Practical Challenges of Systems Thinking and Modeling in Public Health

PubMed Central

Trochim, William M.; Cabrera, Derek A.; Milstein, Bobby; Gallagher, Richard S.; Leischow, Scott J.

2006-01-01

Objectives. Awareness of and support for systems thinking and modeling in the public health field are growing, yet there are many practical challenges to implementation. We sought to identify and describe these challenges from the perspectives of practicing public health professionals. Methods. A systems-based methodology, concept mapping, was used in a study of 133 participants from 2 systems-based public health initiatives (the Initiative for the Study and Implementation of Systems and the Syndemics Prevention Network). This method identified 100 key challenges to implementation of systems thinking and modeling in public health work. Results. The project resulted in a map identifying 8 categories of challenges and the dynamic interactions among them. Conclusions. Implementation by public health professionals of the 8 simple rules we derived from the clusters in the map identified here will help to address challenges and improve the organization of systems that protect the public’s health. PMID:16449581

Environmental decision support systems (EDSS) development - Challenges and best practices

Treesearch

B. S. McIntosh; J. C. Ascough II; S. Chen; J. Chew; S. Cuddy; A. Elmahdi; D. Haase; J. Harou; D. Hepting; A. J. Jakeman; A. Kassahun; S. Lautenbach; K. Matthews; W. Merritt; N. W. T. Quinn; I. Rodriguez-Roda; S. Sieber; M. Stavenga; A. Sulis; J. Ticehurst; M. J. Twery; M. Volk; M. Wrobel; H. van Delden; S. El-Sawah; A. Rizzoli; A. Voinov

2011-01-01

Despite the perceived value of DSS in informing environmental and natural resource management, DSS tools often fail to be adopted by intended end users. By drawing together the experience of a global group of EDSS developers, we have identified and assessed key challenges in EDSS development and offer recommendations to resolve them. Challenges related to engaging end...

Reverberating Echoes: Challenging Teacher Candidates to Tell and Learn from Entwined Narrations of Canadian History

ERIC Educational Resources Information Center

Den Heyer, Kent; Abbott, Laurence

2011-01-01

A key challenge confronting teacher educators is to help their students identify perspectives that depart from dominant historical narratives of a nation-state's development so as to potentially derive alternative meanings of shared pasts from marginalized perspectives. In this article, we examine the nature of this challenge both as a theoretical…

Challenges of standardized continuous quality improvement programs in community pharmacies: the case of SafetyNET-Rx.

PubMed

Boyle, Todd A; MacKinnon, Neil J; Mahaffey, Thomas; Duggan, Kellie; Dow, Natalie

2012-01-01

Research on continuous quality improvement (CQI) in community pharmacies lags in comparison to service, manufacturing, and various health care sectors. As a result, very little is known about the challenges community pharmacies face when implementing CQI programs in general, let alone the challenges of implementing a standardized and technologically sophisticated one. This research identifies the initial challenges of implementing a standardized CQI program in community pharmacies and how such challenges were addressed by pharmacy staff. Through qualitative interviews, a multisite study of the SafetyNET-Rx CQI program involving community pharmacies in Nova Scotia, Canada, was performed to identify such challenges. Interviews were conducted with the CQI facilitator (ie, staff pharmacist or technician) in 55 community pharmacies that adopted the SafetyNET-Rx program. Of these 55 pharmacies, 25 were part of large national corporate chains, 22 were part of banner chains, and 8 were independent pharmacies. A total of 10 different corporate chains and banners were represented among the 55 pharmacies. Thematic content analysis using well-established coding procedures was used to explore the interview data and elicit the key challenges faced. Six major challenges were identified, specifically finding time to report, having all pharmacy staff involved in quality-related event (QRE) reporting, reporting apprehensiveness, changing staff relationships, meeting to discuss QREs, and accepting the online technology. Challenges were addressed in a number of ways including developing a manual-online hybrid reporting system, managers paying staff to meet after hours, and pharmacy managers showing visible commitment to QRE reporting and learning. This research identifies key challenges to implementing CQI programs in community pharmacies and also provides a starting point for future research relating to how the challenges of QRE reporting and learning in community pharmacies change over time. Copyright © 2012 Elsevier Inc. All rights reserved.

Standoff Human Identification Using Body Shape

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

Matzner, Shari; Heredia-Langner, Alejandro; Amidan, Brett G.

2015-09-01

The ability to identify individuals is a key component of maintaining safety and security in public spaces and around critical infrastructure. Monitoring an open space is challenging because individuals must be identified and re-identified from a standoff distance nonintrusively, making methods like fingerprinting and even facial recognition impractical. We propose using body shape features as a means for identification from standoff sensing, either complementing other identifiers or as an alternative. An important challenge in monitoring open spaces is reconstructing identifying features when only a partial observation is available, because of the view-angle limitations and occlusion or subject pose changes. Tomore » address this challenge, we investigated the minimum number of features required for a high probability of correct identification, and we developed models for predicting a key body feature—height—from a limited set of observed features. We found that any set of nine randomly selected body measurements was sufficient to correctly identify an individual in a dataset of 4426 subjects. For predicting height, anthropometric measures were investigated for correlation with height. Their correlation coefficients and associated linear models were reported. These results—a sufficient number of features for identification and height prediction from a single feature—contribute to developing systems for standoff identification when views of a subject are limited.« less

Identifying priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India: a qualitative inquiry

PubMed Central

Chamania, Shobha; Potokar, Tom; Ivers, Rebecca

2018-01-01

Objectives This study aimed to identify priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India. Design Qualitative inquiry; data were collected through semistructured in-depth interviews and focus group discussions. Setting Nine sites in urban and rural settings across India, through primary, secondary and tertiary health facilities. Participants Healthcare providers, key informants, burns survivors and/or their carers. Results Participants acknowledged the challenges of burns care and recovery, and identified the need for prolonged rehabilitation. Challenges identified included poor communication between healthcare providers and survivors, limited rehabilitation services, difficulties with transportation to health facility and high cost associated with burns care. Burns survivors and healthcare providers identified the stigma attached with burns as the biggest challenge within the healthcare system, as well as in the community. Systems barriers (eg, limited infrastructure and human resources), lack of economic and social support, and poor understanding of recovery and rehabilitation were identified as major barriers to recovery. Conclusions Though further research is needed for addressing gaps in data, strengthening of health systems can enable providers to address issues such as developing/providing, protocols, capacity building, effective coordination between key organisations and referral networks. PMID:29523568

Advancing antimicrobial stewardship: Summary of the 2015 CIDSC Report.

PubMed

Khan, F; Arthur, J; Maidment, L; Blue, D

2016-11-03

Antimicrobial resistance (AMR) is recognized as an important global public health concern that has a cross-cutting impact on human health, animal health, food and agriculture and the environment. The Communicable and Infectious Disease Steering Committee (CIDSC) of the Pan-Canadian Public Health Network (PHN) created a Task Group on Antimicrobial Stewardship to look at this issue from a Canadian perspective. To summarize the key findings of the Task Group Report that identified core components of antimicrobial stewardship programs, best practices, key challenges, gaps and recommendations to advance stewardship across jurisdictions. Search strategies were developed to identify scientific literature, grey literature and relevant websites on antimicrobial stewardship. The information was reviewed and based on this evidence, expert opinion and consensus-building, the Task Group identified core components, best practices, key challenges and gaps and developed recommendations to advance stewardship in Canada. The four components of a promising antimicrobial stewardship initiative were: leadership, interventions, monitoring/evaluation and future research. Best practices include a multi-sectoral/multipronged approach involving a wide range of stakeholders at the national, provincial/territorial, local and health care organizational levels. Key challenges and gaps identified were: the success and sustainability of stewardship undertakings require appropriate and sustained resourcing and expertise; there is limited evidence about how to effectively implement treatment guidance; and there is a challenge in ensuring accessibility, standardization and consistency of use among professionals. ​: Recommendations to the CIDSC about how to advance stewardship across jurisdictions included the following: institute a national infrastructure; develop best practices to implement stewardship programs; develop education and promote awareness; establish consistent evidence-based guidance, resources, tools and training; mandate the incorporation of stewardship education; develop audit and feedback tools; establish benchmarks and performance targets for stewardship; and conduct timely evaluation of stewardship programs. Findings of this report will inform a more systematic approach to addressing antimicrobial stewardship Canada-wide.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

PubMed

Petersen, Inge; Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-06-01

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Ethical challenges within Veterans Administration healthcare facilities: perspectives of managers, clinicians, patients, and ethics committee chairpersons.

PubMed

Foglia, Mary Beth; Pearlman, Robert A; Bottrell, Melissa; Altemose, Jane K; Fox, Ellen

2009-04-01

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions.

Tobacco commerce on the internet: a threat to comprehensive tobacco control.

PubMed

Cohen, J E; Sarabia, V; Ashley, M J

2001-12-01

Although internet use continues to increase and e-commerce sales are expected to exceed US$1 trillion by the end of 2001, there have been few assessments in the literature regarding the implications of this medium for tobacco control efforts. This commentary explores the challenges that the internet may pose to the key components of a comprehensive tobacco control strategy, and pinpoints potential approaches for addressing these challenges. Four key challenges that the internet presents for tobacco control are identified: unrestricted sales to minors; cheaper cigarettes through tax avoidance and smuggling; unfettered advertising, marketing and promotion; and continued normalisation of the tobacco industry and its products. Potential strategies for addressing these challenges include international tobacco control agreements, national and state regulation, and legal remedies.

Environmental decision support systems (EDSS)development- challenges and best practices

USDA-ARS?s Scientific Manuscript database

Despite the perceived value of DSS in informing environmental and natural resource management, DSS tools often fail to be adopted by intended end users. By drawing together the experience of a global group of EDSS developers, we have identified and assessed key challenges in EDSS development and off...

Challenges Facing Principals in the First Year at Their Schools

ERIC Educational Resources Information Center

Bayar, Adem

2016-01-01

The aim of this study is to identify key challenges of practice that principals face. In line with this purpose, the researcher has employed a qualitative research methodology, interviewing principals working in Amasya district, over and above doing document analysis to collect detailed information concerning leadership and administration…

Internationalizing Business Education in Latin America: Issues and Challenges

ERIC Educational Resources Information Center

Elahee, Mohammad; Norbis, Mario

2009-01-01

This article examines the extent of internationalization of business education in Latin America and identifies the key challenges facing the Latin American business schools. Based on a survey of the business schools that are members of CLADEA (Consejo Latinoamericano de Escuelas de Administracion--Latin American Council of Management Schools), and…

Challenges confronting female surgical leaders: overcoming the barriers.

PubMed

Kass, Rena B; Souba, Wiley W; Thorndyke, Luanne E

2006-05-15

The number of women reaching top ranks in academic surgery is remarkably low. The purpose of this study was to identify: 1) barriers to becoming a female surgical leader; 2) key attributes that enable advancement and success; and 3) current leadership challenges faced as senior leaders. Semi-structured interviews of ten female surgical leaders queried the following dimensions: attributes for success, lessons learned, mistakes, key career steps, the role of mentoring, gender advantages/disadvantages, and challenges. Perseverance (60%) and drive (50%) were identified as critical success factors, as were good communication skills, a passion for scholarship, a stable home life and a positive outlook. Eighty percent identified discrimination or gender prejudice as a major obstacle in their careers. While 90% percent had mentors, 50% acknowledged that they had not been effectively mentored. Career advice included: develop broad career goals (50%); select a conducive environment (30%); find a mentor (60%); take personal responsibility (40%); organize time and achieve balance (40%); network (30%); create a niche (30%); pursue research (30%); publish (50%); speak in public (30%); and enjoy the process (30%). Being in a minority, being highly visible and being collaborative were identified as advantages. Obtaining buy-in and achieving consensus was the greatest leadership challenge reported. Female academic surgeons face challenges to career advancement. While these barriers are real, they can be overcome by resolve, commitment, and developing strong communication skills. These elements should be taken into consideration in designing career development programs for junior female surgical faculty.

Challenges and priorities for modelling livestock health and pathogens in the context of climate change

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

Özkan, Şeyda

Climate change has the potential to impair livestock health, with consequences for animal welfare, productivity, greenhouse gas emissions, and human livelihoods and health. Modelling has an important role in assessing the impacts of climate change on livestock systems and the efficacy of potential adaptation strategies, to support decision making for more efficient, resilient and sustainable production. However, a coherent set of challenges and research priorities for modelling livestock health and pathogens under climate change has not previously been available. To identify such challenges and priorities, researchers from across Europe were engaged in a horizon-scanning study, involving workshop and questionnaire basedmore » exercises and focussed literature reviews. Eighteen key challenges were identified and grouped into six categories based on subject-specific and capacity building requirements. Across a number of challenges, the need for inventories relating model types to different applications (e.g. the pathogen species, region, scale of focus and purpose to which they can be applied) was identified, in order to identify gaps in capability in relation to the impacts of climate change on animal health. The need for collaboration and learning across disciplines was highlighted in several challenges, e.g. to better understand and model complex ecological interactions between pathogens, vectors, wildlife hosts and livestock in the context of climate change. Collaboration between socio-economic and biophysical disciplines was seen as important for better engagement with stakeholders and for improved modelling of the costs and benefits of poor livestock health. The need for more comprehensive validation of empirical relationships, for harmonising terminology and measurements, and for building capacity for under-researched nations, systems and health problems indicated the importance of joined up approaches across nations. The challenges and priorities identified can help focus the development of modelling capacity and future research structures in this vital field. Well-funded networks capable of managing the long-term development of shared resources are required in order to create a cohesive modelling community equipped to tackle the complex challenges of climate change. - Highlights: • Experts identified challenges for health and pathogen modelling under climate change. • Eighteen key challenges and associated research priorities were identified. • Increasing capacity will require improved organisation and sharing knowledge. • Better communication across the diverse topics and approaches in this field is needed.« less

Advances in space robotics

NASA Technical Reports Server (NTRS)

Varsi, Giulio

1989-01-01

The problem of the remote control of space operations is addressed by identifying the key technical challenge: the management of contact forces and the principal performance parameters. Three principal classes of devices for remote operation are identified: anthropomorphic exoskeletons, computer aided teleoperators, and supervised telerobots. Their fields of application are described, and areas in which progress has reached the level of system or subsystem laboratory demonstrations are indicated. Key test results, indicating performance at a level useful for design tradeoffs, are reported.

Challenges in Aeropropulsion

NASA Technical Reports Server (NTRS)

Campbell, Donald C.

1995-01-01

Aeropropulsion technologies must progress to satisfy increasingly stringent global environmental requirements with economically viable air transportation systems. In this paper, key propulsion technologies to meet future needs are identified and the associated challenges are briefly discussed. Also discussed are NASA's vision, NASA's changing role in meeting today's challenge of a shrinking research budget, and propulsion technology impacts on the environment and air transport economics. Critical aeropropulsion technology drivers are identified and their impact evaluated. The aviation industry is critical to the nation's economy, job creation, and national security. NASA's advanced aeropropulsion technology programs and their relation to the aviation industry are discussed.

Clinical Research Informatics: Challenges, Opportunities and Definition for an Emerging Domain

PubMed Central

Embi, Peter J.; Payne, Philip R.O.

2009-01-01

Objectives Clinical Research Informatics, an emerging sub-domain of Biomedical Informatics, is currently not well defined. A formal description of CRI including major challenges and opportunities is needed to direct progress in the field. Design Given the early stage of CRI knowledge and activity, we engaged in a series of qualitative studies with key stakeholders and opinion leaders to determine the range of challenges and opportunities facing CRI. These phases employed complimentary methods to triangulate upon our findings. Measurements Study phases included: 1) a group interview with key stakeholders, 2) an email follow-up survey with a larger group of self-identified CRI professionals, and 3) validation of our results via electronic peer-debriefing and member-checking with a group of CRI-related opinion leaders. Data were collected, transcribed, and organized for formal, independent content analyses by experienced qualitative investigators, followed by an iterative process to identify emergent categorizations and thematic descriptions of the data. Results We identified a range of challenges and opportunities facing the CRI domain. These included 13 distinct themes spanning academic, practical, and organizational aspects of CRI. These findings also informed the development of a formal definition of CRI and supported further representations that illustrate areas of emphasis critical to advancing the domain. Conclusions CRI has emerged as a distinct discipline that faces multiple challenges and opportunities. The findings presented summarize those challenges and opportunities and provide a framework that should help inform next steps to advance this important new discipline. PMID:19261934

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

PubMed

Schommer, Jon C; Hansen, Richard A

2005-06-01

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

Tobacco commerce on the internet: a threat to comprehensive tobacco control

PubMed Central

COHEN, J.; SARABIA, V.; ASHLEY, M. J.

2001-01-01

Although internet use continues to increase and e-commerce sales are expected to exceed US$1 trillion by the end of 2001, there have been few assessments in the literature regarding the implications of this medium for tobacco control efforts. This commentary explores the challenges that the internet may pose to the key components of a comprehensive tobacco control strategy, and pinpoints potential approaches for addressing these challenges. Four key challenges that the internet presents for tobacco control are identified: unrestricted sales to minors; cheaper cigarettes through tax avoidance and smuggling; unfettered advertising, marketing and promotion; and continued normalisation of the tobacco industry and its products. Potential strategies for addressing these challenges include international tobacco control agreements, national and state regulation, and legal remedies.

 PMID:11740029

Key Challenges of Using Video When Investigating Social Practices in Education: Contextualization, Magnification, and Representation

ERIC Educational Resources Information Center

Blikstad-Balas, Marte

2017-01-01

Audio- and video-recordings are increasingly popular data sources in contemporary qualitative research, making discussions about methodological implications of such recordings timelier than ever. This article goes beyond discussing practical issues and issues of "camera effect" and reactivity to identify three major challenges of using…

Planning Lessons for Refugee-Background Students: Challenges and Strategies

ERIC Educational Resources Information Center

Miller, Jennifer; Windle, Joel Austin; Yazdanpanah, Lilly K.

2014-01-01

This article examines the ways teachers plan lessons for English as an Additional Language (EAL) students from refugee backgrounds in secondary school transition programs. Based on a study of teachers working with students in three Victorian schools, we identify the key challenges teachers face in planning and the strategies they adopt to confront…

Social media and pharmacovigilance: A review of the opportunities and challenges

PubMed Central

Sloane, Richard; Osanlou, Orod; Lewis, David; Bollegala, Danushka; Maskell, Simon; Pirmohamed, Munir

2015-01-01

Adverse drug reactions come at a considerable cost on society. Social media are a potentially invaluable reservoir of information for pharmacovigilance, yet their true value remains to be fully understood. In order to realize the benefits social media holds, a number of technical, regulatory and ethical challenges remain to be addressed. We outline these key challenges identifying relevant current research and present possible solutions. PMID:26147850

Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework

PubMed Central

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

2015-01-01

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

Military Service Member and Veteran Reintegration: A Conceptual Analysis, Unified Definition, and Key Domains

PubMed Central

Elnitsky, Christine A.; Fisher, Michael P.; Blevins, Cara L.

2017-01-01

Returning military service members and veterans (MSMVs) may experience a variety of stress-related disorders and challenges when reintegrating from the military to the community. Facilitating the reintegration, transition, readjustment and coping, and community integration, of MSMVs is a societal priority. To date, research addressing MSMV reintegration has not identified a comprehensive definition of the term or defined the broader context within which the process of reintegration occurs although both are needed to promote valid and reliable measurement of reintegration and clarify related challenges, processes, and their impact on outcomes. Therefore, this principle-based concept analysis sought to review existing empirical reintegration measurement instruments and identify the problems and needs of MSMV reintegration to provide a unified definition of reintegration to guide future research, clinical practice, and related services. We identified 1,459 articles in the health and social sciences literature, published between 1990 and 2015, by searching multiple electronic databases. Screening of abstracts and full text review based on our inclusion/exclusion criteria, yielded 117 articles for review. Two investigators used constant conceptual comparison to evaluate relevant articles independently. We examined the term reintegration and related terms (i.e., transition, readjustment, community integration) identifying trends in their use over time, analyzed the eight reintegration survey instruments, and synthesized service member and veteran self-reported challenges and needs for reintegration. More reintegration research was published during the last 5 years (n = 373) than in the previous 10 years combined (n = 130). The research suggests coping with life stresses plays an integral role in military service member and veteran post-deployment reintegration. Key domains of reintegration include individual, interpersonal, community organizations, and societal factors that may facilitate or challenge successful reintegration, and results suggest that successful coping with life stressors plays an integral role in post-deployment reintegration. Overall, the literature does not provide a comprehensive representation of reintegration among MSMVs. Although, previous research describes military service member and veteran reintegration challenges, this concept analysis provides a unified definition of the phenomenon and identifies key domains of reintegration that may broaden our understanding and guide reintegration research and practice. PMID:28352240

Military Service Member and Veteran Reintegration: A Conceptual Analysis, Unified Definition, and Key Domains.

PubMed

Elnitsky, Christine A; Fisher, Michael P; Blevins, Cara L

2017-01-01

Returning military service members and veterans (MSMVs) may experience a variety of stress-related disorders and challenges when reintegrating from the military to the community. Facilitating the reintegration, transition, readjustment and coping, and community integration, of MSMVs is a societal priority. To date, research addressing MSMV reintegration has not identified a comprehensive definition of the term or defined the broader context within which the process of reintegration occurs although both are needed to promote valid and reliable measurement of reintegration and clarify related challenges, processes, and their impact on outcomes. Therefore, this principle-based concept analysis sought to review existing empirical reintegration measurement instruments and identify the problems and needs of MSMV reintegration to provide a unified definition of reintegration to guide future research, clinical practice, and related services. We identified 1,459 articles in the health and social sciences literature, published between 1990 and 2015, by searching multiple electronic databases. Screening of abstracts and full text review based on our inclusion/exclusion criteria, yielded 117 articles for review. Two investigators used constant conceptual comparison to evaluate relevant articles independently. We examined the term reintegration and related terms (i.e., transition, readjustment, community integration) identifying trends in their use over time, analyzed the eight reintegration survey instruments, and synthesized service member and veteran self-reported challenges and needs for reintegration. More reintegration research was published during the last 5 years ( n = 373) than in the previous 10 years combined ( n = 130). The research suggests coping with life stresses plays an integral role in military service member and veteran post-deployment reintegration. Key domains of reintegration include individual, interpersonal, community organizations, and societal factors that may facilitate or challenge successful reintegration, and results suggest that successful coping with life stressors plays an integral role in post-deployment reintegration. Overall, the literature does not provide a comprehensive representation of reintegration among MSMVs. Although, previous research describes military service member and veteran reintegration challenges, this concept analysis provides a unified definition of the phenomenon and identifies key domains of reintegration that may broaden our understanding and guide reintegration research and practice.

All Paths Lead to TRIM25.

PubMed

Zhou, Hengbo; Costello, James C

2017-10-01

Identifying key factors that regulate the transition from primary to metastatic cancer is a fundamental challenge. Walsh et al. took a systems biology approach integrating computational, in vitro, and in vivo experiments to identify TRIM25 (tripartite motif containing 25) as a key factor that regulates metastatic gene signatures both at the transcriptional and post-transcriptional level in breast cancer. Targeting TRIM25 therapeutically is attractive because it governs a broad set of coordinated transcriptional modules that dictate metastatic progression. Copyright © 2017 Elsevier Inc. All rights reserved.

Introduction to the Personal Access Satellite System Study

NASA Technical Reports Server (NTRS)

Sue, Miles K.

1990-01-01

A recent study by the National Telecommunications and Information Administration (NTIA) has concluded that the 21st century will be the age of information in which the telecommunication infrastructure will be vital to the social and economic well being of society. To meet the challenge of the coming age, JPL has been performing studies on a personal access satellite system (PASS) for the 21st century. The PASS study can be traced back to a study in which the technical feasibility and potential applications of a high frequency, low data rate satellite system were identified using small fixed terminals. Herein, the PASS concept is described along with the strawman design. Then the key challenges are identified along with possible solutions. Finally, the plan for the future is summarized from the key results.

Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America.

PubMed

Salvo, Deborah; Reis, Rodrigo S; Sarmiento, Olga L; Pratt, Michael

2014-12-01

There is evidence linking the built environment (BE) with physical activity (PA), but few studies have been conducted in Latin America (LA). State-of-the-art methods and protocols have been designed in and applied in high-income countries (HIC). In this paper, we identify key challenges and potential solutions to conducting high-quality PA and BE research in LA. The experience of implementing the IPEN data collection protocol (IPEN: International Physical Activity Environment Network) in Curitiba, Brazil; Bogotá, Colombia; and Cuernavaca, Mexico (2010-2011); is described to identify challenges for conducting PA and BE research in LA. Five challenges were identified: lack of academic capacity (implemented solutions (IS): building a strong international collaborative network); limited data availability, access and quality (IS: partnering with influential local institutions, and crafting creative solutions to use the best-available data); socio-political, socio-cultural and socio-economic context (IS: in-person recruitment and data collection, alternative incentives); safety (IS: strict rules for data collection procedures, and specific measures to increase trust); and appropriateness of instruments and measures (IS: survey adaptation, use of standardized additional survey components, and employing a context-based approach to understanding the relationship between PA and the BE). Advantages of conducting PA and BE research in LA were also identified. Conducting high-quality PA and BE research in LA is challenging but feasible. Networks of institutions and researchers from both HIC and LMIC play a key role. The lessons learned from the IPEN LA study may be applicable to other LMIC. Copyright © 2014 Elsevier Inc. All rights reserved.

Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America

PubMed Central

Salvo, Deborah; Reis, Rodrigo S.; Sarmiento, Olga L.; Pratt, Michael

2014-01-01

Objective There is evidence linking the built environment (BE) with physical activity (PA), but few studies have been conducted in Latin America (LA). State-of-the-art methods and protocols have been designed in and applied in high-income countries (HIC). In this paper we identify key challenges and potential solutions to conducting high quality PA and BE research in LA. Methods The experience of implementing the IPEN data collection protocol (IPEN: International Physical Activity Environment Network) in Curitiba, Brazil; Bogotá, Colombia; and Cuernavaca, Mexico (2010-2011); is described to identify challenges for conducting PA and BE research in LA. Results Five challenges were identified: Lack of academic capacity (implemented solutions (IS): building a strong international collaborative network); limited data availability, access and quality (IS: partnering with influential local institutions, and crafting creative solutions to use the best-available data); socio-political, socio-cultural and socio-economic context (IS: in-person recruitment and data collection, alternative incentives); safety (IS: strict rules for data collection procedures, and specific measures to increase trust); appropriateness of instruments and measures (IS: survey adaptation, use of standardized additional survey components, and employing a context-based approach to understanding the relationship between PA and the BE). Advantages of conducting PA and BE research in LA were also identified. Conclusions Conducting high quality PA and BE research in LA is challenging but feasible. Networks of institutions and researchers from both HIC and LMIC play a key role. The lessons learnt from the IPEN LA study may be applicable to other LMIC. PMID:25456800

Predicting Item Difficulty of Science National Curriculum Tests: The Case of Key Stage 2 Assessments

ERIC Educational Resources Information Center

El Masri, Yasmine H.; Ferrara, Steve; Foltz, Peter W.; Baird, Jo-Anne

2017-01-01

Predicting item difficulty is highly important in education for both teachers and item writers. Despite identifying a large number of explanatory variables, predicting item difficulty remains a challenge in educational assessment with empirical attempts rarely exceeding 25% of variance explained. This paper analyses 216 science items of key stage…

An Authentic Online Community of Learning Framework for Higher Education: Development Process

ERIC Educational Resources Information Center

Parker, Jenni

2017-01-01

A key challenge for higher education practitioners is to identify how to construct more engaging online environments that promote key learning skills and encourage self-directed learning. This paper discusses a study that investigated how online university courses could be designed to be more engaging. The study employed a design-based research…

Editorial: Challenges and solutions in GW calculations for complex systems

NASA Astrophysics Data System (ADS)

Giustino, F.; Umari, P.; Rubio, A.

2012-09-01

We report key advances in the area of GW calculations, review the available software implementations and define standardization criteria to render the comparison between GW calculations from different codes meaningful, and identify future major challenges in the area of quasiparticle calculations. This Topical Issue should be a reference point for further developments in the field.

The Small Rural School Principalship: Key Challenges and Cross-School Responses

ERIC Educational Resources Information Center

Starr, Karen; White, Simone

2008-01-01

This article explores the responses of school principals of small rural schools in Victoria, Australia to leadership challenges they identify as characteristic of these contexts. The research is an exercise in grounded theory building, with the focus on the principalship as it is enacted in small rural settings. The article also seeks to trace the…

Early Childhood Education in Europe. Achievements: Challenges and Possibilities

ERIC Educational Resources Information Center

Urban, Mathias

2009-01-01

This document is the report of a study commissioned by Education International. The aim of this study is to present key characteristics of ECE systems, to highlight strengths and successful approaches and to identify major challenges and areas where urgent action is needed. To achieve this aim, the report comprises two main sections. The first…

The Challenges of Planning Individualized Programmes for Gifted Students

ERIC Educational Resources Information Center

Senicar, Maruška Željeznov

2016-01-01

Individualized programmes for gifted students are one of the ways in which curricula can be adapted to take account of the identified educational needs of gifted students. Planning is a key phase in ensuring that these programmes are carried out in a high-quality manner. This article explores the challenges faced in the planning of individualized…

Separating the Wheat from the Chaff: Identifying Key Elements in the NLA .AU Domain Harvest

ERIC Educational Resources Information Center

Fellows, Geoff; Harvey, Ross; Lloyd, Annemaree; Pymm, Bob; Wallis, Jake

2008-01-01

In 2005 and 2006 the National Library of Australia (NLA) carried out two whole-domain web harvests which complement the selective web archiving approach taken by PANDORA. Web harvests of this size pose significant challenges to their use. Despite these challenges, such harvests present fascinating research opportunities. The NLA has provided…

Social media and pharmacovigilance: A review of the opportunities and challenges.

