chlorinated and deuterated analogs. AAS have been divided into three groups according to their ionization behavior and into seven groups according to their CID behavior. Correlations between fragmentation and structure were revealed and fragmentation pathways were postulated. Copyright © 2016 John Wiley & Sons, Ltd.

The Needs Analysis in Self-Concept Module Development

ERIC Educational Resources Information Center

Yusop, Yusni Mohamad; Sumari, Melati; Mohamed, Fatanah; Said, Shahriza; Azeez, Mohd Ibrahim K.; Jamil, Mohd Ridhuan Mohd

2015-01-01

This research studies needs analyses conducted to examine the need for a self-concept module. Two types of analyses had been conducted; content analysis and experts' consensus. Content analysis was conducted to explore the issues of self-concept from the theory and literature perspective. Later, needs analysis had also been carried out to observe…

Language Learning Strategies, Course Grades, and Age in EFL Secondary School Learners

ERIC Educational Resources Information Center

Tragant, Elsa; Victori, Mia

2012-01-01

In studies dealing with language learning strategies in the school context, the variables of proficiency and age are often difficult to isolate since students accumulate more hours of foreign language instruction as they move up from grade to grade. This study aimed to deal with these two variables independently by analysing learning strategy use…

The Effect of Process Writing Activities on the Writing Skills of Prospective Turkish Teachers

ERIC Educational Resources Information Center

Dilidüzgün, Sükran

2013-01-01

Problem statement: Writing an essay is a most difficult creative work and consequently requires detailed instruction. There are in fact two types of instruction that contribute to the development of writing skills: Reading activities analysing texts in content and schematic structure to find out how they are composed and process writing…

Definite Markers, Phi-Features, and Agreement: A Morphosyntactic Investigation of the Amharic DP

ERIC Educational Resources Information Center

Kramer, Ruth

2009-01-01

This dissertation has two inter-related goals: (i) to describe and provide novel analyses of three types of important and difficult phenomena within Amharic DPs and (ii) to explore the properties of the syntax-morphology interface. The core phenomena explicated are the unusual distribution of the definite marker, the gender system (which relies…

The Use of Flow Charts in Sediment Routing Analysis

Treesearch

Leslie M. Reid

1982-01-01

Flow charts are a widely used means of diagramming relationships among transport processes and storage sites during analyses of sediment routing. Because they have taken so many different forms, however, it is very difficult to use published flow charts to compare geomorphic systems. Though they generally are constructed to achieve the same purpose, flow charts...

Navigating Difficult Waters: Learning for Career and Labour Market Transitions. Research Paper No 42

ERIC Educational Resources Information Center

Cedefop - European Centre for the Development of Vocational Training, 2014

2014-01-01

This report analyses how learning supports labour market transitions and career changes of adult workers across five countries (Denmark, Germany, Spain, France and Italy). To make the most of career and labour market opportunities, individuals have to rely on their own resources and their agency but also know how to navigate the institutional…

Human Rights and/or Market Logic: Neoliberalism, Difficult Knowledge, and the Canadian Museum for Human Rights

ERIC Educational Resources Information Center

Milne, Heather

2015-01-01

The Canadian Museum for Human Rights (CMHR) has been plagued by controversy since before its construction even began. Outcries regarding perceived oversights in the museum's programming and objections to the cost of construction, curatorial development, and staffing have erupted frequently in local media. Critical analyses of public responses to…

Fathers' Influences on Children's Development: The Evidence from Two-Parent Families

ERIC Educational Resources Information Center

Lewis, Charlie; Lamb, Michael E.

2003-01-01

Although it is often assumed that men have an important influence on their children's development, the supportive evidence can be difficult to locate and summarize. In this paper, we analyse the evidence with respect to four emergent themes. First, men often appear to interact with their children less sensitively than mothers do, and many children…

Is the Supply of Mathematics and Science Teachers Sufficient?

ERIC Educational Resources Information Center

Ingersoll, Richard M.; Perda, David

2010-01-01

This study seeks to empirically ground the debate over mathematics and science teacher shortages and evaluate the extent to which there is, or is not, sufficient supply of teachers in these fields. The authors' analyses of nationally representative data from multiple sources show that math and science are the fields most difficult to staff, but…

Preservice Elementary School Teachers' Knowledge of Fractions: A Mirror of Students' Knowledge?

ERIC Educational Resources Information Center

Van Steenbrugge, H.; Lesage, E.; Valcke, M.; Desoete, A.

2014-01-01

This research analyses preservice teachers' knowledge of fractions. Fractions are notoriously difficult for students to learn and for teachers to teach. Previous studies suggest that student learning of fractions may be limited by teacher understanding of fractions. If so, teacher education has a key role in solving the problem. We first reviewed…

Harmonising Training and Development across an Industry: The Case of Australian Rail

ERIC Educational Resources Information Center

Short, Tom; Harris, Roger McL.

2017-01-01

Purpose: This paper aims to explore why harmonisation, given its potential, is so difficult to achieve. It analyses the issues and challenges in achieving harmonisation of training and development across an industry. Design/methodology/approach: The approach was a meta-analysis of six research projects undertaken in the Australian rail industry.…

Summary of Forest health monitoring: 2006 national technical report

Treesearch

Mark J. Ambrose

2009-01-01

Forest Health Monitoring (FHM), together with cooperating researchers both in and outside of the Forest Service, continues to investigate a variety of issues relating to forest health. This report provides some of the latest analyses and results. The broad range of indicators presented demonstrates one reason it can be difficult to draw general conclusions about the...

Analysing Student Programs in the PHP Intelligent Tutoring System

ERIC Educational Resources Information Center

Weragama, Dinesha; Reye, Jim

2014-01-01

Programming is a subject that many beginning students find difficult. The PHP Intelligent Tutoring System (PHP ITS) has been designed with the aim of making it easier for novices to learn the PHP language in order to develop dynamic web pages. Programming requires practice. This makes it necessary to include practical exercises in any ITS that…

Shield the volunteers: state, federal laws protect physicians from liability.

PubMed

Conde, Crystal

2009-03-01

Physicians wanting to volunteer their services at a free clinic need not be overly concerned about being sued. State and federal laws offer protection and make it difficult for a plaintiff to succeed.

78 FR 65210 - Federal Travel Regulation; Removal of Conference Lodging Allowance Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... difficult for the hospitality industry to meet the lodging needs of Federal conference attendees. Response... prudently when traveling for the Federal Government. While industry may offer rates as it sees fit...

Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD.

PubMed

Ericson-Lidman, Eva; Larsson, Lise-Lotte Franklin; Norberg, Astrid

2014-06-01

Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health. © 2013 Nordic College of Caring Science.

Telemonitoring: use in the management of hypertension

PubMed Central

Sivakumaran, Darshi; Earle, Kenneth Anthony

2014-01-01

Hypertension is a major modifiable risk factor for cardiovascular, retinal, and kidney disease. In the past decade, attainment rates of treatment targets for blood pressure control in the UK and US have increased; however, <11% of adult men and women have achieved adequate blood pressure control. Technological advances in blood pressure measurement and data transmission may improve the capture of information but also alter the relationship between the patient and the provider of care. Telemonitoring systems can be used to manage patients with hypertension, and have the ability to enable best-practice decisions more consistently. The improvement in choice for patients as to where and who manages their hypertension, as well as better adherence to treatment, are potential benefits. An evidence base is growing that shows that telemonitoring can be more effective than usual care in improving attainment rates of goal blood pressure in the short-to-medium term. In addition, studies are in progress to assess whether this technology could be a part of the solution to address the health care needs of an aging population and improve access for those suffering health inequalities. The variation in methods and systems used in these studies make generalizability to the general hypertension population difficult. Concerns over the reliability of technology, impact on patient quality of life, longer-term utility and cost–benefit analyses all need to be investigated further if wider adoption is to occur. PMID:24748801

Perinatal issues for women with high functioning autism spectrum disorder.

PubMed

Rogers, Cath; Lepherd, Laurence; Ganguly, Rahul; Jacob-Rogers, Sebastian

2017-04-01

Autistic Spectrum Disorder (ASD) is an increasingly commonly diagnosed disability. People with ASD commonly report challenges in social interaction and a heightened sensory perception. These challenges may be particularly difficult for women during pregnancy, birthing and beyond. Very little is known about the experiences and needs of birthing women who have ASD. There is a large body of literature about women who have autistic children, but almost nothing about women who may have this disability themselves. Internet blogs provide some insights and suggest that birthing women with ASD may have particular challenges related to communication, decision making and sensory overload. This study explores the particular issues and experiences of birthing women who have ASD, through pregnancy, birth and early mothering. This qualitative research used a case study approach, with in-depth interviewing and email exchange providing the data for the study. This data was verified, transcribed and analysed thematically. The findings of this case study identified three key issues: communication and service difficulties; sensory stress and parenting challenges. Findings suggest that women with ASD may face particular challenges during pregnancy, birthing and early mothering. These challenges evolve from perceptions of the woman about her midwives and other caregivers. If a woman perceives that her midwife is judgemental about her, then she may withdraw from the care and support she and her baby need. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Engaging workplace representatives in research: what recruitment strategies work best?

PubMed

Coole, C; Nouri, F; Narayanasamy, M; Baker, P; Khan, S; Drummond, A

2018-05-23

Workplaces are key stakeholders in work and health but little is known about the methods used to recruit workplace representatives (WRs), including managers, occupational health advisers and colleagues, to externally funded healthcare research studies. To detail the strategies used in recruiting WRs from three areas of the UK to a qualitative study concerning their experience of employees undergoing hip or knee replacement, to compare the strategies and inform recruitment methods for future studies. Six strategies were used to recruit WRs from organizations of different sizes and sectors. Data on numbers approached and responses received were analysed descriptively. Twenty-five WRs were recruited. Recruitment had to be extended outside the main three study areas, and took several months. It proved more difficult to recruit from non-service sectors and small- and medium-sized enterprises. The most successful strategies were approaching organizations that had participated in previous research studies, or known professionally or personally to team members. Recruiting a diverse sample of WRs to healthcare research requires considerable resources and persistence, and a range of strategies. Recruitment is easier where local relationships already exist; the importance of building and maintaining these relationships cannot be underestimated. However, the potential risks of bias and participant fatigue need to be acknowledged and managed. Further studies are needed to explore how WRs can be recruited to health research, and to identify the researcher effort and costs involved in achieving unbiased and representative samples.

Publishing descriptions of non-public clinical datasets: proposed guidance for researchers, repositories, editors and funding organisations.

PubMed

Hrynaszkiewicz, Iain; Khodiyar, Varsha; Hufton, Andrew L; Sansone, Susanna-Assunta

2016-01-01

Sharing of experimental clinical research data usually happens between individuals or research groups rather than via public repositories, in part due to the need to protect research participant privacy. This approach to data sharing makes it difficult to connect journal articles with their underlying datasets and is often insufficient for ensuring access to data in the long term. Voluntary data sharing services such as the Yale Open Data Access (YODA) and Clinical Study Data Request (CSDR) projects have increased accessibility to clinical datasets for secondary uses while protecting patient privacy and the legitimacy of secondary analyses but these resources are generally disconnected from journal articles-where researchers typically search for reliable information to inform future research. New scholarly journal and article types dedicated to increasing accessibility of research data have emerged in recent years and, in general, journals are developing stronger links with data repositories. There is a need for increased collaboration between journals, data repositories, researchers, funders, and voluntary data sharing services to increase the visibility and reliability of clinical research. Using the journal Scientific Data as a case study, we propose and show examples of changes to the format and peer-review process for journal articles to more robustly link them to data that are only available on request. We also propose additional features for data repositories to better accommodate non-public clinical datasets, including Data Use Agreements (DUAs).

Migration from relational to NoSQL database

NASA Astrophysics Data System (ADS)

Ghotiya, Sunita; Mandal, Juhi; Kandasamy, Saravanakumar

2017-11-01

Data generated by various real time applications, social networking sites and sensor devices is of very huge amount and unstructured, which makes it difficult for Relational database management systems to handle the data. Data is very precious component of any application and needs to be analysed after arranging it in some structure. Relational databases are only able to deal with structured data, so there is need of NoSQL Database management System which can deal with semi -structured data also. Relational database provides the easiest way to manage the data but as the use of NoSQL is increasing it is becoming necessary to migrate the data from Relational to NoSQL databases. Various frameworks has been proposed previously which provides mechanisms for migration of data stored at warehouses in SQL, middle layer solutions which can provide facility of data to be stored in NoSQL databases to handle data which is not structured. This paper provides a literature review of some of the recent approaches proposed by various researchers to migrate data from relational to NoSQL databases. Some researchers proposed mechanisms for the co-existence of NoSQL and Relational databases together. This paper provides a summary of mechanisms which can be used for mapping data stored in Relational databases to NoSQL databases. Various techniques for data transformation and middle layer solutions are summarised in the paper.

The obstetrical and postpartum benefits of continuous support during childbirth.

PubMed

Scott, K D; Klaus, P H; Klaus, M H

1999-12-01

The purpose of this article is to review the evidence regarding the effectiveness of continuous support provided by a trained laywoman (doula) during childbirth on obstetrical and postpartum outcomes. Twelve individual randomized trials have compared obstetrical and postpartum outcomes between doula-supported women and women who did not receive doula support during childbirth. Three meta-analyses, which used different approaches, have been performed on the results of the clinical trials. Emotional and physical support significantly shortens labor and decreases the need for cesarean deliveries, forceps and vacuum extraction, oxytocin augmentation, and analgesia. Doula-supported mothers also rate childbirth as less difficult and painful than do women not supported by a doula. Labor support by fathers does not appear to produce similar obstetrical benefits. Eight of the 12 trials report early or late psychosocial benefits of doula support. Early benefits include reductions in state anxiety scores, positive feelings about the birth experience, and increased rates of breastfeeding initiation. Later postpartum benefits include decreased symptoms of depression, improved self-esteem, exclusive breastfeeding, and increased sensitivity of the mother to her child's needs. The results of these 12 trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor.

Priority needs and wisdom strategy for blood transfusion safety in developing low-resource countries.

PubMed

Abdelrazik, Abeer Mohamed; Ezzat Ahmed, Ghada M

2016-02-01

To evaluate the implementation of alternative safety measures that reduce the risk of transfusion transmissible infections as an affordable measure in low resource countries. It is still difficult in developing countries with limited resources to mandate nucleic acid testing due to its high cost. Although NAT reduces the window period of infection, the developing countries are still in need of an efficient and effective transfusion programme before implementing the complex high cost NAT. Two thousand eight hundred eighty sero-negative first-time and repeat donations from Fayoum University Hospital blood bank were individually analysed by NAT for HIV, HBV and HCV. Only discriminatory-positive NAT were classified comparing the non-remunerated and family replacement donations. Significant discriminatory-positive differences were observed for HBV NAT results, 2 remunerated donations compared to 0 non-remunerated sero-negative donations. The discriminatory positive differences were also significant for HCV NAT results, 4 remunerated donations compared to 1 non-remunerated sero-negative donation. No sero-negative, discriminatory-positive NAT HIV case was found. Seven out of 8 discriminatory positive cases were from first time donations. In order to ensure blood safety, the recruitment and retention of voluntary, non-remunerated repeat donors should be a major commitment for low resource countries in which NAT implementation is costly and not feasible. Copyright © 2016 Elsevier Ltd. All rights reserved.

A facile and low-cost route for sensitive stretchable sensors by controlling kinetic and thermodynamic conductive network regulating strategies.

PubMed

Duan, Lingyan; D'hooge, Dagmar R; Spoerk, Martin; Cornillie, Pieter; Cardon, Ludwig

2018-05-29

Highly sensitive conductive polymer composites (CPCs) are designed, employing a facile and low-cost extrusion manufacturing process for both low and high strain sensing in the field of e.g. structural health/damage monitoring and human body movement tracking. Focus is on the morphology control for extrusion processed carbon black (CB)-filled CPCs, utilizing binary and ternary composites based on thermoplastic polyurethane (TPU) and olefin block copolymer (OBC). The relevance of the correct CB amount, kinetic control through a variation of the compounding sequence, and thermodynamic control induced by annealing is highlighted, considering a wide range of experimental (e.g. static and dynamic resistance/SEM/rheological measurements) and theoretical analyses. High CB mass fractions (20 m%) are needed for OBC (or TPU)-CB binary composites but only lead to an intermediate sensitivity as their conductive network is fully-packed and therefore difficult to be truly destructed. Annealing is needed to enable a monotonic increase of the relative resistance with respect to strain. With ternary composites a much higher sensitivity with a clearer monotonic increase results provided that a low CB mass fraction (10-16 m%) is used and annealing is applied. In particular, with CB first dispersed in OBC and annealing a less compact, hence, brittle conductive network (10-12 m% CB) is obtained, allowing high performance sensing.

A qualitative evaluation of the crucial attributes of contextual information necessary in EHR design to support patient-centered medical home care.

PubMed

Weir, Charlene R; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert

2015-04-16

Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas. A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software. Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality. These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.

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.

Smart Aeronautical Chart Management System Design

NASA Astrophysics Data System (ADS)

Pakdil, M. E.; Celik, R. N.; Kaya, Ö.; Konak, Y. C.; Guney, C.

2015-10-01

Civil aviation is developing rapidly, and the number of domestic and international operations is increasing exponentially every year than the previous one. Airline companies with increased air traffic and the number of passengers increase the demand of new aircrafts. An aircraft needs not only fuel but also pilot and aeronautical information (charts, digital navigation information, flight plan, and etc.) to perform flight operation. One of the most important components in aeronautical information is the terminal chart. Authorized institution in every state is responsible to publish their terminal charts for certain periods. Although these charts are produced in accordance with ICAO's Annex 4 and Annex 15, cartographic representation and page layout differs in each state's publication. This situation makes difficult to read them by pilots. In this paper, standard instrument departure (SID) charts are analysed to produce by use of cutting-edge and competitive technologies instead of classical computer-aided drawing and vector based graphic applications that are currently used by main chart producers. The goal is to design efficient and commercial chart management system that is able to produce aeronautical charts with same cartographic representation for all states.

Sunspot seismology: accounting for magnetohydrodynamic wave processes using imaging spectropolarimetry

NASA Astrophysics Data System (ADS)

Rajaguru, S. P.

Effects of acoustic wave absorption, mode conversion and transmission by a sunspot on the helioseismic inferences are widely discussed, yet accounting for them has proved difficult for lack of a consistent framework within helioseismic modelling. Here, following a discussion of problems and issues that the near-surface magnetohydrodynamics hosts through a complex interplay of radiative transfer, measurement issues, and MHD wave processes, I present some possibilities entirely from observational analyses based on imaging spectropolarimetry. In particular, I present some results on wave evolution as a function of observation height and inclination of magnetic field to the vertical, derived from a high-cadence imaging spectropolarimetric observation of a sunspot and its surroundings using the instrument IBIS (NSO/Sac Peak, USA). These observations were made in magnetically sensitive (Fe I 6173 Å) and insensitive (Fe I 7090 Å) upper photospheric absorption lines. Wave travel time contributions from within the photospheric layers of a sunspot estimated here would then need to be removed from the inversion modelling procedure, that does not have the provision to account for them.

Resistance to drainage of cerebrospinal fluid: clinical measurement and significance1

PubMed Central

Martins, Albert N.

1973-01-01

By infusing saline intrathecally at a constant rate until a new steady-state cerebrospinal fluid (CSF) pressure is attained, one can estimate clinically the apparent resistance (Ra) to drainage of CSF in mm saline/ml./minute. This intrathecal saline infusion test (ITSIT) was performed 36 times on 29 patients with diverse intracranial problems, and the results were analysed and, in most cases, compared with the pneumoencephalogram and the isotope cisternogram. The ITSIT is a safe, simple test to estimate Ra, but factors which are difficult to control (occult leaks from the subarachnoid space; independent fluctuations of CSF pressure) limit its reliability and clinical usefulness. If closely correlated with the clinical syndrome, the pneumoencephalogram, and the isotope cisternogram, an ITSIT may identify decisively the patient who needs a shunt. In addition the ITSIT offers another method by which to investigate the pathophysiological mechanisms of the various states of intracranial hypertension. Results from the test performed on four patients with intracranial hypertension of unknown cause (pseudotumor cerebri) suggest that the underlying mechanism in this condition is probably an impediment to normal CSF drainage. PMID:4541080

Interpretation of medical information acts by UK occupational physicians.

PubMed

Batty, Lucia; Glozier, Nick; Holland-Elliott, Kevin

2009-05-01

Difficulties arise in applying the Data Protection Act 1998 and the Access to Medical Reports Act 1988 in occupational health practice. There is no guidance on detailed aspects of applying these Acts in practice and consistent advice has proved difficult to obtain. To audit the understanding and practice of UK occupational physicians to see if a consensus view existed. A postal questionnaire sent to all UK-based Society of Occupational Medicine (SOM) members between December 2005 and June 2006. Responses were analysed using the SPSS 13.0 software. Responses were received from 726 SOM members, a response rate of 48%. The study revealed wide variation and a limited consensus in practice. Significant differences existed between doctors with a Diploma in Occupational Medicine and those with higher Faculty qualifications, between part-time and full-time practitioners and between doctors who qualified pre- and post-1974. The audit revealed wide variation in responding to clinical scenarios in relation to both the Access to Medical Reports and the Data Protection Acts. The findings have implications for clinical practice, policy and research. The majority of respondents reported that national guidance is needed.

Evaluating Mediated Perception of Narrative Health Messages: The Perception of Narrative Performance Scale

PubMed Central

Lee, Jeong Kyu; Hecht, Michael L.; Miller-Day, Michelle; Elek, Elvira

2011-01-01

Narrative media health messages have proven effective in preventing adolescents’ substance use but as yet few measures exist to assess perceptions of them. Without such a measure it is difficult to evaluate the role these messages play in health promotion or to differentiate them from other message forms. In response to this need, a study was conducted to evaluate the Perception of Narrative Performance Scale that assesses perceptions of narrative health messages. A sample of 1185 fifth graders in public schools at Phoenix, Arizona completed a questionnaire rating of two videos presenting narrative substance use prevention messages. Confirmatory factor analyses were computed to identify the factor structure of the scale. Consistent with prior studies, results suggest a 3 factor structure for the Perception of Narrative Performance Scale: interest, realism, and identification (with characters). In addition, a path analysis was performed to test the predictive power of the scale. The analysis shows that the scale proves useful in predicting intent to use substances. Finally, practical implications and limitations are discussed. PMID:21822459

The experience of being a partner to a spinal cord injured person: A phenomenological-hermeneutic study

PubMed Central

Buus, Niels

2011-01-01

This qualitative focuses on the personal experiences of partners to a spinal cord injured person. Using a Ricoeurian phenomenological-hermeneutic approach, we analysed seven partners’ narratives 1 and 2 years after their partner's injury. The study revealed how the injury was experienced from the partners’ perspective through the aftermath. In the acute phase after the injury, partners also felt harmed, and support was needed in relation to their own daily activities, eating, resting, and managing distress. During the institutionalized rehabilitation, partners felt torn between supporting the injured partner and the demanding tasks of everyday life outside the institution. After discharge, partners struggled for the injured partner to regain a well-functioning everyday life and for reestablishing life as a couple. The partner struggled to manage the overwhelming amount of everyday tasks. Some sought to reestablish their usual functions outside the family, whereas others focused on establishing a new life together. The partners experienced much distress and appreciated the support they got, but felt that they were mainly left to manage the difficult process on their own. PMID:22007262

Networks of innovation or networks of opportunity? The making of the Spanish antibiotics industry.

PubMed

Puig, Nuria

2004-07-01

The pharmaceutical industry is a typically research-intensive, first world-industry. This article seeks to explain why it has been so difficult for late industrialised nations to reproduce the networks of innovation on which the design and manufacturing of new drugs has historically based, and why alternative concepts are needed in order to understand the dynamics of science-based industries in emerging countries. The article analyses the development of the Spanish antibiotics industry, build after the World War II under the strong influence of the new international order and Spain's political framework, academic traditions and business groups. Focusing on the long-term relationships established between two Spanish companies (Antibióticos SA and Compañía Española de Penicilina y Antibióticos, CEPA), their American technological partners (Schenley and Merck), and their social and scientific environment, the article identifies networks of opportunity as the key institutional arrangement of this new industry in Spain. Opportunity (as opposed to innovation) networks are thus proposed to conceptualise the development of technologically complex industries in the European periphery.

Understanding ‘human’ waves: exploiting the physics in a viral video

NASA Astrophysics Data System (ADS)

Ferrer-Roca, Chantal

2018-01-01

Waves are a relevant part of physics that students find difficult to grasp, even in those cases in which wave propagation kinematics can be visualized. This may hinder a proper understanding of sound, light or quantum physics phenomena that are explained using a wave model. So-called ‘human’ waves, choreographed by people, have proved to be an advisable way to understand basic wave concepts. Videos are widely used as a teaching resource and can be of considerable help in order to watch and discuss ‘human’ waves provided their quality is reasonably good. In this paper we propose and analyse a video that went viral online and has been revealed to be a useful teaching resource for introductory physics students. It shows a unique and very complete series of wave propagations, including pulses with different polarizations and periodic waves that can hardly be found elsewhere. After a proposal on how to discuss the video qualitatively, a quantitative analysis is carried out (no video-tracker needed), including a determination of the main wave magnitudes such as period, wavelength and propagation speed.

The Influence of Religious Coping on the Acculturative Stress of Recent Latino Immigrants

PubMed Central

Sanchez, Mariana; Dillon, Frank; Ruffin, Beverly; De La Rosa, Mario

2013-01-01

Acculturative stress negatively impacts the physical and mental health of Latino immigrants. Little is known about the pre-immigration resources that may influence the acculturative stress of Latino immigrants. Religion plays a prominent role in Latino culture and may prove to be an influential resource during difficult life transitions, such as those experienced during the immigration process. The present study examines the association between religious coping resources prior to immigration and acculturative stress after immigration within a multiethnic sample of 527 adult Latinos who have lived in the United States for less than 1 year. Path analyses revealed that pre-immigration external religious coping was associated with high levels of post-immigration acculturative stress. Illegal immigrant status was associated with high levels of pre-immigration religious coping as well as post-immigration acculturative stress. These findings expand scientific understanding as to the function and effect of specific religious coping mechanisms among Latino immigrants. Furthermore, results underscore the need for future research, which could serve to inform culturally relevant prevention and treatment programs. PMID:24307865

New advances in 2-μm high-power dual-frequency single-mode Q-switched Ho:YLF laser for dial and IPDA application

NASA Astrophysics Data System (ADS)

Gibert, F.; Edouart, D.; Cénac, C.; Le Mounier, F.; Dumas, A.

2017-11-01

In the absence of climate change policies, the fossil fuel emissions are projected to increase in the next decades. Depending on how the current carbon sinks change in the future, the atmospheric CO2 concentration is predicted to be between 700-1000 ppmv by 2100, and global mean surface temperature between 1.1-6.4°C, with related changes in sea-level, extreme events and ecosystem drifts. Keeping the atmospheric CO2 concentration at a level that prevents dangerous interference with the climate system poses an unprecedent but necessary challenge to humanity. Beyond this point, global climate change would be very difficult and costly to deal with. There are two main approaches that are currently analysed: (1) to reduce emissions; (2) to capture CO2 and store it, i.e. sequestration. For these two ways, some monitoring at different scales ultimately from space would be needed. Lidar remote sensing is a powerful technique that enables measurements at various space and time resolution.

Public health benefits of strategies to reduce greenhouse-gas emissions: health implications of short-lived greenhouse pollutants.

PubMed

Smith, Kirk R; Jerrett, Michael; Anderson, H Ross; Burnett, Richard T; Stone, Vicki; Derwent, Richard; Atkinson, Richard W; Cohen, Aaron; Shonkoff, Seth B; Krewski, Daniel; Pope, C Arden; Thun, Michael J; Thurston, George

2009-12-19

In this report we review the health effects of three short-lived greenhouse pollutants-black carbon, ozone, and sulphates. We undertook new meta-analyses of existing time-series studies and an analysis of a cohort of 352,000 people in 66 US cities during 18 years of follow-up. This cohort study provides estimates of mortality effects from long-term exposure to elemental carbon, an indicator of black carbon mass, and evidence that ozone exerts an independent risk of mortality. Associations among these pollutants make drawing conclusions about their individual health effects difficult at present, but sulphate seems to have the most robust effects in multiple-pollutant models. Generally, the toxicology of the pure compounds and their epidemiology diverge because atmospheric black carbon, ozone, and sulphate are associated and could interact with related toxic species. Although sulphate is a cooling agent, black carbon and ozone could together exert nearly half as much global warming as carbon dioxide. The complexity of these health and climate effects needs to be recognised in mitigation policies. Copyright 2009 Elsevier Ltd. All rights reserved.

Differences in adjustment by child developmental stage among caregivers of children with disorders of sex development

PubMed Central

2011-01-01

Background The current study sought to compare levels of overprotection and parenting stress reported by caregivers of children with disorders of sex development at four different developmental stages. Methods Caregivers (N = 59) of children with disorders of sex development were recruited from specialty clinics and were asked to complete the Parent Protection Scale and Parenting Stress Index/Short Form as measures of overprotective behaviors and parenting stress, respectively. Results Analyses of covariance (ANCOVAs) were conducted to examine differences between caregiver report of overprotection and parenting stress. Results revealed that caregivers of infants and toddlers exhibited more overprotective behaviors than caregivers of children in the other age groups. Further, caregivers of adolescents experienced significantly more parenting stress than caregivers of school-age children, and this effect was driven by personal distress and problematic parent-child interactions, rather than having a difficult child. Conclusions These results suggest that caregivers of children with disorders of sex development may have different psychosocial needs based upon their child's developmental stage and based upon the disorder-related challenges that are most salient at that developmental stage. PMID:22074416

Science in a New Mode: Good Old (Theoretical) Science Versus Brave New (Commodified) Knowledge Production?

NASA Astrophysics Data System (ADS)

Knuuttila, Tarja

2013-10-01

The present transformation of the university system is conceptualized in terms of such terminologies as "Mode-2 knowledge production" and the "entrepreneurial university." What is remarkable about these analyses is how closely they link the generally accepted requirement of more socially relevant knowledge to the commercialization of university research. This paper critically examines the Mode-1/Mode-2 distinction through a combination of philosophical and empirical analysis. It argues that, from the perspective of actual scientific practice, this Mode-1/Mode-2 distinction and the related transition thesis do not stand closer scrutiny. Theoretical "Mode-1" science shares "Mode-2" features in being also problem-oriented, interventive and transdisciplinary. On the other hand, the empirical case on language technology demonstrates that even in "Mode-2"-like research, undertaken in the "context of application," scientists make a distinction between more difficult scientific problems and those that are considered more applied or commercial. Moreover, the case shows that the need to make such distinctions may even become more acute due to the compromises imposed by the commercialization of research.

Applying business management models in health care.

PubMed

Trisolini, Michael G

2002-01-01

Most health care management training programmes and textbooks focus on only one or two models or conceptual frameworks, but the increasing complexity of health care organizations and their environments worldwide means that a broader perspective is needed. This paper reviews five management models developed for business organizations and analyses issues related to their application in health care. Three older, more 'traditional' models are first presented. These include the functional areas model, the tasks model and the roles model. Each is shown to provide a valuable perspective, but to have limitations if used in isolation. Two newer, more 'innovative' models are next discussed. These include total quality management (TQM) and reengineering. They have shown potential for enabling dramatic improvements in quality and cost, but have also been found to be more difficult to implement. A series of 'lessons learned' are presented to illustrate key success factors for applying them in health care organizations. In sum, each of the five models is shown to provide a useful perspective for health care management. Health care managers should gain experience and training with a broader set of business management models.

Newborn Screening for Biliary Atresia.

PubMed

Wang, Kasper S

2015-12-01

Biliary atresia is the most common cause of pediatric end-stage liver disease and the leading indication for pediatric liver transplantation. Affected infants exhibit evidence of biliary obstruction within the first few weeks after birth. Early diagnosis and successful surgical drainage of bile are associated with greater survival with the child's native liver. Unfortunately, because noncholestatic jaundice is extremely common in early infancy, it is difficult to identify the rare infant with cholestatic jaundice who has biliary atresia. Hence, the need for timely diagnosis of this disease warrants a discussion of the feasibility of screening for biliary atresia to improve outcomes. Herein, newborn screening for biliary atresia in the United States is assessed by using criteria established by the Discretionary Advisory Committee on Heritable Disorders in Newborns and Children. Published analyses indicate that newborn screening for biliary atresia by using serum bilirubin concentrations or stool color cards is potentially life-saving and cost-effective. Further studies are necessary to evaluate the feasibility, effectiveness, and costs of potential screening strategies for early identification of biliary atresia in the United States. Copyright © 2015 by the American Academy of Pediatrics.

Demonstration of decomposition and optimization in the design of experimental space systems

NASA Technical Reports Server (NTRS)

Padula, Sharon; Sandridge, Chris A.; Haftka, Raphael T.; Walsh, Joanne L.

1989-01-01

Effective design strategies for a class of systems which may be termed Experimental Space Systems (ESS) are needed. These systems, which include large space antenna and observatories, space platforms, earth satellites and deep space explorers, have special characteristics which make them particularly difficult to design. It is argued here that these same characteristics encourage the use of advanced computer-aided optimization and planning techniques. The broad goal of this research is to develop optimization strategies for the design of ESS. These strategics would account for the possibly conflicting requirements of mission life, safety, scientific payoffs, initial system cost, launch limitations and maintenance costs. The strategies must also preserve the coupling between disciplines or between subsystems. Here, the specific purpose is to describe a computer-aided planning and scheduling technique. This technique provides the designer with a way to map the flow of data between multidisciplinary analyses. The technique is important because it enables the designer to decompose the system design problem into a number of smaller subproblems. The planning and scheduling technique is demonstrated by its application to a specific preliminary design problem.

Recognizing and dating prehistoric liquefaction features: Lessons learned in the New Madrid seismic zone, central United States

USGS Publications Warehouse

Tuttle, M.P.; Schweig, E.S.

1996-01-01

The New Madrid seismic zone (NMSZ), which experienced severe liquefaction during the great New Madrid, Missouri, earthquakes of 1811 and 1812 as well as during several prehistoric earthquakes, is a superb laboratory for the study of world-class, arthquake-induced liquefaction features and their use in paleoseismology. In seismically active regions like the NMSZ, frequent large earthquakes can produce a complex record of liquefaction events that is difficult to interpret. Lessons learned studying liquefaction features in the NMSZ may help to unravel the paleoseismic record in other seismically active regions. Soil characteristics of liquefaction features, as well as their structural and sratigraphic relations to Native American occupation horizons and other cultural features, an help to distinguish prehistoric liquefaction features from historic features. In addition, analyses of artifact assemblages and botanical content of cultural horizons can help to narrow the age ranges of liquefaction features. Future research should focus on methods for defining source areas and estimating magnitudes of prehistoric earthquakes from liquefaction features. Also, new methods for dating liquefaction features are needed.

Secondary school pupils' perceptions of physics

NASA Astrophysics Data System (ADS)

Barmby, Patrick; Defty, Neil

2006-11-01

This paper describes the analysis of data collected by Durham University’s YELLIS project, over the period of 1999 to 2004. Included in this data was the degree to which pupils in England at the end of their secondary education ‘liked’ or ‘disliked’ different subjects, and their expected examination grades in these subjects. The authors’ study focused on the perceptions of pupils in the science subjects of biology, chemistry and physics. Using the available data, they were able to analyse the perceptions of a large number of pupils (e.g. 9827 pupils in 2004) who took examinations in the separate sciences. The study found that physics was perceived as the least popular science, particularly by female pupils. We also found that the expected grade in a particular science subject correlated quite strongly (Spearman’s rho of around 0.5) with the liking of that subject. These expected grades were found to be the lowest in physics, again particularly for female pupils. The authors therefore concluded that in order to redress the gender imbalance in physics, they need to tackle this problem that physics is perceived as difficult by female pupils.

The detection of large deletions or duplications in genomic DNA.

PubMed

Armour, J A L; Barton, D E; Cockburn, D J; Taylor, G R

2002-11-01

While methods for the detection of point mutations and small insertions or deletions in genomic DNA are well established, the detection of larger (>100 bp) genomic duplications or deletions can be more difficult. Most mutation scanning methods use PCR as a first step, but the subsequent analyses are usually qualitative rather than quantitative. Gene dosage methods based on PCR need to be quantitative (i.e., they should report molar quantities of starting material) or semi-quantitative (i.e., they should report gene dosage relative to an internal standard). Without some sort of quantitation, heterozygous deletions and duplications may be overlooked and therefore be under-ascertained. Gene dosage methods provide the additional benefit of reporting allele drop-out in the PCR. This could impact on SNP surveys, where large-scale genotyping may miss null alleles. Here we review recent developments in techniques for the detection of this type of mutation and compare their relative strengths and weaknesses. We emphasize that comprehensive mutation analysis should include scanning for large insertions and deletions and duplications. Copyright 2002 Wiley-Liss, Inc.

Accounting for methodological, structural, and parameter uncertainty in decision-analytic models: a practical guide.

PubMed

Bilcke, Joke; Beutels, Philippe; Brisson, Marc; Jit, Mark

2011-01-01

Accounting for uncertainty is now a standard part of decision-analytic modeling and is recommended by many health technology agencies and published guidelines. However, the scope of such analyses is often limited, even though techniques have been developed for presenting the effects of methodological, structural, and parameter uncertainty on model results. To help bring these techniques into mainstream use, the authors present a step-by-step guide that offers an integrated approach to account for different kinds of uncertainty in the same model, along with a checklist for assessing the way in which uncertainty has been incorporated. The guide also addresses special situations such as when a source of uncertainty is difficult to parameterize, resources are limited for an ideal exploration of uncertainty, or evidence to inform the model is not available or not reliable. for identifying the sources of uncertainty that influence results most are also described. Besides guiding analysts, the guide and checklist may be useful to decision makers who need to assess how well uncertainty has been accounted for in a decision-analytic model before using the results to make a decision.