PubMed

Sloane, Richard; Osanlou, Orod; Lewis, David; Bollegala, Danushka; Maskell, Simon; Pirmohamed, Munir

2015-10-01

Adverse drug reactions come at a considerable cost on society. Social media are a potentially invaluable reservoir of information for pharmacovigilance, yet their true value remains to be fully understood. In order to realize the benefits social media holds, a number of technical, regulatory and ethical challenges remain to be addressed. We outline these key challenges identifying relevant current research and present possible solutions. © 2015 The British Pharmacological Society.

A data mining paradigm for identifying key factors in biological processes using gene expression data.

PubMed

Li, Jin; Zheng, Le; Uchiyama, Akihiko; Bin, Lianghua; Mauro, Theodora M; Elias, Peter M; Pawelczyk, Tadeusz; Sakowicz-Burkiewicz, Monika; Trzeciak, Magdalena; Leung, Donald Y M; Morasso, Maria I; Yu, Peng

2018-06-13

A large volume of biological data is being generated for studying mechanisms of various biological processes. These precious data enable large-scale computational analyses to gain biological insights. However, it remains a challenge to mine the data efficiently for knowledge discovery. The heterogeneity of these data makes it difficult to consistently integrate them, slowing down the process of biological discovery. We introduce a data processing paradigm to identify key factors in biological processes via systematic collection of gene expression datasets, primary analysis of data, and evaluation of consistent signals. To demonstrate its effectiveness, our paradigm was applied to epidermal development and identified many genes that play a potential role in this process. Besides the known epidermal development genes, a substantial proportion of the identified genes are still not supported by gain- or loss-of-function studies, yielding many novel genes for future studies. Among them, we selected a top gene for loss-of-function experimental validation and confirmed its function in epidermal differentiation, proving the ability of this paradigm to identify new factors in biological processes. In addition, this paradigm revealed many key genes in cold-induced thermogenesis using data from cold-challenged tissues, demonstrating its generalizability. This paradigm can lead to fruitful results for studying molecular mechanisms in an era of explosive accumulation of publicly available biological data.

EnergySmart Schools National Financing Roundtable II - Key Outcomes

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

None

2009-12-01

This document summarizes the discussion at the Financing Roundtable. It provides an overview of the financing opportunities, challenges, and activities involved in achieving high performance schools, as identified by the participants.

Deliberative democracy in health care: current challenges and future prospects.

PubMed

Safaei, Jalil

2015-01-01

There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care. This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries. Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care. Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature. Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is pursued more systematically in the broader sociopolitical domains.

Deliberative democracy in health care: current challenges and future prospects

PubMed Central

Safaei, Jalil

2015-01-01

Background There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care. Objective This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries. Method Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care. Results Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature. Conclusion Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is pursued more systematically in the broader sociopolitical domains. PMID:29355181

Connecting to the Professor: Impact of the Student-Faculty Relationship in a Highly Challenging Course

ERIC Educational Resources Information Center

Micari, Marina; Pazos, Pilar

2012-01-01

While many factors play into college student success, interaction with faculty has been identified as a key component. In highly challenging and anxiety-provoking courses, the student-faculty relationship may be all the more important. This study uses organic chemistry as a case example to investigate the role of the student-faculty relationship…

Stakeholders' views on the ethical challenges of pragmatic trials investigating pharmaceutical drugs.

PubMed

Kalkman, Shona; van Thiel, Ghislaine J M W; Grobbee, Diederick E; Meinecke, Anna-Katharina; Zuidgeest, Mira G P; van Delden, Johannes J M

2016-08-22

We explored the views of key stakeholders to identify the ethical challenges of pragmatic trials investigating pharmaceutical drugs. A secondary aim was to capture stakeholders' attitudes towards the implementation of pragmatic trials in the drug development process. We conducted semistructured, in-depth interviews among individuals from different key stakeholder groups (academia and independent research institutions, the pharmaceutical industry, regulators, Health Technology Assessment (HTA) agencies and patients' organizations) through telephone or face-to-face sessions. Interviews were structured around the question "what challenges were experienced or perceived during the design, conduct and/or review of pragmatic trials." Respondents were additionally asked about their views on implementation of pragmatic trials in the drug development process. Thematic analysis was used to identify the ethically relevant features across data sets. We interviewed 34 stakeholders in 25 individual sessions and four group sessions. The four perceived challenges of ethical relevance were: (1) less controlled conditions creating safety concerns, (2) comparison with usual care potentially compromising clinical equipoise, (3) tailored or waivers of informed consent affecting patient autonomy, and (4) minimal interference with "real-world" practice reducing the knowledge value of trial results. We identified stakeholder concerns regarding risk assessment, use of suboptimal usual care as a comparator, tailoring of informed consent procedures and ensuring the social value of pragmatic trials. These concerns increased when respondents were asked about pragmatic trials conducted before market authorization.

Decision Points and Considerations for Identifying Rural Districts That Have Closed Student Achievement Gaps. REL 2016-130

ERIC Educational Resources Information Center

Culbertson, Michael J.; Billig, Shelley H.

2016-01-01

Rural districts have long faced challenges in closing achievement gaps between subgroups of students. This brief report describes key decision points and considerations for decision-makers interested in identifying rural districts that have closed academic achievement gaps. Examining practices in these districts may suggest activities associated…

The Future of Clinical Education: Opportunities and Challenges from Allied Health Deans' Perspective.

PubMed

Romig, Barbara D; Tucker, Ann W; Hewitt, Anne M; O'Sullivan Maillet, Julie

2017-01-01

There is limited information and consensus on the future of clinical education and the key factors impacting allied health (AH) clinical training. AH deans identified both opportunities and challenges impacting clinical education based on a proposed educational model. From July 2013 to March 2014, 61 deans whose institutions were 2013 members of the Association of Schools of Allied Health Professions (ASAHP) participated in a three-round Delphi survey. Agreement on the relative importance of and the ability to impact the key factors was analyzed. Impact was evaluated for three groups: individual, collective, and both individual and collective deans. AH deans' responses were summarized and refined; individual items were accepted or rerated until agreement was achieved or study conclusion. Based on the deans' ratings of importance and impact, 159 key factors within 13 clinical education categories emerged as important for the future of clinical education. Agreement was achieved on 107 opportunities and 52 challenges. The Delphi technique generated new information where little existed specific to AH deans' perspectives on AH clinical education. This research supports the Key Factors Impacting Allied Health Clinical Education conceptual model proposed earlier and provides a foundation for AH deans to evaluate opportunities and challenges impacting AH clinical education and to design action plans based on this research.

Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology

PubMed Central

Magalhães-Sant'Ana, M.; More, S. J.; Morton, D. B.; Hanlon, A.

2016-01-01

Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. PMID:27613779

Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology.

PubMed

Magalhães-Sant'Ana, M; More, S J; Morton, D B; Hanlon, A

2016-10-29

Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. British Veterinary Association.

Social-ecological innovation in remote mountain areas: Adaptive responses of forest-dependent communities to the challenges of a changing world.

PubMed

Melnykovych, Mariana; Nijnik, Maria; Soloviy, Ihor; Nijnik, Albert; Sarkki, Simo; Bihun, Yurij

2018-02-01

To better understand how constantly changing human-environment interactions could be better organized to respond to current challenges, we examined the Ukrainian Carpathians as an example case of complex forest social-ecological systems (FSES). We did it by interviewing diverse and relevant local stakeholder (N=450). In particular, we strived to: i) outline how people and nature are linked and interact in coupled FSES; ii) examine the preferences of stakeholders on the forests and associated ecosystem services (ES); iii) map key drivers threatening well-being of FSES and iv) identify potential responses to address the challenges at a local scale. To answer these questions we followed a mixed method route by integrating qualitative (participatory) and quantitative data collection and analyses, with further application of a Driving Force-Pressure-State-Impact-Response (DPSIR) framework in combination with the ES approach in order to assess benefits, threats to these benefits, and responses regarding the studied FSES. We found that the key benefit from FSES is timber and non-wood forest products (like berries and mushrooms), but also various regulating services were ranked highly by respondents. To explore social-ecological innovation, with potential responses of forest-dependent communities to challenges they face, we employed a commonly used assumption that governance must fit to the particular characteristics of FSES in order to enable sustainability. For the particular case of the Ukrainian Carpathians, we identified and discussed the following five nonconformities or "misfits" threatening sustainability: 1) Spatial misfit in legislation; 2) Poor contextualization; 3) Trap of the single ES; 4) Participatory misfit; and 5) Robbing the commons. By conceptualizing those key threats, we proposed responses for sustainability. The findings contributed to an advanced understanding of complex FSES, their key challenges and potential solutions in order to secure well-being of people and nature in coupled social-ecological systems, in the conditions of a changing world. Copyright © 2017 Elsevier B.V. All rights reserved.

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

NASA Technical Reports Server (NTRS)

Lizcano, M.

2017-01-01

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

Discussing a diagnosis of human papillomavirus oropharyngeal cancer with patients: An exploratory qualitative study of health professionals

PubMed Central

Dodd, Rachael H.; Marlow, Laura A. V.

2015-01-01

Abstract Background The role of human papillomavirus (HPV) in oropharyngeal squamous cell cancer (SCC) has now been well established. Clinicians' experiences and challenges of talking to patients about HPV have yet to be explored. Methods Fifteen health professionals caring for patients with oropharyngeal SCC were interviewed. Interviews were analyzed thematically. Results Participants expressed mixed views about explaining the causal role of HPV to their patients. Normalizing HPV and emphasizing the positive prognosis associated with it were regarded as key messages to be communicated. Challenging experiences included managing couples in a consultation and patients' concerns about transmitting HPV to their partners. Some participants described limitations to their HPV knowledge and identified the need for further information and training. Conclusion This study identified challenges experienced by health professionals working with patients with oropharyngeal SCC and highlights some key messages to convey to patients. Clinical guidance for health professionals and further information for patients about HPV‐positive oropharyngeal SCC are needed. © 2015 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck 38: 394–401, 2016 PMID:25351993

Autonomy and Responsibility: Online Learning as a Solution for At-Risk High School Students

ERIC Educational Resources Information Center

Lewis, S.; Whiteside, A.; Garrett Dikkers, A.

2014-01-01

In this three-year, mixed methods case study, the benefits and challenges of online learning for at-risk high school students were examined. A key finding was that at-risk students identify the benefits and challenges of online learning to be the same. While students appreciate the opportunity to work ahead and study at their own pace, they see it…

ESA Sample Fetch Rover: Heritage and Way Forward

NASA Astrophysics Data System (ADS)

Duvet, L.; Beyer, F.; Delfa, J.; Zekri, E.

2018-04-01

The Sample Fetch Rover (SFR) is one of the key elements of the Mars Sample Return (MSR) campaign architecture. We will present the SFR heritage as well as a way forward identified to address this engineering challenge.

U.S. Offshore Wind Manufacturing and Supply Chain Development

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

Hamilton, Bruce

2013-02-22

This report seeks to provide an organized, analytical approach to identifying and bounding uncertainties around offshore wind manufacturing and supply chain capabilities; projecting potential component-level supply chain needs under three demand scenarios; and identifying key supply chain challenges and opportunities facing the future U.S. market and current suppliers of the nation’s landbased wind market.

Key enzymes and proteins of crop insects as candidate for RNAi based gene silencing

PubMed Central

Kola, Vijaya Sudhakara Rao; Renuka, P.; Madhav, Maganti Sheshu; Mangrauthia, Satendra K.

2015-01-01

RNA interference (RNAi) is a mechanism of homology dependent gene silencing present in plants and animals. It operates through 21–24 nucleotides small RNAs which are processed through a set of core enzymatic machinery that involves Dicer and Argonaute proteins. In recent past, the technology has been well appreciated toward the control of plant pathogens and insects through suppression of key genes/proteins of infecting organisms. The genes encoding key enzymes/proteins with the great potential for developing an effective insect control by RNAi approach are actylcholinesterase, cytochrome P450 enzymes, amino peptidase N, allatostatin, allatotropin, tryptophan oxygenase, arginine kinase, vacuolar ATPase, chitin synthase, glutathione-S-transferase, catalase, trehalose phosphate synthase, vitellogenin, hydroxy-3-methylglutaryl coenzyme A reductase, and hormone receptor genes. Through various studies, it is demonstrated that RNAi is a reliable molecular tool which offers great promises in meeting the challenges imposed by crop insects with careful selection of key enzymes/proteins. Utilization of RNAi tool to target some of these key proteins of crop insects through various approaches is described here. The major challenges of RNAi based insect control such as identifying potential targets, delivery methods of silencing trigger, off target effects, and complexity of insect biology are very well illustrated. Further, required efforts to address these challenges are also discussed. PMID:25954206

Nanocuration workflows: Establishing best practices for identifying, inputting, and sharing data to inform decisions on nanomaterials

PubMed Central

Powers, Christina M; Mills, Karmann A; Morris, Stephanie A; Klaessig, Fred; Gaheen, Sharon; Lewinski, Nastassja

2015-01-01

Summary There is a critical opportunity in the field of nanoscience to compare and integrate information across diverse fields of study through informatics (i.e., nanoinformatics). This paper is one in a series of articles on the data curation process in nanoinformatics (nanocuration). Other articles in this series discuss key aspects of nanocuration (temporal metadata, data completeness, database integration), while the focus of this article is on the nanocuration workflow, or the process of identifying, inputting, and reviewing nanomaterial data in a data repository. In particular, the article discusses: 1) the rationale and importance of a defined workflow in nanocuration, 2) the influence of organizational goals or purpose on the workflow, 3) established workflow practices in other fields, 4) current workflow practices in nanocuration, 5) key challenges for workflows in emerging fields like nanomaterials, 6) examples to make these challenges more tangible, and 7) recommendations to address the identified challenges. Throughout the article, there is an emphasis on illustrating key concepts and current practices in the field. Data on current practices in the field are from a group of stakeholders active in nanocuration. In general, the development of workflows for nanocuration is nascent, with few individuals formally trained in data curation or utilizing available nanocuration resources (e.g., ISA-TAB-Nano). Additional emphasis on the potential benefits of cultivating nanomaterial data via nanocuration processes (e.g., capability to analyze data from across research groups) and providing nanocuration resources (e.g., training) will likely prove crucial for the wider application of nanocuration workflows in the scientific community. PMID:26425437

Barriers and Negative Nudges: Exploring Challenges in Food Journaling

PubMed Central

Cordeiro, Felicia; Epstein, Daniel A.; Thomaz, Edison; Bales, Elizabeth; Jagannathan, Arvind K.; Abowd, Gregory D.; Fogarty, James

2016-01-01

Although food journaling is understood to be both important and difficult, little work has empirically documented the specific challenges people experience with food journals. We identify key challenges in a qualitative study combining a survey of 141 current and lapsed food journalers with analysis of 5,526 posts in community forums for three mobile food journals. Analyzing themes in this data, we find and discuss barriers to reliable food entry, negative nudges caused by current techniques, and challenges with social features. Our results motivate research exploring a wider range of approaches to food journal design and technology. PMID:26894233

Barriers and Negative Nudges: Exploring Challenges in Food Journaling.

PubMed

Cordeiro, Felicia; Epstein, Daniel A; Thomaz, Edison; Bales, Elizabeth; Jagannathan, Arvind K; Abowd, Gregory D; Fogarty, James

2015-04-01

Although food journaling is understood to be both important and difficult, little work has empirically documented the specific challenges people experience with food journals. We identify key challenges in a qualitative study combining a survey of 141 current and lapsed food journalers with analysis of 5,526 posts in community forums for three mobile food journals. Analyzing themes in this data, we find and discuss barriers to reliable food entry, negative nudges caused by current techniques, and challenges with social features. Our results motivate research exploring a wider range of approaches to food journal design and technology.

Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework.

PubMed

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

2015-08-01

To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The French Revolution and "Revisionism."

ERIC Educational Resources Information Center

Langlois, Claude

1990-01-01

Outlines revisionist interpretations of the French Revolution that challenged the dominant historiographical tradition during the 1950s and 1960s. Distinguishes four central characteristics of revisionist works. Identifies a key split in current French Revolution historiography between reflection on nineteenth-century…

Parameter as a Switch Between Dynamical States of a Network in Population Decoding.

PubMed

Yu, Jiali; Mao, Hua; Yi, Zhang

2017-04-01

Population coding is a method to represent stimuli using the collective activities of a number of neurons. Nevertheless, it is difficult to extract information from these population codes with the noise inherent in neuronal responses. Moreover, it is a challenge to identify the right parameter of the decoding model, which plays a key role for convergence. To address the problem, a population decoding model is proposed for parameter selection. Our method successfully identified the key conditions for a nonzero continuous attractor. Both the theoretical analysis and the application studies demonstrate the correctness and effectiveness of this strategy.

Framing global health: the governance challenge.

PubMed

McInnes, Colin; Kamradt-Scott, Adam; Lee, Kelley; Reubi, David; Roemer-Mahler, Anne; Rushton, Simon; Williams, Owain David; Woodling, Marie

2012-01-01

With the emergence of global health comes governance challenges which are equally global in nature. This article identifies some of the initial limitations in analyses of global health governance (GHG) before discussing the focus of this special supplement: the framing of global health issues and the manner in which this impacts upon GHG. Whilst not denying the importance of material factors (such as resources and institutional competencies), the article identifies how issues can be framed in different ways, thereby creating particular pathways of response which in turn affect the potential for and nature of GHG. It also identifies and discusses the key frames operating in global health: evidence-based medicine, human rights, security, economics and development.

Who is Responsible for Defending United States Interests in Cyberspace?

DTIC Science & Technology

2013-03-01

The U.S. Chamber of Commerce worked openly to challenge legislation that potentially would have directed minimum standards for operators of key...of companies to enable private public collaboration to 6 protect critical infrastructure as the U.S. Chamber of Commerce actively identifies...cyberspace-lawmakers-say/50869/ (accessed November 12, 2012). 19 US Chamber of Commerce , “Key Vote letter on S. 3414, the Cybersecurity Act of 2012

The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya.

PubMed

Izugbara, Chimaraoke; Ezeh, Alex; Fotso, Jean-Christophe

2009-01-01

Through an analysis of focus group discussion data, we examine Kenyan traditional birth attendants' (TBAs) accounts of the persistence of homebirths and the key challenges they present. TBAs associated the continued demand for homebirths with the wide-ranging character and quality of their services. They did not consider their lack of formal training on matters of pregnancy and birthing to be a particular challenge to their work. Rather, they identified the non-cooperative and disrespectful attitudes of their counterparts in hospital settings as the most important issue. Further efforts are needed to make TBAs realize how much better their services could become if they adopted more modern ways of assisting in deliveries, unlearnt their belief in the superiority of their particular type of practice, and understood how their lack of formal training is a key issue.

Smart textiles: Challenges and opportunities

NASA Astrophysics Data System (ADS)

Cherenack, Kunigunde; van Pieterson, Liesbeth

2012-11-01

Smart textiles research represents a new model for generating creative and novel solutions for integrating electronics into unusual environments and will result in new discoveries that push the boundaries of science forward. A key driver for smart textiles research is the fact that both textile and electronics fabrication processes are capable of functionalizing large-area surfaces at very high speeds. In this article we review the history of smart textiles development, introducing the main trends and technological challenges faced in this field. Then, we identify key challenges that are the focus of ongoing research. We then proceed to discuss fundamentals of smart textiles: textile fabrication methods and textile interconnect lines, textile sensor, and output device components and integration of commercial components into textile architectures. Next we discuss representative smart textile systems and finally provide our outlook over the field and a prediction for the future.

Challenges for health care development in Croatia.

PubMed

Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja

2012-09-01

The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.

Opportunities and Challenges in Training Elementary School Teachers in Classroom Management: Initial Results from Classroom Management in Action, an Online Professional Development Program

ERIC Educational Resources Information Center

Marquez, Brion; Vincent, Claudia; Marquez, Jessie; Pennefather, Jordan; Smolkowski, Keith; Sprague, Jeffrey

2016-01-01

Classroom management remains a challenge for many teachers. The approach and delivery of professional development (PD) in classroom management may determine how well teachers are able to apply evidence-based approaches in their classrooms. We use existing literature to identify the key features that make in-service PD effective and present them as…

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

None

In this project, three production home builders—K. Hovnanian Homes, David Weekley Homes, and Transformations, Inc.—partnered with Building America team Building Science Corporation to evaluate the certification of five test homes to the new DOE Challenge Home program performance standard (now DOE Zero Energy Ready Home program). The builders identified key benefits and barriers that impacted the certification of the test homes, and the likelihood of whether DOE Challenge Home certification would be pursued in future homes

Deep brain stimulation and ethics: perspectives from a multisite qualitative study of Canadian neurosurgical centers.

PubMed

Bell, Emily; Maxwell, Bruce; McAndrews, Mary Pat; Sadikot, Abbas; Racine, Eric

2011-12-01

Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS. Health care providers working in Canadian DBS surgery programs participated in a semistructured interview to identify and characterize ethical and social challenges of DBS. A content analysis of the interviews was conducted. Several key ethical issues, such as patient screening and resource allocation, were identified by members of neurosurgical teams. Providers described challenges in selecting patients for DBS on the basis of unclear evidence-based guidance regarding behavioral issues or cognitive criteria. Varied contexts of resource allocation, including some very challenging schemas, were also reported. In addition, the management of patients in the community was highlighted as a source of ethical and clinical complexity, given the need for coordinated long-term care. This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation. Copyright © 2011 Elsevier Inc. All rights reserved.

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond.

PubMed

Ortu, Giuseppina; Williams, Oliver

2017-09-27

Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered. The authors summarise key operational challenges, and based on these, identify two major priorities: strengthening the capacity of the primary health care health system in correctly diagnosing and managing neglected tropical diseases; and establishing an effective disease surveillance process. Five steps are proposed as concrete actions to build an effective primary health care service for neglected tropical diseases, and a health management information system capable of accurately reporting these diseases. Community engagement and formalization of community health workers role are proposed as essential components of these steps. Shift of financial support from disease oriented programmes to disease integrated interventions, improved access to international guidelines for primary health care staff, and availability of donated drugs in health care structures are also suggested as key elements of the proposed process. The authors conclude that failure to address these priorities now may lead to further challenges on the long path towards neglected tropical disease elimination and beyond.

Connecting the records: exploiting tephra deposits to help understand abrupt climate change

NASA Astrophysics Data System (ADS)

Davies, S. M.; Abbott, P. M.; Bourne, A. J.; Chapman, M.; Pearce, N. J. G.; Griggs, A. J.; Cook, E.

2016-12-01

The causal mechanism of abrupt climate change during the last glacial period remains a key challenge. Although these events are well-documented in a wide range of proxy records, the triggers and drivers remain poorly understood, largely due to the dating uncertainties that prevent the integration of different archives. Unravelling the lead/lag responses (hence cause and effect) between the Earth's climate components is limited by the challenges of synchronising palaeoclimate records on a common timescale. Here we present the potential and the challenges of optimising the use of cryptotephra deposits to precisely correlate the Greenland ice-cores with North Atlantic marine records. A series of new cryptotephra deposits have been identified in Greenland, increasing the scope of identifying coeval isochrons in the marine environment. This new framework, however, brings new challenges in the search for unique and robust geochemical fingerprints for unequivocal tephra correlations. As such, some tephra deposits are proposed to be more valuable than others and underpin key snapshots in time during the last glacial period. The North Atlantic Ash Zone II, for instance, represents the most widespread isochron and constrains the cooling of GI-15. Some tephra deposits in the ice-core record originate from ultra-distal sources beyond the North Atlantic region and we also explore the potential for establishing North Pacific linkages.

Challenges in image-guided therapy system design.

PubMed

Dimaio, Simon; Kapur, Tina; Cleary, Kevin; Aylward, Stephen; Kazanzides, Peter; Vosburgh, Kirby; Ellis, Randy; Duncan, James; Farahani, Keyvan; Lemke, Heinz; Peters, Terry; Lorensen, William Bill; Gobbi, David; Haller, John; Clarke, Laurence Larry; Pizer, Stephen; Taylor, Russell; Galloway, Robert; Fichtinger, Gabor; Hata, Nobuhiko; Lawson, Kimberly; Tempany, Clare; Kikinis, Ron; Jolesz, Ferenc

2007-01-01

System development for image-guided therapy (IGT), or image-guided interventions (IGI), continues to be an area of active interest across academic and industry groups. This is an emerging field that is growing rapidly: major academic institutions and medical device manufacturers have produced IGT technologies that are in routine clinical use, dozens of high-impact publications are published in well regarded journals each year, and several small companies have successfully commercialized sophisticated IGT systems. In meetings between IGT investigators over the last two years, a consensus has emerged that several key areas must be addressed collaboratively by the community to reach the next level of impact and efficiency in IGT research and development to improve patient care. These meetings culminated in a two-day workshop that brought together several academic and industrial leaders in the field today. The goals of the workshop were to identify gaps in the engineering infrastructure available to IGT researchers, develop the role of research funding agencies and the recently established US-based National Center for Image Guided Therapy (NCIGT), and ultimately to facilitate the transfer of technology among research centers that are sponsored by the National Institutes of Health (NIH). Workshop discussions spanned many of the current challenges in the development and deployment of new IGT systems. Key challenges were identified in a number of areas, including: validation standards; workflows, use-cases, and application requirements; component reusability; and device interface standards. This report elaborates on these key points and proposes research challenges that are to be addressed by a joint effort between academic, industry, and NIH participants.

Issues in Distance Education: A Primer for Higher Education Decision Makers

ERIC Educational Resources Information Center

Beaudoin, Michael

2016-01-01

This chapter presents an overview of current issues related to distance learning in higher education. It identifies central questions, issues, challenges, and opportunities that must be addressed by decision makers, as well as key attributes of effective leaders.

Key challenges and priorities for modelling European grasslands under climate change.

PubMed

Kipling, Richard P; Virkajärvi, Perttu; Breitsameter, Laura; Curnel, Yannick; De Swaef, Tom; Gustavsson, Anne-Maj; Hennart, Sylvain; Höglind, Mats; Järvenranta, Kirsi; Minet, Julien; Nendel, Claas; Persson, Tomas; Picon-Cochard, Catherine; Rolinski, Susanne; Sandars, Daniel L; Scollan, Nigel D; Sebek, Leon; Seddaiu, Giovanna; Topp, Cairistiona F E; Twardy, Stanislaw; Van Middelkoop, Jantine; Wu, Lianhai; Bellocchi, Gianni

2016-10-01

Grassland-based ruminant production systems are integral to sustainable food production in Europe, converting plant materials indigestible to humans into nutritious food, while providing a range of environmental and cultural benefits. Climate change poses significant challenges for such systems, their productivity and the wider benefits they supply. In this context, grassland models have an important role in predicting and understanding the impacts of climate change on grassland systems, and assessing the efficacy of potential adaptation and mitigation strategies. In order to identify the key challenges for European grassland modelling under climate change, modellers and researchers from across Europe were consulted via workshop and questionnaire. Participants identified fifteen challenges and considered the current state of modelling and priorities for future research in relation to each. A review of literature was undertaken to corroborate and enrich the information provided during the horizon scanning activities. Challenges were in four categories relating to: 1) the direct and indirect effects of climate change on the sward 2) climate change effects on grassland systems outputs 3) mediation of climate change impacts by site, system and management and 4) cross-cutting methodological issues. While research priorities differed between challenges, an underlying theme was the need for accessible, shared inventories of models, approaches and data, as a resource for stakeholders and to stimulate new research. Developing grassland models to effectively support efforts to tackle climate change impacts, while increasing productivity and enhancing ecosystem services, will require engagement with stakeholders and policy-makers, as well as modellers and experimental researchers across many disciplines. The challenges and priorities identified are intended to be a resource 1) for grassland modellers and experimental researchers, to stimulate the development of new research directions and collaborative opportunities, and 2) for policy-makers involved in shaping the research agenda for European grassland modelling under climate change. Copyright © 2016 Elsevier B.V. All rights reserved.

Melanoma central nervous system metastases: current approaches, challenges, and opportunities

PubMed Central

Cohen, Justine V.; Tawbi, Hussain; Margolin, Kim A.; Amravadi, Ravi; Bosenberg, Marcus; Brastianos, Priscilla K.; Chiang, Veronica L.; de Groot, John; Glitza, Isabella C.; Herlyn, Meenhard; Holmen, Sheri L.; Jilaveanu, Lucia B.; Lassman, Andrew; Moschos, Stergios; Postow, Michael A.; Thomas, Reena; Tsiouris, John A.; Wen, Patrick; White, Richard M.; Turnham, Timothy; Davies, Michael A.; Kluger, Harriet M.

2017-01-01

Summary Melanoma central nervous system metastases are increasing, and the challenges presented by this patient population remain complex. In December 2015, the Melanoma Research Foundation and the Wistar Institute hosted the First Summit on Melanoma Central Nervous System (CNS) Metastases in Philadelphia, Pennsylvania. Here, we provide a review of the current status of the field of melanoma brain metastasis research; identify key challenges and opportunities for improving the outcomes in patients with melanoma brain metastases; and set a framework to optimize future research in this critical area. PMID:27615400

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

PubMed Central

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

Tailored combination prevention packages and PrEP for young key populations

PubMed Central

Pettifor, Audrey; Nguyen, Nadia L; Celum, Connie; Cowan, Frances M; Go, Vivian; Hightow-Weidman, Lisa

2015-01-01

Introduction Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at particularly high risk for HIV. Due to the often marginalized and sometimes criminalized status of young people who identify as members of key populations, there is a need for HIV prevention packages that account for the unique and challenging circumstances they face. Pre-exposure prophylaxis (PrEP) is likely to become an important element of combination prevention for many young key populations. Objective In this paper, we discuss important challenges to HIV prevention among young key populations, identify key components of a tailored combination prevention package for this population and examine the role of PrEP in these prevention packages. Methods We conducted a comprehensive review of the evidence to date on prevention strategies, challenges to prevention and combination prevention packages for young key populations. We focused specifically on the role of PrEP in these prevention packages and on young people under the age of 24, and 18 in particular. Results and discussion Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Interventions in these packages should meaningfully involve beneficiaries in the design and implementation of the intervention, and take into account the context in which the intervention is being delivered to thoughtfully address issues of stigma and discrimination. These interventions will likely be most effective if implemented in conjunction with strategies to facilitate an enabling environment, including increasing access to HIV testing and health services for PrEP and other prevention strategies, decriminalizing key populations’ practices, increasing access to prevention and care, reducing stigma and discrimination, and fostering community empowerment. PrEP could offer a highly effective, time-limited primary prevention for young key populations if it is implemented in combination with other programs to increase access to health services and encourage the reliable use of PrEP while at risk of HIV exposure. Conclusions Reductions in HIV incidence will only be achieved through the implementation of combinations of interventions that include biomedical and behavioural interventions, as well as components that address social, economic and other structural factors that influence HIV prevention and transmission. PMID:25724507

A systematic review of cost-effectiveness modeling of pharmaceutical therapies in neuropathic pain: variation in practice, key challenges, and recommendations for the future.

PubMed

Critchlow, Simone; Hirst, Matthew; Akehurst, Ron; Phillips, Ceri; Philips, Zoe; Sullivan, Will; Dunlop, Will C N

2017-02-01

Complexities in the neuropathic-pain care pathway make the condition difficult to manage and difficult to capture in cost-effectiveness models. The aim of this study is to understand, through a systematic review of previous cost-effectiveness studies, some of the key strengths and limitations in data and modeling practices in neuropathic pain. Thus, the aim is to guide future research and practice to improve resource allocation decisions and encourage continued investment to find novel and effective treatments for patients with neuropathic pain. The search strategy was designed to identify peer-reviewed cost-effectiveness evaluations of non-surgical, pharmaceutical therapies for neuropathic pain published since January 2000, accessing five key databases. All identified publications were reviewed and screened according to pre-defined eligibility criteria. Data extraction was designed to reflect key data challenges and approaches to modeling in neuropathic pain and based on published guidelines. The search strategy identified 20 cost-effectiveness analyses meeting the inclusion criteria, of which 14 had original model structures. Cost-effectiveness modeling in neuropathic pain is established and increasing across multiple jurisdictions; however, amongst these studies, there is substantial variation in modeling approach, and there are common limitations. Capturing the effect of treatments upon health outcomes, particularly health-related quality-of-life, is challenging, and the health effects of multiple lines of ineffective treatment, common for patients with neuropathic pain, have not been consistently or robustly modeled. To improve future economic modeling in neuropathic pain, further research is suggested into the effect of multiple lines of treatment and treatment failure upon patient outcomes and subsequent treatment effectiveness; the impact of treatment-emergent adverse events upon patient outcomes; and consistent and appropriate pain measures to inform models. The authors further encourage transparent reporting of inputs used to inform cost-effectiveness models, with robust, comprehensive and clear uncertainty analysis and, where feasible, open-source modeling is encouraged.

Overview of a multi-stakeholder dialogue around Shared Services for Health: the Digital Health Opportunity in Bangladesh.

PubMed

Ashraf, Sania; Moore, Carolyn; Gupta, Vaibhav; Chowdhury, Anir; Azad, Abul K; Singh, Neelu; Hagan, David; Labrique, Alain B

2015-12-09

National level policymaking and implementation includes multiple stakeholders with varied interests and priorities. Multi-stakeholder dialogues (MSDs) can facilitate consensus building through collective identification of challenges, recognition of shared goals and interests, and creation of solution pathways. This can shape joint planning and implementation for long-term efficiency in health and other sectors. Scaling up the effective use of information and communication technologies (ICTs) requires cohesive strategic planning towards a shared goal. In Bangladesh, the government and partners convened an MSD in March 2015 to increase stakeholder engagement in policymaking and implementation of a national ICT or electronic or mobile health (eHealth or mHealth) strategy, which seeks to incorporate ICTs into the national health system, aligning with the Digital Bangladesh Vision 2021. Relevant stakeholders were identified and key priorities and challenges were mapped through key informant interviews. An MSD was conducted with key stakeholders in Dhaka, Bangladesh. The MSD included presentations, group option generation, agreement and prioritization of barriers to scaling up ICTs. The MSD approach to building consensus on key priorities highlights the value of dialogue and collaboration with relevant stakeholders to encourage country ownership of nationwide efforts such as ICT scale-up. This MSD showed the dynamic context in which stakeholders operate, including those from academia, donors and foundations, healthcare professionals, associations, multilateral organizations, non-governmental organizations, partner countries and the private sector. Through this MSD, participants improved understanding of each other's contributions and interests, identified existing relationships, and agreed on policy and implementation gaps that needed to be filled. Collaboration among stakeholders in ICT efforts and research can promote a cohesive approach to scaling up, as well as improve policymaking by integrating interests and feedback of different key cross sectoral actors. MSDs can align stakeholders to identify challenges and solution pathways, and lead to coordinated action and accountability for resources and results. In addition, the MSD template and approach has been useful to guide ICT scale up in Bangladesh and could be replicated in other contexts to facilitate multi-constituency, multi-sector collaboration.

Beyond Affirmative Action: Leadership Diversity That Works.

ERIC Educational Resources Information Center

Gilliland, J. Richard

1990-01-01

Contends that community colleges need to make full use of leadership talents and capabilities of women and persons of color. Identifies key challenge facing community colleges in 1990s is to develop leadership teams that represent diversity of their students and community constituents. (NB)

A quest for macroinvertebrate indicators of flow conditions in small, suburban stream

EPA Science Inventory

Alteration of hydrologic variability is considered a key pathway by which urbanization affects stream assemblages; however, understanding the mechanisms of alteration remains a challenge. One approach is to identify biological metrics that show distinct responses to flows, which ...

REHABILITATION OF AGING WATER INFRASTRUCTURE SYSTEMS: KEY CHALLENGES AND ISSUES

EPA Science Inventory

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

Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study.

PubMed

Samele, Chiara; Forrester, Andrew; Urquía, Norman; Hopkin, Gareth

2016-04-01

This study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services. A purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified. Twenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners. The prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.

Grand Challenges of Advanced Computing for Energy Innovation Report from the Workshop Held July 31-August 2, 2012

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

Larzelere, Alex R.; Ashby, Steven F.; Christensen, Dana C.

2013-03-06

On July 31-August 2 of 2012, the U.S. Department of Energy (DOE) held a workshop entitled Grand Challenges of Advanced Computing for Energy Innovation. This workshop built on three earlier workshops that clearly identified the potential for the Department and its national laboratories to enable energy innovation. The specific goal of the workshop was to identify the key challenges that the nation must overcome to apply the full benefit of taxpayer-funded advanced computing technologies to U.S. energy innovation in the ways that the country produces, moves, stores, and uses energy. Perhaps more importantly, the workshop also developed a set ofmore » recommendations to help the Department overcome those challenges. These recommendations provide an action plan for what the Department can do in the coming years to improve the nation’s energy future.« less

Functional Land Management: Bridging the Think-Do-Gap using a multi-stakeholder science policy interface.

PubMed

O'Sullivan, Lilian; Wall, David; Creamer, Rachel; Bampa, Francesca; Schulte, Rogier P O

2018-03-01

Functional Land Management (FLM) is proposed as an integrator for sustainability policies and assesses the functional capacity of the soil and land to deliver primary productivity, water purification and regulation, carbon cycling and storage, habitat for biodiversity and recycling of nutrients. This paper presents the catchment challenge as a method to bridge the gap between science, stakeholders and policy for the effective management of soils to deliver these functions. Two challenges were completed by a wide range of stakeholders focused around a physical catchment model-(1) to design an optimised catchment based on soil function targets, (2) identify gaps to implementation of the proposed design. In challenge 1, a high level of consensus between different stakeholders emerged on soil and management measures to be implemented to achieve soil function targets. Key gaps including knowledge, a mix of market and voluntary incentives and mandatory measures were identified in challenge 2.

Global megatrends and their implications for environmental assessment practice

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

Retief, Francois, E-mail: francois.retief@nwu.ac.za; Bond, Alan; Research Unit for Environmental Sciences and Management, North-West University

This paper addresses the future of environmental assessment (EA) practice in light of a rapidly changing world. We apply a literature review-based methodology to firstly identify key global megatrends and then reflect upon the implications for EA practice based on some known challenges. The key megatrends identified are synthesised into six categories: i) demographics, ii) urbanization, iii) technological innovation, iv) power shifts, v) resource scarcity and vi) climate change. We then discuss the implications of these megatrends for EA practice against four known EA challenges namely: dealing with i) complexity and uncertainty, ii) efficiency, iii) significance and iv) communication andmore » participation. Our analysis suggests important implications for EA practice such as: increased difficulties with accuracy of prediction; the need for facilitative adaptation; an increase in the occurrence of unexpected events; higher expectations for procedural efficiency; challenges with information and communication management; dealing with significance judgements; and mitigation amidst resource scarcity and increasing pressures on earth systems. The megatrends underscore the need for continued evolution of EA thinking and practice, especially moving away from seeking a predictable single future or outcome towards the possibility of multiple scenarios with associated adaptability and enhanced system resilience capable of responding to rapid change.« less

A free-access online key to identify Amazonian ferns.

PubMed

Zuquim, Gabriela; Tuomisto, Hanna; Prado, Jefferson

2017-01-01

There is urgent need for more data on species distributions in order to improve conservation planning. A crucial but challenging aspect of producing high-quality data is the correct identification of organisms. Traditional printed floras and dichotomous keys are difficult to use for someone not familiar with the technical jargon. In poorly known areas, such as Amazonia, they also become quickly outdated as new species are described or ranges extended. Recently, online tools have allowed developing dynamic, interactive, and accessible keys that make species identification possible for a broader public. In order to facilitate identifying plants collected in field inventories, we developed an internet-based free-access tool to identify Amazonian fern species. We focused on ferns, because they are easy to collect and their edaphic affinities are relatively well known, so they can be used as an indicator group for habitat mapping. Our key includes 302 terrestrial and aquatic entities mainly from lowland Amazonian forests. It is a free-access key, so the user can freely choose which morphological features to use and in which order to assess them. All taxa are richly illustrated, so specimens can be identified by a combination of character choices, visual comparison, and written descriptions. The identification tool was developed in Lucid 3.5 software and it is available at http://keyserver.lucidcentral.org:8080/sandbox/keys.jsp.

A free-access online key to identify Amazonian ferns

PubMed Central

Zuquim, Gabriela; Tuomisto, Hanna; Prado, Jefferson

2017-01-01

Abstract There is urgent need for more data on species distributions in order to improve conservation planning. A crucial but challenging aspect of producing high-quality data is the correct identification of organisms. Traditional printed floras and dichotomous keys are difficult to use for someone not familiar with the technical jargon. In poorly known areas, such as Amazonia, they also become quickly outdated as new species are described or ranges extended. Recently, online tools have allowed developing dynamic, interactive, and accessible keys that make species identification possible for a broader public. In order to facilitate identifying plants collected in field inventories, we developed an internet-based free-access tool to identify Amazonian fern species. We focused on ferns, because they are easy to collect and their edaphic affinities are relatively well known, so they can be used as an indicator group for habitat mapping. Our key includes 302 terrestrial and aquatic entities mainly from lowland Amazonian forests. It is a free-access key, so the user can freely choose which morphological features to use and in which order to assess them. All taxa are richly illustrated, so specimens can be identified by a combination of character choices, visual comparison, and written descriptions. The identification tool was developed in Lucid 3.5 software and it is available at http://keyserver.lucidcentral.org:8080/sandbox/keys.jsp. PMID:28781548

The clinical academic workforce in Australia and New Zealand: report on the second binational summit to implement a sustainable training pathway.

PubMed

Windsor, John; Garrod, Tamsin; Talley, Nicholas J; Tebbutt, Carmel; Churchill, James; Farmer, Elizabeth; Baur, Louise; Smith, Julian A

2017-04-01

There has been a decline in the proportion of clinical academics compared with full-time clinicians, since 2004. A Working Party was established to help develop and implement a model for the training of clinical academics. After a highly successful first summit in 2014 that summarised the challenges faced by clinical academics in Australia and New Zealand, a second summit was convened late in 2015 to report on progress and to identify key areas for further action. The second summit provided survey results that identified the varied training pathways currently offered to clinical academics and the institutions willing to be involved in developing improved pathways. A literature review also described the contributions that clinical academics make to the health sector and the challenges faced by this workforce sector. Current training pathways created for clinical academics by Australasian institutions were presented as examples of what can be done. The perspectives of government and research organisations presented at the summit helped define how key stakeholders can contribute. Following the summit, there was a strong commitment to continue to work towards developing a sustainable and defined training pathway for clinical academics. The need for a coordinated and integrated approach was highlighted. Some key objectives were agreed upon for the next phase, including identifying and engaging key advocates within government and leading institutions; publishing and profiling the contributions of successful clinical academics to healthcare outcomes; defining the stages of a clinical academic training pathway; and establishing a mentoring programme for training clinical academics. © 2017 Royal Australasian College of Physicians.

Toward a patient-centric medical information model: issues and challenges for US adoption.

PubMed

Lorence, Daniel; Monatesti, Sabatini; Margenthaler, Robert; Hoadley, Ellen

2005-01-01

As the USA moves, incrementally, toward evidence-based medicine, there is growing awareness of the importance of innovation in information management. Mandates for change include improved use of resources, accelerated diffusion of knowledge and an advanced consumer role. Key among these requirements is the need for a fundamentally different patient information recording system. Within the challenges identified in the most recent national health information technology initiative, we propose a model for an electronic, patient-centric medical information infrastructure, highlighting a transportable, scalable and integrated resource. We identify resources available for technology transfer, promoting consumers as integral parts of the collaborative medical decision-making process.

Solid-State Lighting: Early Lessons Learned on the Way to Market

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

Sandahl, Linda J.; Cort, Katherine A.; Gordon, Kelly L.

2013-12-31

The purpose of this report is to document early challenges and lessons learned in the solid-state lighting (SSL) market development as part of the DOE’s SSL Program efforts to continually evaluate market progress in this area. This report summarizes early actions taken by DOE and others to avoid potential problems anticipated based on lessons learned from the market introduction of compact fluorescent lamps and identifies issues, challenges, and new lessons that have been learned in the early stages of the SSL market introduction. This study identifies and characterizes12 key lessons that have been distilled from DOE SSL program results.

Followership: An Essential Ingredient of Leadership

DTIC Science & Technology

2015-06-12

takes a different approach to followers then Army doctrine, in his book Leadership. Followers are sorted in four categories. There are top managers ...unique challenges and ways of interacting with each. Top managers are identified as those who are “key players” within an organization. These are...

The Future Growth of Degree Apprenticeships

ERIC Educational Resources Information Center

Universities UK, 2016

2016-01-01

Degree apprenticeships provide an exciting development in vocational higher education and a new opportunity for universities. Universities UK (UUK) commissioned CFE Research to identify lessons and key challenges from universities involved to date and make recommendations to help ensure the future successful development of degree apprenticeships.…

Facilitating Organizational Learning in the Russian Business Context

ERIC Educational Resources Information Center

Molodchik, Mariia; Jardon, Carlos

2015-01-01

Purpose: The paper aims to identify particular traits of the Russian context which condition two key enablers of organizational learning--organizational culture and transformational leadership. Design/methodology/approach: Drawing on a literature review, the study determines management challenges by implementation of organizational learning in the…

“I Need my Own Place to get Better”: Patient Perspectives on the Role of Housing in Potentially Preventable Hospitalizations

PubMed Central

Quensell, Michelle L.; Taira, Deborah A.; Seto, Todd B.; Braun, Kathryn L.; Sentell, Tetine L.

2017-01-01

Objective To analyze patient perspectives on the role of housing in their potentially preventable hospitalization. Methods Individuals admitted with cardiovascular-or diabetes-related diagnoses (n = 90) in a major medical center in Hawai‘i completed an in-person interview eliciting patient perspectives on key factors leading to hospitalization. Using the framework approach, two independent coders identified themes. This study focused on housing-related findings. Results Overall, 23% of participants reported housing as a precipitating factor to their hospitalization, including 12 with no regular place to stay. Four housing-related themes emerged: challenges meeting basic needs, complex chronic care management difficulties, stigma and relationship with provider, and stress and other mental health issues. Discussion Almost 25% of patients identified housing as a key factor to their hospital stay. Patient-reported themes highlight specific mechanisms by which housing challenges may lead to hospitalization. Addressing housing issues could help reduce the number and associated cost burden of preventable hospitalizations. PMID:28529224

Perception of touch quality in piano tones.

PubMed

Goebl, Werner; Bresin, Roberto; Fujinaga, Ichiro

2014-11-01

Both timbre and dynamics of isolated piano tones are determined exclusively by the speed with which the hammer hits the strings. This physical view has been challenged by pianists who emphasize the importance of the way the keyboard is touched. This article presents empirical evidence from two perception experiments showing that touch-dependent sound components make sounds with identical hammer velocities but produced with different touch forms clearly distinguishable. The first experiment focused on finger-key sounds: musicians could identify pressed and struck touches. When the finger-key sounds were removed from the sounds, the effect vanished, suggesting that these sounds were the primary identification cue. The second experiment looked at key-keyframe sounds that occur when the key reaches key-bottom. Key-bottom impact was identified from key motion measured by a computer-controlled piano. Musicians were able to discriminate between piano tones that contain a key-bottom sound from those that do not. However, this effect might be attributable to sounds associated with the mechanical components of the piano action. In addition to the demonstrated acoustical effects of different touch forms, visual and tactile modalities may play important roles during piano performance that influence the production and perception of musical expression on the piano.

Postharvest technology for developing countries: challenges and opportunities in research, outreach and advocacy.

PubMed

Kitinoja, Lisa; Saran, Sunil; Roy, Susanta K; Kader, Adel A

2011-03-15

This article discusses the needs and challenges of developing good, science-based, simple methods for postharvest handling that can be made available in developing countries. Some of the traditional challenges have been successfully met (i.e. identifying causes and sources of losses for key crops, identifying many potential postharvest technologies of practical use for reducing losses), but many challenges remain. These include the characterization of indigenous crops in terms of their unique postharvest physiology (e.g. respiration rate, susceptibility to water loss, chilling sensitivity, ethylene sensitivity), ascertaining the differences between handling recommendations made for well-known varieties and the needs of local varieties of crops, and determining cost effectiveness of scale-appropriate postharvest technologies in each locale and for each crop. Key issues include building capacity at the local level in postharvest science, university teaching and extension, and continued adaptive research efforts to match emerging postharvest technologies to local needs as these continue to change over time. Development of appropriate postharvest technology relies upon many disciplines that are relevant to the overall success of horticulture, i.e. plant biology, engineering, agricultural economics, food processing, nutrition, food safety, and environmental conservation. The expanding pool of new information derived from postharvest research and outreach efforts in these areas can lead in many directions which are likely to have an impact on relieving poverty in developing countries. Copyright © 2011 Society of Chemical Industry.

Identifying the "Right Stuff": An Exploration-Focused Astronaut Job Analysis

NASA Technical Reports Server (NTRS)

Barrett, J. D.; Holland, A. W.; Vessey, W. B.

2015-01-01

Industrial and organizational (I/O) psychologists play a key role in NASA astronaut candidate selection through the identification of the competencies necessary to successfully engage in the astronaut job. A set of psychosocial competencies, developed by I/O psychologists during a prior job analysis conducted in 1996 and updated in 2003, were identified as necessary for individuals working and living in the space shuttle and on the International Space Station (ISS). This set of competencies applied to the space shuttle and applies to current ISS missions, but may not apply to longer-duration or long-distance exploration missions. With the 2015 launch of the first 12- month ISS mission and the shift in the 2020s to missions beyond low earth orbit, the type of missions that astronauts will conduct and the environment in which they do their work will change dramatically, leading to new challenges for these crews. To support future astronaut selection, training, and research, I/O psychologists in NASA's Behavioral Health and Performance (BHP) Operations and Research groups engaged in a joint effort to conduct an updated analysis of the astronaut job for current and future operations. This project will result in the identification of behavioral competencies critical to performing the astronaut job, along with relative weights for each of the identified competencies, through the application of job analysis techniques. While this job analysis is being conducted according to job analysis best practices, the project poses a number of novel challenges. These challenges include the need to identify competencies for multiple mission types simultaneously, to evaluate jobs that have no incumbents as they have never before been conducted, and working with a very limited population of subject matter experts. Given these challenges, under the guidance of job analysis experts, we used the following methods to conduct the job analysis and identify the key competencies for current and potential future missions.

Translation of tobacco policy into practice in disadvantaged and marginalized subpopulations: a study of challenges and opportunities in remote Australian Indigenous communities

PubMed Central

2012-01-01

Background In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Australian communities, local and operational-level participants' views point to an 'implementation gap'. Their views should be heard because they are in a position to provide practical recommendations for effective policy implementation faithful to its design, thereby translating sound policy into meaningful action. Some recommendations may also find a place in culturally diverse low- and middle-income countries. Key words: tobacco policy implementation, challenges, opportunities, remote Indigenous Australian communities. PMID:22839197

Identifying Key Events in AOPs for Embryonic Disruption using Computational Toxicology (European Teratology Society - AOP symp.)

EPA Science Inventory

Addressing safety aspects of drugs and environmental chemicals relies extensively on animal testing; however, the quantity of chemicals needing assessment and challenges of species extrapolation require alternative approaches to traditional animal studies. Newer in vitro and in s...

Chemical analysis of plants that poison livestock: Successes, challenges, and opportunities

USDA-ARS?s Scientific Manuscript database

Poisonous plants have a devastating impact on the livestock industry, as well as human health. In order to fully understand the effects of poisonous plants, multiple scientific disciplines are required. Chemical analysis of plant secondary compounds is key to identifying the responsible toxins, char...

Framework for Assessing Environmental, Social, and Economic Sustainability of ICT Organizations

ERIC Educational Resources Information Center

Odeh, Khuloud

2013-01-01

Key challenges that confront the Information and Communication Technology (ICT) industry today in defining and achieving social, environmental, and economic sustainability goals include identifying sustainable operating standards and best practices and measuring and assessing performance against those practices. The industry lacks a framework for…

Identifying Barriers to Collaboration Between Primary Care and Public Health: Experiences at the Local Level.

PubMed

Pratt, Rebekah; Gyllstrom, Beth; Gearin, Kim; Lange, Carol; Hahn, David; Baldwin, Laura-Mae; VanRaemdonck, Lisa; Nease, Don; Zahner, Susan

Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states. The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory. Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources. Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration.

Microeconomic institutions and personnel economics for health care delivery: a formal exploration of what matters to health workers in Rwanda.

PubMed

Serneels, Pieter; Lievens, Tomas

2018-01-26

Most developing countries face important challenges regarding the quality of health care, and there is a growing consensus that health workers play a key role in this process. Our understanding as to what are the key institutional challenges in human resources, and their underlying driving forces, is more limited. A conceptual framework that structures existing insights and provides concrete directions for policymaking is also missing. To gain a bottom-up perspective, we gather qualitative data through semi-structured interviews with different levels of health workers and users of health services in rural and urban Rwanda. We conducted discussions with 48 health workers and 25 users of health services in nine different groups in 2005. We maximized within-group heterogeneity by selecting participants using specific criteria that affect health worker performance and career choice. The discussion were analysed electronically, to identify key themes and insights, and are documented with a descriptive quantitative analysis relating to the associations between quotations. The findings from this research are then revisited 10 years later making use of detailed follow-up studies that have been carried out since then. The original discussions identified both key challenges in human resources for health and driving forces of these challenges, as well as possible solutions. Two sets of issues were highlighted: those related to the size and distribution of the workforce and those related to health workers' on-the-job performance. Among the latter, four categories were identified: health workers' poor attitudes towards patients, absenteeism, corruption and embezzlement and lack of medical skills among some categories of health workers. The discussion suggest that four components constitute the deeper causal factors, which are, ranked in order of ease of malleability, incentives, monitoring arrangements, professional and workplace norms and intrinsic motivation. Three institutional innovations are identified that aim at improving performance: performance pay, community health workers and increased attention to training of health workers. Revisiting the findings from this primary research making use of later in-depth studies, the analysis demonstrates their continued relevance and usefulness. We discuss how the different factors affect the quality of care by impacting on health worker performance and labour market choices, making use of insights from economics and development studies on the role of institutions. The study results indicate that health care quality to an important degree depends on four institutional factors at the microlevel that strongly impact on health workers' performance and career choice, and which deserve more attention in applied research and policy reform. The analysis also helps to identify ways forwards, which fit well with the Ministry's most recent strategic plan.

The establishment and expansion of an innovative centre for rational pharmacotherapy--determinants and challenges.

PubMed

Kardakis, Therese; Tomson, Göran; Wettermark, Björn; Brommels, Mats; Godman, Brian; Bastholm-Rahmner, Pia

2015-01-01

The regional Board of Health in Stockholm, Sweden, established the Pharmacotherapy Centre (PTC) to enhance the rational use of medicines. The PTC initiated computerised decision support systems and developed a range of electronic service products to sustain rational prescribing. However, knowledge about which determinants have supported or hindered the sustainability of this type of healthcare organisation is limited. This study aims to identify and explore determinants that support or challenge the development and sustainability of the PTC organisation, as well as investigate the key elements of their implementation efforts. An in-depth interview study among key informants involved in the establishment of the PTC organisation was conducted. Data were analysed using qualitative content analysis. Findings suggest that determinants enabling the development and expansion of this organisation include the presence of innovative characteristics among the PTC leadership and the ability of leaders to nurture visionary innovation in others, as well as the instigation of informal social networks and to identify end-user needs. Challenges included an ambiguous relationship to the pharmaceutical industry, an underestimation of the innovation-system fit and to undertake systematic evaluation of created impact by the organisation. Although prescriber use of electronic service products and adherence to an essential drug list increased over time, it remains difficult to identify methods required for demonstrating patient effects. Whereas some determinants enabled the successful expansion of the PTC organisation, others served to substantially hinder it. The determinants identified can pave the way for systematic investigations into organisational change and development research in the pharmaceutical field. Copyright © 2013 John Wiley & Sons, Ltd.

UAS Integration into the NAS Project

NASA Technical Reports Server (NTRS)

Bauer, Jeff

2010-01-01

The goal of the UAS Integration in the NAS Project is to contribute capabilities that reduce technical barriers related to the safety and operational challenges associated with enabling routine UAS access to the NAS This goal will be accomplished through a two-phased approach of system-level integration of key concepts, technologies and/or procedures, and demonstrations of integrated capabilities in an operationally relevant environment. Technical objectives include: PHASE 1: a) Validating the key technical areas identified by this project. System-level analyses, a State of the Art Analysis (SOAA), and a ConOps will identify the challenges and barriers preventing routine UAS access to the NAS. b) Developing a national roadmap and gap analysis identifying specific deliverables in the area of operations, procedures, and technologies that will impact future policy decisions. PHASE 2: a) Provide regulators with a methodology for developing airworthiness requirements for UAS and data to support development of certifications standards and regulatory guidance. b) Provide systems-level integrated testing of concepts and/or capabilities that address barriers to routine access to the NAS. Through simulation and flight testing, address issues including separation assurance, communications requirements, and Pilot Aircraft Interfaces (PAIs) in operationally relevant environments

Computing elastic anisotropy to discover gum-metal-like structural alloys

NASA Astrophysics Data System (ADS)

Winter, I. S.; de Jong, M.; Asta, M.; Chrzan, D. C.

2017-08-01

The computer aided discovery of structural alloys is a burgeoning but still challenging area of research. A primary challenge in the field is to identify computable screening parameters that embody key structural alloy properties. Here, an elastic anisotropy parameter that captures a material's susceptibility to solute solution strengthening is identified. The parameter has many applications in the discovery and optimization of structural materials. As a first example, the parameter is used to identify alloys that might display the super elasticity, super strength, and high ductility of the class of TiNb alloys known as gum metals. In addition, it is noted that the parameter can be used to screen candidate alloys for shape memory response, and potentially aid in the optimization of the mechanical properties of high-entropy alloys.

Key team physical and technical performance indicators indicative of team quality in the soccer Chinese super league.

PubMed

Yang, Gai; Leicht, Anthony S; Lago, Carlos; Gómez, Miguel-Ángel

2018-01-01

The aim of this study was to identify the key physical and technical performance variables related to team quality in the Chinese Super League (CSL). Teams' performance variables were collected from 240 matches and analysed via analysis of variance between end-of-season-ranked groups and multinomial logistic regression. Significant physical performance differences between groups were identified for sprinting (top-ranked group vs. upper-middle-ranked group) and total distance covered without possession (upper and upper-middle-ranked groups and lower-ranked group). For technical performance, teams in the top-ranked group exhibited a significantly greater amount of possession in opponent's half, number of entry passes in the final 1/3 of the field and the Penalty Area, and 50-50 challenges than lower-ranked teams. Finally, time of possession increased the probability of a win compared with a draw. The current study identified key performance indicators that differentiated end-season team quality within the CSL.

The Management Development Needs of Front-Line Managers: Voices from the Field.

ERIC Educational Resources Information Center

Longenecker, Clinton O.; Neubert, Mitchell

2003-01-01

A survey of 524 managers identified key practices to improve performance in a changing environment: clarifying roles, goals, and expectations; ongoing performance evaluation, feedback, and coaching; mentoring; challenging assignments; formal career planning; customer contact; cross-training; and 360-degree feedback. (Contains 31 references.) (SK)

Weighing the Evidence: From Chaos to Consilience

ERIC Educational Resources Information Center

Brendtro, Larry K.; Mitchell, Martin L.