Public health benefits of strategies to reduce greenhouse-gas emissions: health implications of short-lived greenhouse pollutants

PubMed Central

Smith, Kirk R.; Jerrett, Michael; Anderson, H Ross; Burnett, Richard T.; Stone, Vicki; Derwent, Richard; Atkinson, Richard W.; Cohen, Aaron; Shonkoff, Seth B.; Krewski, Daniel; Pope, C. Arden; Thun, Michael J.; Thurston, George

2014-01-01

In this report we review the health effects of three short-lived greenhouse pollutants—black carbon, ozone, and sulphates. We undertook new meta-analyses of existing time-series studies and an analysis of a cohort of 352 000 people in 66 US cities during 18 years of follow-up. This cohort study provides estimates of mortality effects from long-term exposure to elemental carbon, an indicator of black carbon mass, and evidence that ozone exerts an independent risk of mortality. Associations among these pollutants make drawing conclusions about their individual health effects difficult at present, but sulphate seems to have the most robust effects in multiple-pollutant models. Generally, the toxicology of the pure compounds and their epidemiology diverge because atmospheric black carbon, ozone, and sulphate are associated and could interact with related toxic species. Although sulphate is a cooling agent, black carbon and ozone could together exert nearly half as much global warming as carbon dioxide. The complexity of these health and climate effects needs to be recognised in mitigation policies. PMID:19942276

Approaches for integrated assessment of ecological and eutrophication status of surface waters in Nordic Countries.

PubMed

Andersen, Jesper H; Aroviita, Jukka; Carstensen, Jacob; Friberg, Nikolai; Johnson, Richard K; Kauppila, Pirkko; Lindegarth, Mats; Murray, Ciarán; Norling, Karl

2016-10-01

We review approaches and tools currently used in Nordic countries (Denmark, Finland, Norway and Sweden) for integrated assessment of 'ecological status' sensu the EU Water Framework Directive as well as assessment of 'eutrophication status' in coastal and marine waters. Integration principles for combining indicators within biological quality elements (BQEs) and combining BQEs into a final-integrated assessment are discussed. Specific focus has been put on combining different types of information into indices, since several methods are currently employed. As a consequence of the variety of methods used, comparisons across both BQEs and water categories (river, lakes and coastal waters) can be difficult. Based on our analyses, we conclude that some principles and methods for integration can be critical and that a harmonised approach should be developed. Further, we conclude that the integration principles applied within BQEs are critical and in need of harmonisation if we want a better understanding of potential transition in ecological status between surface water types, e.g. when riverine water enters a downstream lake or coastal water body.

The Research Needs of Historians in Russian and Slavic History; A Citation Analysis of "The Russian Review," 1991-1994.

ERIC Educational Resources Information Center

Mahowald, Teresa Tickle

In an era of tight library budgets, librarians must carefully consider materials selection. The interdisciplinary nature of the social science and humanities fields makes determining what a researcher needs a difficult task. This study seeks to determine what materials are being used by scholars in the field of Russian and Slavic studies analyzing…

Demystifying Concepts of Epidemic and Causal Association for Public Health Students--A Pedagogical Approach to Promote Critical and Analytical Thinking

ERIC Educational Resources Information Center

Patil, Rajan R.

2011-01-01

Epidemiology is a difficult but an important subject in public health curriculum. As teachers, we need to be very innovative in teaching the core concepts in epidemiology since it is basically a research oriented subject that calls for enormous application of logic and mathematical skills. Very often, complex epidemiological concepts need to be…

Emergence of native plant seeds in response to seed pelleting, planting depth, scarification, and soil anti-crusting treatment, 2009

Treesearch

Clint Shock; Erik Feibert; Lamont Saunders; Nancy Shaw

2010-01-01

Seed of native plants is needed to restore rangelands of the Intermountain West. Reliable commercial seed production is desirable to provide the quantity of seed needed for restoration efforts. Establishment of native seed crops has been difficult, because fall-planted seed is susceptible to bird damage, soil crusting, and soil erosion. Fall planting is important for...

5 Key Findings for Middle Grades from "Looking Forward to High School and College"

ERIC Educational Resources Information Center

Allensworth, Elaine M.; Gwynne, Julia A.; Moore, Paul; de La Torre, Marisa

2014-01-01

Preparation for college and careers begins when students are young, yet, it can be difficult for middle grade educators to know how best to prepare these students for future success. Middle grade practitioners need to know what to pay attention to and who needs additional support. Without knowing how to identify students who are on-track for high…

Empowerment in the interpersonal field: discourses of acute mental health nurses.

PubMed

Lloyd, M

2007-08-01

Social policy greatly influences the working environment of mental health nurses but in practice can be difficult to translate. Empowerment of service users is one area that is constantly significant in policy, locally and nationally, yet quite difficult to define in practice. This ethnomethodological study explored the practice of 10 mental health nurses working in an acute admissions unit. Through semi-structured interviews, the nurses were asked to discuss the taken-for-granted methods of empowerment with individual service users, their families and with work colleagues. The results were thematically analysed and compared with international findings, which reflected an awareness among mental health nurses of empowering practice in four areas. These were: Working with mental illness, Making connections, Responsibility and Teamworking.

Difficult Decisions Made Easier

NASA Technical Reports Server (NTRS)

2006-01-01

NASA missions are extremely complex and prone to sudden, catastrophic failure if equipment falters or if an unforeseen event occurs. For these reasons, NASA trains to expect the unexpected. It tests its equipment and systems in extreme conditions, and it develops risk-analysis tests to foresee any possible problems. The Space Agency recently worked with an industry partner to develop reliability analysis software capable of modeling complex, highly dynamic systems, taking into account variations in input parameters and the evolution of the system over the course of a mission. The goal of this research was multifold. It included performance and risk analyses of complex, multiphase missions, like the insertion of the Mars Reconnaissance Orbiter; reliability analyses of systems with redundant and/or repairable components; optimization analyses of system configurations with respect to cost and reliability; and sensitivity analyses to identify optimal areas for uncertainty reduction or performance enhancement.

Estimating cost per lane mile for routine highway operations and maintenance

DOT National Transportation Integrated Search

2011-01-01

The disparity between maintenance budgets and maintenance requirements causes agencies to make difficult choices : about maintenance priorities. There is a growing need to effectively link maintenance costs and condition to provide clear : evidence o...

SOIL AND SEDIMENT SAMPLING METHODS

EPA Science Inventory

The EPA Office of Solid Waste and Emergency Response's (OSWER) Office of Superfund Remediation and Technology Innovation (OSRTI) needs innovative methods and techniques to solve new and difficult sampling and analytical problems found at the numerous Superfund sites throughout th...

Novel nanoparticle vaccines for Listeriosis.

PubMed

Calderon-Gonzalez, Ricardo; Marradi, Marco; Garcia, Isabel; Petrovsky, Nikolai; Alvarez-Dominguez, Carmen

2015-01-01

In recent years, nanomedicine has transformed many areas of traditional medicine, and enabled fresh insights into the prevention of previously difficult to treat diseases. An example of the transformative power of nanomedicine is a recent nano-vaccine against listeriosis, a serious bacterial infection affecting not only pregnant women and their neonates, but also immune-compromised patients with neoplastic or chronic autoimmune diseases. There is a major unmet need for an effective and safe vaccine against listeriosis, with the challenge that an effective vaccine needs to generate protective T cell immunity, a hitherto difficult to achieve objective. Now utilizing a gold nanoparticle antigen delivery approach together with a novel polysaccharide nanoparticulate adjuvant, an effective T-cell vaccine has been developed that provides robust protection in animal models of listeriosis, raising the hope that one day this nanovaccine technology may protect immune-compromised humans against this serious opportunistic infection.

High Leverage Technologies for In-Space Assembly of Complex Structures

NASA Technical Reports Server (NTRS)

Hamill, Doris; Bowman, Lynn M.; Belvin, W. Keith; Gilman, David A.

2016-01-01

In-space assembly (ISA), the ability to build structures in space, has the potential to enable or support a wide range of advanced mission capabilities. Many different individual assembly technologies would be needed in different combinations to serve many mission concepts. The many-to-many relationship between mission needs and technologies makes it difficult to determine exactly which specific technologies should receive priority for development and demonstration. Furthermore, because enabling technologies are still immature, no realistic, near-term design reference mission has been described that would form the basis for flowing down requirements for such development and demonstration. This broad applicability without a single, well-articulated mission makes it difficult to advance the technology all the way to flight readiness. This paper reports on a study that prioritized individual technologies across a broad field of possible missions to determine priority for future technology investment.

Diode laser (980nm) cartilage reshaping

NASA Astrophysics Data System (ADS)

El Kharbotly, A.; El Tayeb, T.; Mostafa, Y.; Hesham, I.

2011-03-01

Loss of facial or ear cartilage due to trauma or surgery is a major challenge to the otolaryngologists and plastic surgeons as the complicated geometric contours are difficult to be animated. Diode laser (980 nm) has been proven effective in reshaping and maintaining the new geometric shape achieved by laser. This study focused on determining the optimum laser parameters needed for cartilage reshaping with a controlled water cooling system. Harvested animal cartilages were angulated with different degrees and irradiated with different diode laser powers (980nm, 4x8mm spot size). The cartilage specimens were maintained in a deformation angle for two hours after irradiation then released for another two hours. They were serially measured and photographed. High-power Diode laser irradiation with water cooling is a cheep and effective method for reshaping the cartilage needed for reconstruction of difficult situations in otorhinolaryngologic surgery. Key words: cartilage,diode laser (980nm), reshaping.

Self-inflicted injuries. Challenging knowledge, skill, and compassion.

PubMed

Haswell, D E; Graham, M

1996-09-01

Self-inflicted injuries and other serious self-destructive behaviours are common and difficult to recognize, prevent, and manage. Although they have previously been understood as repeated, failed attempts at suicide, they are better understood as maladaptive coping strategies. Women who present repeatedly with self-inflicted injuries need help to control this self-destructive behaviour and substitute more positive coping strategies. Physicians also need help in working with patients who respond to problems in this way. The program is made up of two broad sections. The first section involves understanding the problem and its origins in post-traumatic stress disorders. The second section offers a practical approach to helping patients presenting with injuries inflict upon themselves. A deeper understanding of the etiology and management of repeated self-inflicted injuries will enable physicians to help patients with this difficult problem while minimizing their own anxiety and frustration.

A survey of Canadian anesthesiologists' preferences in difficult intubation and "cannot intubate, cannot ventilate" situations.

PubMed

Wong, David T; Mehta, Arpan; Tam, Amanda D; Yau, Brian; Wong, Jean

2014-08-01

The purpose of this survey was to determine the equipment that anesthesiologists prefer in difficult tracheal intubation and "cannot intubate, cannot ventilate" (CICV) situations. A questionnaire was e-mailed to members of the Canadian Anesthesiologists' Society to ascertain their preferences, experience, and comfort level with regard to their use of airway equipment in difficult intubation and CICV situations in adult patients. A Chi square test was used to analyse the data. All reported P values are two-sided. Nine hundred ninety-seven of 2,532 questionnaires (39%) were returned. In an unanticipated difficult direct laryngoscopic intubation situation, 893 of 997 (90%) respondents chose a video laryngoscope as the first-choice rescue technique, while 41 (4%) and 21 (2%) of respondents chose a flexible bronchoscope and an intubating laryngeal mask airway device, respectively. The majority of anesthesiologists had experience and were comfortable with using a flexible bronchoscope or a video laryngoscope. Regarding CICV, 294 of 955 (31%) respondents stated that they had never encountered it. Wire-guided cricothyroidotomy was chosen as the first-choice surgical airway by 375 of 955 (39%) respondents, while intravenous catheter cricothyroidotomy and "defer to tracheostomy by surgeon" were selected by 266 (28%) and 215 (23%) respondents, respectively. Seven hundred eighty-five of 997 (78%) respondents were familiar with the exact steps of the American Society of Anesthesiologists' difficult airway algorithm, while 448 (47%) had attended an airway workshop within the past five years. In a difficult intubation situation, the most frequently selected first-choice airway device was a video laryngoscope, followed by a flexible bronchoscope. In a CICV situation, the most frequently selected first-choice surgical airway technique was a wire-guided cricothyroidotomy, followed by an intravenous catheter cricothyroidotomy.

The experience of international nursing students studying for a PhD in the U.K: A qualitative study.

PubMed

Evans, Catrin; Stevenson, Keith

2011-06-13

Educating nurses to doctoral level is an important means of developing nursing capacity globally. There is an international shortage of doctoral nursing programmes, hence many nurses seek their doctorates overseas. The UK is a key provider of doctoral education for international nursing students, however, very little is known about international doctoral nursing students' learning experiences during their doctoral study. This paper reports on a national study that sought to investigate the learning expectations and experiences of overseas doctoral nursing students in the UK. Semi-structured qualitative interviews were conducted in 2008/09 with 17 international doctoral nursing students representing 9 different countries from 6 different UK universities. Data were analysed thematically. All 17 interviewees were enrolled on 'traditional' 3 year PhD programmes and the majority (15/17) planned to work in higher education institutions back in their home country upon graduation. Studying for a UK PhD involved a number of significant transitions, including adjusting to a new country/culture, to new pedagogical approaches and, in some cases, to learning in a second language. Many students had expected a more structured programme of study, with a stronger emphasis on professional nursing issues as well as research - akin to the professional doctorate. Students did not always feel well integrated into their department's wider research environment, and wanted more opportunities to network with their UK peers. A good supervision relationship was perceived as the most critical element of support in a doctoral programme, but good relationships were sometimes difficult to attain due to differences in student/supervisor expectations and in approaches to supervision. The PhD was perceived as a difficult and stressful journey, but those nearing the end reflected positively on it as a life changing experience in which they had developed key professional and personal skills. Doctoral programmes need to ensure that structures are in place to support international students at different stages of their doctoral journey, and to support greater local-international student networking. Further research is needed to investigate good supervision practice and the suitability of the PhD vis a vis other doctoral models (e.g. the professional doctorate) for international nursing students.

Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study.

PubMed

Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

2016-01-01

While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling's thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers' insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed.

Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study

PubMed Central

Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

2016-01-01

Background While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed. PMID:27347880

Genotype × Environment Interaction in Smoking Behaviors: A Systematic Review.

PubMed

Do, Elizabeth K; Maes, Hermine H

2017-04-01

There has been rapid growth in research exploring gene-environment interaction (G×E) contributing to smoking behaviors. Yet, no systematic review exists to date. This article aims to review evidence on the contribution of G×E to the risk of smoking. Through a search of electronic databases (ie, Google Scholar, PubMed, ScienceDirect, and Elsevier) up until May 2014, 16 studies of G×E focused on smoking behaviors were identified. These studies were compared in terms of: research design and sample studied, measure of smoking behavior and environments used, genes explored, and G×E in relation to these factors. Thirteen of 16 studies (81.2%) found at least one significant G×E association. Wide variation in analytic methods was found across studies, especially with respect to the phenotypes of interest, environmental measures used, and tests conducted to estimate G×E. Heterogeneity across studies made it difficult to compare findings and evaluate the strength of evidence for G×E. G×E research on smoking contains studies that are methodologically different, making it difficult to assess the current state of the evidence. To decrease heterogeneity, we offer recommendations related to: (1) choice of measurement for environmental variables, (2) testing and reporting of main and interaction effects, (3) treatment of covariates, (4) reporting gene-environment correlation, and (5) conducting sensitivity analyses and checking for scaling artifacts. Continued study is needed to identify mechanisms by which genes and environmental factors combine to influence smoking behaviors. No comprehensive review of G×E studies of smoking behavior has previously been published. The present article seeks to fill this gap by providing a comprehensive review of: how G×E has been defined, how twin and molecular genetic methodologies have been used to test for G×E, and which genes and environmental factors are associated with smoking behaviors. Variations in methodological approaches make it difficult to interpret and summarize findings, so recommendations for future research are provided as a means to more easily compare and replicate findings across studies. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment.

PubMed

Schmidt, H G; Van Gog, Tamara; Schuit, Stephanie Ce; Van den Berge, Kees; Van Daele, Paul L; Bueving, Herman; Van der Zee, Tim; Van den Broek, Walter W; Van Saase, Jan L; Mamede, Sílvia

2017-01-01

Literature suggests that patients who display disruptive behaviours in the consulting room fuel negative emotions in doctors. These emotions, in turn, are said to cause diagnostic errors. Evidence substantiating this claim is however lacking. The purpose of the present experiment was to study the effect of such difficult patients' behaviours on doctors' diagnostic performance. We created six vignettes in which patients were depicted as difficult (displaying distressing behaviours) or neutral. Three clinical cases were deemed to be diagnostically simple and three deemed diagnostically complex. Sixty-three family practice residents were asked to evaluate the vignettes and make the patient's diagnosis quickly and then through deliberate reflection. In addition, amount of time needed to arrive at a diagnosis was measured. Finally, the participants rated the patient's likability. Mean diagnostic accuracy scores (range 0-1) were significantly lower for difficult than for neutral patients (0.54 vs 0.64; p=0.017). Overall diagnostic accuracy was higher for simple than for complex cases. Deliberate reflection upon the case improved initial diagnostic, regardless of case complexity and of patient behaviours (0.60 vs 0.68, p=0.002). Amount of time needed to diagnose the case was similar regardless of the patient's behaviour. Finally, average likability ratings were lower for difficult than for neutral-patient cases. Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likability and diagnostic performance. 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/.

Phospholipids in sera of horses with summer eczema: lipid analysis of the autoserum preparation used in therapy.

PubMed

Hallamaa, R E; Batchu, K C; Tallberg, T

2014-05-01

Equine summer eczema, also known as insect bite hypersensitivity, affects horses recurrently during summer months. The treatment of this allergic pruritus is difficult and therefore there is a need for efficacious treatments. Autoserum therapy, based on the use of autogenous serum that is specifically prepared for oral administration and given when the animal shows clinical signs has been introduced recently. Lipids are thought to be responsible for the effect of this therapy. The main aim of this study was to analyse the phospholipid content of autogenous serum preparations and to further assess whether these preparations have different lipid profiles depending on the clinical status of the horse. The hypothesis is that the major serum phospholipids typical of the horse are present in the autoserum preparation. Descriptive controlled clinical study. Sera were collected from 10 affected and 6 healthy horses, prepared in a similar fashion and the lipids contained in the resulting autoserum preparations were analysed by electrospray ionisation mass spectrometry. The major phospholipid classes detected were phosphatidylcholine, sphingomyelin, phosphatidic acid and traces of lysophosphatidylcholine. Horses with summer eczema had significantly abundant concentrations of phosphatidylcholine (P = 0.042) and sphingomyelin (P = 0.0017) in comparison with healthy horses, while the concentration of phosphatidic acid was significantly higher in healthy horses (P = 0.0075). The autoserum preparation contains minute amounts of the main serum phospholipids in differing concentrations in healthy horses and horses with an allergic skin disease. © 2013 EVJ Ltd.

Trends and variability of water quality in Lake Tana, Ethiopia using MODIS-Aqua

NASA Astrophysics Data System (ADS)

DeLuca, N. M.; Zaitchik, B. F.; Monger, B. C.