2010-01-01

A flood of contradictory publications claim widely different methods to be "evidence-based." What then are the key principles for success with challenging youth? Amidst all the confusion, how do we identify powerful universal truths? The answer lies in a "consilience," which involves drawing information from multiple fields of knowledge.…

A Multiyear Investigation of Combating Bullying in Middle School: Stakeholder Perspectives

ERIC Educational Resources Information Center

Shriberg, David; Burns, Mallory; Desai, Poonam; Grunewald, Stephanie; Pitt, Rachel

2015-01-01

Working collaboratively to address bullying among middle school students is an ongoing challenge. This study used participatory action research to collaborate with key stakeholders within a middle school to identify needs and implement more effective practices. Extensive qualitative and quantitative data are presented, along with process…

Identifying and Funding the Greatest Needs in School Facilities

ERIC Educational Resources Information Center

Gorrell, Bob; Salamone, Frank

2012-01-01

How should public school facilities programs allocate limited resources to school facilities needs fairly, cost-effectively, and efficiently while taking into account facility condition, educational adequacy, and other priorities? New Mexico has developed a solution that overcomes key challenges that are common to school facilities programs across…

Identifying and Addressing Themes of Job Dissatisfaction for Secondary Principals

ERIC Educational Resources Information Center

De Jong, David; Grundmeyer, Trent; Yankey, Julie

2017-01-01

Secondary principals serve in important roles that are complex, high-stress, and include demanding job responsibilities. Key stakeholders such as superintendents, school board members, and legislators must understand the challenges facing secondary principals in order to address the current themes of job dissatisfaction. Using new survey data…

The American University: National Treasure or Endangered Species?

ERIC Educational Resources Information Center

Ehrenberg, Ronald G. Ed.

This book of nine essays was written to honor Frank H. T. Rhodes, President Emeritus of Cornell University (New York) and addresses ways in which research universities can respond to current challenges. An introductory chapter, "The American University: Dilemmas and Directions" (Ronald G. Ehrenberg), identifies key issues raised in the following…

Leadership and Futuring: Making Visions Happen

ERIC Educational Resources Information Center

Hoyle, John R.

2006-01-01

Well-educated, charismatic leaders who can improve systems to enrich the lives of others are needed today more than ever. In this updated edition, John Hoyle identifies vision, motivation, flexibility, and openness to invention and opportunity as key characteristics of effective leaders, and challenges school administrators to think outside the…

Trypanosoma congolense: Natural and Acquired Resistance in the Bovine

DTIC Science & Technology

1980-08-01

1CmTAR’V NOTES V It. KeY WOPOS (Cohitlue Wof, 70 sre s i N6deawy and Identify by block nismb.r) B3OVINE, S1,U!,VfVE, CHALIT.1(itN, THERAPY , GEOGRAPHICAL...Rmforol,.l WHICH REQUIRED TREATMENT TO SURVIVE WERE ALSO CHALLENGED AT INTERVALS AFTER THERAPY . THREE ANIMALS INFECTED FOR 49 TO 75 DAYS BEFORE TREATMENT...their iast patent parasitemia. Older animals which required treatment to survive were also challenged at Interval% miller therapy . Three animals

The Grand Challenges of Organ Banking: Proceedings from the first global summit on complex tissue cryopreservation.

PubMed

Lewis, Jedediah K; Bischof, John C; Braslavsky, Ido; Brockbank, Kelvin G M; Fahy, Gregory M; Fuller, Barry J; Rabin, Yoed; Tocchio, Alessandro; Woods, Erik J; Wowk, Brian G; Acker, Jason P; Giwa, Sebastian

2016-04-01

The first Organ Banking Summit was convened from Feb. 27 - March 1, 2015 in Palo Alto, CA, with events at Stanford University, NASA Research Park, and Lawrence Berkeley National Labs. Experts at the summit outlined the potential public health impact of organ banking, discussed the major remaining scientific challenges that need to be overcome in order to bank organs, and identified key opportunities to accelerate progress toward this goal. Many areas of public health could be revolutionized by the banking of organs and other complex tissues, including transplantation, oncofertility, tissue engineering, trauma medicine and emergency preparedness, basic biomedical research and drug discovery - and even space travel. Key remaining scientific sub-challenges were discussed including ice nucleation and growth, cryoprotectant and osmotic toxicities, chilling injury, thermo-mechanical stress, the need for rapid and uniform rewarming, and ischemia/reperfusion injury. A variety of opportunities to overcome these challenge areas were discussed, i.e. preconditioning for enhanced stress tolerance, nanoparticle rewarming, cyroprotectant screening strategies, and the use of cryoprotectant cocktails including ice binding agents. Copyright © 2015.

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

PubMed

Hopwood, Nick

2015-01-01

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

Solar Sail Roadmap Mission GN and C Challenges

NASA Technical Reports Server (NTRS)

Heaton, Andrew F.

2005-01-01

The NASA In-Space Propulsion program is funding development work for solar sails to enhance future scientific opportunities. Key to this effort are scientific solar sail roadmap missions identified by peer review. The two near-term missions of interest are L1 Diamond and Solar Polar Imager. Additionally, the New Millennium Program is sponsoring the Space Technology 9 (ST9) demonstration mission. Solar sails are one of five technologies competing for the ST9 flight demonstration. Two candidate solar sail missions have been identified for a potential ST9 flight. All the roadmap missions and candidate flight demonstration missions face various GN&C challenges. A variety of efforts are underway to address these challenges. These include control actuator design and testing, low thrust optimization studies, attitude control system design and modeling, control-structure interaction studies, trajectory control design, and solar radiation pressure model development. Here we survey the various efforts underway and identify a few of specific recent interest and focus.

Cooperative Vehicular Networking: A Survey

PubMed Central

Ahmed, Ejaz

2018-01-01

With the remarkable progress of cooperative communication technology in recent years, its transformation to vehicular networking is gaining momentum. Such a transformation has brought a new research challenge in facing the realization of cooperative vehicular networking (CVN). This paper presents a comprehensive survey of recent advances in the field of CVN. We cover important aspects of CVN research, including physical, medium access control, and routing protocols, as well as link scheduling and security. We also classify these research efforts in a taxonomy of cooperative vehicular networks. A set of key requirements for realizing the vision of cooperative vehicular networks is then identified and discussed. We also discuss open research challenges in enabling CVN. Lastly, the paper concludes by highlighting key points of research and future directions in the domain of CVN. PMID:29881331

Design and implementation of a secure wireless mote-based medical sensor network.

PubMed

Malasri, Kriangsiri; Wang, Lan

2009-01-01

A medical sensor network can wirelessly monitor vital signs of humans, making it useful for long-term health care without sacrificing patient comfort and mobility. For such a network to be viable, its design must protect data privacy and authenticity given that medical data are highly sensitive. We identify the unique security challenges of such a sensor network and propose a set of resource-efficient mechanisms to address these challenges. Our solution includes (1) a novel two-tier scheme for verifying the authenticity of patient data, (2) a secure key agreement protocol to set up shared keys between sensor nodes and base stations, and (3) symmetric encryption/decryption for protecting data confidentiality and integrity. We have implemented the proposed mechanisms on a wireless mote platform, and our results confirm their feasibility.

Automated Rock Identification for Future Mars Exploration Missions

NASA Technical Reports Server (NTRS)

Gulick, V. C.; Morris, R. L.; Gazis, P.; Bishop, J. L.; Alena, R.; Hart, S. D.; Horton, A.

2003-01-01

A key task for human or robotic explorers on the surface of Mars is choosing which particular rock or mineral samples should be selected for more intensive study. The usual challenges of such a task are compounded by the lack of sensory input available to a suited astronaut or the limited downlink bandwidth available to a rover. Additional challenges facing a human mission include limited surface time and the similarities in appearance of important minerals (e.g. carbonates, silicates, salts). Yet the choice of which sample to collect is critical. To address this challenge we are developing science analysis algorithms to interface with a Geologist's Field Assistant (GFA) device that will allow robotic or human remote explorers to better sense and explore their surroundings during limited surface excursions. We aim for our algorithms to interpret spectral and imaging data obtained by various sensors. The algorithms, for example, will identify key minerals, rocks, and sediments from mid-IR, Raman, and visible/near-IR spectra as well as from high resolution and microscopic images to help interpret data and to provide high-level advice to the remote explorer. A top-level system will consider multiple inputs from raw sensor data output by imagers and spectrometers (visible/near-IR, mid-IR, and Raman) as well as human opinion to identify rock and mineral samples.

Ethics issues for HIV/AIDS researchers in international settings - perspectives from the Canadian experience.

PubMed

Gahagan, Jacqueline; Sweeney, Ellen; Worthington, Catherine; Perry, Darryl; Satzinger, Franziska; Rogers, Erin

2008-11-01

In recognition of the level of international HIV/AIDS research being conducted by Canadians, the Canadian Association for HIV Research (CAHR), along with its partners, has developed a resource document to assist researchers in identifying and preparing for the unique ethics issues and challenges that may arise during international HIV/AIDS research. Between 2004 and 2007, face-to-face consultations were undertaken with community and government stakeholders, and interviews were conducted with eight prominent HIV/AIDS researchers with international experience to identify key research ethics challenges and structural, cultural, political, social, and economic factors that may impact HIV/AIDS research ethics in resource-limited settings. These challenges and factors served as the basis for the hypothetical ethics issues case scenarios developed for each of the four research tracks. Ethics issues were identified at every stage of the research process. Key contextual issues included: (1) stigma and culturally-embedded conceptualizations of HIV; (2) local and global politics and economics; (3) gender inequities, power dynamics, and sexual roles; and (4) allocation and availability of resources for research and health services. The final document resulting from the consultation process provides a framework for open dialogue on the complex and interconnected ethics issues researchers may experience in the field of international HIV/AIDS research, and contributes to the HIV/AIDS research field by reinforcing the need for high quality and ethically sound research. This document can be found at http://ethics.cahr-acrv.ca/.

Technical challenges in designing post-marketing eCRFs to address clinical safety and pharmacovigilance needs.

PubMed

Lu, Zhengwu

2010-01-01

To identify key challenges and propose technical considerations in designing electronic case report form (eCRF) for post-marketing studies, the author undertakes a comprehensive literature review of peer reviewed and grey literature to assess the key aspects, processes, standards, recommendations, and best practices in designing eCRFs based on industry experience in designing and supporting electronic data capture (EDC) studies. Literature search using strings on MEDLINE and PUBMED returned few papers directly related to CRF design. Health informatics and general practice journals were searched and results reviewed. Many conference, government commission, health professional and special interests group websites provide relevant information from practical experience - summarization of this information is presented. Further, we presented a list of concrete technical considerations in dealing with EDC technology/system limitations based on literature assessment and industry implementation experience. It is recognized that cross-functional teams be involved in eCRF design process and decision making. To summarize the keys in designing eCRFs to address post-market study safety and pharmacovigilance needs, the first is to identify required data elements from the study protocol supporting data analyses and reporting requirements. Secondly, accepted best practices, CDASH & CDISC guidelines, and company internal or therapeutic unit standard should be considered and applied. Coding (MedDRA & WHODD) mapping should be managed and implemented as well when possible. Finally, we need to be on top of the EDC technologies, challenge the technologies, drive EDC improvement via working with vendors, and utilize the technologies to drive clinical effectiveness. Copyright (c) 2009 Elsevier Inc. All rights reserved.

AMCP Partnership Forum: Improving Quality, Value, and Outcomes with Patient-Reported Outcomes.

PubMed

2018-03-01

Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions. While there have been significant strides by key health care stakeholders to further the development and use of PROs, there are a number of challenges limiting more widespread use. In light of these current challenges and the potential for PROs to improve health care quality and value, on October 19, 2017, the Academy of Managed Care Pharmacy convened a forum of key stakeholders representing patients, payers, providers, government, and pharmaceutical companies to discuss and identify solutions to the current challenges and barriers to further use of PROs. These discussions informed the development of participants' ideal future state in which PROs maximize the goals of all health care stakeholders and the actionable steps required to make the future state a reality. While stakeholders shared unique perspectives throughout the forum, they had consensus on 2 overarching issues: the importance of PROs in defining value, improving patient care, and implementing value-based payment models and the need for strong organizational and operational systems to achieve optimal adoption and use. Participants identified several key challenges in PRO use and adoption: achieving a representative patient population, inclusion of PRO data in medication labels, the necessity for both standardized and customizable PROs, and operational and organizational barriers to collecting and analyzing PROs. To overcome these challenges, participants recommended that manufacturers should engage key stakeholders early and throughout the drug development process to ensure the most valid and representative PROs and patient populations will be included. To streamline the PRO collection process, participants suggested engaging pharmacists and other providers who may have more frequent interaction with patients. Participants also recommended that PRO collection and analysis should use common technology platforms, streamline components of clinician care to reduce workflow, and be integrated with claims data to provider payers a better understanding of patient health in real time. Finally, additional work should be done to develop patient-reported outcome measures that contain relevant measures for all healthcare stakeholders. While significant challenges remain in PRO development and adoption, participants agreed that greater use can only be achieved through collaboration and patient-centered care. The AMCP Partnership Forum titled "Improving Quality, Value, and Outcomes with Patient-Reported Outcomes" and the development of this proceedings report were supported by Amgen, Boehringer Ingelheim Pharmaceuticals, Genentech, GlaxoSmithKline, Novartis Pharmaceuticals, Novo Nordisk, Precision for Value, Premier, Sanofi, Takeda Pharmaceuticals USA, and Xcenda.

National Institute of Justice (NIJ): technology challenges

NASA Astrophysics Data System (ADS)

Morgan, John S.

2004-09-01

Law enforcement agencies play a key role in protecting the nation from and responding to terrorist attacks. The National Institute of Justice (NIJ) is the focal point for the research, development, test and evaluation of technology for law enforcement. NIJ and the Department of Homeland Security's Directorate of Science & Technology (DHS S&T) have related missions to support research and technology development for public safety. DHS S&T provides law enforcement agencies technology to respond to terrorist threats involving weapons of mass destruction, while NIJ focuses on technologies applicable across the spectrum of law enforcement needs. Investment in C3I technology offers perhaps the greatest potential benefit with respect to improving the ability to law enforcement agencies to respond to all types of crime including terrorist acts. Providing effective communications and information systems remains a key technology challenge, as does providing law enforcement responders accurate information that they can act on. Sensors and surveillance systems can play a key role in identifying terrorists and preventing or effectively responding to a terrorist attack.

Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships.

PubMed

Reddy, Madhu C; Purao, Sandeep; Kelly, Mary

2008-01-01

This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP's benefits and challenges from both the rural hospitals' and vendor hospital's perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful.

Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships

PubMed Central

Reddy, Madhu C.; Purao, Sandeep; Kelly, Mary

2008-01-01

This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP's benefits and challenges from both the rural hospitals' and vendor hospital's perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful. PMID:18436901

Families of returned defence force personnel: a changing landscape of challenges.

PubMed

Berle, David; Steel, Zachary

2015-08-01

This paper aims to identify the key challenges experienced by the families of defence force personnel following deployment. We undertook a selective review of four post-deployment challenges to the families of defence force personnel: (1) changes to relationships; (2) changes to family member roles and responsibilities; (3) adjustment of children and parenting challenges; and (4) anger, family conflict and violence. Emerging issues in the area of post-deployment adjustment are also discussed. Empirical studies of post-deployment family adjustment are lacking. Each of the reviewed challenges can contribute to psychological difficulties and precipitate contact with mental health services. The challenges faced by defence force personnel when returning from deployment arise within a family context. Clinicians should thoroughly assess these factors in families following deployment, but also recognise family strengths and resilience to these challenges. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Opportunities for Enhanced Strategic Use of Surveys, Medical Records, and Program Data for HIV Surveillance of Key Populations: Scoping Review

PubMed Central

Baral, Stefan D; Edwards, Jessie K; Zadrozny, Sabrina; Hargreaves, James; Zhao, Jinkou; Sabin, Keith

2018-01-01

Background Normative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately. Objective The aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs. Methods To provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched. Results There remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and medical record data continue to be insufficiently robust to provide estimates of the 90-90-90 targets for key populations. Conclusions Current reliance on more active data collection processes, including key population-specific surveys, remains warranted until the quality and validity of passively collected routine program and medical record data for key populations is optimized. PMID:29789279

Perspectives on the role of stakeholders in knowledge translation in health policy development in Uganda.

PubMed

Nabyonga Orem, Juliet; Marchal, Bruno; Mafigiri, DavidKaawa; Ssengooba, Freddie; Macq, Jean; Da Silveira, Valeria Campos; Criel, Bart

2013-08-19

Stakeholder roles in the application of evidence are influenced by context, the nature of the evidence, the policy development process, and stakeholder interactions. Past research has highlighted the role of stakeholders in knowledge translation (KT) without paying adequate attention to the peculiarities of low-income countries. Here we identify the roles, relations, and interactions among the key stakeholders involved in KT in Uganda and the challenges that they face. This study employed qualitative approaches to examine the roles of and links among various stakeholders in KT. In-depth interviews were conducted with 21 key informants and focused on the key actors in KT, their perceived roles, and challenges. Major stakeholders included civil society organizations with perceived roles of advocacy, community mobilization, and implementation. These stakeholders may ignore unconvincing evidence. The community's role was perceived as advocacy and participation in setting research priorities. The key role of the media was perceived as knowledge dissemination, but respondents noted that the media may misrepresent evidence if it is received in a poorly packaged form. The perceived roles of policy makers were evidence uptake, establishing platforms for KT and stewardship; negative roles included ignoring or even misrepresenting evidence that is not in their favor. The roles of parliamentarians were perceived as advocacy and community mobilization, but they were noted to pursue objectives that may not be supported by the evidence. The researchers' main role was defined as evidence generation, but focusing disproportionately on academic interests was cited as a concern. The donors' main role was defined as funding research and KT, but respondents were concerned about the local relevance of donor-supported research. Respondents reported that links among stakeholders were weak due to the absence of institutionalized, inclusive platforms. Challenges facing the stakeholders in the process of KT were identified. Our investigation revealed the need to consider the roles that various stakeholders are best placed to play. Links and necessary platforms must be put in place to achieve synergy in KT. Relevant capacities need to be built to overcome the challenges faced by the various stakeholders.

Including refugees in disease elimination: challenges observed from a sleeping sickness programme in Uganda.

PubMed

Palmer, Jennifer J; Robert, Okello; Kansiime, Freddie

2017-01-01

Ensuring equity between forcibly-displaced and host area populations is a key challenge for global elimination programmes. We studied Uganda's response to the recent refugee influx from South Sudan to identify key governance and operational lessons for national sleeping sickness programmes working with displaced populations today. A refugee policy which favours integration of primary healthcare services for refugee and host populations and the availability of rapid diagnostic tests (RDTs) to detect sleeping sickness at this health system level makes Uganda well-placed to include refugees in sleeping sickness surveillance. Using ethnographic observations of coordination meetings, review of programme data, interviews with sleeping sickness and refugee authorities and group discussions with health staff and refugees (2013-2016), we nevertheless identified some key challenges to equitably integrating refugees into government sleeping sickness surveillance. Despite fears that refugees were at risk of disease and posed a threat to elimination, six months into the response, programme coordinators progressed to a sentinel surveillance strategy in districts hosting the highest concentrations of refugees. This meant that RDTs, the programme's primary surveillance tool, were removed from most refugee-serving facilities, exacerbating existing inequitable access to surveillance and leading refugees to claim that their access to sleeping sickness tests had been better in South Sudan. This was not intentionally done to exclude refugees from care, rather, four key governance challenges made it difficult for the programme to recognise and correct inequities affecting refugees: (a) perceived donor pressure to reduce the sleeping sickness programme's scope without clear international elimination guidance on surveillance quality; (b) a problematic history of programme relations with refugee-hosting districts which strained supervision of surveillance quality; (c) difficulties that government health workers faced to produce good quality surveillance in a crisis; and (d) reluctant engagement between the sleeping sickness programme and humanitarian structures. Despite progressive policy intentions, several entrenched governance norms and practices worked against integration of refugees into the national sleeping sickness surveillance system. Elimination programmes which marginalise forced migrants risk unwittingly contributing to disease spread and reinforce social inequities, so new norms urgently need to be established at local, national and international levels.

Principals on L-Plates: Rear View Mirror Reflections

ERIC Educational Resources Information Center

Wildy, Helen; Clarke, Simon

2008-01-01

Purpose: This paper aims to contribute to the literature on beginning the principalship by identifying and illustrating key challenges that novice principals encounter in their first year for which they would benefit from improved preparation. Design/methodology/approach: The paper is a synthesis of a decade of research focusing on the principal…

A Conceptual Model for School-Based Management Operation and Quality Assurance in Nigerian Secondary Schools

ERIC Educational Resources Information Center

Ayeni, Adeolu Joshua; Ibukun, Williams Olusola

2013-01-01

This paper examined the School-Based Management Committee's (SBMC) involvement and effectiveness in school governance, curriculum implementation and students' learning outcomes in Nigerian secondary schools; the major challenges facing effective operation of SBMCs were identified as low capacity of key members of the SBMCs; poor attendance of…

Student and Tutor Perspectives of On-Line Moderation

ERIC Educational Resources Information Center

Packham, Gary; Jones, Paul; Thomas, Brychan; Miller, Christopher

2006-01-01

Purpose: The on-line tutor or e-moderator faces a diversity of new challenges, including instructional design, organisation, direct instruction and facilitating discourse. This study aims to contrast the views of students and tutors regarding what factors constitute effective e-moderation in order to identify key attributes of an on-line tutor.…

Down the Rabbit Hole: Challenges and Methodological Recommendations in Researching Writing-Related Student Dispositions

ERIC Educational Resources Information Center

Driscoll, Dana Lynn; Gorzelsky, Gwen; Wells, Jennifer; Hayes, Carol; Jones, Ed; Salchak, Steve

2017-01-01

Researching writing-related dispositions is of critical concern for understanding writing transfer and writing development. However, as a field we need better tools and methods for identifying, tracking, and analyzing dispositions. This article describes a failed attempt to code for five key dispositions (attribution, self-efficacy, persistence,…

Genetic Variation in the MAPK/ERK Pathway Affects Contact Hypersensitivity Responses.

PubMed

Legrand, Julien M D; Roy, Edwige; Baz, Batoul; Mukhopadhyay, Pamela; Wong, Ho Yi; Ram, Ramesh; Morahan, Grant; Walker, Graeme; Khosrotehrani, Kiarash

2018-05-10

Using a genetic resource that enables rapid mapping of genes for complex traits, we demonstrate dramatic diversity between murine strains in response to immune challenge. We identified several candidate genes that point to the MAPK/ERK pathway as a key modulator of this process. Copyright © 2018. Published by Elsevier Inc.

Those Were the Days: Learning about History through Literature

ERIC Educational Resources Information Center

Crawford, Patricia A.; Zygouris-Coe, Vicky

2008-01-01

At a recent professional development program, the authors asked teachers to recall the ways in which they learned about history in the course of their own schooling. The teachers at this professional development gathering not only identified some of the key challenges facing elementary teachers charged with teaching social studies curricula, they…

Flexible Pedagogies: Technology-Enhanced Learning. Flexible Pedagogies: Preparing for the Future Series

ERIC Educational Resources Information Center

Gordon, Neil

2014-01-01

This publication is part of our five-strand research project "Flexible Pedagogies: preparing for the future". It focuses on a better understanding of technology-enhanced learning (TEL) and: (1) identifies key international drivers in the move towards technology-enhanced learning; (2) highlights some of the challenges and opportunities…

Responsible Research and Innovation Indicators for Science Education Assessment: How to Measure the Impact?

ERIC Educational Resources Information Center

Heras, Maria; Ruiz-Mallén, Isabel

2017-01-01

The emerging paradigm of responsible research and innovation (RRI) in the European Commission policy discourse identifies science education as a key agenda for better equipping students with skills and knowledge to tackle complex societal challenges and foster active citizenship in democratic societies. The operationalisation of this broad…

Accreditation in the Profession of Psychology: A Cautionary Tale

ERIC Educational Resources Information Center

Maiden, Robert; Knight, Bob G.; Howe, Judith L.; Kim, Seungyoun

2012-01-01

This article examines the history of accreditation in psychology and applies the lessons learned to the Association for Gerontology in Higher Education's (AGHE) consideration of forming an organization to accredit programs in gerontology. The authors identify the challenges met and unmet, the successes and failures, and the key issues that emerged…

The Development of Faith Leadership in Novice Principals

ERIC Educational Resources Information Center

Rieckhoff, Barbara Stacy

2014-01-01

This article describes the Catholic School Principal Support Program (CSPSP), a mentoring program for first and second-year Catholic school principals in a large urban diocese, and identifies key challenges, impacts and influences on decision-making. Ten school leaders describe their work and provide the lens by which they reflect on their role as…

Reconfiguring Urban Leadership: Taking a Perspective on Community

ERIC Educational Resources Information Center

Riley, Kathryn A.

2009-01-01

This article maps the key features of the community contexts in which a range of challenging urban schools are located, highlighting the community-related issues facing school leaders. Whilst recognising the growing demands on school leaders and the need to reconfigure leadership, the author also identifies steps which they can take to strengthen…

Magnetic resonance microscopy: concepts, challenges, and state-of-the-art.

PubMed

Gimi, Barjor

2006-01-01

Recent strides in targeted therapy and regenerative medicine have created a need to identify molecules and metabolic pathways implicated in a disease and its treatment. These molecules and pathways must be discerned at the cellular level to meaningfully reveal the biochemical underpinnings of the disease and to identify key molecular targets for therapy. Magnetic resonance (MR) techniques are well suited for molecular and functional imaging because of their noninvasive nature and their versatility in extracting physiological, biochemical, and functional information over time. However, MR is an insensitive technique; MR microscopy seeks to increase detection sensitivity, thereby localizing biochemical and functional information at the level of single cells or small cellular clusters. Here, we discuss some of the challenges facing MR microscopy and the technical and phenomenological strategies used to overcome these challenges. Some of the applications of MR microscopy are highlighted in this chapter.

Conservation biology in Asia: the major policy challenges.

PubMed

McNeely, Jeffrey A; Kapoor-Vijay, Promila; Zhi, Lu; Olsvig-Whittaker, Linda; Sheikh, Kashif M; Smith, Andrew T

2009-08-01

With about half the world's human population and booming economies, Asia faces numerous challenges to its biodiversity. The Asia Section of the Society for Conservation Biology has identified some key policy issues in which significant progress can be made. These include developing new sources of funding for forest conservation; identifying potential impacts of energy alternatives on the conservation of biodiversity; curbing the trade in endangered species of plants and animals; a special focus on the conservation of mountain biodiversity; enhancing relevant research; ensuring that conservation biology contributes to major international conventions and funding mechanisms; using conservation biology to build a better understanding of zoonotic diseases; more effectively addressing human-animal conflicts; enhancing community-based conservation; and using conservation biology to help address the pervasive water-deficit problems in much of Asia. These challenges can be met through improved regional cooperation among the relevant stakeholders.

The psychosocial challenges of solid organ transplant recipients during childhood.

PubMed

Annunziato, Rachel A; Jerson, Bradley; Seidel, Jordan; Glenwick, David S

2012-11-01

A large proportion of pediatric solid organ transplant recipients are young children, yet dedicated studies on the challenges faced by these patients are sparse. The present article aims to provide a summary of key considerations for pediatric solid organ transplant teams, describing what challenges are more likely for younger patients and how they might identify and address these circumstances. Our findings suggest that the mental health of patients and caregivers, issues at school, neurocognitive difficulties, and self-management are areas of particular relevance for children. We offer several recommendations that stem from these identified areas of concern. Dedicated focus on the well-being of younger patients could in the long-term stave off adverse events that are often associated with adolescence. In the short-term, certainly intervening in any of these domains could lead to improved quality of life during childhood. © 2012 John Wiley & Sons A/S.

Innovations in health service organization and delivery in northern rural and remote regions: a review of the literature.

PubMed

Mitton, Craig; Dionne, Francois; Masucci, Lisa; Wong, Sabrina; Law, Susan

2011-01-01

To identify and review innovations relevant to improving access, quality, efficiency and/or effectiveness in the organization and delivery of health care services in rural and remote areas. Literature review. Key bibliographic databases that index health research were searched: MEDLINE, EMBASE and CINAHL. Other databases relevant to Arctic health were also accessed. Abstracts were assessed for relevancy and full articles were reviewed and categorized according to emergent themes. Many innovations in delivering services to rural and remote areas were identified, particularly in the public health realm. These innovations were grouped into 4 key themes: organizational structure of health services; utilization of telehealth and ehealth; medical transportation; and public health challenges. Despite the challenges facing rural and remote regions, there is a distinctly positive message from this broad literature review. Evidence-based initiatives exist across a range of areas - which include operational efficiency and integration, access to care, organizational structure, public health, continuing education and workforce composition - that have the potential to positively impact health care quality and health-related outcomes.

When worlds collide: challenges and opportunities for conservation of biodiversity in the Hawaiian Islands

USGS Publications Warehouse

Atkinson, Carter T.; Pratt, Thane K.; Banko, Paul C.; Jacobi, James D.; Woodworth, Bethany L.

2013-01-01

This chapter identifies four key challenges and opportunities for long-term conservation of biodiversity in the Hawaii's Islands. Following are the challenges that need to be resolved for remaining species of native forest birds to survive into the next century: invasive species, landscape processes, social factors, and climate change. These challenges are also relevant to other threatened terrestrial taxonomic groups (i.e., plants and invertebrates) in the Hawaiian Islands. Such threats are familiar to conservation biologists the world over, but rarely do they act as synergistically as they do in the Hawaiian Islands. The chapter reviews conservation successes and failures in Hawaii, and provides an example of the possible future course of conservation in other island communities.

Enablers and challenges to occupational therapists’ research engagement: A qualitative study

PubMed Central

Di Bona, Laura; Wenborn, Jennifer; Field, Becky; Hynes, Sinéad M; Ledgerd, Ritchard; Mountain, Gail; Swinson, Tom

2017-01-01

Introduction To develop occupational therapy’s evidence base and improve its clinical outcomes, occupational therapists must increase their research involvement. Barriers to research consumption and leadership are well documented, but those relating to delivering research interventions, less so. Yet, interventions need to be researched within practice to demonstrate their clinical effectiveness. This study aims to improve understanding of challenges and enablers experienced by occupational therapists who deliver interventions within research programmes. Method Twenty-eight occupational therapists who participated in the Valuing Active Life in Dementia (VALID) research programme reported their experiences in five focus groups. Data were analysed thematically to identify key and subthemes. Results Occupational therapists reported that overwhelming paperwork, use of videos, recruitment and introducing a new intervention challenged their research involvement, whereas support, protected time and a positive attitude enabled it. The impact of these challenges and enablers varied between therapists and organisations. Conclusion Challenges and enablers to research involvement can be identified but must be addressed within individual and organisational contexts. Multifaceted collective action to minimise challenges and maximise enablers can facilitate clinicians’ involvement in research. Using this approach should enable occupational therapists to increase their research involvement, thus demonstrating the clinical effectiveness of their interventions. PMID:29170592

Core-oscillator model of Caulobacter crescentus

NASA Astrophysics Data System (ADS)

Vandecan, Yves; Biondi, Emanuele; Blossey, Ralf

2016-06-01

The gram-negative bacterium Caulobacter crescentus is a powerful model organism for studies of bacterial cell cycle regulation. Although the major regulators and their connections in Caulobacter have been identified, it still is a challenge to properly understand the dynamics of its circuitry which accounts for both cell cycle progression and arrest. We show that the key decision module in Caulobacter is built from a limit cycle oscillator which controls the DNA replication program. The effect of an induced cell cycle arrest is demonstrated to be a key feature to classify the underlying dynamics.

Regulatory and quality considerations for continuous manufacturing. May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Allison, Gretchen; Cain, Yanxi Tan; Cooney, Charles; Garcia, Tom; Bizjak, Tara Gooen; Holte, Oyvind; Jagota, Nirdosh; Komas, Bekki; Korakianiti, Evdokia; Kourti, Dora; Madurawe, Rapti; Morefield, Elaine; Montgomery, Frank; Nasr, Moheb; Randolph, William; Robert, Jean-Louis; Rudd, Dave; Zezza, Diane

2015-03-01

This paper assesses the current regulatory environment, relevant regulations and guidelines, and their impact on continuous manufacturing. It summarizes current regulatory experience and learning from both review and inspection perspectives. It outlines key regulatory aspects, including continuous manufacturing process description and control strategy in regulatory files, process validation, and key Good Manufacturing Practice (GMP) requirements. In addition, the paper identifies regulatory gaps and challenges and proposes a way forward to facilitate implementation. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Community Advisory Boards Guiding Engaged Research Efforts within a Clinical Translational Sciences Award: Key Contextual Factors Explored.

PubMed

Halladay, Jacqueline R; Donahue, Katrina E; Sleath, Betsy; Reuland, Dan; Black, Adina; Mitchell, C Madeline; Breland, Carol E; Coyne-Beasley, Tamera; Mottus, Kathleen; Watson, Sable Noelle; Lewis, Virginia; Wynn, Mysha; Corbie-Smith, Giselle

2017-01-01

Engaging stakeholders in research carries the promise of enhancing the research relevance, transparency, and speed of getting findings into practice. By describing the context and functional aspects of stakeholder groups, like those working as community advisory boards (CABs), others can learn from these experiences and operationalize their own CABs. Our objective is to describe our experiences with diverse CABs affiliated with our community engagement group within our institution's Clinical Translational Sciences Award (CTSA). We identify key contextual elements that are important to administering CABs. A group of investigators, staff, and community members engaged in a 6-month collaboration to describe their experiences of working with six research CABs. We identified the key contextual domains that illustrate how CABS are developed and sustained. Two lead authors, with experience with CABs and identifying contextual domains in other work, led a team of 13 through the process. Additionally, we devised a list of key tips to consider when devising CABs. The final domains include (1) aligned missions among stakeholders (2) resources/support, (3) defined operational processes/shared power, (4) well-described member roles, and (5) understanding and mitigating challenges. The tips are a set of actions that support the domains. Identifying key contextual domains was relatively easy, despite differences in the respective CAB's condition of focus, overall mission, or patient demographics represented. By contextualizing these five domains, other research and community partners can take an informed approach to move forward with CAB planning and engaged research.

Design and Implementation of a Secure Wireless Mote-Based Medical Sensor Network

PubMed Central

Malasri, Kriangsiri; Wang, Lan

2009-01-01

A medical sensor network can wirelessly monitor vital signs of humans, making it useful for long-term health care without sacrificing patient comfort and mobility. For such a network to be viable, its design must protect data privacy and authenticity given that medical data are highly sensitive. We identify the unique security challenges of such a sensor network and propose a set of resource-efficient mechanisms to address these challenges. Our solution includes (1) a novel two-tier scheme for verifying the authenticity of patient data, (2) a secure key agreement protocol to set up shared keys between sensor nodes and base stations, and (3) symmetric encryption/decryption for protecting data confidentiality and integrity. We have implemented the proposed mechanisms on a wireless mote platform, and our results confirm their feasibility. PMID:22454585

Partnerships and the Future of NASA

NASA Technical Reports Server (NTRS)

Blome, Elizabeth; Gowan, John W.; Sampson, Margarita

2015-01-01

Partnerships have become a more integral part of the journey to Mars as NASA continues to lead human space exploration. The current budgetary and political reality requires that partnerships be a key component of moving beyond Low Earth Orbit. This paper will discuss the challenge of finding innovative partnerships that take advantage of the capabilities of the growing commercial space market. Challenges include identifying specific technological needs, recognizing the growing expertise and desires of commercial space to move beyond Low Earth Orbit, incorporating commercial partners into the Mars Roadmap, and working with international partners.

Chemical Analysis of Plants that Poison Livestock: Successes, Challenges, and Opportunities.

PubMed

Welch, Kevin D; Lee, Stephen T; Cook, Daniel; Gardner, Dale R; Pfister, James A

2018-04-04

Poisonous plants have a devastating impact on the livestock industry as well as human health. To fully understand the effects of poisonous plants, multiple scientific disciplines are required. Chemical analysis of plant secondary compounds is key to identifying the responsible toxins, characterizing their metabolism, and understanding their effects on animals and humans. In this review, we highlight some of the successes in studying poisonous plants and mitigating their toxic effects. We also highlight some of the remaining challenges and opportunities with regards to the chemical analysis of poisonous plants.

E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review.

PubMed

Naseriasl, Mansour; Adham, Davoud; Janati, Ali

2015-06-01

around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment's and services. In order to respond these challenges and reduction of health system's transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby's index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner.

What are the barriers of quality survivorship care for haematology cancer patients? Qualitative insights from cancer nurses.

PubMed

Langbecker, Danette; Ekberg, Stuart; Yates, Patsy; Chan, Alexandre; Chan, Raymond Javan

2016-02-01

Many haematological cancer survivors report long-term physiological and psychosocial effects beyond treatment completion. These survivors continue to experience impaired quality of life (QoL) as a result of their disease and aggressive treatment. As key members of the multidisciplinary team, the purpose of this study is to examine the insights of cancer nurses to inform future developments in survivorship care provision. Open text qualitative responses from two prospective Australian cross-sectional surveys of nurses (n = 136) caring for patients with haematological cancer. Data were analysed thematically, using an inductive approach to identify themes. This study has identified a number of issues that nurses perceive as barriers to quality survivorship care provision. Two main themes were identified: the first relating to the challenges nurses face in providing care ('care challenges') and the second relating to the challenges of providing survivorship care within contemporary health care systems ('system challenges'). Cancer nurses perceive the nature of haematological cancer and its treatment and of the health care system itself, as barriers to the provision of quality survivorship care. Care challenges such as the lack of a standard treatment path and the relapsing or remitting nature of haematological cancers may be somewhat intractable, but system challenges relating to clearly defining and delineating professional responsibilities and exchanging information with other clinicians are not. Addressing the issues identified will facilitate cancer nurses' provision of survivorship care and help address haematological survivors' needs with regard to the physical and psychosocial consequences of their cancer and treatment.

The development of a questionnaire to assess the perceptions of care staff towards people with intellectual disabilities who display challenging behaviour.

PubMed

Williams, Ruth J; Rose, John L

2007-06-01

The perceptions of staff about challenging behaviour may be a key factor in designing successful behavioural interventions. There is a lack of robust psychometric instruments designed to assess staff attributions towards incidents of challenging behaviour. The aim of this research was to develop a scale based upon the self-regulation theory of illness behaviour. Two staff focus groups identified and clarified relevant constructs to be included in the Challenging Behaviour Perception Questionnaire (CBPQ), which was then completed by 51 staff. Some correlations between the CBPQ and the Attributional Style Questionnaire were found. A significant amount of the variance in the perception of challenging behaviour was explained by the subscales of the new questionnaire. In particular, episodic timeline would seem to be a promising area for further investigation.

Practical challenges in quantum key distribution

DOE PAGES

Diamanti, Eleni; Lo, Hoi -Kwong; Qi, Bing; ...

2016-11-08

Here, quantum key distribution (QKD) promises unconditional security in data communication and is currently being deployed in commercial applications. Nonetheless, before QKD can be widely adopted, it faces a number of important challenges such as secret key rate, distance, size, cost and practical security. Here, we survey those key challenges and the approaches that are currently being taken to address them.

Practical challenges in quantum key distribution

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

Diamanti, Eleni; Lo, Hoi -Kwong; Qi, Bing

Here, quantum key distribution (QKD) promises unconditional security in data communication and is currently being deployed in commercial applications. Nonetheless, before QKD can be widely adopted, it faces a number of important challenges such as secret key rate, distance, size, cost and practical security. Here, we survey those key challenges and the approaches that are currently being taken to address them.

Key issues and challenges in developing a pedagogical intervention in the simulation skills center--an action research study.

PubMed

Reierson, Inger Åse; Hvidsten, Anne; Wighus, Marianne; Brungot, Solvor; Bjørk, Ida Torunn

2013-07-01

Simulation skills centers (SSC) are considered important learning arenas for preparing and qualifying nursing students. Limited clinical placements and claims of diminished learning opportunities raise concerns that newly educated nurses lack proficiency in many psychomotor skills. Accordingly, there is an increased focus on learning in the SSC. However, it has been questioned if the pedagogical underpinning of teaching and learning in the SSC is missing or unclear. At a bachelor nursing education in Norway, there was a desire to change practice and enhance learning in the SSC by systematic use of The Model of Practical Skill Performance (Bjørk and Kirkevold, 2000). A participatory action research design was chosen. A pedagogical intervention was developed and implemented in 2010 in a cohort of eighty-seven first year bachelor nursing students during their basic nursing skill course. The intervention is shortly described. This article reports key issues and challenges that emerged during development of the new intervention. Data to inform the study were collected via thorough meeting minutes and the project leader's logbook, and analyzed using fieldnotes analysis. Six key issues and challenges were identified. These are presented and discussed consecutively in light of their importance for development and implementation of the new intervention. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Systematic Review of Wearable Systems for Cancer Detection: Current State and Challenges.

PubMed

Ray, Partha Pratim; Dash, Dinesh; De, Debashis

2017-10-02

Rapid growth of sensor and computing platforms have introduced the wearable systems. In recent years, wearable systems have led to new applications across all medical fields. The aim of this review is to present current state-of-the-art approach in the field of wearable system based cancer detection and identify key challenges that resist it from clinical adoption. A total of 472 records were screened and 11 were finally included in this study. Two types of records were studied in this context that includes 45% research articles and 55% manufactured products. The review was performed per PRISMA guidelines where considerations was given to records that were published or reported between 2009 and 2017. The identified records included 4 cancer detecting wearable systems such as breast cancer (36.3%), skin cancer (36.3%), prostate cancer (18.1%), and multi-type cancer (9%). Most works involved sensor based smart systems comprising of microcontroller, Bluetooth module, and smart phone. Few demonstrated Ultra-Wide Band (i.e. UWB) antenna based wearable systems. Skin cancer detecting wearable systems were most comprehensible ones. The current works are gradually progressing with seamless integration of sensory units along with smart networking. However, they lack in cloud computing and long-range communication paradigms. Artificial intelligence and machine learning are key ports that need to be attached with current wearable systems. Further, clinical inertia, lack of awareness, and high cost are altogether pulling back the actual growth of such system. It is well comprehended that upon sincere orientation of all identified challenges, wearable systems would emerge as vital alternative to futuristic cancer detection.

Identifying and characterizing key nodes among communities based on electrical-circuit networks.

PubMed

Zhu, Fenghui; Wang, Wenxu; Di, Zengru; Fan, Ying

2014-01-01

Complex networks with community structures are ubiquitous in the real world. Despite many approaches developed for detecting communities, we continue to lack tools for identifying overlapping and bridging nodes that play crucial roles in the interactions and communications among communities in complex networks. Here we develop an algorithm based on the local flow conservation to effectively and efficiently identify and distinguish the two types of nodes. Our method is applicable in both undirected and directed networks without a priori knowledge of the community structure. Our method bypasses the extremely challenging problem of partitioning communities in the presence of overlapping nodes that may belong to multiple communities. Due to the fact that overlapping and bridging nodes are of paramount importance in maintaining the function of many social and biological networks, our tools open new avenues towards understanding and controlling real complex networks with communities accompanied with the key nodes.

Media Scrutiny of Higher Education: An Ongoing Challenge and Long-Term Trend

ERIC Educational Resources Information Center

Peyronel, Anthony C.

2004-01-01

Increasing skepticism was identified as a key trend in a recent American Journalism Review assessment of media coverage of higher education. However, this trend is hardly new, as American colleges and universities have been subjected to intense media scrutiny for at least the last two decades. This article examines the frequently adversarial…

Perspectives of UK Vice-Chancellors on Leading Universities in a Knowledge-Based Economy

ERIC Educational Resources Information Center

Bosetti, Lynn; Walker, Keith

2010-01-01

This paper draws upon the experiences and perceptions of ten university vice-chancellors in the United Kingdom on the challenges they face in providing leadership and strategic direction for their institutions into the twenty-first century. The paper reveals the perceptions and spoken words of these leaders as they identify the key challenges…

Assessing Capacity to Promote Science-Based Programs: A Key Informant Study of State Teen Pregnancy Prevention Organizations

ERIC Educational Resources Information Center

Saunders, Edward; Sabri, Bushra; Huberman, Barbara; Klaus, T. W.; Davis, Laura

2011-01-01

The purpose of this qualitative study was to identify significant external and internal challenges that state organization leaders face in promoting science-based teen pregnancy prevention programs within their states. The state organization administrators were chosen because their organizations were funded by the U.S. Centers for Disease Control…

Students' Reflections on the Relationships between Safe Learning Environments, Learning Challenge and Positive Experiences of Learning in a Simulated GP Clinic

ERIC Educational Resources Information Center

Young, J. E.; Williamson, M. I.; Egan, T. G.

2016-01-01

Learning environments are a significant determinant of student behaviour, achievement and satisfaction. In this article we use students' reflective essays to identify key features of the learning environment that contributed to positive and transformative learning experiences. We explore the relationships between these features, the students'…

Listening in a Multilingual World: The Challenges of Second Language (L2) Listening

ERIC Educational Resources Information Center

Rost, Michael

2014-01-01

Research into language acquisition and oral language use was examined in order to identify key factors that contribute to the successful acquisition of second language (L2) listening ability. The factors were grouped into three major domains: affective, cognitive, and interpersonal. It is claimed that in each domain, proficient L2 listeners have…

The Acquisition of Cultural Competence: A Phenomenological Inquiry Highlighting the Processes, Challenges and Triumphs of Counselor Education Graduate Students

ERIC Educational Resources Information Center

Garner, Douglas L.

2012-01-01

Although research has effectively isolated and identified the key characteristics of a culturally competent counselor, there are few studies regarding the acquisition of these characteristics. To close the gap between theory and practice, studies are needed researching the emergence and, acquisition of these characteristics. This study explores…

Creating Working Partnerships: How Can School Districts and Charter Schools Work Together Effectively? Knowledge Brief.

ERIC Educational Resources Information Center

Izu, JoAnn

Drawing on the Los Angeles Unified School District's experiences with charter schools, this brief highlights the difficulties in balancing the twin needs of charter-school autonomy and accountability, and their implications for the way in which charter schools and districts can work together. It identifies key challenges in district-school…

Federal Student Aid (FSA) Five-Year Strategic Plan. FY 2004-2008

ERIC Educational Resources Information Center

US Department of Education, 2004

2004-01-01

The FSA Five-Year Strategic Plan is a roadmap for FY 2004-2008 that identifies five long-range strategic objectives, tactical short-term goals, and performance management initiatives. In working toward the goals outlined in the plan, FSA will address a number of key challenges, including legacy system migration, business process re-engineering,…

A Case Study of American and Chinese College Students' Motivation Differences in Online Learning Environment

ERIC Educational Resources Information Center

Zhao, Chunjuan; Mei, Zongxiang

2016-01-01

Motivating students has been a key challenge facing instructors in non-face-to-face instructional contexts. Existing researches into motivation in online learning environment have revealed that there are learning motivation differences among students from different cultural backgrounds. The purpose of this study is to identify whether American and…

Influence of Linguistic Challenges on Attitude towards Mathematics Learning among Upper Primary Students of Kerala

ERIC Educational Resources Information Center

Sarabi, M. K.; Gafoor, K. Abdul

2017-01-01

Aspects that influences mathematics learning is widely studied and language factors have been identified as a key backer to difficulties in learning Mathematics. It is evidenced that not only cognitive factors but also affective factors have vital role in learning mathematics. Such affective beliefs sources from various aspects of mathematics…

An integrated science plan for the Lake Tahoe basin: conceptual framework and research strategies

Treesearch

Zachary P. Hymanson; Michael W. Collopy

2010-01-01

An integrated science plan was developed to identify and refine contemporary science information needs for the Lake Tahoe basin ecosystem. The main objectives were to describe a conceptual framework for an integrated science program, and to develop research strategies addressing key uncertainties and information gaps that challenge government agencies in the theme...

Parental Practices and Developmental Challenges of Boys of Color: Opportunities for Early Intervention

ERIC Educational Resources Information Center

Barbarin, Oscar A.

2015-01-01

The "My Brother's Keeper" Initiative (Obama, 2014) has helped to attract public attention to the vulnerabilities faced by many boys of color (BOC). In this article, I review what is known about the developmental status of BOC, identify key family practices that are critical to their development, and consider the implications of both for…

Fit for Purpose: A Framework for Developing and Assessing Complex Graduate Attributes in a Changing Higher Education Environment

ERIC Educational Resources Information Center

Sin, Samantha; McGuigan, Nicholas

2013-01-01

This paper provides an assessment framework for shared collaboration among accounting educators. Key developments in higher education more broadly and challenges specific to accounting education are synthesised to identify their combined effects on the accounting curriculum and on accounting academics in fulfilling the teaching component of their…

Liquid Chromatography Mass Spectrometry-Based Proteomics: Biological and Technological Aspects

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

Karpievitch, Yuliya V.; Polpitiya, Ashoka D.; Anderson, Gordon A.

2010-12-01

Mass spectrometry-based proteomics has become the tool of choice for identifying and quantifying the proteome of an organism. Though recent years have seen a tremendous improvement in instrument performance and the computational tools used, significant challenges remain, and there are many opportunities for statisticians to make important contributions. In the most widely used "bottom-up" approach to proteomics, complex mixtures of proteins are first subjected to enzymatic cleavage, the resulting peptide products are separated based on chemical or physical properties and analyzed using a mass spectrometer. The two fundamental challenges in the analysis of bottom-up MS-based proteomics are: (1) Identifying themore » proteins that are present in a sample, and (2) Quantifying the abundance levels of the identified proteins. Both of these challenges require knowledge of the biological and technological context that gives rise to observed data, as well as the application of sound statistical principles for estimation and inference. We present an overview of bottom-up proteomics and outline the key statistical issues that arise in protein identification and quantification.« less

Autoimmune encephalitis in children: clinical phenomenology, therapeutics, and emerging challenges.

PubMed

Dale, Russell C; Gorman, Mark P; Lim, Ming

2017-06-01

Auto-antibodies that bind to conformational extracellular epitopes of neuronal receptors or synaptic proteins have provided clinicians with essential biomarkers in acute neurology. This review summarizes the current status and challenges in the field. In children, anti-N-methyl-D-aspartate receptor encephalitis remains the most identifiable autoimmune encephalitis, although many patients have a clinical syndrome of brain inflammation in which no antibodies are identified. Anti-myelin oligodendrocyte glycoprotein antibody associated demyelination is now recognized as a major cause of monophasic and relapsing demyelination, often presenting with encephalopathy. We discuss the importance of auto-antibody detection methodology and the possible influence of intrathecal antibody synthesis on the speed of recovery and response to immune therapy. The current, often pragmatic rather than evidence-based therapeutic pathway will be discussed, highlighting key challenges such as the timing of second-line therapy, monitoring of disease activity, and identifying the patient who is responding poorly to treatment. Although there have been significant developments, future priorities include the need for paediatric-specific consensus definitions for seronegative suspected autoimmune encephalitis, novel tools for monitoring patients with autoimmune encephalitis, consensus treatment recommendations, and neuroprotective strategies.

"In the same boat": considerations on the partnership between healthcare providers and manufacturers of health IT products and medical devices.

PubMed

Bergh, B

2009-01-01

To assess the current culture of cooperation between healthcare providers (HCPs) and the healthcare industry (HCI) in the domain of Health-IT and Engineering (HITE) and identify possible strategies for improvement. Based on reports in the literature and personal experience, major challenges were identified, the current ways of cooperation defined and their relation to each other analyzed. Four main challenges were identified for both sides involving: products and functionality, integration of IT-Systems with each other and with medical devices, usability, visions and strategic management. None of the four defined cooperation categories cover all aspects of the challenges, but cooperation in small, dedicated groups appeared to provide the most advantages. An increased participation of HCPs in standardization activities is crucial either directly or indirectly via professional or scientific organizations. Cooperation between provider management (hospitals, clinics or systems) and manufacturers of health IT products will be the key factor for success of the HCI while providing substantial benefits for providers. Both sides should invest heavily in such efforts.

Unpacking the concept of land degradation neutrality and addressing its operation through the Rio Conventions.

PubMed

Akhtar-Schuster, Mariam; Stringer, Lindsay C; Erlewein, Alexander; Metternicht, Graciela; Minelli, Sara; Safriel, Uriel; Sommer, Stefan

2017-06-15

The world's commitment towards land degradation neutrality (LDN) became enshrined in various international agreements and decisions throughout the year 2015. The challenge now becomes one of addressing its operation, in order to achieve these new policy goals and targets by the year 2030. Advancing LDN demands attention to what the concept seeks to achieve, as well as unravelling the perspectives of the key multi-lateral environmental agreements through which progress can be made. The three Rio Conventions (the UN Convention to Combat Desertification (UNCCD), the UN Framework Convention on Climate Change (UNFCCC) and the Convention on Biological Diversity (CBD)) all play key roles in shaping the international LDN governance and implementation context. Their different but related foci create a number of challenges and opportunities for advancing LDN. In this paper we critically analyze the literature to elucidate potential challenges and opportunities in moving LDN towards implementation, considering the mandates and objectives of all three Rio Conventions. We first unpack the concept of LDN's aspirations. We highlight the importance of the definitions and terminology used, and the relationships between those definitions, terms and the actors using them, as well as their implications in framing the range of policy actions and synergies that could benefit progress towards multiple Sustainable Development Goals. We then examine the LDN pilot project spearheaded by the UNCCD to identify key lessons for LDN implementation. Synthesizing these lessons, we present a portfolio of blended interventions that seeks to address the aspirations of the UNCCD, UNFCCC and CBD in the LDN space, identifying synergistic options for national actions to move towards LDN. Overall, our analysis provides insights in advancing LDN from its current position as a policy target, towards synergetic action. Copyright © 2016 Elsevier Ltd. All rights reserved.

Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group123

PubMed Central

Yetley, Elizabeth A; MacFarlane, Amanda J; Greene-Finestone, Linda S; Garza, Cutberto; Ard, Jamy D; Atkinson, Stephanie A; Bier, Dennis M; Carriquiry, Alicia L; Harlan, William R; Hattis, Dale; King, Janet C; Krewski, Daniel; O’Connor, Deborah L; Prentice, Ross L; Rodricks, Joseph V; Wells, George A

2017-01-01

Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option. PMID:27927637

Experimental Design for Evaluating Selected Nondestructive Measurement Technologies - Advanced Reactor Technology Milestone: M3AT-16PN2301043

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

Ramuhalli, Pradeep; Hirt, Evelyn H.; Pitman, Stan G.

The harsh environments in advanced reactors (AdvRx) increase the possibility of degradation of safety-critical passive components, and therefore pose a particular challenge for deployment and extended operation of these concepts. Nondestructive evaluation technologies are an essential element for obtaining information on passive component condition in AdvRx, with the development of sensor technologies for nondestructively inspecting AdvRx passive components identified as a key need. Given the challenges posed by AdvRx environments and the potential needs for reducing the burden posed by periodic in-service inspection of hard-to-access and hard-to-replace components, a viable solution may be provided by online condition monitoring of components.more » This report identifies the key challenges that will need to be overcome for sensor development in this context, and documents an experimental plan for sensor development, test, and evaluation. The focus of initial research and development is on sodium fast reactors, with the eventual goal of the research being developing the necessary sensor technology, quantifying sensor survivability and long-term measurement reliability for nondestructively inspecting critical components. Materials for sensor development that are likely to withstand the harsh environments are described, along with a status on the fabrication of reference specimens, and the planned approach for design and evaluation of the sensor and measurement technology.« less

Method meets application: on the use of earthquake scenarios in community-based disaster preparedness and response

NASA Astrophysics Data System (ADS)

Sargeant, S.; Sorensen, M. B.

2011-12-01

More than 50% of the world's population now live in urban areas. In less developed countries, future urban population increase will be due to natural population growth and rural-to-urban migration. As urban growth continues, the vulnerability of those living in these areas is also increasing. This presents a wide variety of challenges for humanitarian organisations that often have more experience of disaster response in rural settings rather than planning for large urban disasters. The 2010 Haiti earthquake highlighted the vulnerability of these organisations and the communities that they seek to support. To meet this challenge, a key consideration is how scientific information can support the humanitarian sector and their working practices. Here we review the current state of earthquake scenario modelling practice, with special focus on scenarios to be used in disaster response and response planning, and present an evaluation of how the field looks set to evolve. We also review current good practice and lessons learned from previous earthquakes with respect to planning for and responding to earthquakes in urban settings in the humanitarian sector, identifying key sectoral priorities. We then investigate the interface between these two areas to investigate the use of earthquake scenarios in disaster response planning and identify potential challenges both with respect to development of scientific models and their application on the ground.

Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay.

PubMed

Tyler, Denise A; McHugh, John P; Shield, Renée R; Winblad, Ulrika; Gadbois, Emily A; Mor, Vincent

2018-06-05

To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients. Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs. Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted. We conducted 70 semistructured interviews. LOS data were derived from minimum dataset (MDS) admission records available for all patients in all U.S. SNFs from 2012 to 2014. Challenges reported regardless of reductions in LOS included frequent and more complicated re-authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNFs being pressured to discharge patients within certain time limits. Some SNFs reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities. The push for shorter LOS has resulted in unexpected challenges and costs for SNFs and possible unintended consequences for PAC patients. © Health Research and Educational Trust.

Implementing Multisector Nutrition Programs in Ethiopia and Nepal: Challenges and Opportunities From a Stakeholder Perspective.

PubMed

Kennedy, Eileen; Fekadu, Habtamu; Ghosh, Shibani; Baral, Kedar; Davis, Dale; Sapkota, Diplav; Webb, Patrick

2016-12-01

Effective governance is essential for effective nutrition program implementation. There are additional challenges in launching multisector plans to enhance nutritional status. The present study compares the challenges and opportunities in Ethiopia and Nepal in designing and implementing a multisector plan for nutrition. A semi-quantitative questionnaire with open-ended questions was used to solicit information from senior national-level policy officials and other key stakeholders. The nature of the major nutrition problems in each country was similar; these include malnutrition (particularly stunting), food insecurity, and micronutrient malnutrition. The main challenges identified included the need for more specificity in the roles of agencies/individuals in program implementation, more effective mechanisms for linking national to subnational officials, methods for creating awareness of the plans, and a dedicated line item in the budgets of each agency. The level of enthusiasm was high in both countries. Respondents in both countries highlighted the need to identify a "champion" at the highest level who would keep the momentum for the respective plans alive. © The Author(s) 2016.

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

PubMed

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

2015-09-27

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

Occupational Health in Community Health Centers: Practitioner Challenges and Recommendations.

PubMed

Simmons, Juliana M; Liebman, Amy K; Sokas, Rosemary K

2018-05-01

Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.

New Frontiers in Analyzing Dynamic Group Interactions: Bridging Social and Computer Science

PubMed Central

Lehmann-Willenbrock, Nale; Hung, Hayley; Keyton, Joann

2017-01-01

This special issue on advancing interdisciplinary collaboration between computer scientists and social scientists documents the joint results of the international Lorentz workshop, “Interdisciplinary Insights into Group and Team Dynamics,” which took place in Leiden, The Netherlands, July 2016. An equal number of scholars from social and computer science participated in the workshop and contributed to the papers included in this special issue. In this introduction, we first identify interaction dynamics as the core of group and team models and review how scholars in social and computer science have typically approached behavioral interactions in groups and teams. Next, we identify key challenges for interdisciplinary collaboration between social and computer scientists, and we provide an overview of the different articles in this special issue aimed at addressing these challenges. PMID:29249891

[Progress in the spectral library based protein identification strategy].

PubMed

Yu, Derui; Ma, Jie; Xie, Zengyan; Bai, Mingze; Zhu, Yunping; Shu, Kunxian

2018-04-25

Exponential growth of the mass spectrometry (MS) data is exhibited when the mass spectrometry-based proteomics has been developing rapidly. It is a great challenge to develop some quick, accurate and repeatable methods to identify peptides and proteins. Nowadays, the spectral library searching has become a mature strategy for tandem mass spectra based proteins identification in proteomics, which searches the experiment spectra against a collection of confidently identified MS/MS spectra that have been observed previously, and fully utilizes the abundance in the spectrum, peaks from non-canonical fragment ions, and other features. This review provides an overview of the implement of spectral library search strategy, and two key steps, spectral library construction and spectral library searching comprehensively, and discusses the progress and challenge of the library search strategy.

New Frontiers in Analyzing Dynamic Group Interactions: Bridging Social and Computer Science.