2017-12-01

Determining long-term water quality trends and variability in remote inland lakes has been challenging due to a lack of continuous in situ measurements. Utilizing ocean color remote sensing techniques for these lakes is difficult due to their sizes, shapes, and optically complex waters. Lake Tana is the largest body of water in Ethiopia, and is located in the country's northwestern highlands. The lake is quite shallow, averaging at about 8 meters depth, and is characteristically turbid due to nearby land degradation and high soil erosion rates. Lake Tana is an important source of accessible water for the rapidly growing population of Ethiopia and serves as the headwaters for the Blue Nile. Therefore, understanding water quality trends and seasonal variation over the past decade is essential to better preparing for future water needs. Here we use MODIS-Aqua data spanning years 2002-2016 to investigate these trends and variability in Lake Tana, where in situ measurements are limited. Daily water quality products were first processed using SeaDAS and then aggregated by month and year for analyses. Frequent cloud cover in the June, July, and August (JJA) rainy season due to monsoon and zonal dynamics presents an obstacle for obtaining mean lake values during these months. We also performed analyses on targeted regions of Lake Tana to determine whether some of the major tributaries and their corresponding watersheds have more influence on observed trends than others.

medplot: a web application for dynamic summary and analysis of longitudinal medical data based on R.

PubMed

Ahlin, Črt; Stupica, Daša; Strle, Franc; Lusa, Lara

2015-01-01

In biomedical studies the patients are often evaluated numerous times and a large number of variables are recorded at each time-point. Data entry and manipulation of longitudinal data can be performed using spreadsheet programs, which usually include some data plotting and analysis capabilities and are straightforward to use, but are not designed for the analyses of complex longitudinal data. Specialized statistical software offers more flexibility and capabilities, but first time users with biomedical background often find its use difficult. We developed medplot, an interactive web application that simplifies the exploration and analysis of longitudinal data. The application can be used to summarize, visualize and analyze data by researchers that are not familiar with statistical programs and whose knowledge of statistics is limited. The summary tools produce publication-ready tables and graphs. The analysis tools include features that are seldom available in spreadsheet software, such as correction for multiple testing, repeated measurement analyses and flexible non-linear modeling of the association of the numerical variables with the outcome. medplot is freely available and open source, it has an intuitive graphical user interface (GUI), it is accessible via the Internet and can be used within a web browser, without the need for installing and maintaining programs locally on the user's computer. This paper describes the application and gives detailed examples describing how to use the application on real data from a clinical study including patients with early Lyme borreliosis.

Men's experience of their partners' postpartum psychiatric disorders: narratives from the internet

PubMed Central

2011-01-01

Objectives Postpartum psychiatric disorders (PPPD) can be serious and disabling, and may lead to long-term adverse consequences. Partners of women with PPPD are also affected by the illness, but their experiences are seldom described. The aim of this study was to explore men's experience of women with PPPD. Methods Eleven written narratives from the internet were used to analyse men's perceived experience of their partner's PPPDs. Data were analysed using content analysis. Results The men revealed a major disruption in their lives. They expressed fear, confusion and anger; they were also extremely concerned about their partners, and felt unable to help in overcoming the disorder. Most of the men described making sacrifices in order to hold the relationship and the family together. Although the disorder improved over time, they were left to face an uncertain future with a woman who seemed to be very different from the person they had known previously. Most of the men gained maturity and increased self-esteem, but for some the result was divorce, custody disputes and loneliness. Conclusions The men in this study experienced the woman's PPPD as a difficult time, when everything familiar was turned upside down. Health professionals should pay more attention to men's mental health in the postpartum period. Furthermore, information regarding the possibility of these disorders should be given to expectant couples in prenatal classes. Further research is needed to ascertain how and to what extent this should be included in the education. PMID:22942895

Evidence of Natural Hybridization and Introgression between Vasconcellea Species (Caricaceae) from Southern Ecuador Revealed by Chloroplast, Mitochondrial and Nuclear DNA Markers

PubMed Central

VAN DROOGENBROECK, B.; KYNDT, T.; ROMEIJN-PEETERS, E.; VAN THUYNE, W.; GOETGHEBEUR, P.; ROMERO-MOTOCHI, J. P.; GHEYSEN, G.

2006-01-01

• Background and Aims Vasconcellea × heilbornii is believed to be of natural hybrid origin between V. cundinamarcensis and V. stipulata, and is often difficult to discriminate from V. stipulata on morphological grounds. The aim of this paper is to examine individuals of these three taxa and of individuals from the closely related species V. parviflora and V. weberbaueri, which all inhabit a hybrid zone in southern Ecuador. • Methods Molecular data from mitochondrial, chloroplast and nuclear DNA from 61 individuals were analysed. • Key Results Molecular analysis confirmed occasional contemporary hybridization between V. stipulata, V. cundinamarcensis and V. × heilbornii and suggested the possible involvement of V. weberbaueri in the origin of V. × heilbornii. In addition, the molecular data indicated unidirectional introgression of the V. cundinamarcensis nuclear genome into that of V. stipulata. Several of the individuals examined with morphology similar to that of V. stipulata had genetic traces of hybridization with V. cundinamarcensis, which only seems to act as pollen donor in interspecific hybridization events. Molecular analyses also strongly suggested that most of the V. × heilbornii individuals are not F1 hybrids but instead are progeny of repeated backcrosses with V. stipulata. • Conclusions The results of the present study point to the need for re-evaluation of natural populations of V. stipulata and V. × heilbornii. In general, this analysis demonstrates the complex patterns of genetic and morphological diversity found in natural plant hybrid zones. PMID:16500954

Health literacy and the Internet: a study on the readability of Australian online health information.

PubMed

Cheng, Christina; Dunn, Matthew

2015-08-01

Almost 80% of Australian Internet users seek out health information online so the readability of this information is important. This study aimed to evaluate the readability of Australian online health information and determine if it matches the average reading level of Australians. Two hundred and fifty-one web pages with information on 12 common health conditions were identified across sectors. Readability was assessed by the Flesch-Kincaid (F-K), Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease (FRE) formulas, with grade 8 adopted as the average Australian reading level. The average reading grade measured by F-K and SMOG was 10.54 and 12.12 respectively. The mean FRE was 47.54, a 'difficult-to-read' score. Only 0.4% of web pages were written at or below grade 8 according to SMOG. Information on dementia was the most difficult to read overall, while obesity was the most difficult among government websites. The findings suggest that the readability of Australian health websites is above the average Australian levels of reading. A quantifiable guideline is needed to ensure online health information accommodates the reading needs of the general public to effectively use the Internet as an enabler of health literacy. © 2015 Public Health Association of Australia.

[A MULTIDISCIPLINARY BIOPSYCHOSOCIAL INTEGRATED APPROACH IN ORGANIZATION OF REHABILITATIVE ACTIVITY IN NURSING HOMES (RSA)].

PubMed

Panella, Lorenzo; Piccioni, Davide; Borcescu, Lidia; Isella, Celeste; Callegari, Camilla

2015-01-01

Objectives, social role and organization of Italian nursing homes (RSA) are characterized by a pronounced regional differentiation that causes situations which are difficult to compare about expected outcomes. The definition of a functional outcome is particularly difficult in institutionalized patients and this is due to the failure of a conclusive moment of the rehabilitative treatment. Furthermore we often take care of patients who have already been admitted to intensive and/or extensive rehabilitation units time after time, without further functional profit margin. The inconstant presence of professional figures of rehabilitation in nursing homes' staff makes difficult the drafting of an adequate rehabilitative project, especially for the multiple needs of frail old people. Starting with these assumptions, authors hypothesize and adopt a model of sanitary organization to consent a correct allocation of available resources, according to the patient's needs. They stratified all nursing home patients, using the Multidimensional Prognostic Index (MPI) and "Scheda di osservazione intermedia assistenza" (SOSIA), and measured the residual function. They concluded that a multidimensional evaluation of patients allows to identify wellness (of the sick person and of caregivers) as the main objective; nursing home organization could be think as a "complex supportive prosthesis for old people", made by the interaction among structure, operators and activities.

Incidence and predictors of difficult nasotracheal intubation with airway scope.

PubMed

Ono, Koyu; Goto, Tomoko; Nakai, Daishi; Ueki, Shuhei; Takenaka, Seiichiro; Moriya, Tomomi

2014-10-01

The airway scope (AWS) improves views of the larynx during orotracheal intubation. However, the role of the AWS in routine nasotracheal intubation has not been studied adequately. One hundred and three patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. The study was approved by our Institution Review Board, and written informed consent was obtained from all patients. We evaluated the success rate of AWS intubation and the incidence of difficult nasotracheal intubation using a modified intubation difficulty scale (IDS) to examine preoperative characteristics and intubation profiles. Categories were difficult intubation (IDS ≥5), mildly difficult (IDS = 1-4), and intubation without difficulty (IDS = 0). We also assessed the incidence of the use of Magill forceps or cuff inflation (the cuff of endotracheal tube is inflated with 10-15 ml air) to guide the endotracheal tube into the glottis. AWS nasotracheal intubation was 100% successful. The cuff inflation technique was used in 37 patients. Neither Magill forceps nor other devices were needed for any patient during AWS use. The incidence of difficult nasotracheal intubation was 10% (n = 10). Of the patients, 61% (n = 63) had mildly difficult intubation and 29% (n = 30) had no difficulty. Patients with difficult intubation were more likely to be male and to have a larger tongue and a higher Cormack grade than in the other two groups. Complications, involving minor soft tissue injury, were observed in only 1 patient (1%). The AWS achieves a high success rate for nasotracheal intubation with cuff inflation in patients undergoing dental and maxillofacial surgery.

Patterns of Marine Corps Reserve Continuation Behavior: Pre- and Post-9/11

DTIC Science & Technology

2011-03-01

to consider when studying reserve retention and very difficult to measure using multivariate econometric models, which rely solely on observational...chapter present an interesting supplement to standard economic theoretical perspectives commonly used in econometric analyses. Notably, the structural...relevant to this thesis. These factors contribute to the over- arching themes of job satisfaction and organizational commitment and therefore ultimately

L2 vs. L1 Use of Synonymy: An Empirical Study of Synonym Use/Acquisition

ERIC Educational Resources Information Center

Liu, Dilin; Zhong, Shouman

2016-01-01

Synonymy is important but difficult for language learners to grasp. Using a forced-choice question instrument, along with corpus data as reference, this study examines the use of four sets of synonyms by intermediate/advanced Chinese EFL/ESL learners and native English speakers. The data analyses reveal several key findings, including a general…

Characteristics and Trends of Attrition from the United States Naval Academy

DTIC Science & Technology

2006-06-01

dissatisfaction, they are having a more difficult time fitting in and finding large social circles that fully support their development . 3. Stage 3 The...degree of MASTER OF SCIENCE IN LEADERSHIP AND HUMAN RESOURCE DEVELOPMENT from the NAVAL POSTGRADUATE SCHOOL June 2006 Author: James W. Bishop Approved...21 B. STAGE 1: COHORT ANALYSES...............................................................21 C. STAGE 2: DATA SET ANALYSIS

Acculturation and School Adjustment of Early-Adolescent Immigrant Boys and Girls in Germany: Conditions in School, Family, and Ethnic Group

ERIC Educational Resources Information Center

Schachner, Maja K.; Van de Vijver, Fons J. R.; Noack, Peter

2018-01-01

Navigating between cultures in addition to developmental changes and challenges in early adolescence can be difficult. We investigated school, family, and ethnic group as conditions for acculturation and school adjustment among early-adolescent boys and girls. Analyses were based on 860 mostly second- and third-generation immigrant students from…

A Novel Method for the In-Depth Multimodal Analysis of Student Learning Trajectories in Intelligent Tutoring Systems

ERIC Educational Resources Information Center

Liu, Ran; Stamper, John; Davenport, Jodi

2018-01-01

Temporal analyses are critical to understanding learning processes, yet understudied in education research. Data from different sources are often collected at different grain sizes, which are difficult to integrate. Making sense of data at many levels of analysis, including the most detailed levels, is highly time-consuming. In this paper, we…

The Hidden Turmoil: Females Achieving Longevity in the Outdoor Learning Profession

ERIC Educational Resources Information Center

Wright, Michelle; Gray, Tonia

2013-01-01

Being a woman in the outdoor learning profession can bring distinctive challenges and roadblocks. Even more difficult is sustaining a life-long career, flourishing into a woman's 50s or 60s. Based on this premise, career longevity seems elusive for some women who aspire to work in the outdoors. This paper analyses the autobiographies of three…

OER (Re)Use and Language Teachers' Tacit Professional Knowledge: Three Vignettes

ERIC Educational Resources Information Center

Beaven, Tita

2015-01-01

The pedagogic practical knowledge that teachers use in their lessons is very difficult to make visible and often remains tacit. This chapter draws on data from a recent study and closely analyses a number of Open Educational Resources used by three language teachers at the UK Open University in order to try to capture how their use of the…

Task Analyses for Difficult-to-Assess Collective Tasks

DTIC Science & Technology

2014-02-01

FOR THE KLE MISSION Review and rehearse social nuances, customs, and etiquette of the host nation, e.g., gift exchange expectations. Practice... etiquette to foster rapport with the leader and demonstrate cultural awareness. Negotiate with the key leader in a manner that demonstrates...requirements for police applicants by establishing minimum entry requirements, physical fitness tests, literacy tests, and medical screening protocols

Advances in stable isotope assisted labeling strategies with information science.

PubMed

Kigawa, Takanori

2017-08-15

Stable-isotope (SI) labeling of proteins is an essential technique to investigate their structures, interactions or dynamics by nuclear magnetic resonance (NMR) spectroscopy. The assignment of the main-chain signals, which is the fundamental first step in these analyses, is usually achieved by a sequential assignment method based on triple resonance experiments. Independently of the triple resonance experiment-based sequential assignment, amino acid-selective SI labeling is beneficial for discriminating the amino acid type of each signal; therefore, it is especially useful for the signal assignment of difficult targets. Various combinatorial selective labeling schemes have been developed as more sophisticated labeling strategies. In these strategies, amino acids are represented by combinations of SI labeled samples, rather than simply assigning one amino acid to one SI labeled sample as in the case of conventional amino acid-selective labeling. These strategies have proven to be useful for NMR analyses of difficult proteins, such as those in large complex systems, in living cells, attached or integrated into membranes, or with poor solubility. In this review, recent advances in stable isotope assisted labeling strategies will be discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

Predicting the Lifetime of Dynamic Networks Experiencing Persistent Random Attacks.

PubMed

Podobnik, Boris; Lipic, Tomislav; Horvatic, Davor; Majdandzic, Antonio; Bishop, Steven R; Eugene Stanley, H

2015-09-21

Estimating the critical points at which complex systems abruptly flip from one state to another is one of the remaining challenges in network science. Due to lack of knowledge about the underlying stochastic processes controlling critical transitions, it is widely considered difficult to determine the location of critical points for real-world networks, and it is even more difficult to predict the time at which these potentially catastrophic failures occur. We analyse a class of decaying dynamic networks experiencing persistent failures in which the magnitude of the overall failure is quantified by the probability that a potentially permanent internal failure will occur. When the fraction of active neighbours is reduced to a critical threshold, cascading failures can trigger a total network failure. For this class of network we find that the time to network failure, which is equivalent to network lifetime, is inversely dependent upon the magnitude of the failure and logarithmically dependent on the threshold. We analyse how permanent failures affect network robustness using network lifetime as a measure. These findings provide new methodological insight into system dynamics and, in particular, of the dynamic processes of networks. We illustrate the network model by selected examples from biology, and social science.

Phylogenomic analyses of more than 4000 nuclear loci resolve the origin of snakes among lizard families.

PubMed

Streicher, Jeffrey W; Wiens, John J

2017-09-01

Squamate reptiles (lizards and snakes) are the most diverse group of terrestrial vertebrates, with more than 10 000 species. Despite considerable effort to resolve relationships among major squamates clades, some branches have remained difficult. Among the most vexing has been the placement of snakes among lizard families, with most studies yielding only weak support for the position of snakes. Furthermore, the placement of iguanian lizards has remained controversial. Here we used targeted sequence capture to obtain data from 4178 nuclear loci from ultraconserved elements from 32 squamate taxa (and five outgroups) including representatives of all major squamate groups. Using both concatenated and species-tree methods, we recover strong support for a sister relationship between iguanian and anguimorph lizards, with snakes strongly supported as the sister group of these two clades. These analyses strongly resolve the difficult placement of snakes within squamates and show overwhelming support for the contentious position of iguanians. More generally, we provide a strongly supported hypothesis of higher-level relationships in the most species-rich tetrapod clade using coalescent-based species-tree methods and approximately 100 times more loci than previous estimates. © 2017 The Author(s).

Idea of Identification of Copper Ore with the Use of Process Analyser Technology Sensors

NASA Astrophysics Data System (ADS)

Jurdziak, Leszek; Kaszuba, Damian; Kawalec, Witold; Król, Robert

2016-10-01

The Polish resources of the copper ore exploited by the KGHM S.A. underground mines are considered as one of the most complex in the world and - consequently - the most difficult to be processed. The ore consists of three lithology forms: dolomites, shales and sandstones but in different proportions which has a significant impact on the effectiveness of the grinding and flotation processes. The lithological composition of the ore is generally recognised in-situ but after being mined it is blended on its long way from various mining fields to the processing plant by the complex transportation system consisting of belt conveyors with numerous switching points, ore bunkers and shafts. Identification of the lithological composition of the ore being supplied to the processing plant should improve the adjustments of the ore processing machinery equipment aiming to decrease the specific processing (mainly grinding) energy consumption as well as increase the metal recovery. The novel idea of Process Analyser Technology (PAT) sensors - information carrying pellets, dropped into the transported or processed bulk material which can be read directly when needed - is investigated for various applications within the DISIRE project (a part of the SPIRE initiative, acting under the Horizon2020 framework program) and here is adopted for implementing the annotation the transported copper ore for the needs of ore processing plants control. The identification of the lithological composition of ore blended on its way to the processing plant can be achieved by an information system consisting of pellets that keep the information about the original location of the portions of conveyed ore, the digital, geological database keeping the data of in-situ lithology and the simulation models of the transportation system, necessary to evaluate the composition of the blended ore. The assumptions of the proposed solution and the plan of necessary in-situ tests (with the special respect to harsh environment of

Translating Medical Effectiveness Research into Policy: Lessons from the California Health Benefits Review Program

PubMed Central

Coffman, Janet M; Hong, Mi-Kyung; Aubry, Wade M; Luft, Harold S; Yelin, Edward

2009-01-01

Context: Legislatures and executive branch agencies in the United States and other nations are increasingly using reviews of the medical literature to inform health policy decisions. To clarify these efforts to give policymakers evidence of medical effectiveness, this article discusses the California Health Benefits Review Program (CHBRP). This program, based at the University of California, analyzes the medical effectiveness of health insurance benefit mandate bills for the California legislature, as well as their impact on cost and public health. Methods: This article is based on the authors’ experience reviewing benefit mandate bills for CHBRP and findings from evaluations of the program. General observations are illustrated with examples from CHBRP's reports. Information about efforts to incorporate evidence into health policymaking in other states and nations was obtained through a review of published literature. Findings: CHBRP produces reports that California legislators, legislative staff, and other major stakeholders value and use routinely in deliberations about benefit mandate bills. Where available, the program relies on previously published meta-analyses and systematic reviews to streamline the review of the medical literature. Faculty and staff responsible for the medical effectiveness sections of CHBRP's reports have learned four major lessons over the course of the program's six-year history: the need to (1) recognize the limitations of the medical literature, (2) anticipate the need to inform legislators about the complexity of evidence, (3) have realistic expectations regarding the impact of medical effectiveness reviews, and (4) understand the consequences of the reactive nature of mandated benefit reviews. Conclusions: CHBRP has demonstrated that it is possible to produce useful reviews of the medical literature within the tight time constraints of the legislative process. The program's reports have provided state legislators with independent analyses that allow them to move beyond sifting through conflicting information from proponents and opponents to consider difficult policy choices and their implications. PMID:20021589

Drivers for inappropriate fever management in children: a systematic review.

PubMed

Kelly, M; McCarthy, S; O'Sullivan, R; Shiely, F; Larkin, P; Brenner, M; Sahm, L J

2016-08-01

Background Fever is one of the most common childhood symptoms and accounts for numerous consultations with healthcare practitioners. It causes much anxiety amongst parents as many struggle with managing a feverish child and find it difficult to assess fever severity. Over- and under-dosing of antipyretics has been reported. Aim of the review The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children. Method A systematic search was conducted in ten bibliographic databases from database inception to June 2014. Citation lists of studies and consultation with experts were used as secondary sources to identify further relevant studies. Titles and abstracts were screened for inclusion according to pre-defined inclusion and exclusion criteria. Quantitative studies using a questionnaire were analysed using narrative synthesis. Qualitative studies with a semi-structured interview or focus group methodology were analysed thematically. Results Of the 1565 studies which were screened for inclusion in the review, the final review comprised of 14 studies (three qualitative and 11 quantitative). Three categories emerged from the narrative synthesis of quantitative studies: (i) parental practices; (ii) knowledge; (iii) expectations and information seeking. A further three analytical themes emerged from the qualitative studies: (i) control; (ii) impact on family; (iii) experiences. Conclusion Our review identifies the multifaceted nature of the factors which impact on how parents manage fever and febrile illness in children. A coherent approach to the management of fever and febrile illness needs to be implemented so a consistent message is communicated to parents. Healthcare professionals including pharmacists regularly advise parents on fever management. Information given to parents needs to be timely, consistent and accurate so that inappropriate fever management is reduced or eliminated. This review is a necessary foundation for further research in this area.

Health and demographic surveillance systems: contributing to an understanding of the dynamics in migration and health

PubMed Central

Gerritsen, Annette; Bocquier, Philippe; White, Michael; Mbacké, Cheikh; Alam, Nurul; Beguy, Donatien; Odhiambo, Frank; Sacoor, Charfudin; Phuc, Ho Dang; Punpuing, Sureeporn; Collinson, Mark A.

2013-01-01

Background Migration is difficult to measure because it is highly repeatable. Health and Demographic Surveillance Systems (HDSSs) provide a unique opportunity to study migration as multiple episodes of migration are captured over time. A conceptual framework is needed to show the public health implications of migration. Objective/design Research conducted in seven HDSS centres [International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network], published in a peer-reviewed volume in 2009, is summarised focussing on the age–sex profile of migrants, the relation between migration and livelihoods, and the impact of migration on health. This illustrates the conceptual structure of the implications of migration. The next phase is described, the Multi-centre Analysis of the Dynamics In Migration And Health (MADIMAH) project, consisting of workshops focussed on preparing data and conducting the analyses for comparative studies amongst HDSS centres in Africa and Asia. The focus here is on the (standardisation of) determinants of migration and the impact of migration on adult mortality. Results The findings in the volume showed a relatively regular age structure for migration among all HDSS centres. Furthermore, migration generally contributes to improved living conditions at the place of origin. However, there are potential negative consequences of migration on health. It was concluded that there is a need to compare results from multiple centres using uniform covariate definitions as well as longitudinal analysis techniques. This was the starting point for the on-going MADIMAH initiative, which has increased capacity at the participating HDSS centres to produce the required datasets and conduct the analyses. Conclusions HDSS centres brought together within INDEPTH Network have already provided strong evidence of the potential negative consequences of migration on health, which contrast with the beneficial impacts of migration on livelihoods. Future comparative evidence using standardised tools will help design policies for mitigating the negative effects, and enhancing the positive effects, of migration on health. PMID:23849188

Translating medical effectiveness research into policy: lessons from the California Health Benefits Review Program.

PubMed

Coffman, Janet M; Hong, Mi-Kyung; Aubry, Wade M; Luft, Harold S; Yelin, Edward

2009-12-01

Legislatures and executive branch agencies in the United States and other nations are increasingly using reviews of the medical literature to inform health policy decisions. To clarify these efforts to give policymakers evidence of medical effectiveness, this article discusses the California Health Benefits Review Program (CHBRP). This program, based at the University of California, analyzes the medical effectiveness of health insurance benefit mandate bills for the California legislature, as well as their impact on cost and public health. This article is based on the authors' experience reviewing benefit mandate bills for CHBRP and findings from evaluations of the program. General observations are illustrated with examples from CHBRP's reports. Information about efforts to incorporate evidence into health policymaking in other states and nations was obtained through a review of published literature. CHBRP produces reports that California legislators, legislative staff, and other major stakeholders value and use routinely in deliberations about benefit mandate bills. Where available, the program relies on previously published meta-analyses and systematic reviews to streamline the review of the medical literature. Faculty and staff responsible for the medical effectiveness sections of CHBRP's reports have learned four major lessons over the course of the program's six-year history: the need to (1) recognize the limitations of the medical literature, (2) anticipate the need to inform legislators about the complexity of evidence, (3) have realistic expectations regarding the impact of medical effectiveness reviews, and (4) understand the consequences of the reactive nature of mandated benefit reviews. CHBRP has demonstrated that it is possible to produce useful reviews of the medical literature within the tight time constraints of the legislative process. The program's reports have provided state legislators with independent analyses that allow them to move beyond sifting through conflicting information from proponents and opponents to consider difficult policy choices and their implications.

20 CFR 641.560 - May grantees place participants directly into unsubsidized employment?

Code of Federal Regulations, 2010 CFR

2010-04-01

... grantees to work closely with participants to develop an IEP and assessment to determine what training the... difficult to place to provide them with the services necessary to develop the skills needed for job...

Preschool Age Populations Research Needs - NCS Dietary Assessment Literature Review

Cancer.gov

Drawing conclusions from the validation studies on preschool populations discussed in this chapter is difficult because of the varied study designs, the relatively small study populations, and limited number of studies on each dietary assessment method.

Probiotics in Preventing Recurrent Urinary Tract Infections in Women: A Literature Review.

PubMed

Chisholm, Annie H

2015-01-01

Increasing antibiotic resistance and increasing resistance to commonly used antibiotics makes treatment and prevention of urinary tract infections difficult. Although more research is needed, probiotics should be considered a useful and safe alternative to antibiotics.

Environmental Accounting Using Emergy: Evaluation of Minnesota

EPA Science Inventory

Often questions related to environmental policy are difficult to resolve successfully, because robust solutions depend on accurately balancing the needs of both human and natural systems. To accomplish this end the socioeconomic and environmental effects of policies must be expre...

Say "Yes" to Metric Measure.

ERIC Educational Resources Information Center

Monroe, Eula Ewing; Nelson, Marvin N.

2000-01-01

Provides a brief history of the metric system. Discusses the infrequent use of the metric measurement system in the United States, why conversion from the customary system to the metric system is difficult, and the need for change. (Contains 14 resources.) (ASK)

Books to Help Kids Deal with Difficult Times, I.

ERIC Educational Resources Information Center

Klein, Norma

1987-01-01

An author of books for young adults discusses the need for realism in adolescent literature as a means of helping teenagers to cope with real problems and describes her most recent book, which deals with euthanasia. (CLB)

Adolescent Populations Research Needs - NCS Dietary Assessment Literature Review

Cancer.gov

As with school age children, it is difficult to make conclusions about the validity of available dietary assessment instruments for adolescents because of the differences in instruments, research designs, reference methods, and populations in the validation literature.

Data Quality Screening Using Trend Charts. October, 2011 v.2

EPA Pesticide Factsheets

Frequently the quality of results from data collection activities are difficult to assess due to the number of reports one needs to review and digest. These reviews may take place months after data collection is conducted.

Vulvar Cancer

MedlinePlus

... sex painful and difficult. If found early, vulvar cancer has a high cure rate and the treatment options involve less surgery. ... people may also need radiation therapy. When vulvar cancer is found and treated early, the cure rate is over 90%. The key to a ...

The Challenge of Interdisciplinary Research.

ERIC Educational Resources Information Center

Locker, Kitty O.

1994-01-01

Discusses what makes business communication research interdisciplinary and why interdisciplinary research is difficult yet desirable. Details the value of interdisciplinary concepts, methods, and perspectives. Notes how business communication research might be made interdisciplinary and points out the need for tolerance in interdisciplinary…

The Design and Development of a Web-Interface for the Software Engineering Automation System

DTIC Science & Technology

2001-09-01

application on the Internet. 14. SUBJECT TERMS Computer Aided Prototyping, Real Time Systems , Java 15. NUMBER OF...difficult. Developing the entire system only to find it does not meet the customer’s needs is a tremendous waste of time. Real - time systems need a...software prototyping is an iterative software development methodology utilized to improve the analysis and design of real - time systems [2]. One

Problems in Determining School District Need for Hurd Aid and Alternatives to the Revenue Shortfall Approach for Determining Need.

ERIC Educational Resources Information Center

Curley, John R.

In New York State there is an uneven distribution of wealth and an unequal tax burden among the small city school districts. Because of the tax limits and rising costs for goods and services, many of these school districts have found it difficult to support their educational programs without emergency aid from the state. Such aid is frequently…

Military Personnel: Actions Needed to Address Sexual Assaults of Male Servicemembers

DTIC Science & Technology

2015-03-01

providers we interviewed said that these same traditional gender stereotypes can make it particularly difficult for males to report that they were...develop a plan for using its data to inform program development; systematically evaluate whether male victims have gender - specific medical and...not systematically identified whether male victims have any gender -specific needs. DOD sexual assault policies specify that care be sensitive to gender

Open Source ERP Applications: A Reality Check for Their Possible Adoption and Use in Teaching Business Process Integration

ERIC Educational Resources Information Center

Huynh, Minh; Pinto, Ivan

2010-01-01

For years, there has been a need for teaching students about business process integration. The use of ERP systems has been proposed as a mechanism to meet this need. Yet, in the midst of a recent economic crisis, it is difficult to find funding for the acquisition and implementation of an ERP system for teaching purpose. While it is recognized…

The Development of an Assessment Tool for the Bereavement Needs of People with Learning Disabilities

ERIC Educational Resources Information Center

Blackman, Noelle

2008-01-01

Many people with learning disabilities are not well supported when someone close to them dies. This can make it an even more difficult time than it needs to be. This is about how staff can help people with learning disabilities when somebody close to them dies. It has some questions for them to think about. It is well documented that the death of…

A new and standardized method to sample and analyse vitreous samples by the Cellient automated cell block system.

PubMed

Van Ginderdeuren, Rita; Van Calster, Joachim; Stalmans, Peter; Van den Oord, Joost

2014-08-01

In this prospective study, a universal protocol for sampling and analysing vitreous material was investigated. Vitreous biopsies are difficult to handle because of the paucity of cells and the gelatinous structure of the vitreous. Histopathological analysis of the vitreous is useful in difficult uveitis cases to differentiate uveitis from lymphoma or infection and to define the type of cellular reaction. Hundred consecutive vitreous samples were analysed with the Cellient tissue processor (Hologic). This machine is a fully automated processor starting from a specified container with PreservCyt (fixative fluid) with cells to paraffin. Cytology was compared with fixatives Cytolyt (contains a mucolyticum) and PreservCyt. Routine histochemical and immunostainings were evaluated. In 92% of the cases, sufficient material was found for diagnosis. In 14%, a Cytolyt wash was necessary to prevent clotting of the tubes in the Cellient due to the viscosity of the sample. In 23%, the diagnosis was an acute inflammation (presence of granulocytes); in 33%, chronic active inflammation (presence of T lymphocytes); in 33%, low-grade inflammation (presence of CD68 cells, without T lymphocytes); and in 3%, a malignant process. A standardized protocol for sampling and handling vitreous biopsies, fixing in PreservCyt and processing by the Cellient gives a satisfactory result in morphology, number of cells and possibility of immuno-histochemical stainings. The diagnosis can be established or confirmed in more than 90% of cases. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Advanced Simulation and Computing Fiscal Year 14 Implementation Plan, Rev. 0.5

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

Meisner, Robert; McCoy, Michel; Archer, Bill

2013-09-11

The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the surety and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational enhancements to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities andmore » computational resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balanced resource, including technical staff, hardware, simulation software, and computer science solutions. In its first decade, the ASC strategy focused on demonstrating simulation capabilities of unprecedented scale in three spatial dimensions. In its second decade, ASC is now focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), quantify critical margins and uncertainties, and resolve increasingly difficult analyses needed for the SSP. Moreover, ASC’s business model is integrated and focused on requirements-driven products that address long-standing technical questions related to enhanced predictive capability in the simulation tools.« less

Non-steroidal anti-inflammatory drugs and antibiotics prescription trends at a central west bank hospital.

PubMed

Tayem, Yasin I; Qubaja, Marwan M; Shraim, Riyad K; Taha, Omar B; Abu Shkheidem, Imadeddin A; Ibrahim, Murad A

2013-11-01

We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine. This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians' knowledge of the rational prescription of these agents.

Maternal complications in a geographically challenging and hard to reach district of Bangladesh: a qualitative study

PubMed Central

Biswas, Animesh; Dalal, Koustuv; Abdullah, Abu Sayeed Md; Gifford, Mervyn; Halim, MA

2016-01-01

Background: Maternal complications contribute to maternal deaths in developing countries. Bangladesh still has a high prevalence of maternal mortality, which is often preventable. There are some geographically challenging and hard to reach rural districts in Bangladesh and it is difficult to get information about maternal complications in these areas. In this study, we examined the community lay knowledge of possible pregnancy complications. We also examined the common practices associated with complications and we discuss the challenges for the community. Methods: The study was conducted in Moulvibazar of north east Bangladesh, a geographically challenged, difficult to reach district. Qualitative methods were used to collect the information. Pregnant women, mothers who had recently delivered, their guardians and traditional birth attendants participated in focus group discussions. Additionally, in-depth interviews were conducted with the family members. Thematic analyses were performed. Results: The study revealed that there is a lack of knowledge of maternal complications. In the majority of cases, the mothers did not receive proper treatment for maternal complications.   There are significant challenges that these rural societies need to address: problems of ignorance, traditional myths and family restrictions on seeking better treatment. Moreover, traditional birth attendants and village doctors also have an important role in assuring appropriate, effective and timely treatment. Conclusions:  The rural community lacks adequate knowledge on maternal complications.  Reduction of the societal barriers including barriers within the family can improve overall practices. Moreover, dissemination of adequate information to the traditional birth attendant and village doctors may improve the overall situation, which would eventually help to reduce maternal deaths. PMID:27853517

Parent's and children's judgements about their outdoor environment in relation to children's injuries.

PubMed

Moussa, Amiri; Hamid, Soori; Elaheh, Ainy; Reza, Mehmandar Mohammad

2013-12-01

To explore views of parents and childrens on safety and danger of outdoor environment, and implications for outdoor activities after school. The cross-sectional study was carried out in 2009-2010 and comprised 952 students between 7 and 9 years of age and 942 parents in Tehran. Two separate pre-designed questionnaires were used for children and parent. Data was analysed using SPSS 16. The response rate of parents' and children's questionnaires regarding to socioeconomic deprivation were 830 (88.1%) from 942 and 932 (97.9%) from 952 respectively. Overall, 224 (27.0%) parents believed that the outdoor places children usually play after school are 'not dangerous" while 612 (65.7%) children believed that the streets they usually play on are safe. Besides, 238 (28.7%) parents believed that the volume of traffic in their neighbourhood makes crossing roads difficult. There was no significant difference between the responses of less and more economically deprived parents relating to the presence of dangerous places near their home within less than 5-minute walk (66.8% vs. 62.5%), on general safety describing their areas as being 'not dangerous' (25.6% vs. 18.8%) and who did not regard the volume of traffic in local environment as making crossing the road difficult (55.3% vs. 53.4%). Many parents judged their outdoor places where their children played to be safe. If we assume that the physical environment of the more deprived areas is a more hazardous place than the less deprived areas, it suggests that the risk perception among the more deprived parents is poorer. If so, there is a need to be better informed about hazards in outdoor environment.

Organization of marine phenology data in support of planning and conservation in ocean and coastal ecosystems

USGS Publications Warehouse

Thomas, Kathryn A.; Fornwall, Mark D.; Weltzin, Jake F.; Griffis, R.B.

2014-01-01

Among the many effects of climate change is its influence on the phenology of biota. In marine and coastal ecosystems, phenological shifts have been documented for multiple life forms; however, biological data related to marine species' phenology remain difficult to access and is under-used. We conducted an assessment of potential sources of biological data for marine species and their availability for use in phenological analyses and assessments. Our evaluations showed that data potentially related to understanding marine species' phenology are available through online resources of governmental, academic, and non-governmental organizations, but appropriate datasets are often difficult to discover and access, presenting opportunities for scientific infrastructure improvement. The developing Federal Marine Data Architecture when fully implemented will improve data flow and standardization for marine data within major federal repositories and provide an archival repository for collaborating academic and public data contributors. Another opportunity, largely untapped, is the engagement of citizen scientists in standardized collection of marine phenology data and contribution of these data to established data flows. Use of metadata with marine phenology related keywords could improve discovery and access to appropriate datasets. When data originators choose to self-publish, publication of research datasets with a digital object identifier, linked to metadata, will also improve subsequent discovery and access. Phenological changes in the marine environment will affect human economics, food systems, and recreation. No one source of data will be sufficient to understand these changes. The collective attention of marine data collectors is needed—whether with an agency, an educational institution, or a citizen scientist group—toward adopting the data management processes and standards needed to ensure availability of sufficient and useable marine data to understand marine phenology.

Doctors' learning experiences in end-of-life care - a focus group study from nursing homes.

PubMed

Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase

2017-01-31

Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life care. The aim of this study was to explore newly qualified doctors' learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped and transcribed verbatim. Data were analysed with systematic text condensation. Lave & Wenger's theory about situated learning was used to support interpretations, focusing on how the newly qualified doctors gained knowledge of end-of-life care through participation in the nursing home's community of practice. Newly qualified doctors explained how nursing home staff's attitudes taught them how calmness and acceptance could be more appropriate than heroic action when death was imminent. Shifting focus from disease treatment to symptom relief was demanding, yet participants comprehended situations where death could even be welcomed. Through challenging dialogues dealing with family members' hope and trust, they learnt how to adjust words and decisions according to family and patient's life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position of being in charge while also needing surveillance. There is a considerable potential for training doctors in EOL care in nursing homes, which can be developed and integrated in medical education. This practice based learning arena offers newly qualified doctors close interaction with patients, relatives and nurses, teaching them to perform difficult dialogues, individualize medical decisions and balance their professional role in an interdisciplinary setting.