PubMed

Lehmann-Willenbrock, Nale; Hung, Hayley; Keyton, Joann

2017-10-01

This special issue on advancing interdisciplinary collaboration between computer scientists and social scientists documents the joint results of the international Lorentz workshop, "Interdisciplinary Insights into Group and Team Dynamics," which took place in Leiden, The Netherlands, July 2016. An equal number of scholars from social and computer science participated in the workshop and contributed to the papers included in this special issue. In this introduction, we first identify interaction dynamics as the core of group and team models and review how scholars in social and computer science have typically approached behavioral interactions in groups and teams. Next, we identify key challenges for interdisciplinary collaboration between social and computer scientists, and we provide an overview of the different articles in this special issue aimed at addressing these challenges.

Use of conserved key amino acid positions to morph protein folds.

PubMed

Reddy, Boojala V B; Li, Wilfred W; Bourne, Philip E

2002-07-15

By using three-dimensional (3D) structure alignments and a previously published method to determine Conserved Key Amino Acid Positions (CKAAPs) we propose a theoretical method to design mutations that can be used to morph the protein folds. The original Paracelsus challenge, met by several groups, called for the engineering of a stable but different structure by modifying less than 50% of the amino acid residues. We have used the sequences from the Protein Data Bank (PDB) identifiers 1ROP, and 2CRO, which were previously used in the Paracelsus challenge by those groups, and suggest mutation to CKAAPs to morph the protein fold. The total number of mutations suggested is less than 40% of the starting sequence theoretically improving the challenge results. From secondary structure prediction experiments of the proposed mutant sequence structures, we observe that each of the suggested mutant protein sequences likely folds to a different, non-native potentially stable target structure. These results are an early indicator that analyses using structure alignments leading to CKAAPs of a given structure are of value in protein engineering experiments. Copyright 2002 Wiley Periodicals, Inc.

The gains and pains of being a cancer support group leader: a qualitative survey of rewards and challenges.

PubMed

Butow, Phyllis; Beeney, Linda; Juraskova, Ilona; Ussher, Jane; Zordan, Rachel

2009-01-01

Rewards derived from leading a cancer support group are poorly understood yet may be crucial to offset the challenges and difficulties of this role. This study sought to obtain the views of a representative sample of Australian cancer support group leaders (CSGLs) concerning the perceived rewards and challenges of their role. All CSGLs identified by the state-based Cancer Councils were invited to participate by postal questionnaire. Qualitative methods were used to analyze responses to open-ended questions concerning rewards and challenges. A total of 300 CSGLs returned the questionnaire (response rate = 66%) with 272 providing qualitative comments. Four parallel themes emerged from the qualitative analysis: (i) Personal, (ii) Relationship, (iii) Group, and (iv) Community rewards and challenges. These were integrated into a model depicting key positive and negative aspects of the CSGL's role, to provide direction for future training and ongoing support of CSGLs.

Regulatory and Quality Considerations for Continuous Manufacturing May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Allison, Gretchen; Cain, Yanxi Tan; Cooney, Charles; Garcia, Tom; Bizjak, Tara Gooen; Holte, Oyvind; Jagota, Nirdosh; Komas, Bekki; Korakianiti, Evdokia; Kourti, Dora; Madurawe, Rapti; Morefield, Elaine; Montgomery, Frank; Nasr, Moheb; Randolph, William; Robert, Jean-Louis; Rudd, Dave; Zezza, Diane

2015-03-01

This paper assesses the current regulatory environment, relevant regulations and guidelines, and their impact on continuous manufacturing. It summarizes current regulatory experience and learning from both review and inspection perspectives. It outlines key regulatory aspects, including continuous manufacturing process description and control strategy in regulatory files, process validation, and key Good Manufacturing Practice (GMP) requirements. In addition, the paper identifies regulatory gaps and challenges and proposes a way forward to facilitate implementation. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Exploring the Human Fabric through an Analyst's Eyes

NASA Astrophysics Data System (ADS)

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

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

Towards a Pedagogy of Philoxenia (Hospitality): Negotiating Policy Priorities for Immigrant Students in Greek Public Schools

ERIC Educational Resources Information Center

Macris, Vicki

2012-01-01

This paper reflects and supports the focus of my doctoral research that aims to identify, underscore and examine some of the key challenges and policy barriers that are shaped or hindered by socio-political, ethno-cultural and economic factors that subsequently impede immigrant students' transition and future academic and social success in their…

Networking switches for smart functions using copper signaling and dynamic heteroleptic complexation.

PubMed

Schmittel, Michael

2018-04-17

This personal frontier account describes our recent progress in networking nanoswitches to generate emergent functions, such as catalytic machinery, and identifies the key impediments in mastering the paradigm shift from pure compounds to smart mixtures. A crucial challenge is the setup of reliable signaling protocols that are based on highly selective metal ion translocation and metal-ligand receptor events.

Computer Based Testing Using "Digital Ink": Participatory Design of a Tablet PC Based Assessment Application for Secondary Education

ERIC Educational Resources Information Center

Siozos, Panagiotis; Palaigeorgiou, George; Triantafyllakos, George; Despotakis, Theofanis

2009-01-01

In this paper, we identify key challenges faced by computer-based assessment (CBA) in secondary education and we put forward a framework of design considerations: design with the students and teachers, select the most appropriate media platform and plan an evolution rather than a revolution of prior practices. We present the CBA application…

Meeting the Highly Qualified Teachers Challenge: The Secretary's Second Annual Report on Teacher Quality

ERIC Educational Resources Information Center

US Department of Education, 2003

2003-01-01

One of the most important provisions of the No Child Left Behind Act (NCLB) is the requirement that all teachers of core academic subjects be "highly qualified" by the end of school year 2005-2006. Key principles for recruiting and preparing future teachers have been identified as raising academic standards for teachers and lowering…

Gearing up to Teach the Common Core State Standards for Mathematics in Rural Northeast Region Schools. REL 2015-031

ERIC Educational Resources Information Center

Walters, Kirk; Torres, Aubrey Scheopner; Smith, Toni; Ford, Jennifer

2014-01-01

This study describes key challenges and necessary supports related to implementation of the Common Core State Standards for Mathematics (CCSSM) identified by rural math educators in the Northeast. The research team interviewed state and district math coordinators and surveyed teachers in Maine, New Hampshire, New York and Vermont, to assess their…

Invited Review: Challenges of Residential and Community Care--"The Times They Are a-Changin"

ERIC Educational Resources Information Center

Jackson, R.

2011-01-01

This paper seeks to examine a number of issues which relate to the provision of appropriate and high-quality residential and community care for people with an intellectual disability. A number of key themes emerging from this Special Issue of the "Journal of Intellectual Disability Research" are identified and explored: (1) normalisation; (2)…

Acceptable bit-rates for human face identification from CCTV imagery

NASA Astrophysics Data System (ADS)

Tsifouti, Anastasia; Triantaphillidou, Sophie; Bilissi, Efthimia; Larabi, Mohamed-Chaker

2013-01-01

The objective of this investigation is to produce recommendations for acceptable bit-rates of CCTV footage of people onboard London buses. The majority of CCTV recorders on buses use a proprietary format based on the H.264/AVC video coding standard, exploiting both spatial and temporal redundancy. Low bit-rates are favored in the CCTV industry but they compromise the image usefulness of the recorded imagery. In this context usefulness is defined by the presence of enough facial information remaining in the compressed image to allow a specialist to identify a person. The investigation includes four steps: 1) Collection of representative video footage. 2) The grouping of video scenes based on content attributes. 3) Psychophysical investigations to identify key scenes, which are most affected by compression. 4) Testing of recording systems using the key scenes and further psychophysical investigations. The results are highly dependent upon scene content. For example, very dark and very bright scenes were the most challenging to compress, requiring higher bit-rates to maintain useful information. The acceptable bit-rates are also found to be dependent upon the specific CCTV system used to compress the footage, presenting challenges in drawing conclusions about universal `average' bit-rates.

Micronutrient Fortification of Food in Southeast Asia: Recommendations from an Expert Workshop

PubMed Central

Gayer, Justine; Smith, Geoffry

2015-01-01

Micronutrient deficiencies remain a significant public health issue in Southeast Asia, particularly in vulnerable populations, such as women of reproductive age and young children. An important nutrition-specific intervention to address micronutrient malnutrition is fortification of staple foods and condiments. In October 2013, the International Life Sciences Institute (ILSI) Southeast Asia Region held a workshop on micronutrient fortification of food in Bangkok, Thailand. The objective was to engage multiple stakeholders in a discussion on food fortification and its importance as a public health intervention in Southeast Asia, and to identify and address key challenges/gaps in and potential opportunities for fortification of foods in ASEAN countries. Key challenges that were identified include: “scaling up” and mobilizing sustainable support for fortification programs in the form of multi-stakeholder partnerships, effecting policy change to support mandatory fortification, long-term monitoring of the programs’ compliance and efficacy in light of limited resources, and increasing awareness and uptake of fortified products through social marketing campaigns. Future actions recommended include the development of terms of engagement and governance for multi-stakeholder partnerships, moving towards a sustainable business model and more extensive monitoring, both for effectiveness and efficacy and for enforcement of fortification legislation. PMID:25608937

American Society of Clinical Oncology Summit on Addressing Obesity Through Multidisciplinary Provider Collaboration: Key Findings and Recommendations for Action.

PubMed

Ligibel, Jennifer A; Alfano, Catherine M; Hershman, Dawn L; Merrill, Janette K; Basen-Engquist, Karen; Bloomgarden, Zachary T; Demark-Wahnefried, Wendy; Dixon, Suzanne; Hassink, Sandra G; Jakicic, John M; Morton, John Magaña; Okwuosa, Tochi M; Powell-Wiley, Tiffany M; Rothberg, Amy E; Stephens, Mark; Streett, Sarah E; Wild, Robert A; Westman, Eric A; Williams, Ronald J; Wollins, Dana S; Hudis, Clifford A

2017-11-01

Given the increasing evidence that obesity increases the risk of developing and dying from malignancy, the American Society of Clinical Oncology (ASCO) launched an Obesity Initiative in 2013 that was designed to increase awareness among oncology providers and the general public of the relationship between obesity and cancer and to promote research in this area. Recognizing that the type of societal change required to impact the obesity epidemic will require a broad-based effort, ASCO hosted the "Summit on Addressing Obesity through Multidisciplinary Collaboration" in 2016. This meeting was held to review current challenges in addressing obesity within the respective health care provider communities and to identify priorities that would most benefit from a collective and cross-disciplinary approach. Efforts focused on four key areas: provider education and training; public education and activation; research; and policy and advocacy. Summit attendees discussed current challenges in addressing obesity within their provider communities and identified priorities that would most benefit from multidisciplinary collaboration. A synopsis of recommendations to facilitate future collaboration, as well as examples of ongoing cooperative efforts, provides a blueprint for multidisciplinary provider collaboration focused on obesity prevention and treatment. © 2017 The Obesity Society.

A Framework for Considering Comprehensibility in Modeling

PubMed Central

Gleicher, Michael

2016-01-01

Abstract Comprehensibility in modeling is the ability of stakeholders to understand relevant aspects of the modeling process. In this article, we provide a framework to help guide exploration of the space of comprehensibility challenges. We consider facets organized around key questions: Who is comprehending? Why are they trying to comprehend? Where in the process are they trying to comprehend? How can we help them comprehend? How do we measure their comprehension? With each facet we consider the broad range of options. We discuss why taking a broad view of comprehensibility in modeling is useful in identifying challenges and opportunities for solutions. PMID:27441712

A review of clinical practice guidelines for lung cancer

PubMed Central

Ball, David; Silvestri, Gerard A.

2013-01-01

Clinical practice guidelines are important evidence-based resources to guide complex clinical decision making. However, it is challenging for health professionals to keep abreast available guidelines and to know how and where to access relevant guidelines. This review examines currently available guidelines for lung cancer published in the English language. Important key features are listed for each identified guideline. The methodology, approaches to dissemination and implementation, and associated resources are summarised. General challenges in the area of guideline development are highlighted. The potential to collaborate more widely across lung cancer guideline developers by sharing literature searches and assessments is discussed. PMID:24163752

Arabinogalactan-proteins and the research challenges for these enigmatic plant cell surface proteoglycans

PubMed Central

Tan, Li; Showalter, Allan M.; Egelund, Jack; Hernandez-Sanchez, Arianna; Doblin, Monika S.; Bacic, Antony

2012-01-01

Arabinogalactan-proteins (AGPs) are complex glycoconjugates that are commonly found at the cell surface and in secretions of plants. Their location and diversity of structures have made them attractive targets as modulators of plant development but definitive proof of their direct role(s) in biological processes remains elusive. Here we overview the current state of knowledge on AGPs, identify key challenges impeding progress in the field and propose approaches using modern bioinformatic, (bio)chemical, cell biological, molecular and genetic techniques that could be applied to redress these gaps in our knowledge. PMID:22754559

Staff variables associated with the challenging behaviour of clients with severe or profound intellectual disabilities.

PubMed

Lambrechts, G; Kuppens, S; Maes, B

2009-07-01

Previous research has identified that staff-client interactions play an important role in the origin and maintenance of challenging behaviour. Particularly, the reciprocity between staff behaviour and client behaviour has been considered a key issue. Furthermore, severe challenging behaviour has been found to elicit negative emotional reactions from staff which in turn may influence staff's behaviour. Another variable that has been associated with staff behaviour are staff's attributions regarding clients' challenging behaviour. The present study tested several hypotheses about associations between staff variables and challenging behaviour. Questionnaires were used to investigate associations between the attributions, emotional reactions and behavioural reactions of 51 staff members towards challenging behaviour of clients with severe or profound intellectual disabilities who displayed self-injurious behaviour, stereotyped behaviour and/or aggressive/destructive behaviour. Staff members reported that reactions to challenging behaviour differed according to the type of challenging behaviour. Negative emotional reactions were positively associated with challenging behaviour. Associations between emotional reactions, staff beliefs and staff reactions were inconsistent. The findings suggest that there is a need to look for a better conceptualization and assessment of the variables under investigation.

Social Work Grand Challenges: Leaders' Perceptions of the Potential for Partnering with Business.

PubMed

Long, Ashley

2018-04-23

Social work's ability to address complex societal problems such as those identified in the American Academy of Social Work and Social Welfare's Grand Challenges for Social Work is reliant on being innovative in how we prepare social workers and how we collaborate with others, including business. This research seeks to understand how leaders of major social work organizations perceive potential partnership with the business sector-including both possible threats and opportunities. Interviews were conducted with those serving on the Council on Social Work Education's Leadership Roundtable. The research explores how emerging partnership models can be helpful and ways in which the profession can prepare practitioners for better partnering with the business sector. Qualitative findings identify four key strategies to address the grand challenges and enhance partnerships: (1) more interdisciplinary work is needed, (2) social work students need to be adequately equipped for collaborative work, (3) a cohesive message is needed from the field, and (4) the potential benefits for partnering with business outweigh the risks.

Challenges faced by public health nursing leaders in hyperturbulent times.

PubMed

Reyes, David J; Bekemeier, Betty; Issel, L Michele

2014-01-01

This study discusses the challenges and characteristics of effective public health nursing leaders in local health departments and barriers to effective leadership during the hyperturbulent conditions of 2008-2010. Participants were drawn from a purposive sample of seven directors of nursing (DON) in six county LHDs in two states for this qualitative study using inductive methods. Semistructured telephone interviews were conducted, using open-ended questions. Data analysis consisted of coding, pattern identification, and theme development, assisted by the use of ATLAS.ti™. Credibility was achieved through intercoder agreement and resonance of the findings with participants. Two underlying challenges emerged: leadership dissonance and leading through ambiguity. Three key effective leadership attributes identified were as follows: collaborative change management, life-long learning, and being visionary. DONs identified extrinsic and intrinsic barriers to leadership effectiveness and leading change in public health systems and PHN practice. Results suggest ways to support PHN leaders in order to overcome barriers to effective leadership such as defined leadership competencies, continuing education, and mentorship opportunities. © 2013 Wiley Periodicals, Inc.

The changing model of big pharma: impact of key trends.

PubMed

Gautam, Ajay; Pan, Xiaogang

2016-03-01

Recent years have seen exciting breakthroughs in biomedical sciences that are producing truly novel therapeutics for unmet patient needs. However, the pharmaceutical industry is also facing significant barriers in the form of pricing and reimbursement, continued patent expirations and challenging market dynamics. In this article, we have analyzed data from the 1995-2015 period, on key aspects such as revenue distribution, research units, portfolio mix and emerging markets to identify four key trends that help to understand the change in strategic focus, realignment of R&D footprint, the shift from primary care toward specialty drugs and biologics and the growth of emerging markets as major revenue drivers for big pharma. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

International clinical placements for Australian undergraduate nursing students: A systematic thematic synthesis of the literature.

PubMed

Browne, Caroline A; Fetherston, Catherine M; Medigovich, Kristina

2015-10-01

International clinical placements provide undergraduate nursing students with the opportunity to experience or practice nursing care in diverse countries, settings, and cultures. This systematic review aims to ascertain the current knowledge on international clinical placements offered by undergraduate nursing programs in Australia. It seeks to explore three questions: (1) How have previous experiences of nursing students' international clinical placements been described? (2) How have participants and stakeholders determined if the placement has been successful? And (3) What benefits or challenges have been identified by stakeholders as a result of participating in international clinical placements? A systematic thematic synthesis was undertaken. A search of electronic databases including CINAHL, Proquest Central, Scopus, PubMed, and Health Collection was undertaken between September and October 2014. Key terms including 'international clinical placement', 'study abroad', 'international exchange', 'nursing', and 'Australia' were used to identify articles that appeared in peer-reviewed English language journals and that explored international clinical placements offered to undergraduate nursing students by Australian universities. Eight studies were identified that meet the inclusion criteria, and through thematic analysis, five key themes were identified including developing cultural awareness and competence, providing a global perspective on health care, translation of theory to practice, growing personally through reflection, and overcoming apprehension to successfully meet the challenge. A comparison search of literature from Canada and the United Kingdom revealed that similar themes occurred internationally. Although personal successes were identified by students undertaking international clinical placement, further research is required to identify all stakeholder experiences including those of the educators, the educational institutions, and travel providers supporting these placements and the communities where the placements take place. Copyright © 2015 Elsevier Ltd. All rights reserved.

Otolaryngology residency education: a scoping review on the shift towards competency-based medical education.

PubMed

Wagner, N; Fahim, C; Dunn, K; Reid, D; Sonnadara, R R

2017-06-01

Residency training programmes worldwide are experiencing a shift from the traditional time-based curriculum to competency-based medical education (CBME), due to changes in the healthcare system that have impacted clinical learning opportunities. Otolaryngology-Head and Neck Surgery (OTL-HNS) programmes are one of the first North American surgical specialties to adopt the new CBME curriculum. The purpose of this scoping review is to examine the literature pertaining to CBME in OTL-HNS programmes worldwide, to identify the tools that have been developed and identify potential barriers to the implementation of CBME. Four online databases, OVID MEDLINE (R) from 1946 to 5 August 2015, EMBASE 1974 to 5 August 2015, Cochrane and CINAHL databases up to 5 August 2015, were searched using key words related to OTL-HNS and CBME. Two researchers independently reviewed the literature in a systematic manner and met to discuss and address any discrepancies at each step of the review process. Of the 207 publications identified in the initial search, 31 were included in this scoping review. Two key themes emerged from the literature: first, OTL-HNS programmes reported a need for new assessment tools that assess competency and also provide the learner with formative feedback. Second, although varieties of tools assessing both technical and non-technical skills have been developed, implementation of such tools has been met with some challenges. These challenges include a lack of faculty support, inadequate administrative support and a lack of knowledge on how to start the transition to CBME. This scoping review suggests that task-specific checklists, entrustment scales, evaluation portfolios from multiple assessments and faculty training sessions are key aspects to incorporate as OTL-HNS training programmes shift towards a CBME curriculum. © 2016 John Wiley & Sons Ltd.

Using the Consolidated Framework for Implementation Research to implement and evaluate national surgical planning

PubMed Central

Saluja, Saurabh; Silverstein, Allison; Mukhopadhyay, Swagoto; Lin, Yihan; Raykar, Nakul; Keshavjee, Salmaan; Samad, Lubna; Meara, John G

2017-01-01

The Lancet Commission on Global Surgery defined six surgical indicators and a framework for a national surgical plan that aimed to incorporate surgical care as a part of global public health. Multiple countries have since begun national surgical planning; each faces unique challenges in doing so. Implementation science can be used to more systematically explain this heterogeneous process, guide implementation efforts and ultimately evaluate progress. We describe our intervention using the Consolidated Framework for Implementation Research. This framework requires identifying characteristics of the intervention, the individuals involved, the inner and outer setting of the intervention, and finally describing implementation processes. By hosting a consultative symposium with clinicians and policy makers from around the world, we are able to specify key aspects of each element of this framework. We define our intervention as the incorporation of surgical care into public health planning, identify local champions as the key individuals involved, and describe elements of the inner and outer settings. Ultimately we describe top-down and bottom-up models that are distinct implementation processes. With the Consolidated Framework for Implementation Research, we are able to identify specific strategic models that can be used by implementers in various settings. While the integration of surgical care into public health throughout the world may seem like an insurmountable challenge, this work adds to a growing effort that seeks to find a way forward. PMID:29225930

Message Variability and Heterogeneity: A Core Challenge for Communication Research

PubMed Central

Slater, Michael D.; Peter, Jochen; Valkenberg, Patti

2015-01-01

Messages are central to human social experience, and pose key conceptual and methodological challenges in the study of communication. In response to these challenges, we outline a systematic approach to conceptualizing, operationalizing, and analyzing messages. At the conceptual level, we distinguish between two core aspects of messages: message variability (the defined and operationalized features of messages) and message heterogeneity (the undefined and unmeasured features of messages), and suggest preferred approaches to defining message variables. At the operational level, we identify message sampling, selection, and research design strategies responsive to issues of message variability and heterogeneity in experimental and survey research. At the analytical level, we highlight effective techniques to deal with message variability and heterogeneity. We conclude with seven recommendations to increase rigor in the study of communication through appropriately addressing the challenges presented by messages. PMID:26681816

Concept Mapping of PMTCT Implementation Challenges and Solutions Across 6 sub-Saharan African Countries in the NIH-PEPFAR PMTCT Implementation Science Alliance.

PubMed

Aarons, Gregory A; Sommerfeld, David H; Chi, Benjamin H; Ezeanolue, Echezona E; Sturke, Rachel; Guay, Laura; Siberry, George K

2016-08-01

Although tremendous gains have been made to reduce mother-to-child HIV transmission (MTCT) globally, evidence-based practice implementation remains inconsistent in sub-Saharan Africa. We sought to identify the key domains for effective prevention of MTCT (PMTCT) implementation, using a participatory mixed-methods approach. Participants were members of the NIH-PEPFAR PMTCT Implementation Science Alliance (ISA), a platform of researchers, public-health practitioners, policymakers, and donors supported through NIH/PEPFAR. We used concept mapping to identify priority areas for PMTCT implementation science. Participants responded to the focus question: "In your experience, what factors have facilitated or hindered implementation of PMTCT interventions?" Responses were consolidated into discrete statements, grouped together based on similarity, and rated for importance, changeability, and extent to which ISA participation enhanced the capacity to influence/change the factor. Using multidimensional scaling and cluster analysis, we identified 12 key domains of PMTCT implementation. Two domains (Governmental Commitment and Data Measurement & Collection) were consistently ranked at or near the top for overall importance, perceived changeability, and enhanced ability to address through ISA participation. Through a stakeholder-based, participatory approach, we identified key domains for that should be considered for future PMTCT implementation research in sub-Saharan Africa.

A qualitative exploration of supports and unmet needs of diverse young women with breast cancer.

PubMed

Ruddy, Kathryn J; Greaney, Mary L; Sprunck-Harrild, Kim; Meyer, Meghan E; Emmons, Karen M; Partridge, Ann H

2015-09-01

Young women with breast cancer face different challenges than those faced by older women because of their age and life stage, yet few studies have focused on the different challenges faced by women from diverse populations. To explore existing supports that are important during diagnosis and treatment and the unmet needs for information and support in young women with breast cancer. We conducted 20 semistructured interviews in English with women aged 42 or younger who had been diagnosed with stage I-III invasive breast cancer within the previous 4 years. We recorded and transcribed the interviews and used collaborative group immersion/ crystallization to analyze data, identify emergent themes, and determine if there were differences by race/ethnicity. 20 participants, recruited from 9 US states and Canada, were interviewed, of whom 25% were Hispanic, 15% were black, 50% were white and non-Hispanic, and 10% were another race/ethnicity. Faith and/or spirituality and family were reported as important sources of support by many of the participants. Most of them lamented the inadequacy of their connections with other young survivors and also of supports for their family. Some recommended that young patients be provided with more information about: treatment-related physical and emotional changes; fertility and menopause; relationships after cancer; navigating work challenges; and transitioning into survivorship. None of these supports or recommendations was limited to a specific race/ethnicity or geographic region. Small sample size, exclusion of non-English speakers. Conclusions Key informant interviews of young breast cancer survivors identified similar needs for education and support across various races/ethnicities and geographies. Key informant interviews of young breast cancer survivors identified similar needs for education and support across various races/ethnicities and geographies. ©2015 Frontline Medical Communications.

The gendered realities and talent management imperatives of women physicians.

PubMed

Hoff, Timothy; Scott, Sarah

2016-01-01

U.S. medicine is increasingly a gender-balanced profession with half of all medical school graduates now female. Despite this reality and the potentially transformative nature of a large female physician cohort in U.S. health care, there is less examination of their workplace realities and the key talent management strategies for health care organizations employing women physicians. First, we identify current knowledge about U.S. women physician satisfaction, role challenges, and work tradeoffs. Gender theory is used to help interpret these workplace realities. Second, we use this information to identify talent management strategies health care organizations might consider to mitigate the realities and provide greater support for women physicians. To facilitate our analysis, we conducted a narrative review of published research that includes analysis focused on U.S. women physicians for the time period 2006-2014. Applying ideas from gender theory, we extrapolated key findings from that research related to three issues: satisfaction, role challenges, and tradeoffs. Then we synthesized the findings to identify general talent management strategies that could address these dynamics proactively while enhancing recruitment and retention with respect to women physicians. U.S. women physicians express strong levels of satisfaction, particularly with their careers, at the same time they continue to experience gender-based inequities, role challenges, and lack of work-life balance in their chosen specialty fields. Lack of suitable role models and appropriate mentoring for women physicians, in addition to barriers to career advancement, are also prevalent across different medical specialties. Similar to other occupations and industries, gender-based inequities and role strains are very real issues for women physicians. Health care organizations must acknowledge these issues and employ effective talent management strategies aimed at women doctors if they are to be viewed as an employer of choice by this increasingly important occupational cohort.

The District Health Information System (DHIS2): A literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries.

PubMed

Dehnavieh, Reza; Haghdoost, AliAkbar; Khosravi, Ardeshir; Hoseinabadi, Fahime; Rahimi, Hamed; Poursheikhali, Atousa; Khajehpour, Nahid; Khajeh, Zahra; Mirshekari, Nadia; Hasani, Marziyeh; Radmerikhi, Samera; Haghighi, Hajar; Mehrolhassani, Mohammad Hossain; Kazemi, Elaheh; Aghamohamadi, Saeide

2018-01-01

Health information systems offer many potential benefits for healthcare, including financial benefits and for improving the quality of patient care. The purpose of District Health Information Systems (DHIS) is to document data that are routinely collected in all public health facilities in a country using the system. The aim of this study was to examine the strengths and operational challenges of DHIS2, with a goal to enable decision makers in different counties to more accurately evaluate the outcomes of introducing DHIS2 into their particular country. A review of the literature combined with the method of meta-synthesis was used to source information and interpret results relating to the strengths and operational challenges of DHIS2. Databases (Embase, PubMed, Scopus and Google Scholar) were searched for documents related to strengths and operational challenges of DHIS2, with no time limit up to 8 April 2017. The review and evaluation of selected studies was conducted in three stages: title, abstract and full text. Each of the selected studies was reviewed carefully and key concepts extracted. These key concepts were divided into two categories of strengths and operational challenges of DHIS2. Then, each category was grouped based on conceptual similarity to achieve the main themes and sub-themes. Content analysis was used to analyse extracted data. Of 766 identified citations, 20 studies from 11 countries were included and analysed in this study. Identified strengths in the DHIS were represented in seven themes (with 21 categories): technical features of software, proper management of data, application flexibility, networking and increasing the satisfaction of stakeholders, development of data management, increasing access to information and economic benefits. Operational challenges were identified and captured in 11 themes (with 18 categories): funds; appropriate communication infrastructure; the need for the existence of appropriate data; political, cultural, social and structural infrastructure; manpower; senior managers; training; using academic potentials; definition and standardising the deployment processes; neglect to application of criteria and clinical guidelines in the use of system; data security; stakeholder communications challenges and the necessity to establish a pilot system. This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.

TaxaGloss - A Glossary and Translation Tool for Biodiversity Studies.

PubMed

Collin, Rachel; Fredericq, Suzanne; Freshwater, D Wilson; Gilbert, Edward; Madrid, Maycol; Maslakova, Svetlana; Miglietta, Maria Pia; Rocha, Rosana M; Rodríguez, Estefanía; Thacker, Robert W

2016-01-01

Correctly identifying organisms is key to most biological research, and is especially critical in areas of biodiversity and conservation. Yet it remains one of the greatest challenges when studying all but the few well-established model systems. The challenge is in part due to the fact that most species have yet to be described, vanishing taxonomic expertise and the relative inaccessibility of taxonomic information. Furthermore, identification keys and other taxonomic resources are based on complex, taxon-specific vocabularies used to describe important morphological characters. Using these resources is made difficult by the fact that taxonomic documentation of the world's biodiversity is an international endeavour, and keys and field guides are not always available in the practitioner's native language. To address this challenge, we have developed a publicly available on-line illustrated multilingual glossary and translation tool for technical taxonomic terms using the Symbiota Software Project biodiversity platform. Illustrations, photographs and translations have been sourced from the global community of taxonomists working with marine invertebrates and seaweeds. These can be used as single-language illustrated glossaries or to make customized translation tables. The glossary has been launched with terms and illustrations of seaweeds, tunicates, sponges, hydrozoans, sea anemones, and nemerteans, and already includes translations into seven languages for some groups. Additional translations and development of terms for more taxa are underway, but the ultimate utility of this tool depends on active participation of the international taxonomic community.

Challenges in the development and reimbursement of personalized medicine-payer and manufacturer perspectives and implications for health economics and outcomes research: a report of the ISPOR personalized medicine special interest group.

PubMed

Faulkner, Eric; Annemans, Lieven; Garrison, Lou; Helfand, Mark; Holtorf, Anke-Peggy; Hornberger, John; Hughes, Dyfrig; Li, Tracy; Malone, Daniel; Payne, Katherine; Siebert, Uwe; Towse, Adrian; Veenstra, David; Watkins, John

2012-12-01

Personalized medicine technologies can improve individual health by delivering the right dose of the right drug to the right patient at the right time but create challenges in deciding which technologies offer sufficient value to justify widespread diffusion. Personalized medicine technologies, however, do not neatly fit into existing health technology assessment and reimbursement processes. In this article, the Personalized Medicine Special Interest Group of the International Society for Pharmacoeconomics and Outcomes Research evaluated key development and reimbursement considerations from the payer and manufacturer perspectives. Five key areas in which health economics and outcomes research best practices could be developed to improve value assessment, reimbursement, and patient access decisions for personalized medicine have been identified. These areas are as follows: 1 research prioritization and early value assessment, 2 best practices for clinical evidence development, 3 best practices for health economic assessment, 4 addressing health technology assessment challenges, and 5 new incentive and reimbursement approaches for personalized medicine. Key gaps in health economics and outcomes research best practices, decision standards, and value assessment processes are also discussed, along with next steps for evolving health economics and outcomes research practices in personalized medicine. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Ergonomics and sustainability--challenges from global supply chains.

PubMed

Hasle, Peter; Jensen, Per Langaa

2012-01-01

The development of globalised supply chains is a major challenge for sustainability. For several years, there has been discussion within the profession whether and how ergonomics and human factors can play a role. Based on our research, we have identified five major challenges from global supply chains especially related to the social aspects of sustainability: (1) criteria for social sustainability, (2) the role of key performance indicators in the management of supply chains, (3) the constant changes in supply chains, (4) the challenge in establishing participation, and (5) the development of agency and regulatory mechanisms. There are obviously no clear and simple solutions to these challenges. One possible avenue for progress might lie in acquiring a greater understanding of the challenges from global supply chains and developing a strategy which combines social and long-term business sustainability. Starting from such a basis, the next step would be to find ways for the ergonomics and human factors community to create international collaboration which can impact specific global supply chains.

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

PubMed

Malatzky, Christina; Bourke, Lisa

2018-05-25

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

Challenges and priorities for modelling livestock health and pathogens in the context of climate change.

PubMed

Özkan, Şeyda; Vitali, Andrea; Lacetera, Nicola; Amon, Barbara; Bannink, André; Bartley, Dave J; Blanco-Penedo, Isabel; de Haas, Yvette; Dufrasne, Isabelle; Elliott, John; Eory, Vera; Fox, Naomi J; Garnsworthy, Phil C; Gengler, Nicolas; Hammami, Hedi; Kyriazakis, Ilias; Leclère, David; Lessire, Françoise; Macleod, Michael; Robinson, Timothy P; Ruete, Alejandro; Sandars, Daniel L; Shrestha, Shailesh; Stott, Alistair W; Twardy, Stanislaw; Vanrobays, Marie-Laure; Ahmadi, Bouda Vosough; Weindl, Isabelle; Wheelhouse, Nick; Williams, Adrian G; Williams, Hefin W; Wilson, Anthony J; Østergaard, Søren; Kipling, Richard P

2016-11-01

Climate change has the potential to impair livestock health, with consequences for animal welfare, productivity, greenhouse gas emissions, and human livelihoods and health. Modelling has an important role in assessing the impacts of climate change on livestock systems and the efficacy of potential adaptation strategies, to support decision making for more efficient, resilient and sustainable production. However, a coherent set of challenges and research priorities for modelling livestock health and pathogens under climate change has not previously been available. To identify such challenges and priorities, researchers from across Europe were engaged in a horizon-scanning study, involving workshop and questionnaire based exercises and focussed literature reviews. Eighteen key challenges were identified and grouped into six categories based on subject-specific and capacity building requirements. Across a number of challenges, the need for inventories relating model types to different applications (e.g. the pathogen species, region, scale of focus and purpose to which they can be applied) was identified, in order to identify gaps in capability in relation to the impacts of climate change on animal health. The need for collaboration and learning across disciplines was highlighted in several challenges, e.g. to better understand and model complex ecological interactions between pathogens, vectors, wildlife hosts and livestock in the context of climate change. Collaboration between socio-economic and biophysical disciplines was seen as important for better engagement with stakeholders and for improved modelling of the costs and benefits of poor livestock health. The need for more comprehensive validation of empirical relationships, for harmonising terminology and measurements, and for building capacity for under-researched nations, systems and health problems indicated the importance of joined up approaches across nations. The challenges and priorities identified can help focus the development of modelling capacity and future research structures in this vital field. Well-funded networks capable of managing the long-term development of shared resources are required in order to create a cohesive modelling community equipped to tackle the complex challenges of climate change. Copyright © 2016 Elsevier Inc. All rights reserved.

New Roles for Medical Assistants in Innovative Primary Care Practices.

PubMed

Chapman, Susan A; Blash, Lisel K

2017-02-01

To identify and describe new roles for medical assistants (MAs) in innovative care models that improve care while providing training and career advancement opportunities for MAs. Primary data collected at 15 case study sites; 173 key informant interviews and de-identified secondary data on staffing, wages, patient satisfaction, and health outcomes. Researchers used snowball sampling and screening calls to identify 15 organizations using MAs in new roles. Conducted site visits from 2010 to 2012 and updated information in 2014. Thematic analysis explored key topics: factors driving MA role innovation, role description, training required, and wage gains. Categorized outcome data in patient and staff satisfaction, quality of care, and efficiency. New MA roles included health coach, medical scribe, dual role translator, health navigator, panel manager, cross-trained flexible role, and supervisor. Implementation of new roles required extensive training. MA incentives and enhanced compensation varied by role type. New MA roles are part of a larger attempt to reform workflow and relieve primary care providers. Despite some evidence of success, spread has been limited. Key challenges to adoption included leadership and provider resistance to change, cost of additional MA training, and lack of reimbursement for nonbillable services. © Health Research and Educational Trust.

The challenges and benefits of job sharing in palliative care education.

PubMed

Cooper, J; Spencer, D

This article examines the authors' experience of job sharing a post in palliative care education. It discusses the concept of job sharing and examines factors such as power sharing, compatibility and other people's perception of the job sharing role. Effective communication is identified as a key issue. Benefits such as reduced professional isolation, increased job satisfaction and the opportunity to offer the knowledge and skills of two people are highlighted. The authors identify the factors which they consider to be crucial to the success of job sharing.

Cancer heterogeneity and imaging.

PubMed

O'Connor, James P B

2017-04-01

There is interest in identifying and quantifying tumor heterogeneity at the genomic, tissue pathology and clinical imaging scales, as this may help better understand tumor biology and may yield useful biomarkers for guiding therapy-based decision making. This review focuses on the role and value of using x-ray, CT, MRI and PET based imaging methods that identify, measure and map tumor heterogeneity. In particular we highlight the potential value of these techniques and the key challenges required to validate and qualify these biomarkers for clinical use. Copyright © 2016. Published by Elsevier Ltd.

Voluntary medical male circumcision: a qualitative study exploring the challenges of costing demand creation in eastern and southern Africa.

PubMed

Bertrand, Jane T; Njeuhmeli, Emmanuel; Forsythe, Steven; Mattison, Sarah K; Mahler, Hally; Hankins, Catherine A

2011-01-01

This paper proposes an approach to estimating the costs of demand creation for voluntary medical male circumcision (VMMC) scale-up in 13 countries of eastern and southern Africa. It addresses two key questions: (1) what are the elements of a standardized package for demand creation? And (2) what challenges exist and must be taken into account in estimating the costs of demand creation? We conducted a key informant study on VMMC demand creation using purposive sampling to recruit seven people who provide technical assistance to government programs and manage budgets for VMMC demand creation. Key informants provided their views on the important elements of VMMC demand creation and the most effective funding allocations across different types of communication approaches (e.g., mass media, small media, outreach/mobilization). The key finding was the wide range of views, suggesting that a standard package of core demand creation elements would not be universally applicable. This underscored the importance of tailoring demand creation strategies and estimates to specific country contexts before estimating costs. The key informant interviews, supplemented by the researchers' field experience, identified these issues to be addressed in future costing exercises: variations in the cost of VMMC demand creation activities by country and program, decisions about the quality and comprehensiveness of programming, and lack of data on critical elements needed to "trigger the decision" among eligible men. Based on this study's findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions. However, further work is needed to better understand core components of a demand creation package and how to cost them. Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving estimates of the total costs for VMMC scale-up in eastern and southern Africa.

Voluntary Medical Male Circumcision: A Qualitative Study Exploring the Challenges of Costing Demand Creation in Eastern and Southern Africa

PubMed Central

Bertrand, Jane T.; Njeuhmeli, Emmanuel; Forsythe, Steven; Mattison, Sarah K.; Mahler, Hally; Hankins, Catherine A.

2011-01-01

Background This paper proposes an approach to estimating the costs of demand creation for voluntary medical male circumcision (VMMC) scale-up in 13 countries of eastern and southern Africa. It addresses two key questions: (1) what are the elements of a standardized package for demand creation? And (2) what challenges exist and must be taken into account in estimating the costs of demand creation? Methods and Findings We conducted a key informant study on VMMC demand creation using purposive sampling to recruit seven people who provide technical assistance to government programs and manage budgets for VMMC demand creation. Key informants provided their views on the important elements of VMMC demand creation and the most effective funding allocations across different types of communication approaches (e.g., mass media, small media, outreach/mobilization). The key finding was the wide range of views, suggesting that a standard package of core demand creation elements would not be universally applicable. This underscored the importance of tailoring demand creation strategies and estimates to specific country contexts before estimating costs. The key informant interviews, supplemented by the researchers' field experience, identified these issues to be addressed in future costing exercises: variations in the cost of VMMC demand creation activities by country and program, decisions about the quality and comprehensiveness of programming, and lack of data on critical elements needed to “trigger the decision” among eligible men. Conclusions Based on this study's findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions. However, further work is needed to better understand core components of a demand creation package and how to cost them. Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving estimates of the total costs for VMMC scale-up in eastern and southern Africa. PMID:22140450

From Programs to Systems: Deploying Implementation Science and Practice for Sustained Real World Effectiveness in Services for Children and Families.

PubMed

Ghate, Deborah

2016-01-01

The transfer of knowledge of effective practice, especially into "usual care" settings, remains challenging. This article argues that to close this gap we need to recognize the particular challenges of whole-system improvement. We need to move beyond a limited focus on individual programs and experimental research on their effectiveness. The rapidly developing field of implementation science and practice (ISP) provides a particular lens and a set of important constructs that can helpfully accelerate progress. A review of selected key constructs and distinctive features of ISP, including recognizing invisible system infrastructure, co-construction involving active collaboration between stakeholders, and attention to active implementation, supports for providers beyond education and training. Key aspects of an implementation lens likely to be most helpful in sustaining effectiveness include assisting innovators to identify and accommodate the architecture of existing systems, understand the implementation process as a series of distinct but nonlinear stages, identify implementation outcomes as prerequisites for treatment outcomes, and analyse implementation challenges using frameworks of implementation drivers. In complex adaptive systems, how services are implemented may matter more than their specific content, and how services align and adapt to local context may determine their sustained usefulness. To improve implementation-relevant research, we need better process evaluation and cannot rely on experimental methods that do not capture complex systemic contexts. Deployment of an implementation lens may perhaps help to avoid future "rigor mortis," enabling more productively flexible and integrative approaches to both program design and evaluation.

Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement.

PubMed

Abdulmalik, J; Kola, L; Gureje, O

2016-01-01

A health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it. This study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG. The existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system. The identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.

STAKEHOLDER INVOLVEMENT THROUGHOUT HEALTH TECHNOLOGY ASSESSMENT: AN EXAMPLE FROM PALLIATIVE CARE.

PubMed

Brereton, Louise; Wahlster, Philip; Mozygemba, Kati; Lysdahl, Kristin Bakke; Burns, Jake; Polus, Stephanie; Tummers, Marcia; Refolo, Pietro; Sacchini, Dario; Leppert, Wojciech; Chilcott, James; Ingleton, Christine; Gardiner, Clare; Goyder, Elizabeth

2017-01-01

Internationally, funders require stakeholder involvement throughout health technology assessment (HTA). We report successes, challenges, and lessons learned from extensive stakeholder involvement throughout a palliative care case study that demonstrates new concepts and methods for HTA. A 5-step "INTEGRATE-HTA Model" developed within the INTEGRATE-HTA project guided the case study. Using convenience or purposive sampling or directly / indirectly identifying and approaching individuals / groups, stakeholders participated in qualitative research or consultation meetings. During scoping, 132 stakeholders, aged ≥ 18 years in seven countries (England, Italy, Germany, The Netherlands, Norway, Lithuania, and Poland), highlighted key issues in palliative care that assisted identification of the intervention and comparator. Subsequently stakeholders in four countries participated in face-face, telephone and / or video Skype meetings to inform evidence collection and / or review assessment results. An applicability assessment to identify contextual and implementation barriers and enablers for the case study findings involved twelve professionals in the three countries. Finally, thirteen stakeholders participated in a mock decision-making meeting in England. Views about the best methods of stakeholder involvement vary internationally. Stakeholders make valuable contributions in all stages of HTA; assisting decision making about interventions, comparators, research questions; providing evidence and insights into findings, gap analyses and applicability assessments. Key challenges exist regarding inclusivity, time, and resource use. Stakeholder involvement is feasible and worthwhile throughout HTA, sometimes providing unique insights. Various methods can be used to include stakeholders, although challenges exist. Recognition of stakeholder expertise and further guidance about stakeholder consultation methods is needed.

National Incident Management System (NIMS) Standards Review Panel Workshop Summary Report

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

Stenner, Robert D.; Kirk, Jennifer L.; Stanton, James R.

The importance and need for full compliant implementation of NIMS nationwide was clearly demonstrated during the Hurricane Katrina event, which was clearly expressed in Secretary Chertoff's October 4, 2005 letter addressed to the State's governors. It states, ''Hurricane Katrina was a stark reminder of how critical it is for our nation to approach incident management in a coordinated, consistent, and efficient manner. We must be able to come together, at all levels of government, to prevent, prepare for, respond to, and recover from any emergency or disaster. Our operations must be seamless and based on common incident management doctrine, becausemore » the challenges we face as a nation are far greater than capabilities of any one jurisdiction.'' The NIMS is a system/architecture for organizing response on a ''national'' level. It incorporations ICS as a main component of that structure (i.e., it institutionalizes ICS in NIMS). In a paper published on the NIMS Website, the following statements were made: ''NIMS represents a core set of doctrine, principles, terminology, and organizational processes to enable effective, efficient and collaborative incident management at all levels. To provide the framework for interoperability and compatibility, the NIMS is based on a balance between flexibility and standardization.'' Thus the NIC is challenged with the need to adopt quality SDO generated standards to support NIMS compliance, but in doing so maintain the flexibility necessary so that response operations can be tailored for the specific jurisdictional and geographical needs across the nation. In support of this large and complex challenge facing the NIC, the Pacific Northwest National Laboratory (PNNL) was asked to provide technical support to the NIC, through their DHS Science and Technology ? Standards Portfolio Contract, to help identify, review, and develop key standards for NIMS compliance. Upon examining the challenge, the following general process appears to be a reasonable approach for identifying and establishing existing standards that would be applicable to NIMS compliance. The suggested generalized steps to establishing existing SDO generated standards for NIMS compliance are: (1) establish search criteria from the NIMS and its support documents, (2) search SDO databases to identify key existing nationally and/or internationally recognized standards that have potential application to NIMS compliance needs, (3) review the identified standards against the specific component needs of the NIMS, (4) identify the pertinent aspects/components of those identified standards that clearly address specific NIMS compliance needs, (5) establish a process to adopt the pertinent standards, which includes the generation of formalized FEMA Guidance that identifies the specific NIMS component compliance needs addressed in the respective standard, (6) develop performance criteria for which to measure compliance with the identified NIMS components addressed by the respective adopted standard, and (7) adopt the standard, publish the guidance and performance criteria, and incorporate it into routine FEMA/NIC NIMS management operations. This review process will also help identify real gaps in standards for which new NIMS specific standards should be developed. To jump start this process and hopefully identify some key ''low hanging fruit'' standards the NIC could use to begin such a process, a panel of first-responder experts (familiar with the current standards of common use in the first-responder community) from various response disciplines was formed and a workshop held. The workshop included a pre-workshop information gathering process. This report discusses the workshop and its findings in detail.« less

Update in perioperative medicine: practice changing evidence published in 2016.

PubMed

Regan, Dennis W; Kashiwagi, Deanne; Dougan, Brian; Sundsted, Karna; Mauck, Karen

2017-10-01

This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change. We integrated the new evidence into the existing body of medical knowledge and identified practical implications for real world patient care. The articles address issues related to anticoagulation, transfusion threshold, immunosuppressive medications, postoperative delirium, myocardial injury after noncardiac surgery, postoperative pain management, perioperative management of antihypertensives, perioperative fasting, and perioperative diabetic control.

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers: A "Positive Deviance" Approach.

PubMed

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N

2018-01-01

Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These "positive deviant" practices translate into organizational policies to improve health care access and patient experience. To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient-provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

When doctor becomes patient: challenges and strategies in caring for physician-patients.

PubMed

Domeyer-Klenske, Amy; Rosenbaum, Marcy

2012-01-01

The current study was aimed at exploring the challenges that arise in the doctor-patient relationship when the patient is also a physician and identifying strategies physicians use to meet these challenges. No previous research has systematically investigated primary care physicians' perspectives on caring for physician-patients. Family medicine (n=15) and general internal medicine (n=14) physicians at a large Midwestern university participated in semi-structured interviews where they were asked questions about their experiences with physician-patients and the strategies they used to meet the unique needs of this patient population. Thematic analysis was used to identify common responses. Three of the challenges most commonly discussed by physician participants were: (1) maintaining boundaries between relationships with colleagues or between roles as physician/colleague/friend, (2) avoiding assumptions about patient knowledge and health behaviors, and (3) managing physician-patients' access to informal consultations, personal test results, and opinions from other colleagues. We were able to identify three main strategies clinicians use in addressing these perceived challenges: (1) Ignore the physician-patient's background, (2) Acknowledge the physician-patient's background and negotiate care, and (3) Allow care to be driven primarily by the physician-patient. It is important that primary care physicians understand the challenges inherent in treating physicians and develop a strategy with which they are comfortable addressing them. Explicitly communicating with the physician-patient to ensure boundaries are maintained, assumptions about the physician-patient are avoided, and physician-patient access is properly managed are key to providing quality care to physician-patients.

Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation

PubMed Central

Pintye, Jillian; Jacob, Sheena; Chung, Michael H.; Middleton, Lyn; Iliffe, Jill; Kim, H. Nina

2017-01-01

Background As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD. Methods Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach. Results Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings. Conclusion To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together, these improvements may improve TB/HIV CPD quality and patient outcomes. PMID:29040303

Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation.

PubMed

Feldacker, Caryl; Pintye, Jillian; Jacob, Sheena; Chung, Michael H; Middleton, Lyn; Iliffe, Jill; Kim, H Nina

2017-01-01

As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD. Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach. Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings. To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together, these improvements may improve TB/HIV CPD quality and patient outcomes.

Our Children...Today's Investment, Tomorrow's Promise. Building an Early Childhood Development System for Nova Scotia.

ERIC Educational Resources Information Center

2001

This report provides the framework for response to Nova Scotia's agreement with the government of Canada to invest in an early childhood development (ECD) strategy. The report begins with a list of guiding principles for child and family services. The major challenge for the ECD strategy is to identify the key areas of investment that will create…

Managing e-Learning: What Are the Real Implications for Schools?

ERIC Educational Resources Information Center

Boulton, Helen

2008-01-01

This paper is concerned with the use of e-learning in secondary education. It is based on research that has taken place over a period of two years with students aged 14-16 (Key Stage 4). The paper considers the current research in e-learning and identifies the challenges faced by students, the changing role of the learner, and the impact elearning…

Migration of P-12 Education from Its Current State to One of High Quality: The Aspirations of Abu Dhabi

ERIC Educational Resources Information Center

Badri, Masood; Al Khaili, Mugheer

2014-01-01

Key system challenges identified by the Abu Dhabi Education Council provided the impetus for an aggressive strategic plan as necessary guidance and support for the development of the P-12 education system to contribute to advancing its positioning in the global knowledge economy. For the Abu Dhabi Education Council, the analysis served as a tool…

Gearing up to Teach the Common Core State Standards for Mathematics in the Rural Northeast Region. Stated Briefly. REL 2015-066

ERIC Educational Resources Information Center

Kirk, Walters; Smith, Toni M.; Ford, Jennifer; Scheopner Torres, Aubrey

2014-01-01

This study describes key challenges and necessary supports related to implementation of the Common Core State Standards for Mathematics (CCSSM) identified by rural math educators in the Northeast. The research team interviewed state and district math coordinators and surveyed teachers in Maine, New Hampshire, New York and Vermont, to assess their…

Improving Outcomes for Teenage Pregnancy and Early Parenthood for Young People in Out-of-Home Care: A Review of the Literature

ERIC Educational Resources Information Center

Mendes, Philip

2009-01-01

Young people leaving out-of-home care are overrepresented among teenage parents. This paper examines the research literature and identifies key factors that contribute to early pregnancy and parenthood for care leavers, the challenges of early parenting and the positive effects of early parenting. The implications for out-of-home care policy and…

MOMA: The Challenge to Search for Organics and Biosignatures on Mars

NASA Technical Reports Server (NTRS)

Goetz, Walter; Brinckerhoff, W. B.; Arevalo, R., Jr.; Freissinet, C.; Getty, S.; Glavin, D. P.; Siljestroem, S.; Buch, A.; Stalport, F.; Grubisic, A.;

Higher Education Research Agendas for the Coming Decade: A UK Perspective on the Policy-Research Nexus

ERIC Educational Resources Information Center

Middlehurst, Robin

2014-01-01

From the perspective of the UK, this paper addresses two main themes. It presents a higher education (HE) research agenda for the next decade linked to key policy challenges and reflects on the dynamics of the research-policy landscape. The paper begins by identifying four dimensions of the UK that will continue to be important as a focus for…

Putting more power in your pocket

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

Chapman, Karena

Representing the Northeastern Center for Chemical Energy Storage (NECCES), this document is one of the entries in the Ten Hundred and One Word Challenge. As part of the challenge, the 46 Energy Frontier Research Centers were invited to represent their science in images, cartoons, photos, words and original paintings, but any descriptions or words could only use the 1000 most commonly used words in the English language, with the addition of one word important to each of the EFRCs and the mission of DOE energy. The mission of NECCEC is to identify the key atomic-scale processes which govern electrode functionmore » in rechargeable batteries, over a wide range of time and length scales, via the development and use of novel characterization and theoretical tools, and to use this information to identify and design new battery systems.« less

Graduate capabilities for health service managers: reconfiguring health management education @UNSW.

PubMed

Meyer, Lois D; Hodgkinson, Alan R; Knight, Rosemary; Ho, Maria Theresa; di Corpo, Sophie K; Bhalla, Sonal

2007-08-01

The Master of Health Administration program at UNSW was extensively revised in 2006 to ensure that it effectively meets the challenging and dynamic environment of health service managers in local and global health contexts. This paper describes the innovative approach to the redesign of the health management program within the Faculty of Medicine. It outlines the method and considerations undertaken, particularly in identifying and embedding new graduate capabilities within the program. The paper concludes that using an outcomes-based approach and engaging with key stakeholders provides opportunity to identify and promote critical capabilities needed by managers to support the challenges confronting health services, including workforce flexibility. Further research is required on how such curriculum initiatives might impact on the performance of health service managers, but initial indications are that the health industry recognises the need and value of this approach.

Preprocessing Structured Clinical Data for Predictive Modeling and Decision Support

PubMed Central

Oliveira, Mónica Duarte; Janela, Filipe; Martins, Henrique M. G.

2016-01-01

Summary Background EHR systems have high potential to improve healthcare delivery and management. Although structured EHR data generates information in machine-readable formats, their use for decision support still poses technical challenges for researchers due to the need to preprocess and convert data into a matrix format. During our research, we observed that clinical informatics literature does not provide guidance for researchers on how to build this matrix while avoiding potential pitfalls. Objectives This article aims to provide researchers a roadmap of the main technical challenges of preprocessing structured EHR data and possible strategies to overcome them. Methods Along standard data processing stages – extracting database entries, defining features, processing data, assessing feature values and integrating data elements, within an EDPAI framework –, we identified the main challenges faced by researchers and reflect on how to address those challenges based on lessons learned from our research experience and on best practices from related literature. We highlight the main potential sources of error, present strategies to approach those challenges and discuss implications of these strategies. Results Following the EDPAI framework, researchers face five key challenges: (1) gathering and integrating data, (2) identifying and handling different feature types, (3) combining features to handle redundancy and granularity, (4) addressing data missingness, and (5) handling multiple feature values. Strategies to address these challenges include: cross-checking identifiers for robust data retrieval and integration; applying clinical knowledge in identifying feature types, in addressing redundancy and granularity, and in accommodating multiple feature values; and investigating missing patterns adequately. Conclusions This article contributes to literature by providing a roadmap to inform structured EHR data preprocessing. It may advise researchers on potential pitfalls and implications of methodological decisions in handling structured data, so as to avoid biases and help realize the benefits of the secondary use of EHR data. PMID:27924347

A conceptual framework toward identifying and analyzing challenges to the advancement of pharmacy.

PubMed

Bader, Lina R; McGrath, Simon; Rouse, Michael J; Anderson, Claire

Pharmacists and health care professionals are faced with increasing and changing health care needs around the world. To meet these demands, they are required to continuously upgrade and develop their professions. Reprofessionalization is therefore crucial to the successful delivery of health services, but traditional theories might provide little practical guidance to evaluating the overall status of a profession. This study proposes a new conceptual framework of three interrelated professional sectors: education, regulation and practice, and uses it to identify and analyze challenges facing the pharmacy profession in Jordan. A multiple-method qualitative study comprised of semi-structured interviews and focus groups was conducted in Amman, Jordan. To explore and identify the challenges, a purposively recruited cross-sector sample of 53 key informants, stakeholders and pharmacists were interviewed. Interview transcripts were translated and analyzed using QSR NVivo 10. Thematic analysis identified eight main challenges facing pharmacy in Jordan. The original participants were then invited to participate in focus groups, the purpose of which was to validate the interview findings, map them against the conceptual framework and discuss recommendations for development. The eight validated challenges span the following areas: graduates preparedness for practice, pharmacy education accreditation and quality assurance, pre-registration requirements, workforce development, workforce planning, remuneration and wage rate, pharmacy assistants, and Pharm.D. pharmacists. Focus group participants used the framework to map each of the challenges to the primary sector-to-sector disconnect that they perceived to explain it. A list of recommendations addressing each of the challenges was also devised. The framework was found to offer valuable insight as an explanatory and diagnostic tool in policy-relevant research. By emphasizing the processual and contextual nature of reprofessionalization, the framework presents an alternative approach to traditional theories. This study also raises important questions regarding the status of pharmacy in Jordan and aims to provide guidance for local development and much-needed reprofessionalization drives. Copyright © 2016 Elsevier Inc. All rights reserved.

Challenges in the clinical education of the nursing profession in Iran: A qualitative study.

PubMed

Jasemi, Madineh; Whitehead, Bill; Habibzadeh, Hosein; Zabihi, Roghaieh Esmaeili; Rezaie, Soheila Ahangarzadeh

2018-04-21

Clinical education is an important part of nurse training. It provides students with the opportunity to gain useful experience and has a key role in their professional preparation. The importance of clinical education in nursing students' professional performance means that identifying the challenges in this field is crucial. The goal of this study is to identify challenges in the field of clinical nurse education. A qualitative content analysis study. A faculty of Nursing and Midwifery, in Iran 2017. Nine student nurses, three qualified nurses and two nursing educators. This study has been applied to various depths of interpretation. Semi-structured interviews were used to collect the data. Nine student nurses, three qualified nurses and two nursing educators were interviewed. The analysis of the interviews generated five categories. Two main themes were extracted as challenges in the clinical training of nursing professionals: 1. Inefficient educational structure and 2. Inefficient professional performance environment. Considering the inadequate professional performance environment and defective educational structure, designing and delivering lessons with clear goals is essential. Using objective and measurable scales for evaluating educational standards, the use of empowered instructors with high communicational skills is useful for increasing students' motivation and interest toward clinical education and solving existing challenges. Copyright © 2018 Elsevier Ltd. All rights reserved.

Challenges for strengthening the health workforce in the Lao People's Democratic Republic: perspectives from key stakeholders.