Coalescent: an open-source and scalable framework for exact calculations in coalescent theory

PubMed Central

2012-01-01

Background Currently, there is no open-source, cross-platform and scalable framework for coalescent analysis in population genetics. There is no scalable GUI based user application either. Such a framework and application would not only drive the creation of more complex and realistic models but also make them truly accessible. Results As a first attempt, we built a framework and user application for the domain of exact calculations in coalescent analysis. The framework provides an API with the concepts of model, data, statistic, phylogeny, gene tree and recursion. Infinite-alleles and infinite-sites models are considered. It defines pluggable computations such as counting and listing all the ancestral configurations and genealogies and computing the exact probability of data. It can visualize a gene tree, trace and visualize the internals of the recursion algorithm for further improvement and attach dynamically a number of output processors. The user application defines jobs in a plug-in like manner so that they can be activated, deactivated, installed or uninstalled on demand. Multiple jobs can be run and their inputs edited. Job inputs are persisted across restarts and running jobs can be cancelled where applicable. Conclusions Coalescent theory plays an increasingly important role in analysing molecular population genetic data. Models involved are mathematically difficult and computationally challenging. An open-source, scalable framework that lets users immediately take advantage of the progress made by others will enable exploration of yet more difficult and realistic models. As models become more complex and mathematically less tractable, the need for an integrated computational approach is obvious. Object oriented designs, though has upfront costs, are practical now and can provide such an integrated approach. PMID:23033878

What are families most grateful for after receiving palliative care? Content analysis of written documents received: a chance to improve the quality of care.

PubMed

Aparicio, María; Centeno, Carlos; Carrasco, José Miguel; Barbosa, Antonio; Arantzamendi, María

2017-09-06

Family members are involved in the care of palliative patients at home and therefore, should be viewed as important sources of information to help clinicians better understand the quality palliative care service patients receive. The objective of the study was to analyse what is valued most by family carers undergoing bereavement of a palliative care home service in order to identify factors of quality of care. Qualitative exploratory study based on documentary analysis. Content analysis of 77 gratitude documents received over 8 years by a palliative home service in Odivelas, near Lisbon (Portugal) was undertaken, through an inductive approach and using investigator triangulation. Frequency of distinct categories was quantitatively defined. Three different content categories emerged from the analysis: a) Recognition of the care received and the value of particular aspects of care within recognised difficult situations included aspects such as kindness, listening, attention to the family, empathy, closeness, affection and the therapeutic relationships established (63/77 documents); b) Family recognition of the achievements of the palliative care team (29/77) indicated as relief from suffering for the patient and family, opportunity of dying at home, help in facing difficult situations, improvement in quality of life and wellbeing, and feeling of serenity during bereavement; c) Messages of support (45/77) related to the need of resources provided. The relational component emerges as an underlying key aspect of family carers' experience with palliative care home service. Family carers show spontaneous gratitude for the professionalism and humanity found in palliative care. The relational component of care emerges as key to achieve a high quality care experience of palliative care homes service, and could be one indicator of quality of palliative care.

Non-Steroidal Anti-Inflammatory Drugs and Antibiotics Prescription Trends at a Central West Bank Hospital

PubMed Central

Tayem, Yasin I.; Qubaja, Marwan M.; Shraim, Riyad K.; Taha, Omar B.; Abu Shkheidem, Imadeddin A.; Ibrahim, Murad A.

2013-01-01

Objectives: We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine. Methods: This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Results: Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. Conclusion: These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians’ knowledge of the rational prescription of these agents. PMID:24273668

[Perioperative onset of sarcoidosis : Rare differential diagnosis of a difficult airway].

PubMed

Jansen, G; Nowak, A

2018-05-01

Sarcoidosis is a rare multisystemic chronic inflammatory condition. Typically, there is a big discrepancy between the patient's subjectively perceived symptoms and the presence of clinical signs. Due to the high number of potential sites of onset (e. g. larynx, lungs, heart, liver, kidneys) the affected organs may show functional restrictions that are relevant for decisions related to anesthesia. Therefore, an anesthetists working in a clinical setting should be familiar with the special needs of this patient collective. This article describes the onset of sarcoidosis in a case of an unexpected difficult airway.

The appropriate use of technology (particularly in medical problems of the elderly).

PubMed

Gilbert, F I

1990-09-01

Technology, particularly "high" technology, with little solid data, is often blamed for much of our increasing cost of health care. Politics and emotions are poor substitutes for accurate information needed for rational solutions. By targeting the desired outcome and studying the process needed to reach the outcome, we can make better decisions. The methods of designing, conducting and funding the studies needed to answer the difficult questions posed by the use of high technology in the elderly are available. Do we have the wisdom to use them?

Do They Need More or Deserve Less?

ERIC Educational Resources Information Center

Forster, Bill

1997-01-01

Prison educators are caught between public opinion swings from retribution to rehabilitation, from security to human rights. Even prisoners do not see education as a tool for future employment. The link between education and recidivism rates is difficult to establish. (SK)

Needing a Second Chance.

ERIC Educational Resources Information Center

Hargrave, Lou Ann

2003-01-01

Temporary Assistance to Needy Families offers welfare recipients a second chance for success. How good that chance will be depends on the next version of the legislation. If its work requirements do not allow for sufficient training, achieving success may be more difficult. (Author/JOW)

The quality of reporting methods and results of cost-effectiveness analyses in Spain: a methodological systematic review.

PubMed

Catalá-López, Ferrán; Ridao, Manuel; Alonso-Arroyo, Adolfo; García-Altés, Anna; Cameron, Chris; González-Bermejo, Diana; Aleixandre-Benavent, Rafael; Bernal-Delgado, Enrique; Peiró, Salvador; Tabarés-Seisdedos, Rafael; Hutton, Brian

2016-01-07

Cost-effectiveness analysis has been recognized as an important tool to determine the efficiency of healthcare interventions and services. There is a need for evaluating the reporting of methods and results of cost-effectiveness analyses and establishing their validity. We describe and examine reporting characteristics of methods and results of cost-effectiveness analyses conducted in Spain during more than two decades. A methodological systematic review was conducted with the information obtained through an updated literature review in PubMed and complementary databases (e.g. Scopus, ISI Web of Science, National Health Service Economic Evaluation Database (NHS EED) and Health Technology Assessment (HTA) databases from Centre for Reviews and Dissemination (CRD), Índice Médico Español (IME) Índice Bibliográfico Español en Ciencias de la Salud (IBECS)). We identified cost-effectiveness analyses conducted in Spain that used quality-adjusted life years (QALYs) as outcome measures (period 1989-December 2014). Two reviewers independently extracted the data from each paper. The data were analysed descriptively. In total, 223 studies were included. Very few studies (10; 4.5 %) reported working from a protocol. Most studies (200; 89.7 %) were simulation models and included a median of 1000 patients. Only 105 (47.1 %) studies presented an adequate description of the characteristics of the target population. Most study interventions were categorized as therapeutic (189; 84.8 %) and nearly half (111; 49.8 %) considered an active alternative as the comparator. Effectiveness of data was derived from a single study in 87 (39.0 %) reports, and only few (40; 17.9 %) used evidence synthesis-based estimates. Few studies (42; 18.8 %) reported a full description of methods for QALY calculation. The majority of the studies (147; 65.9 %) reported that the study intervention produced "more costs and more QALYs" than the comparator. Most studies (200; 89.7 %) reported favourable conclusions. Main funding source was the private for-profit sector (135; 60.5 %). Conflicts of interest were not disclosed in 88 (39.5 %) studies. This methodological review reflects that reporting of several important aspects of methods and results are frequently missing in published cost-effectiveness analyses. Without full and transparent reporting of how studies were designed and conducted, it is difficult to assess the validity of study findings and conclusions.

The effects of sexism, psychological distress, and difficult sexual situations on U.S. women's sexual risk behaviors.

PubMed

Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B

2011-10-01

Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women's HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms-psychological distress and difficult sexual situations-that link social discrimination to women's sexual risk for HIV.

Persistently obese youth: interactions between parenting styles and feeding practices with child temperament.

PubMed

Boles, Richard E; Reiter-Purtill, Jennifer; Zeller, Meg H

2013-12-01

To assess the interaction of parent and child characteristics with feeding practices and mealtime functioning. Longitudinal, predictive study comparing baseline characteristics with follow-up assessments. The caregivers of 52 persistently obese youth and 32 nonoverweight comparison youth completed measurements of child temperament, parental feeding practices, parenting styles, and interactions during mealtimes. Adolescents with persistent obesity were significantly more likely to be parented using problematic feeding practices when parents also reported difficult child temperaments. Additionally, adolescents with persistent obesity and difficult temperaments were significantly more likely to have lower levels of positive mealtime interactions. Persistently obese youth are at increased risk for problematic parental feeding practices and mealtime functioning, particularly when youth are described as having difficult temperaments. These results indicate that further investigations are needed to better understand the mechanisms linking parent and child characteristics with health-related behaviors for adolescents with obesity.

Persistently Obese Youth: Interactions Between Parenting Styles and Feeding Practices With Child Temperament

PubMed Central

Boles, Richard E.; Reiter-Purtill, Jennifer; Zeller, Meg H.

2013-01-01

Objective To assess the interaction of parent and child characteristics with feeding practices and mealtime functioning. Design Longitudinal, predictive study comparing baseline characteristics with follow-up assessments. Participants The caregivers of 52 persistently obese youth and 32 nonoverweight comparison youth completed measurements of child temperament, parental feeding practices, parenting styles, and interactions during mealtimes. Results Adolescents with persistent obesity were significantly more likely to be parented using problematic feeding practices when parents also reported difficult child temperaments. Additionally, adolescents with persistent obesity and difficult temperaments were significantly more likely to have lower levels of positive mealtime interactions. Conclusion Persistently obese youth are at increased risk for problematic parental feeding practices and mealtime functioning, particularly when youth are described as having difficult temperaments. These results indicate that further investigations are needed to better understand the mechanisms linking parent and child characteristics with health-related behaviors for adolescents with obesity. PMID:23884967

The Effects of Sexism, Psychological Distress, and Difficult Sexual Situations on U.S. Women’s Sexual Risk Behaviors

PubMed Central

Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B.

2011-01-01

Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women’s HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms ---psychological distress and difficult sexual situations --- that link social discrimination to women’s sexual risk for HIV. PMID:22010804

A Protein Chimera Strategy Supports Production of a Model "Difficult-to-Express" Recombinant Target.

PubMed

Hussain, Hirra; Fisher, David I; Roth, Robert G; Abbott, W Mark; Carballo-Amador, Manuel Alejandro; Warwicker, Jim; Dickson, Alan J

2018-06-22

Due in part to the needs of the biopharmaceutical industry, there has been an increased drive to generate high quality recombinant proteins in large amounts. However, achieving high yields can be a challenge as the novelty and increased complexity of new targets often makes them 'difficult-to-express'. This study aimed to define the molecular features that restrict the production of a model 'difficult-to-express' recombinant protein, Tissue Inhibitor Metalloproteinase-3 (TIMP-3). Building from experimental data, computational approaches were used to rationalise the re-design of this recombinant target to generate a chimera with enhanced secretion. The results highlight the importance of early identification of unfavourable sequence attributes, enabling the generation of engineered protein forms that bypass 'secretory' bottlenecks and result in efficient recombinant protein production. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The Time and Effort in Taking Care for Children with Profound Intellectual and Multiple Disabilities: A Study on Care Load and Support

ERIC Educational Resources Information Center

Tadema, Annemarie C.; Vlaskamp, Carla

2010-01-01

Raising children with profound intellectual and multiple disabilities is considered to be extremely difficult for parents, but figures on the content and amount of time needed for the caring task of parents is lacking. Data on what the caring task actually means (in terms of amount of time and type of task) is needed to be able to understand the…

Investigation of Field-Collected Data Using Diffuse and Specular, Forward and Reverse Radiative Transfer Models

DTIC Science & Technology

2015-03-26

Statement It is very difficult to obtain and use spectral BRDFs due to aforementioned reasons, while the need to accurately model the spectral and...Lambertian and MERL nickel-shaped BRDF models (Butler, 2014:1- 3 10), suggesting that accurate BRDFs are required to account for the significance of... BRDF -based radiative transfer models . Research Objectives /Hypotheses The need to represent the spectral reflected radiance of a material using

Improving Demonstration Using Better Interaction Techniques

DTIC Science & Technology

1997-01-14

Programming by demonstration (PBD) can be used to create tools and methods that eliminate the need to learn difficult computer languages. Gamut is a...do this, Gamut uses advanced interaction techniques that make it easier for a software author to express all needed aspects of one’s program. These...techniques include a simplified way to demonstrate new examples, called nudges, and a way to highlight objects to show they are important. Also, Gamut

Eagle Hats Mini-Technology Integration Experiment (TIE)

DTIC Science & Technology

2005-07-01

exceptionally well on the sample datasets which indicates that we may be seeing a ceiling effect . More study is needed using more difficult datasets in order to...performance. Once again, further analysis is needed to understand what we are seeing in part because of ceiling effects . Another possible problem is that...them would produce radically different policy implementations – clearly an undesirable outcome . This is a simple guilt-by-association model and our

Diagnosing ion-beam targets, data acquisition, reactor conditions

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

Mendel, Jr., C. W.

1982-01-01

The final lecture will discuss diagnostics of the target. These are very difficult because of the short times, small spatial extent, and extreme values of temperature and pressure. Diagnostics for temperature, density profile, and neutron production will be discussed. A few minutes will be devoted to data acquisition needs. The lecture will end with a discussion of current areas where improvements are needed and future diagnostics that will be required for reactor conditions.

Experiences of mental health nursing staff working with voice hearers in an acute setting: An interpretive phenomenological approach.

PubMed

McMullan, E; Gupta, A; Collins, S C

2018-04-01

WHAT IS KNOWN ON THE SUBJECT?: Community mental health staff and their service users have reported mixed views on the importance of talking about the content of voices. Community staff have reported feeling that they do not have the skills to explore voice content and worry about making things worse. Voice hearers experiencing extreme distress due to the content of their voices can access support through acute inpatient mental health services. No previous studies have focused on the experiences of staff who nurse voice hearers at a time of acute distress. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: MHNs and HSWs working with voice hearers in acute distress report feeling powerless and helpless, as they feel that they cannot lessen the distress experienced by the voice hearer. Despite these difficult feelings, staff report finding ways of coping, including using structured tools to help make sense of their service users' voice-hearing experiences and accessing reflective practice forums. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Due to the current context of increased acuity and limited resources in acute services, there may be a need to further protect time for staff to access reflective practice groups and supervision forums to help them manage the difficult feelings arising from their work with voice hearers. Introduction Mental health nursing (MHN) staff in acute settings work with voice hearers at times of crises when they experience high levels of distress. Previous research has focused on community mental health staff's experiences and their service users views on exploring the content of voices. No studies have explored this from an acute mental health service perspective. Aim This study therefore sought to explore the experiences of staff working with voice hearers in an acute mental health service. Method Due to the exploratory nature of the research, a qualitative design was chosen. Three MHNs and five healthcare support workers (HSWs) were interviewed. The data were analysed using Interpretative Phenomenological Analysis. Results A group analysis elicited three master themes: "It's quite scary really, not unlike a horror movie;" "I can only influence what's in front of me;" and "Just chipping away". Discussion Staff working with voice hearers in acute settings experience feelings of powerlessness and helplessness, as they feel unable to reduce the distress experienced by voice hearers in their care. Staff employ coping strategies to help manage these difficult feelings, including using structured tools in their work with voice hearers and attending reflective practice forums. Implications for Practice Acute mental health services may need to protect time for staff to access regular reflective practice and other supervision forums to help manage their feelings of powerlessness and helplessness arising from their work with voice hearers. © 2017 John Wiley & Sons Ltd.

Training as a Tool for Community Development: 25 Years of Experience in Sparsely Populated Rural Areas in Cuenca, Spain

ERIC Educational Resources Information Center

Diaz-Puente, Jose M.; Moreno, Francisco Jose Gallego; Zamorano, Ramon

2012-01-01

Training is a key tool for community development processes in rural areas. This training is made difficult by the characteristics of the rural areas and their population. Furthermore, the methods used by traditional training bodies are not adapted to the peculiarities of these areas. This article analyses the training methodology used by the…

Robust Prediction of Hydraulic Roughness

DTIC Science & Technology

2011-03-01

Manning’s n were required as input for further hydraulic analyses with HEC - RAS . HYDROCAL was applied to compare different estimates of resistance... River Restoration Science Synthesis (NRRSS) demonstrated that, in 2007, river and stream restoration projects and funding were at an all time high...behavior makes this parameter very difficult to quan- tify repeatedly and accurately. A fundamental concept of hydraulic theory in the context of river

Innovations in Defense Acquisition: Asymmetric Information, Mechanism Design and Prediction Markets

DTIC Science & Technology

2011-02-03

Analyst at the Center for Naval Analyses and as an Economist at Rand Corporation . Dr. Arkes’ research interests include Posttraumatic Stress Disorder...this report are those of the author and do not reflect the official policy position of the Navy, the Department of Defense, or the Federal Government ...43  Lessons Learned: Implementing prediction markets is difficult ................ 43  12.  Conclusion: The

Publication Bias Currently Makes an Accurate Estimate of the Benefits of Enrichment Programs Difficult: A Postmortem of Two Meta-Analyses Using Statistical Power Analysis

ERIC Educational Resources Information Center

Warne, Russell T.

2016-01-01

Recently Kim (2016) published a meta-analysis on the effects of enrichment programs for gifted students. She found that these programs produced substantial effects for academic achievement (g = 0.96) and socioemotional outcomes (g = 0.55). However, given current theory and empirical research these estimates of the benefits of enrichment programs…

Conceptual Change about Outer Space: How Does Informal Training Combined with Formal Teaching Affect Seventh Graders' Understanding of Gravitation?

ERIC Educational Resources Information Center

Frappart, Sören; Frède, Valérie

2016-01-01

Concepts relating to outer space are difficult to grasp because we lack direct experience of this environment. We analysed students' understanding of gravitation on Earth and beyond by testing the effect of training on it. In a pretest (T1), 28 seventh graders answered a questionnaire about space concepts. They all then underwent the same formal…

Longitudinal Analyses of a Hierarchical Model of Peer Social Competence for Preschool Children: Structural Fidelity and External Correlates

ERIC Educational Resources Information Center

Shin, Nana; Vaughn, Brian E.; Kim, Mina; Krzysik, Lisa; Bost, Kelly K.; McBride, Brent; Santos, Antonio J.; Peceguina, Ines; Coppola, Gabrielle

2011-01-01

Achieving consensus on the definition and measurement of social competence (SC) for preschool children has proven difficult in the developmental sciences. We tested a hierarchical model in which SC is assumed to be a second-order latent variable by using longitudinal data (N = 345). We also tested the degree to which peer SC at Time 1 predicted…

Phylogenomic evidence for a recent and rapid radiation of lizards in the Patagonian Liolaemus fitzingerii species group.

PubMed

Grummer, Jared A; Morando, Mariana M; Avila, Luciano J; Sites, Jack W; Leaché, Adam D

2018-08-01

Rapid evolutionary radiations are difficult to resolve because divergence events are nearly synchronous and gene flow among nascent species can be high, resulting in a phylogenetic "bush". Large datasets composed of sequence loci from across the genome can potentially help resolve some of these difficult phylogenetic problems. A suitable test case is the Liolaemus fitzingerii species group of lizards, which includes twelve species that are broadly distributed in Argentinean Patagonia. The species in the group have had a complex evolutionary history that has led to high morphological variation and unstable taxonomy. We generated a sequence capture dataset for 28 ingroup individuals of 580 nuclear loci, alongside a mitogenomic dataset, to infer phylogenetic relationships among species in this group. Relationships among species were generally weakly supported with the nuclear data, and along with an inferred age of ∼2.6 million years old, indicate either rapid evolution, hybridization, incomplete lineage sorting, non-informative data, or a combination thereof. We inferred a signal of mito-nuclear discordance, indicating potential hybridization between L. melanops and L. martorii, and phylogenetic network analyses provided support for 5 reticulation events among species. Phasing the nuclear loci did not provide additional insight into relationships or suspected patterns of hybridization. Only one clade, composed of L. camarones, L. fitzingerii, and L. xanthoviridis was recovered across all analyses. Genomic datasets provide molecular systematists with new opportunities to resolve difficult phylogenetic problems, yet the lack of phylogenetic resolution in Patagonian Liolaemus is biologically meaningful and indicative of a recent and rapid evolutionary radiation. The phylogenetic relationships of the Liolaemus fitzingerii group may be best modeled as a reticulated network instead of a bifurcating phylogeny. Copyright © 2018 Elsevier Inc. All rights reserved.

Patients with difficult intubation may need referral to sleep clinics.

PubMed

Chung, Frances; Yegneswaran, Balaji; Herrera, Francisco; Shenderey, Alex; Shapiro, Colin M

2008-09-01

Upper airway abnormalities carry the risk of obstructive sleep apnea (OSA) and difficult tracheal intubations. Both conditions contribute to significant clinical problems and have increased perioperative morbidity and mortality. We hypothesized that patients who presented with difficult intubation would have a very high prevalence of OSA and that those with unexpected difficult intubation may require referral to sleep clinics for polysomnography (PSG). Patients classified as a grade 4 Cormack and Lehane on direct laryngoscopic view, and who required more than two attempts for successful endotracheal intubation, were referred to the study by consultant anesthesiologists at four hospitals. Apnea-hypopnea index (AHI) data and postoperative events were collected. Patients with AHI >5/h were considered positive for OSA. Clinical and PSG variables were compared using t-tests and chi(2) test. Over a 20-mo period, 84 patients with a difficult intubation were referred into the study. Thirty-three patients agreed to participate. Sixty-six percent (22 of 33) had OSA (AHI >5/h). Of the 22 OSA patients, 10 patients (64%) had mild OSA (AHI 5-15), 6 (18%) had moderate OSA (AHI >15/h), and 6 (18%) had severe OSA (AHI >30/h). Of the 33 patients, 11 patients (33%) were recommended for continuous positive airway pressure treatment. Between the OSA group and the non-OSA group, there were significant differences in gender, neck size, and the quality of sleep, but there were no significant differences in age and body mass index. Sixty-six percent of patients with unexpected difficult intubation who consented to undergo a sleep study were diagnosed with OSA by PSG. Patients with difficult intubation are at high risk for OSA and should be screened for signs and symptoms of sleep apnea. Screening for OSA should be considered by referral to a sleep clinic for PSG.

DECISION-MAKING USING EXISTING DATA

EPA Science Inventory

Decision-makers need information on cumulative and aggregate stressors as well as clear information on where problems are likely to occur in the future in order to prioritize risk management actions. The most prevasive and difficult to assess changes are the result of regional-s...

Education and Ideology

ERIC Educational Resources Information Center

Ivashevskii, S. L.

2011-01-01

These days politicians and scientists refer to the importance of consensus for understanding society's new ideological need, but the path to consensus is difficult. Political differences account for the wide variety of approaches to the problem. The United Russia Party supports a "conservative European" ideology, while the Communist…

EPIDEMIOLOGY IN RISK ASSESSMENT FOR REGULATORY POLICY

EPA Science Inventory

Epidemiology and risk assessment have several of the features needed to make the difficult decisions required in setting standards for levels of toxic agents in the workplace and environment. hey differ in their aims, orientation, and time scale. While the distribution of disease...

Sourcing Life Cycle Inventory Data

EPA Science Inventory

The collection and validation of quality lifecycle inventory (LCI) data can be the most difficult and time-consuming aspect of developing a life cycle assessment (LCA). Large amounts of process and production data are needed to complete the LCI. For many studies, the LCA analyst ...

n-Alcohol/Water Partition Coefficients for Decachlorobiphenyl (PCB 209)

EPA Science Inventory

Measurements of n-octanol/water partition coefficients (Kow) for highly hydrophobic chemicals are extremely difficult and are rarely made, in part due to the large volumes of water typically needed to quantify these compounds in the aqueous phase. An extrapolation approach using ...

Does Your Parent Handbook Need a Makeover?

ERIC Educational Resources Information Center

Rafanello, Donna

2006-01-01

In a survey, directors and teachers rated parent relations ("difficult parents"), parent communication, and effective communication among their greatest frustrations and most important training topics. Readers named discipline, nutrition, toilet training, and kindergarten readiness among the most common concerns expressed by parents regarding…

Double Bind: Primary Caregivers of Children with Special Health Care Needs and Their Access to Leave Benefits

PubMed Central

Chung, Paul J.; Garfield, Craig F.; Elliott, Marc N.; Vestal, Katherine D.; Klein, David J.; Schuster, Mark A.

2013-01-01

Objective Family leave benefits are a critical tool allowing parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). Methods We conducted telephone interviews with three successive cohorts of employed parents of CSHCN, randomly sampled from a California children’s hospital. At Wave 1 (November 2003 to January 2004) we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006) we conducted 396 parent interviews. At Wave 3 (November 2007 to December 2008) we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses, using wave indicators and sample weights. Results Parents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs. 82%, P<.001), access to paid leave outside of sick leave/vacation (41% vs. 51%, P<.05), and FMLA eligibility (2890025; vs. 44%, P<.001) than secondary caregivers. Part-time employment and female gender largely explained two of the three associations between more childcare responsibilities and less access to leave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child’s illness and to report being unable to miss work when they needed to. Conclusions Due in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve health for CSHCN and their families. PMID:23477748

Review and comparison of quality standards, guidelines and regulations for laboratories.

PubMed

Datema, Tjeerd A M; Oskam, Linda; Klatser, Paul R

2012-01-01

The variety and number of laboratory quality standards, guidelines and regulations (hereafter: quality documents) makes it difficult to choose the most suitable one for establishing and maintaining a laboratory quality management system. There is a need to compare the characteristics, suitability and applicability of quality documents in view of the increasing efforts to introduce quality management in laboratories, especially in clinical diagnostic laboratories in low income and middle income countries. This may provide valuable insights for policy makers developing national laboratory policies, and for laboratory managers and quality officers in choosing the most appropriate quality document for upgrading their laboratories. We reviewed the history of quality document development and then selected a subset based on their current use. We analysed these documents following a framework for comparison of quality documents that was adapted from the Clinical Laboratory Standards Institute guideline GP26 Quality management system model for clinical laboratory services . Differences were identified between national and international, and non-clinical and clinical quality documents. The most salient findings were the absence of provisions on occurrence management and customer service in almost all non-clinical quality documents, a low number of safety requirements aimed at protecting laboratory personnel in international quality documents and no requirements regarding ethical behaviour in almost all quality documents. Each laboratory needs to investigate whether national regulatory standards are present. These are preferred as they most closely suit the needs of laboratories in the country. A laboratory should always use both a standard and a guideline: a standard sums up the requirements to a quality management system, a guideline describes how quality management can be integrated in the laboratory processes.

Perception, consequences, communication, and strategies for handling fatigue in persons with rheumatoid arthritis of working age--a focus group study.

PubMed

Feldthusen, Caroline; Björk, Mathilda; Forsblad-d'Elia, Helena; Mannerkorpi, Kaisa

2013-05-01

The aim of this study was to describe how persons with rheumatoid arthritis (RA) of working age experience and handle their fatigue in everyday life. Six focus group discussions were conducted focusing on experiences of fatigue in 25 persons with RA (19 women, 6 men), aged 20-60 years. The discussions were recorded, transcribed verbatim, and analyzed according to qualitative content analysis. The analyses resulted in four categories. (1) Perception of fatigue: Fatigue was experienced different from normal tiredness, unpredictable, and overwhelming. It was associated with negative emotions, changed self-image, and fears. Feelings of frustration and shame were central when the persons were forced to omit valued life activities. (2) Consequences due to fatigue: The fatigue caused changes in cognitive ability, ability to act, and overall activity pattern where the increased need for rest and sleep caused an imbalance in daily life. The participants struggled not to let the fatigue interfere with work. The fatigue also brought negative consequences for their significant others. (3) Communicating fatigue: Fatigue was difficult to gain understanding for, and the participants adjusted their communication accordingly; it was important to keep up appearances. During medical consultation, fatigue was perceived as a factor not given much consideration, and the participants expressed taking responsibility for managing their fatigue symptoms themselves. (4) Strategies to handle fatigue: Strategies comprised conscious self-care, mental strategies, planning, and prioritizing. Fatigue caused considerable health problems for persons with RA of working age: negative emotions, imbalance in daily life due to increased need for rest, and difficulties gaining understanding. This draws attention to the importance of developing new modes of care to address fatigue in RA. Person-centered care to improve balance in life may be one approach needing further investigations.

'The ones that turn up are the ones that are responsible': Key stakeholders perspectives on liquor accords.

PubMed

Curtis, Ashlee; Miller, Peter; Droste, Nicolas; McFarlane, Emma; Martino, Florentine; Palmer, Darren

2016-05-01

Liquor accords were introduced as an intervention to reduce alcohol-related harm in and around licensed venues. There have been very few evaluations of the accords, made all the more difficult given the multitude of measures that are often implemented under their banner. This study provides perspectives on the effectiveness of the liquor accords from key stakeholders who were involved in the strategy. In-depth interviews were conducted with 97 key stakeholders as part of a larger study, of which 46 spoke about the effectiveness of liquor accords. Responses were analysed using thematic analysis. Stakeholders reported the greatest benefit of liquor accords to be their ability to improve communication. Many stakeholders recognised the need for mandatory attendance and discussed whether the accords are a waste of time of resources. Stakeholders did not generally view liquor accords as effective means of reducing alcohol-related harm. There was a lack of positive feedback about liquor accords provided by stakeholders, indicating a clear need to better understand the role of liquor accords, and what they aim to achieve. Responsive regulation theory suggests that the dual roles of communication and intervention are confused, leading to some of the inherent problems with accords. The role and aims of liquor accords need to be clearly defined. The findings suggest that separating the communication and regulatory functions from accords will lead to a clearer role for accords, and interventions and regulation might be better placed in the hands of regulators and enforcement. [Curtis A, Miller P, Droste N, McFarlane E, Martino F, Palmer D. 'The ones that turn up are the ones that are responsible': Key stakeholders perspectives on liquor accords. Drug Alcohol Rev 2016;35:273-279]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

Are the investments in national HIV monitoring and evaluation systems paying off?

PubMed

Peersman, Greet; Rugg, Deborah; Erkkola, Taavi; Kiwango, Eva; Yang, Ju

2009-12-01

Concerted efforts and substantial financial resources have gone toward strengthening national monitoring and evaluation (M&E) systems for HIV programs. This article explores whether those investments have made a difference in terms of data availability, quality and use for assessing whether national programs are on track to achieve the 2015 Millennium Development Goal (MDG) of halting and reversing the HIV epidemic. Descriptive analyses, including trends, of the National Composite Policy Index data and M&E expenditures were conducted. Global Fund funding continuation assessments were reviewed for concerns related to M&E. Availability of population-based survey data was assessed. There has been a marked increase in the number of countries where the prerequisites for a national HIV M&E system are in place and in human resources devoted to M&E at the national level. However, crucial gaps remain in M&E capacity, available M&E data, and data quality assurance. The extent to which data are used for program improvement is difficult to ascertain. There is a potential threat to sustaining the current momentum in M&E as governments have not committed long-term funding and current M&E-related expenditures are below the minimum needed to make M&E systems fully functional. There is evidence of rapid scale-up of basic HIV M&E systems, but if M&E is to fulfil its role in guiding optimal use of resources, ensuring effective HIV programs and providing evidence of progress toward the Millennium Development Goal of halting and reversing the HIV epidemic, essential data gaps will need to be filled urgently and those data will need to be used to guide decision making.

What it means to be an adult child of a person with dementia

PubMed Central

Kjällman-Alm, Annika; Norbergh, Karl-Gustaf; Hellzen, Ove

2013-01-01

The prevalence of dementia as a disease has increased worldwide with advancing age and growing population numbers, affecting whole families. However, most previous research does not separate the spouses or cohabitants from the adult children, but instead regards all next of kin involved in the everyday care of the person suffering from dementia as caregivers. This has made it difficult to find previous research regarding what it means to be an adult child of a person with dementia, and as such, the aim of this study is to explore that topic. The method used was narrative interviews analysed using phenomenological hermeneutics. Our comprehensive understanding showed that to be an adult child of a person with dementia means being burdened with the responsibility to act on behalf of the diseased parent despite a deep sense of grief and loss, which leads to frustration and despondence. The adult children's existence and reality are threatened not only by the loss of the parent but also by the possibility that one day they too may inherit the disease. This could be compared to a psychic crisis, which is defined as a situation that leads to radical changes in the afflicted person's relationship to life and reality, or, simply, “an upset in a steady state”. The findings suggest that adult children of people with dementia are in need of support for a substantial period of time in order to adapt to the fact that they have lost a parent who is still alive. They also need information about the disease and the process of diagnosis and treatment to feel more a part of the process, as well as understand the behavior and needs of their parent. PMID:24152431

Risk assessment of vector-borne diseases for public health governance.

PubMed

Sedda, L; Morley, D W; Braks, M A H; De Simone, L; Benz, D; Rogers, D J

2014-12-01

In the context of public health, risk governance (or risk analysis) is a framework for the assessment and subsequent management and/or control of the danger posed by an identified disease threat. Generic frameworks in which to carry out risk assessment have been developed by various agencies. These include monitoring, data collection, statistical analysis and dissemination. Due to the inherent complexity of disease systems, however, the generic approach must be modified for individual, disease-specific risk assessment frameworks. The analysis was based on the review of the current risk assessments of vector-borne diseases adopted by the main Public Health organisations (OIE, WHO, ECDC, FAO, CDC etc…). Literature, legislation and statistical assessment of the risk analysis frameworks. This review outlines the need for the development of a general public health risk assessment method for vector-borne diseases, in order to guarantee that sufficient information is gathered to apply robust models of risk assessment. Stochastic (especially spatial) methods, often in Bayesian frameworks are now gaining prominence in standard risk assessment procedures because of their ability to assess accurately model uncertainties. Risk assessment needs to be addressed quantitatively wherever possible, and submitted with its quality assessment in order to enable successful public health measures to be adopted. In terms of current practice, often a series of different models and analyses are applied to the same problem, with results and outcomes that are difficult to compare because of the unknown model and data uncertainties. Therefore, the risk assessment areas in need of further research are identified in this article. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Waiting for a kidney transplant: the experience of patients with end-stage renal disease in South Korea.

PubMed

Chong, Hye Jin; Kim, Hyun Kyung; Kim, Sung Reul; Lee, Sik

2016-04-01

To explore the experiences of Korean patients with end-stage renal disease awaiting kidney transplantation. The need for kidney transplantation has increased worldwide, while the number of kidney donors has not increased commensurately. This mismatch is a serious issue in South Korea. Prolonged waits for transplantation may cause physical and psychosocial issues and lead to poor outcomes. Nevertheless, the experience of waiting for kidney transplantation in South Korea has never been explored in depth. A qualitative descriptive design was used. The participants were eight patients diagnosed with end-stage renal disease on the waiting list for kidney transplantation in South Korea. Data were collected through individual in-depth interviews. All conversations during interviews were recorded and transcribed verbatim. Transcribed data were analysed using conventional content analysis. The experience of waiting for kidney transplantation consisted of six categories: (1) the light at the end of the tunnel, (2) being on call without any promise, (3) a tough tug of war between excitement and frustration, (4) doubts in the complexity, (5) A companion on the hard journey and (6) getting ready for D-day. Kidney transplantation candidates experience psychosocial difficulties and concerns while waiting for long periods of time without any assurance of resolution. Systematic education and psychosocial support from health care professionals and family members help patients get through what they describe as a difficult journey. Comprehensive management programs for kidney transplantation candidates are needed. Health care professionals need to recognise the psychosocial concerns of patients awaiting kidney transplantation. Clinicians should provide patients with information and support throughout the waiting period. © 2016 John Wiley & Sons Ltd.

Automating the evaluation of flood damages: methodology and potential gains

NASA Astrophysics Data System (ADS)

Eleutério, Julian; Martinez, Edgar Daniel

2010-05-01

The evaluation of flood damage potential consists of three main steps: assessing and processing data, combining data and calculating potential damages. The first step consists of modelling hazard and assessing vulnerability. In general, this step of the evaluation demands more time and investments than the others. The second step of the evaluation consists of combining spatial data on hazard with spatial data on vulnerability. Geographic Information System (GIS) is a fundamental tool in the realization of this step. GIS software allows the simultaneous analysis of spatial and matrix data. The third step of the evaluation consists of calculating potential damages by means of damage-functions or contingent analysis. All steps demand time and expertise. However, the last two steps must be realized several times when comparing different management scenarios. In addition, uncertainty analysis and sensitivity test are made during the second and third steps of the evaluation. The feasibility of these steps could be relevant in the choice of the extent of the evaluation. Low feasibility could lead to choosing not to evaluate uncertainty or to limit the number of scenario comparisons. Several computer models have been developed over time in order to evaluate the flood risk. GIS software is largely used to realise flood risk analysis. The software is used to combine and process different types of data, and to visualise the risk and the evaluation results. The main advantages of using a GIS in these analyses are: the possibility of "easily" realising the analyses several times, in order to compare different scenarios and study uncertainty; the generation of datasets which could be used any time in future to support territorial decision making; the possibility of adding information over time to update the dataset and make other analyses. However, these analyses require personnel specialisation and time. The use of GIS software to evaluate the flood risk requires personnel with a double professional specialisation. The professional should be proficient in GIS software and in flood damage analysis (which is already a multidisciplinary field). Great effort is necessary in order to correctly evaluate flood damages, and the updating and the improvement of the evaluation over time become a difficult task. The automation of this process should bring great advance in flood management studies over time, especially for public utilities. This study has two specific objectives: (1) show the entire process of automation of the second and third steps of flood damage evaluations; and (2) analyse the induced potential gains in terms of time and expertise needed in the analysis. A programming language is used within GIS software in order to automate hazard and vulnerability data combination and potential damages calculation. We discuss the overall process of flood damage evaluation. The main result of this study is a computational tool which allows significant operational gains on flood loss analyses. We quantify these gains by means of a hypothetical example. The tool significantly reduces the time of analysis and the needs for expertise. An indirect gain is that sensitivity and cost-benefit analyses can be more easily realized.

Is mental heal care in women's prisons adequate?

PubMed

Sims, Joyce

Some individuals and groups, find it difficult to seek healthcare, including prisoners. This group is recognised as needing input but are often difficult to engage, yet failure to meet their needs can be devastating for the health of individuals and have wider implications on society. This qualitative study explored the perceptions of female prisoners who had not yet consulted the mental health team. I aimed to find out what support these women seek out while in prison, what difficulties they encountered in getting psychological help and whether they avoided statutory mental health services. Participants revealed during semistructured interviews that continuing to have a caring role for their families encouraged them to feel more positive and supported. Support from family members, specialist prison officers and the multi-faith centre staff team was also highly regarded. Some of the participants reported experiencing problems self-referring to prison mental health services, for example when transferred to a new prison. They identified the prison application system and inreach administrative failings as weaknesses, alongside other variables. I found that prisoners did not avoid mental health services and often once settled in the prison, they reconsidered their need for statutory support.

Model-Based Systems

NASA Technical Reports Server (NTRS)

Frisch, Harold P.

2007-01-01

Engineers, who design systems using text specification documents, focus their work upon the completed system to meet Performance, time and budget goals. Consistency and integrity is difficult to maintain within text documents for a single complex system and more difficult to maintain as several systems are combined into higher-level systems, are maintained over decades, and evolve technically and in performance through updates. This system design approach frequently results in major changes during the system integration and test phase, and in time and budget overruns. Engineers who build system specification documents within a model-based systems environment go a step further and aggregate all of the data. They interrelate all of the data to insure consistency and integrity. After the model is constructed, the various system specification documents are prepared, all from the same database. The consistency and integrity of the model is assured, therefore the consistency and integrity of the various specification documents is insured. This article attempts to define model-based systems relative to such an environment. The intent is to expose the complexity of the enabling problem by outlining what is needed, why it is needed and how needs are being addressed by international standards writing teams.

The effects of goal variation on adult physical activity behaviour.

PubMed

Moon, Dal-Hyun; Yun, Joonkoo; McNamee, Jeff

2016-10-01

The purposes of this study were to examine the effects of varying levels of goals on increasing daily steps and the frequency of goal achievement among middle-aged adults. Ninety-six adults participated in a randomised control study. Participants were randomly assigned to five different step goal groups: (1) Easy (n = 19), (2) Medium (n = 19), (3) Difficult (n = 19), (4) Do-your-best (n = 19), and (5) No goal (n = 20) based on previous research. The participants wore a pedometer and were asked to reach a pre-established goal during the experimental period. In order to examine the effectiveness of the goal difficulty, (a) an average number of steps taken by different goal conditions and (b) the number of days meeting the assigned goal were tested. A one-way ANCOVA revealed significant step count differences among goal groups. Post hoc analyses indicated that the change in step count in both the Medium and Difficult goal groups was significantly greater than the remaining groups. However, there was no significant difference between the medium and difficult goal conditions. In addition, a one-way ANOVA indicated that there were no significant differences in the frequency of goal achievement among the Easy, Medium, and Difficult goal groups. Results suggest that when promoting physical activity through increasing step counts, researchers and clinicians should design goals that are specific and challenging.

A cross-sectional study examining the expression of splice variants K-RAS4A and K-RAS4B in advanced non-small-cell lung cancer patients.

PubMed

Aran, Veronica; Masson Domingues, Pedro; Carvalho de Macedo, Fabiane; Moreira de Sousa, Carlos Augusto; Caldas Montella, Tatiane; de Souza Accioly, Maria Theresa; Ferreira, Carlos Gil

2018-02-01

Mammalian cells differently express 4 RAS isoforms: H-RAS, N-RAS, K-RAS4A and K-RAS4B, which are important in promoting oncogenic processes when mutated. In lung cancer, the K-RAS isoform is the most frequently altered RAS protein, being also a difficult therapeutic target. Interestingly, there are two K-RAS splice variants (K-RAS4A and K-RAS4B) and little is known about the role of K-RAS4A. Most studies targeting K-RAS, or analysing it as a prognostic factor, have not taken into account the two isoforms. Consequently, the in-depth investigation of them is needed. The present study analysed 98 specimens from advanced non-small cell lung cancer (NSCLC) adenocarcinoma patients originated from Brazil. The alterations present in K-RAS at the DNA level (Sanger sequencing) as well as the expression of the splicing isoforms at the RNA (qRT-PCR) and protein levels (immunohistochemistry analysis), were evaluated. Possible associations between clinicopathological features and the molecular findings were also investigated. Our results showed that in the non-smoking population, the cancer incidence was higher among women. In contrast, in smokers and former smokers, the incidence was higher among men. Regarding sequencing results, 10.5% of valid samples presented mutations in exon 2, being all wild-type for exon 3, and the most frequently occurring base change was the transversion G → T. Our qRT-PCR and immunohistochemical analysis showed that both, K-RAS4A and K-RAS4B, were differently expressed in NSCLC tumour samples. For example, tumour specimens showed higher K-RAS4A mRNA expression in relation to commercial normal lung control than did K-RAS4B. In addition, K-RAS4B protein expression was frequently stronger than K-RAS4A in the patients analysed. Our results highlight the differential expression of K-RAS4A and K-RAS4B in advanced adenocarcinoma NSCLC patients and underline the need to further clarify the enigma behind their biological significance in various cancer types, including NSCLC. Copyright © 2017 Elsevier B.V. All rights reserved.

Planning of a Demonstration Project for Main Channel Disposal of Dredged Material.

DTIC Science & Technology

1980-07-01

S imon Eng lieerlng Reserch Center Y.. C Colorado State University Fort C.Ilin, Colredo- 0 -d - *-¢ i ,.., . . . FOREWORD This study was...program which identifies data needs, equipment needs and methods for collection and analyses of samples , sampling frequencies and spacing and cost...4.3.1 Data Needs .. ........ ....... 65 4.3.2 Equipment Needs and Methods for Collection and Analyses of Samples . 5 4.3.3 Sampling Frequencies and

Clearly written, easily comprehended? The readability of websites providing information on epilepsy.

PubMed

Brigo, Francesco; Otte, Willem M; Igwe, Stanley C; Tezzon, Frediano; Nardone, Raffaele

2015-03-01

There is a general need for high-quality, easily accessible, and comprehensive health-care information on epilepsy to better inform the general population about this highly stigmatized neurological disorder. The aim of this study was to evaluate the health literacy level of eight popular English-written websites that provide information on epilepsy in quantitative terms of readability. Educational epilepsy material on these websites, including 41 Wikipedia articles, were analyzed for their overall level of readability and the corresponding academic grade level needed to comprehend the published texts on the first reading. The Flesch Reading Ease (FRE) was used to assess ease of comprehension while the Gunning Fog Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Automated Readability Index, and Simple Measure of Gobbledygook scales estimated the corresponding academic grade level needed for comprehension. The average readability of websites yielded results indicative of a difficult-to-fairly-difficult readability level (FRE results: 44.0±8.2), with text readability corresponding to an 11th academic grade level (11.3±1.9). The average FRE score of the Wikipedia articles was indicative of a difficult readability level (25.6±9.5), with the other readability scales yielding results corresponding to a 14th grade level (14.3±1.7). Popular websites providing information on epilepsy, including Wikipedia, often demonstrate a low level of readability. This can be ameliorated by increasing access to clear and concise online information on epilepsy and health in general. Short "basic" summaries targeted to patients and nonmedical users should be added to articles published in specialist websites and Wikipedia to ease readability. Copyright © 2014 Elsevier Inc. All rights reserved.

Communication Skills Training in Ophthalmology: Results of a Needs Assessment and Pilot Training Program.

PubMed

Mishra, Anuradha; Browning, David; Haviland, Miriam J; Jackson, Mary Lou; Luff, Donna; Meyer, Elaine C; Talcott, Katherine; Kloek, Carolyn E

To conduct a needs assessment to identify gaps in communication skills training in ophthalmology residency programs and to use these results to pilot a communication workshop that prepares residents for difficult conversations. A mixed-methods design was used to perform the needs assessment. A pre-and postsurvey was administered to workshop participants. Mass Eye and Ear Infirmary, Harvard Medical School (HMS), Department of Ophthalmology. HMS ophthalmology residents from postgraduate years 2-4 participated in the needs assessment and the workshop. Ophthalmology residency program directors in the United States participated in national needs assessment. Ophthalmology program directors across the United States were queried on their perception of resident communication skills training through an online survey. A targeted needs assessment in the form of a narrative exercise captured resident perspectives on communication in ophthalmology from HMS residents. A group of HMS residents participated in the pilot workshop and a pre- and postsurvey was administered to participants to assess its effectiveness. The survey of program directors yielded a response rate of 40%. Ninety percent of respondents agreed that the communication skills training in their programs could be improved. Fifteen of 24 residents (62%) completed the needs assessment. Qualitative analysis of the narrative material revealed four themes; (1) differing expectations, (2) work role and environment, (3) challenges specific to ophthalmology, and (4) successful strategies adopted. Nine residents participated in the workshop. There was a significant improvement post-workshop in resident reported scores on their ability to manage their emotions during difficult conversations (p = 0.03). There is an opportunity to improve communication skills training in ophthalmology residency through formalized curriculum. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Forming isolated brown dwarfs by turbulent fragmentation

NASA Astrophysics Data System (ADS)

Lomax, O.; Whitworth, A. P.; Hubber, D. A.

2016-05-01

We use Smoothed Particle Hydrodynamics to explore the circumstances under which an isolated very low mass pre-stellar core can be formed by colliding turbulent flows and collapse to form a brown dwarf. Our simulations suggest that the flows need not be very fast, but do need to be very strongly convergent, I.e. the gas must flow in at comparable speeds from all sides, which seems rather unlikely. We therefore revisit the object Oph-B11, which André et al. have identified as a pre-stellar core with mass between ˜0.020 M⊙ and ˜0.030 M⊙. We re-analyse the observations using a Markov-chain Monte Carlo method that allows us (I) to include the uncertainties on the distance, temperature and dust mass opacity, and (II) to consider different Bayesian prior distributions of the mass. We estimate that the posterior probability that Oph-B11 has a mass below the hydrogen-burning limit at ˜0.075 M⊙, is between 0.66 and 0.86 . We conclude that, if Oph-B11 is destined to collapse, it probably will form a brown dwarf. However, the flows required to trigger this appear to be so contrived that it is difficult to envisage this being the only way, or even a major way, of forming isolated brown dwarfs. Moreover, Oph-B11 could easily be a transient, bouncing, prolate core, seen end-on; there could, indeed should, be many such objects masquerading as very low mass pre-stellar cores.

Current status, uncertainty and future needs in soil organic carbon monitoring.

PubMed

Jandl, Robert; Rodeghiero, Mirco; Martinez, Cristina; Cotrufo, M Francesca; Bampa, Francesca; van Wesemael, Bas; Harrison, Robert B; Guerrini, Iraê Amaral; Richter, Daniel Deb; Rustad, Lindsey; Lorenz, Klaus; Chabbi, Abad; Miglietta, Franco

2014-01-15

Increasing human demands on soil-derived ecosystem services requires reliable data on global soil resources for sustainable development. The soil organic carbon (SOC) pool is a key indicator of soil quality as it affects essential biological, chemical and physical soil functions such as nutrient cycling, pesticide and water retention, and soil structure maintenance. However, information on the SOC pool, and its temporal and spatial dynamics is unbalanced. Even in well-studied regions with a pronounced interest in environmental issues information on soil carbon (C) is inconsistent. Several activities for the compilation of global soil C data are under way. However, different approaches for soil sampling and chemical analyses make even regional comparisons highly uncertain. Often, the procedures used so far have not allowed the reliable estimation of the total SOC pool, partly because the available knowledge is focused on not clearly defined upper soil horizons and the contribution of subsoil to SOC stocks has been less considered. Even more difficult is quantifying SOC pool changes over time. SOC consists of variable amounts of labile and recalcitrant molecules of plant, and microbial and animal origin that are often operationally defined. A comprehensively active soil expert community needs to agree on protocols of soil surveying and lab procedures towards reliable SOC pool estimates. Already established long-term ecological research sites, where SOC changes are quantified and the underlying mechanisms are investigated, are potentially the backbones for regional, national, and international SOC monitoring programs. © 2013.

The Law of Communicable Diseases Act and disclosure to sexual partners among HIV-positive youth.

PubMed

Christiansen, Monica; Lalos, Ann; Johansson, Eva E

2008-12-01

In Sweden, human immunodeficiency virus (HIV) is included among the venereal diseases covered by the Law of Communicable Diseases Act. HIV-positive (HIV(+)) people are required to inform their sexual partners about their infection and adopt safe sex behaviours. However, it is unclear how the law is perceived. This study explores how HIV(+) youth in Sweden perceive the law, handle their sexuality and disclose their HIV diagnosis to sexual partners. Ten HIV(+) women and men between 17 and 24 years of age were recruited from three different HIV infection clinics. These participants were interviewed in depth. The interviews were tape-recorded, transcribed verbatim and analysed according to a grounded theory approach. The core category-cultured to take responsibility-illuminates the informants' double-edged experiences regarding the law and how they handle disclosure to sexual partners. The legislation implies both support and burden for these HIV(+) youth; they feel that they have a great deal of responsibility, sometimes more than they can handle. 'Switch off lust', 'balancing lust, fear and obedience' and 'switch off the disease' are strategies that describe how the informants manage sexuality and disclosure. Young HIV(+) people have a difficult time informing partners of their HIV diagnosis and discussing safe sex strategies. These are challenges that health care providers need to take seriously. HIV(+) youth need better communication strategies to negotiate safer sex. Staff with extended education on sexuality should be a part of HIV health care.

Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective.

PubMed

Wu, Shu-Mei; Lee, Hui-Ling; Yeh, Mei-Yu; Che, Hui-Lian

2014-12-01

To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement. Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women. Qualitative, in-depth interview A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data. Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust. The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions. Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions. © 2014 John Wiley & Sons Ltd.

The Law of Communicable Diseases Act and disclosure to sexual partners among HIV-positive youth

PubMed Central

Christiansen, Monica; Lalos, Ann; Johansson, Eva. E.

2008-01-01

In Sweden, human immunodeficiency virus (HIV) is included among the venereal diseases covered by the Law of Communicable Diseases Act. HIV-positive (HIV+) people are required to inform their sexual partners about their infection and adopt safe sex behaviours. However, it is unclear how the law is perceived. This study explores how HIV+ youth in Sweden perceive the law, handle their sexuality and disclose their HIV diagnosis to sexual partners. Ten HIV+ women and men between 17 and 24 years of age were recruited from three different HIV infection clinics. These participants were interviewed in depth. The interviews were tape-recorded, transcribed verbatim and analysed according to a grounded theory approach. The core category—cultured to take responsibility—illuminates the informants’ double-edged experiences regarding the law and how they handle disclosure to sexual partners. The legislation implies both support and burden for these HIV+ youth; they feel that they have a great deal of responsibility, sometimes more than they can handle. ‘Switch off lust’, ‘balancing lust, fear and obedience’ and ‘switch off the disease’ are strategies that describe how the informants manage sexuality and disclosure. Young HIV+ people have a difficult time informing partners of their HIV diagnosis and discussing safe sex strategies. These are challenges that health care providers need to take seriously. HIV+ youth need better communication strategies to negotiate safer sex. Staff with extended education on sexuality should be a part of HIV health care. PMID:22639678

Protein requirements in male adolescent soccer players.

PubMed

Boisseau, N; Vermorel, M; Rance, M; Duché, P; Patureau-Mirand, P

2007-05-01

Few investigations have studied protein metabolism in children and adolescent athletes which makes difficult the assessment of daily recommended dietary protein allowances in this population. The problematic in paediatric competitors is the determination of additional protein needs resulting from intensive physical training. The aim of this investigation was to determine protein requirement in 14-year-old male adolescent soccer players. Healthy male adolescent soccer players (N = 11, 13.8 +/- 0.1 year) participated in a short term repeated nitrogen balance study. Diets were designed to provide proteins at three levels: 1.4, 1.2 and 1.0 g protein per kg body weight (BW). Nutrient and energy intakes were assessed from 4 day food records corresponding to 4 day training periods during 3 weeks. Urine was collected during four consecutive days and analysed for nitrogen. The nitrogen balances were calculated from mean daily protein intake, mean urinary nitrogen excretion and estimated faecal and integumental nitrogen losses. Nitrogen balance increased with both protein intake and energy balance. At energy equilibrium, the daily protein intake needed to balance nitrogen losses was 1.04 g kg(-1) day(-1). This corresponds to an estimated average requirement (EAR) for protein of 1.20 g kg(-1) day(-1) and a recommended daily allowance (RDA) of 1.40 g kg(-1) day(-1) assuming a daily nitrogen deposition of 11 mg kg(-1). The results of the present study suggest that the protein requirements of 14-year-old male athletes are above the RDA for non-active male adolescents.

Cyclosporine treatment of severe Hidradenitis suppurativa--A case series.

PubMed

Anderson, Marianne D; Zauli, Stefania; Bettoli, Vincenzo; Boer, Jurr; Jemec, Gregor B E

2016-01-01

Hidradenitis suppurativa (HS) is an overlooked but common disease severely affecting both genders. HS is generally perceived as difficult to treat and although a number of treatments are available, the need for more effective treatment is apparent. Cyclosporine A (CsA) has been suggested as an effective treatment in four smaller case series. It was therefore decided to review a larger series of cases, reporting all outcomes in order to provide a less biased base for evaluating the potential of CsA for use in HS. An exploratory retrospective review of case notes was performed at three departments of dermatology with a special interest in HS, where HS had been treated with CsA in the period 2009-2012. In total, 18 HS patients treated with CsA were identified and analysed and 50% reported some benefit. All patients had previously been treated with multiple various other modalities. This is an exploratory retrospective review with a limited number of patients. This retrospective review found some effect of CsA in the recalcitrant cases studied, mainly reported as "slight improvement". This may be due to a number of factors which may have overestimated (e.g., concommitant therapy) or underestimated (e.g., case selection of recalcitrant cases) the effect, and indicates the need for prospective evaluation of the claims. The present data provide a basis for power calculations in future studies investigating the potential for treating HS with CsA in a randomised controlled trial.

Resource allocation in public health practice: a national survey of local public health officials.

PubMed

Baum, Nancy M; DesRoches, Catherine; Campbell, Eric G; Goold, Susan Dorr

2011-01-01

The purpose of this study was to gain an empirical understanding of the types of allocation decisions local health officials (LHOs) make and the factors that influence those allocation decisions. We conducted a national survey of LHOs in the United States in 2008 to 2009. The sample was stratified by the size of the population served by the department. We merged our data with data from the 2008 National Association of County and City Health Officials Profile survey. Descriptive statistics were generated using weighted data. Our final sample size was 608 respondents, with an average of 10 years experience. The LHOs reported little shifting of resources among population groups but greater capacity to redirect staffing time. Less than half of LHOs reported using economic analyses or conducting needs assessments when setting priorities. Having sole provider status in a community strongly influenced LHOs' allocation decisions. In addition, the effectiveness of activities, previous budget allocations, and input from boards of health were influential factors in allocation decisions. Public expectations were moderately to very influential, but direct public input had a low impact on allocation decisions. Survey findings provide a clearer understanding of how LHOs fulfill their obligations as stewards of public health resources and ensure effective activities and access to needed services. It may be useful to assess the value of more structured allocation methods (eg, decision frameworks) in the allocation process. Expanding opportunities for public engagement in priority setting may also be valuable for difficult allocation decisions.