PubMed

Qian, Yi; Yan, Fei; Wang, Wei; Clancy, Shayna; Akkhavong, Kongsap; Vonglokham, Manithong; Outhensackda, Somphou; Østbye, Truls

2016-11-29

The Lao People's Democratic Republic is facing a critical shortage and maldistribution of health workers. Strengthening of the health workforce has been adopted as one of the five priorities of the National Health Sector Strategy (2013-2025). This study aims to identify, explore, and better understand the key challenges for strengthening the Laotian health workforce. This study applied exploratory and descriptive qualitative methods and adapted a working life-span framework. Twenty-three key stakeholders with particular insights into the current situation of the health workforce were purposively recruited for in-depth interviews. Important policy documents were also collected from key informants during the interviews. Thematic analysis was employed for the textual data using MAXQDA 10. The overarching problem is that there is a perceived severe shortage of skilled health workers (doctors, nurses, and midwives) and lab technicians, especially in primary health facilities and rural areas. Key informants also identified five problems: insufficient production of health workers both in quantity and quality, a limited national budget to recruit enough health staff and provide sufficient and equitable salaries and incentives, limited management capacity, poor recruitment for work in rural areas, and lack of well-designed continuing education programs for professional development. These problems are interrelated, both in how the issues arise and in the effect they have on one another. To improve the distribution of health workers in rural areas, strategies for increasing production and strengthening retention should be well integrated for better effectiveness. It is also essential to take the Laotian-specific context into consideration during intervention development and implementation. Furthermore, the government should acknowledge the inadequate health management capacity and invest to improve human resource management capacity at all levels. Finally, assessment of interventions for health workforce strengthening should be developed as early as possible to learn from the experiences and lessons in the Lao People's Democratic Republic.

Temporal Expression of Peripheral Blood Leukocyte Biomarkers in a Macaca fascicularis Infection Model of Tuberculosis; Comparison with Human Datasets and Analysis with Parametric/Non-parametric Tools for Improved Diagnostic Biomarker Identification

PubMed Central

Wareham, Alice; Lewandowski, Kuiama S.; Williams, Ann; Dennis, Michael J.; Sharpe, Sally; Vipond, Richard; Silman, Nigel; Ball, Graham

2016-01-01

A temporal study of gene expression in peripheral blood leukocytes (PBLs) from a Mycobacterium tuberculosis primary, pulmonary challenge model Macaca fascicularis has been conducted. PBL samples were taken prior to challenge and at one, two, four and six weeks post-challenge and labelled, purified RNAs hybridised to Operon Human Genome AROS V4.0 slides. Data analyses revealed a large number of differentially regulated gene entities, which exhibited temporal profiles of expression across the time course study. Further data refinements identified groups of key markers showing group-specific expression patterns, with a substantial reprogramming event evident at the four to six week interval. Selected statistically-significant gene entities from this study and other immune and apoptotic markers were validated using qPCR, which confirmed many of the results obtained using microarray hybridisation. These showed evidence of a step-change in gene expression from an ‘early’ FOS-associated response, to a ‘late’ predominantly type I interferon-driven response, with coincident reduction of expression of other markers. Loss of T-cell-associate marker expression was observed in responsive animals, with concordant elevation of markers which may be associated with a myeloid suppressor cell phenotype e.g. CD163. The animals in the study were of different lineages and these Chinese and Mauritian cynomolgous macaque lines showed clear evidence of differing susceptibilities to Tuberculosis challenge. We determined a number of key differences in response profiles between the groups, particularly in expression of T-cell and apoptotic makers, amongst others. These have provided interesting insights into innate susceptibility related to different host `phenotypes. Using a combination of parametric and non-parametric artificial neural network analyses we have identified key genes and regulatory pathways which may be important in early and adaptive responses to TB. Using comparisons between data outputs of each analytical pipeline and comparisons with previously published Human TB datasets, we have delineated a subset of gene entities which may be of use for biomarker diagnostic test development. PMID:27228113

Visualization of Time-Series Sensor Data to Inform the Design of Just-In-Time Adaptive Stress Interventions.

PubMed

Sharmin, Moushumi; Raij, Andrew; Epstien, David; Nahum-Shani, Inbal; Beck, J Gayle; Vhaduri, Sudip; Preston, Kenzie; Kumar, Santosh

2015-09-01

We investigate needs, challenges, and opportunities in visualizing time-series sensor data on stress to inform the design of just-in-time adaptive interventions (JITAIs). We identify seven key challenges: massive volume and variety of data, complexity in identifying stressors, scalability of space, multifaceted relationship between stress and time, a need for representation at multiple granularities, interperson variability, and limited understanding of JITAI design requirements due to its novelty. We propose four new visualizations based on one million minutes of sensor data (n=70). We evaluate our visualizations with stress researchers (n=6) to gain first insights into its usability and usefulness in JITAI design. Our results indicate that spatio-temporal visualizations help identify and explain between- and within-person variability in stress patterns and contextual visualizations enable decisions regarding the timing, content, and modality of intervention. Interestingly, a granular representation is considered informative but noise-prone; an abstract representation is the preferred starting point for designing JITAIs.

Visualization of Time-Series Sensor Data to Inform the Design of Just-In-Time Adaptive Stress Interventions

PubMed Central

Sharmin, Moushumi; Raij, Andrew; Epstien, David; Nahum-Shani, Inbal; Beck, J. Gayle; Vhaduri, Sudip; Preston, Kenzie; Kumar, Santosh

2015-01-01

We investigate needs, challenges, and opportunities in visualizing time-series sensor data on stress to inform the design of just-in-time adaptive interventions (JITAIs). We identify seven key challenges: massive volume and variety of data, complexity in identifying stressors, scalability of space, multifaceted relationship between stress and time, a need for representation at multiple granularities, interperson variability, and limited understanding of JITAI design requirements due to its novelty. We propose four new visualizations based on one million minutes of sensor data (n=70). We evaluate our visualizations with stress researchers (n=6) to gain first insights into its usability and usefulness in JITAI design. Our results indicate that spatio-temporal visualizations help identify and explain between- and within-person variability in stress patterns and contextual visualizations enable decisions regarding the timing, content, and modality of intervention. Interestingly, a granular representation is considered informative but noise-prone; an abstract representation is the preferred starting point for designing JITAIs. PMID:26539566

Ten key principles for successful health systems integration.

PubMed

Suter, Esther; Oelke, Nelly D; Adair, Carol E; Armitage, Gail D

2009-01-01

Integrated health systems are considered part of the solution to the challenge of sustaining Canada's healthcare system. This systematic literature review was undertaken to guide decision-makers and others to plan for and implement integrated health systems. This review identified 10 universal principles of successfully integrated healthcare systems that may be used by decision-makers to assist with integration efforts. These principles define key areas for restructuring and allow organizational flexibility and adaptation to local context. The literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for specific integration strategies and processes.

High Temperature Materials Needs in NASA's Advanced Space Propulsion Programs

NASA Technical Reports Server (NTRS)

Eckel, Andrew J.; Glass, David E.

2005-01-01

In recent years, NASA has embarked on several new and exciting efforts in the exploration and use of space. The successful accomplishment of many planned missions and projects is dependent upon the development and deployment of previously unproven propulsion systems. Key to many of the propulsion systems is the use of emergent materials systems, particularly high temperature structural composites. A review of the general missions and benefits of utilizing high temperature materials will be presented. The design parameters and operating conditions will be presented for both specific missions/vehicles and classes of components. Key technical challenges and opportunities are identified along with suggested paths for addressing them.

Performance Prediction and Validation: Data, Frameworks, and Considerations

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

Tinnesand, Heidi

2017-05-19

Improving the predictability and reliability of wind power generation and operations will reduce costs and potentially establish a framework to attract new capital into the distributed wind sector, a key cost reduction requirement highlighted in results from the distributed wind future market assessment conducted with dWind. Quantifying and refining the accuracy of project performance estimates will also directly address several of the key challenges identified by industry stakeholders in 2015 as part of the distributed wind resource assessment workshop and be cross-cutting for several other facets of the distributed wind portfolio. This presentation covers the efforts undertaken in 2016 tomore » address these topics.« less

Consensus Statement on Electronic Health Predictive Analytics: A Guiding Framework to Address Challenges

PubMed Central

Amarasingham, Ruben; Audet, Anne-Marie J.; Bates, David W.; Glenn Cohen, I.; Entwistle, Martin; Escobar, G. J.; Liu, Vincent; Etheredge, Lynn; Lo, Bernard; Ohno-Machado, Lucila; Ram, Sudha; Saria, Suchi; Schilling, Lisa M.; Shahi, Anand; Stewart, Walter F.; Steyerberg, Ewout W.; Xie, Bin

2016-01-01

Context: The recent explosion in available electronic health record (EHR) data is motivating a rapid expansion of electronic health care predictive analytic (e-HPA) applications, defined as the use of electronic algorithms that forecast clinical events in real time with the intent to improve patient outcomes and reduce costs. There is an urgent need for a systematic framework to guide the development and application of e-HPA to ensure that the field develops in a scientifically sound, ethical, and efficient manner. Objectives: Building upon earlier frameworks of model development and utilization, we identify the emerging opportunities and challenges of e-HPA, propose a framework that enables us to realize these opportunities, address these challenges, and motivate e-HPA stakeholders to both adopt and continuously refine the framework as the applications of e-HPA emerge. Methods: To achieve these objectives, 17 experts with diverse expertise including methodology, ethics, legal, regulation, and health care delivery systems were assembled to identify emerging opportunities and challenges of e-HPA and to propose a framework to guide the development and application of e-HPA. Findings: The framework proposed by the panel includes three key domains where e-HPA differs qualitatively from earlier generations of models and algorithms (Data Barriers, Transparency, and Ethics) and areas where current frameworks are insufficient to address the emerging opportunities and challenges of e-HPA (Regulation and Certification; and Education and Training). The following list of recommendations summarizes the key points of the framework: Data Barriers: Establish mechanisms within the scientific community to support data sharing for predictive model development and testing.Transparency: Set standards around e-HPA validation based on principles of scientific transparency and reproducibility.Ethics: Develop both individual-centered and society-centered risk-benefit approaches to evaluate e-HPA.Regulation and Certification: Construct a self-regulation and certification framework within e-HPA.Education and Training: Make significant changes to medical, nursing, and paraprofessional curricula by including training for understanding, evaluating, and utilizing predictive models. PMID:27141516

Consensus Statement on Electronic Health Predictive Analytics: A Guiding Framework to Address Challenges.

PubMed

Amarasingham, Ruben; Audet, Anne-Marie J; Bates, David W; Glenn Cohen, I; Entwistle, Martin; Escobar, G J; Liu, Vincent; Etheredge, Lynn; Lo, Bernard; Ohno-Machado, Lucila; Ram, Sudha; Saria, Suchi; Schilling, Lisa M; Shahi, Anand; Stewart, Walter F; Steyerberg, Ewout W; Xie, Bin

2016-01-01

The recent explosion in available electronic health record (EHR) data is motivating a rapid expansion of electronic health care predictive analytic (e-HPA) applications, defined as the use of electronic algorithms that forecast clinical events in real time with the intent to improve patient outcomes and reduce costs. There is an urgent need for a systematic framework to guide the development and application of e-HPA to ensure that the field develops in a scientifically sound, ethical, and efficient manner. Building upon earlier frameworks of model development and utilization, we identify the emerging opportunities and challenges of e-HPA, propose a framework that enables us to realize these opportunities, address these challenges, and motivate e-HPA stakeholders to both adopt and continuously refine the framework as the applications of e-HPA emerge. To achieve these objectives, 17 experts with diverse expertise including methodology, ethics, legal, regulation, and health care delivery systems were assembled to identify emerging opportunities and challenges of e-HPA and to propose a framework to guide the development and application of e-HPA. The framework proposed by the panel includes three key domains where e-HPA differs qualitatively from earlier generations of models and algorithms (Data Barriers, Transparency, and ETHICS) and areas where current frameworks are insufficient to address the emerging opportunities and challenges of e-HPA (Regulation and Certification; and Education and Training). The following list of recommendations summarizes the key points of the framework: Data Barriers: Establish mechanisms within the scientific community to support data sharing for predictive model development and testing.Transparency: Set standards around e-HPA validation based on principles of scientific transparency and reproducibility. Develop both individual-centered and society-centered risk-benefit approaches to evaluate e-HPA.Regulation and Certification: Construct a self-regulation and certification framework within e-HPA.Education and Training: Make significant changes to medical, nursing, and paraprofessional curricula by including training for understanding, evaluating, and utilizing predictive models.

Orphans of the Mexican drug war: insights on a public health challenge.

PubMed

Camacho, Salvador; Horstick, Olaf; Sax, Sylvia

2014-08-01

To describe how the Government of Mexico and other direct stakeholders perceive children orphaned by the drug war; to determine the current measures addressing this as a public health problem; and to compare these measures to international frameworks so that relevant recommendations can be identified. This was an exploratory, descriptive case study using qualitative methods. Semi-structured interviews were performed with key informants at the federal, state, and municipal government levels in Mexico, as well as non-governmental organizations, and other institutes working with orphans. Participants were identified with a purposive snowball sample. No official definition of "orphan" was identified; nor was there a shared perception among the key informants of what constitutes being an orphan. An official, collective definition is important because it modifies the quantity of children categorized as such within the target population. Although most of the interviewees perceive that the number of orphans and vulnerable children (OVC) has increased in the last 6 years, they acknowledged there is no reliable data to prove it. The increase, they believe, is due not to the drug war, but to a loss of family cohesion. Stakeholders recommend improving public policies, currently identified as the most difficult barrier to overcome due to a perceived inability to modify existing laws. However, the General Law for Victims was recently passed by the Government of Mexico and addresses many of the challenges identified. When compared to the international frameworks, there are three major issues in Mexico's current situation: coordination among and within stakeholders; emphasis on using community solutions; and putting in place preventive programs. For two of these problems, the General Law of Victims offers solutions.

High-order interactions observed in multi-task intrinsic networks are dominant indicators of aberrant brain function in schizophrenia

PubMed Central

Plis, Sergey M; Sui, Jing; Lane, Terran; Roy, Sushmita; Clark, Vincent P; Potluru, Vamsi K; Huster, Rene J; Michael, Andrew; Sponheim, Scott R; Weisend, Michael P; Calhoun, Vince D

2013-01-01

Identifying the complex activity relationships present in rich, modern neuroimaging data sets remains a key challenge for neuroscience. The problem is hard because (a) the underlying spatial and temporal networks may be nonlinear and multivariate and (b) the observed data may be driven by numerous latent factors. Further, modern experiments often produce data sets containing multiple stimulus contexts or tasks processed by the same subjects. Fusing such multi-session data sets may reveal additional structure, but raises further statistical challenges. We present a novel analysis method for extracting complex activity networks from such multifaceted imaging data sets. Compared to previous methods, we choose a new point in the trade-off space, sacrificing detailed generative probability models and explicit latent variable inference in order to achieve robust estimation of multivariate, nonlinear group factors (“network clusters”). We apply our method to identify relationships of task-specific intrinsic networks in schizophrenia patients and control subjects from a large fMRI study. After identifying network-clusters characterized by within- and between-task interactions, we find significant differences between patient and control groups in interaction strength among networks. Our results are consistent with known findings of brain regions exhibiting deviations in schizophrenic patients. However, we also find high-order, nonlinear interactions that discriminate groups but that are not detected by linear, pair-wise methods. We additionally identify high-order relationships that provide new insights into schizophrenia but that have not been found by traditional univariate or second-order methods. Overall, our approach can identify key relationships that are missed by existing analysis methods, without losing the ability to find relationships that are known to be important. PMID:23876245

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

PubMed

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

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

Searching for signposts: Adaptive planning thresholds in long-term water supply projections for the Western U.S.

NASA Astrophysics Data System (ADS)

Robinson, B.; Herman, J. D.

2017-12-01

Long-term water supply planning is challenged by highly uncertain streamflow projections across climate models and emissions scenarios. Recent studies have devised infrastructure and policy responses that can withstand or adapt to an ensemble of scenarios, particularly those outside the envelope of historical variability. An important aspect of this process is whether the proposed thresholds for adaptation (i.e., observations that trigger a response) truly represent a trend toward future change. Here we propose an approach to connect observations of annual mean streamflow with long-term projections by filtering GCM-based streamflow ensembles. Visualizations are developed to investigate whether observed changes in mean annual streamflow can be linked to projected changes in end-of-century mean and variance relative to the full ensemble. A key focus is identifying thresholds that point to significant long-term changes in the distribution of streamflow (+/- 20% or greater) as early as possible. The analysis is performed on 87 sites in the Western United States, using streamflow ensembles through 2100 from a recent study by the U.S. Bureau of Reclamation. Results focus on three primary questions: (1) how many years of observed data are needed to identify the most extreme scenarios, and by what year can they be identified? (2) are these features different between sites? and (3) using this analysis, do observed flows to date at each site point to significant long-term changes? This study addresses the challenge of severe uncertainty in long-term streamflow projections by identifying key thresholds that can be observed to support water supply planning.

Community strategies to address cancer disparities in Appalachian Kentucky

PubMed Central

Schoenberg, Nancy E.; Howell, Britteny M.; Fields, Nell

2012-01-01

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included: (1) inadequate awareness of screening need; (2) insufficient access to screening; and (3) lack of privacy. Strategies included (1) witnessing/storytelling; (2) capitalizing on family history; (3) improving publicity about screening resources; (4) relying on lay health advisors; and (5) bundling preventive services. These insights shaped our CBPR intervention and offer strategies to others working in Appalachia, rural locales, and other traditionally underserved communities. PMID:22143486

Long-range strategic planning: a case study.

PubMed

Moller-Tiger, D

1999-05-01

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

Community strategies to address cancer disparities in Appalachian Kentucky.

PubMed

Schoenberg, Nancy E; Howell, Britteny M; Fields, Nell

2012-01-01

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.

The role of manufacturing in affecting the social dimension of sustainability

DOE PAGES

Sutherland, John W.; Richter, Justin S.; Hutchins, Margot J.; ...

2016-08-03

Manufacturing affects all three dimensions of sustainability: economy, environment, and society. This paper addresses the last of these dimensions. It explores social impacts identified by national level social indicators, frameworks, and principles. The effects of manufacturing on social performance are framed for different stakeholder groups with associated social needs. Methodology development as well as various challenges for social life cycle assessment (S-LCA) are further examined. Efforts to integrate social and another dimension of sustainability are considered, with attention to globalization challenges, including offshoring and reshoring. The study concludes with a summary of key takeaways and promising directions for future work.

The role of manufacturing in affecting the social dimension of sustainability

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

Sutherland, John W.; Richter, Justin S.; Hutchins, Margot J.

Manufacturing affects all three dimensions of sustainability: economy, environment, and society. This paper addresses the last of these dimensions. It explores social impacts identified by national level social indicators, frameworks, and principles. The effects of manufacturing on social performance are framed for different stakeholder groups with associated social needs. Methodology development as well as various challenges for social life cycle assessment (S-LCA) are further examined. Efforts to integrate social and another dimension of sustainability are considered, with attention to globalization challenges, including offshoring and reshoring. The study concludes with a summary of key takeaways and promising directions for future work.

First- and third-party ground truth for key frame extraction from consumer video clips

NASA Astrophysics Data System (ADS)

Costello, Kathleen; Luo, Jiebo

2007-02-01

Extracting key frames (KF) from video is of great interest in many applications, such as video summary, video organization, video compression, and prints from video. KF extraction is not a new problem. However, current literature has been focused mainly on sports or news video. In the consumer video space, the biggest challenges for key frame selection from consumer videos are the unconstrained content and lack of any preimposed structure. In this study, we conduct ground truth collection of key frames from video clips taken by digital cameras (as opposed to camcorders) using both first- and third-party judges. The goals of this study are: (1) to create a reference database of video clips reasonably representative of the consumer video space; (2) to identify associated key frames by which automated algorithms can be compared and judged for effectiveness; and (3) to uncover the criteria used by both first- and thirdparty human judges so these criteria can influence algorithm design. The findings from these ground truths will be discussed.

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

PubMed Central

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

2018-01-01

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

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

PubMed

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

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

Key Aspects of a Sustainable Health Insurance System in Germany.

PubMed

Pelster, Matthias; Hagemann, Vera; Laporte Uribe, Franziska

2016-06-01

The main goals of health-care systems are to improve the health of the population they serve, respond to people's legitimate expectations, and offer fair financing. As a result, the health system in Germany is subject to continuous adaption as well as public and political discussions about its design. This paper analyzes the key challenges for the German health-care system and the underlying factors driving these challenges. We aim to identify possible solutions to put the German health-care system in a better position to face these challenges. We utilize a broad array of methods to answer these questions, including a review of the published and grey literature on health-care planning in Germany, semi-structured interviews with stakeholders in the system, and an online questionnaire. We find that the most urgent (and manageable) aspects that merit attention are holistic hospital planning, initiatives to increase (administrative) innovation in the health-care system, incentives to increase prevention, and approaches to increase analytical quality assurance. We found that hospital planning, innovation, quality control, and prevention, are considered to be the topics most in need of attention in the German health system.

Strategies to design clinical studies to identify predictive biomarkers in cancer research.

PubMed

Perez-Gracia, Jose Luis; Sanmamed, Miguel F; Bosch, Ana; Patiño-Garcia, Ana; Schalper, Kurt A; Segura, Victor; Bellmunt, Joaquim; Tabernero, Josep; Sweeney, Christopher J; Choueiri, Toni K; Martín, Miguel; Fusco, Juan Pablo; Rodriguez-Ruiz, Maria Esperanza; Calvo, Alfonso; Prior, Celia; Paz-Ares, Luis; Pio, Ruben; Gonzalez-Billalabeitia, Enrique; Gonzalez Hernandez, Alvaro; Páez, David; Piulats, Jose María; Gurpide, Alfonso; Andueza, Mapi; de Velasco, Guillermo; Pazo, Roberto; Grande, Enrique; Nicolas, Pilar; Abad-Santos, Francisco; Garcia-Donas, Jesus; Castellano, Daniel; Pajares, María J; Suarez, Cristina; Colomer, Ramon; Montuenga, Luis M; Melero, Ignacio

2017-02-01

The discovery of reliable biomarkers to predict efficacy and toxicity of anticancer drugs remains one of the key challenges in cancer research. Despite its relevance, no efficient study designs to identify promising candidate biomarkers have been established. This has led to the proliferation of a myriad of exploratory studies using dissimilar strategies, most of which fail to identify any promising targets and are seldom validated. The lack of a proper methodology also determines that many anti-cancer drugs are developed below their potential, due to failure to identify predictive biomarkers. While some drugs will be systematically administered to many patients who will not benefit from them, leading to unnecessary toxicities and costs, others will never reach registration due to our inability to identify the specific patient population in which they are active. Despite these drawbacks, a limited number of outstanding predictive biomarkers have been successfully identified and validated, and have changed the standard practice of oncology. In this manuscript, a multidisciplinary panel reviews how those key biomarkers were identified and, based on those experiences, proposes a methodological framework-the DESIGN guidelines-to standardize the clinical design of biomarker identification studies and to develop future research in this pivotal field. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Toxicogenomics and cancer risk assessment: a framework for key event analysis and dose-response assessment for nongenotoxic carcinogens.

PubMed

Bercu, Joel P; Jolly, Robert A; Flagella, Kelly M; Baker, Thomas K; Romero, Pedro; Stevens, James L

2010-12-01

In order to determine a threshold for nongenotoxic carcinogens, the traditional risk assessment approach has been to identify a mode of action (MOA) with a nonlinear dose-response. The dose-response for one or more key event(s) linked to the MOA for carcinogenicity allows a point of departure (POD) to be selected from the most sensitive effect dose or no-effect dose. However, this can be challenging because multiple MOAs and key events may exist for carcinogenicity and oftentimes extensive research is required to elucidate the MOA. In the present study, a microarray analysis was conducted to determine if a POD could be identified following short-term oral rat exposure with two nongenotoxic rodent carcinogens, fenofibrate and methapyrilene, using a benchmark dose analysis of genes aggregated in Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and Gene Ontology (GO) biological processes, which likely encompass key event(s) for carcinogenicity. The gene expression response for fenofibrate given to rats for 2days was consistent with its MOA and known key events linked to PPARα activation. The temporal response from daily dosing with methapyrilene demonstrated biological complexity with waves of pathways/biological processes occurring over 1, 3, and 7days; nonetheless, the benchmark dose values were consistent over time. When comparing the dose-response of toxicogenomic data to tumorigenesis or precursor events, the toxicogenomics POD was slightly below any effect level. Our results suggest that toxicogenomic analysis using short-term studies can be used to identify a threshold for nongenotoxic carcinogens based on evaluation of potential key event(s) which then can be used within a risk assessment framework. Copyright © 2010 Elsevier Inc. All rights reserved.

Meeting the Challenges of Regional Security

DTIC Science & Technology

1994-02-01

targets over time, assessing strike damage, and, of course, developing up-to- date maps of crucial urban and industrial areas. Coupled with modem digital ...of huge diverse data bases is key to dissecting criminal infrastructures, and identifying relevant regional and global linkages. New digital processing...cities). They can aid in reaction force planning and training. One 10-inch optical disc can easily store 25 (and display at any scale with 4- digit

Tracking Online Trails

NASA Astrophysics Data System (ADS)

Qi, Man; Edgar-Nevill, Denis; Wang, Yongquan; Xu, Rongsheng

Traceability is a key to the investigation of the internet criminal and a cornerstone of internet research. It is impossible to prevent all internet misuse but may be possible to identify and trace the users, and then take appropriate action. This paper presents the value of traceability within the email/-newsposting utilities, the technologies being using to hide identities, the difficulties in locating the traceable data and the challenges in tracking online trails.

Creativity and Innovation in Health Care: Tapping Into Organizational Enablers Through Human-Centered Design.

PubMed

Zuber, Christi Dining; Moody, Louise

There is an increasing drive in health care for creativity and innovation to tackle key health challenges, improve quality and access, and reduce harm and costs. Human-centered design (HCD) is a potential approach to achieving organizational innovation. However, research suggests the nursing workforce feels unsupported to take the risks needed for innovation, and leaders may not understand the conditions required to fully support them. The aim of this study was to identify enabling conditions that support frontline nurses in their attempts to behave as champions of innovation and change. An HCD workshop was undertaken with 125 nurses employed in clinical practice at Kaiser Permanente. The workshop included empathy mapping and semistructured questions that probed participant experiences with innovation and change. The data were collated and thematic analysis undertaken through a Grounded Theory approach. The data were analyzed to identify key enabling conditions. Seven enablers emerged: personal need for a solution; challenges that have meaningful purpose; clarity of goal and control of resources; active experimentation; experiences indicating progress; positive encouragement and confidence; and provision of psychological safety. These enablers were then translated into pragmatic guidelines for leaders on how the tools of HCD may be leveraged for innovation and change in health care.

High Altitude Venus Operational Concept (HAVOC): Proofs of Concept

NASA Technical Reports Server (NTRS)

Jones, Christopher A.; Arney, Dale C.; Bassett, George Z.; Clark, James R.; Hennig, Anthony I.; Snyder, Jessica C.

2015-01-01

The atmosphere of Venus is an exciting destination for both further scientific study and future human exploration. A recent internal NASA study of a High Altitude Venus Operational Concept (HAVOC) led to the development of an evolutionary program for the exploration of Venus, with focus on the mission architecture and vehicle concept for a 30-day crewed mission into Venus's atmosphere at 50 kilometers. Key technical challenges for the mission include performing the aerocapture maneuvers at Venus and Earth, inserting and inflating the airship at Venus during the entry sequence, and protecting the solar panels and structure from the sulfuric acid in the atmosphere. Two proofs of concept were identified that would aid in addressing some of the key technical challenges. To mitigate the threat posed by the sulfuric acid ambient in the atmosphere of Venus, a material was needed that could protect the systems while being lightweight and not inhibiting the performance of the solar panels. The first proof of concept identified candidate materials and evaluated them, finding FEP-Teflon (Fluorinated Ethylene Propylene-Teflon) to maintain 90 percent transmittance to relevant spectra even after 30 days of immersion in concentrated sulfuric acid. The second proof of concept developed and verified a packaging algorithm for the airship envelope to inform the entry, descent, and inflation analysis.

PARTNER INVOLVEMENT: NEGOTIATING THE PRESENCE OF PARTNERS IN PSYCHOSOCIAL ASSESSMENT AS CONDUCTED BY MIDWIVES AND CHILD AND FAMILY HEALTH NURSES.

PubMed

Rollans, Mellanie; Kohlhoff, Jane; Meade, Tanya; Kemp, Lynn; Schmied, Virginia

2016-05-01

Universal screening for maternal depression and assessment of psychosocial risks has been integrated into the routine perinatal care provided in many Australian hospitals, but to date, partners/fathers have been largely excluded from the process. This study explored the ways in which clinicians in health service settings include partners who attend antenatal and postnatal visits with women. Qualitative data were collected using observations (n = 54), interviews (n = 60), and discussion groups (n = 7) with midwives and child and family health nurses who conducted the appointments. Transcripts from observations, interviews, and discussion groups underwent qualitative analysis, and key themes were identified. Results showed partners to have little or no involvement in psychosocial assessment and depression screening. Thematic analysis revealed four key themes: negotiating partner exclusion, partial inclusion, women's business or a couple concern? and they know anyway. Partner involvement appeared to be challenged particularly by mandatory interpersonal violence screening, which, according to health service policy, is to be conducted confidentially. Overall, results highlighted partner involvement in perinatal depression screening and psychosocial assessment processes and identified some of the benefits such as partner disclosure, but also the challenges and complexities of inclusion of partners. Clinical implications and directions for further education and research are discussed. © 2016 Michigan Association for Infant Mental Health.

Canadian Adjuvant Initiative Workshop, March 26–27, 2013—Ottawa, Canada

PubMed Central

Krishnan, Lakshmi; Twine, Susan; Gerdts, Volker; Barreto, Luis; Richards, James C

2014-01-01

Novel adjuvants hold the promise for developing effective modern subunit vaccines capable of appropriately modulating the immune response against challenging diseases such as those caused by chronic and/or intracellular pathogens and cancer. Over the past decade there has been intensive research into discovering new adjuvants, however, their translation into routine clinical use is lagging. To stimulate discussion and identify opportunities for networking and collaboration among various stakeholders, a Canadian Adjuvant Initiative Workshop was held in Ottawa. Sponsored by the National Research Council Canada, Canadian Institutes of Health Research and the Vaccine Industry Committee, a two day workshop was held that brought together key Canadian and international stakeholders in adjuvant research from industry, academia and government. To discover innovation gaps and unmet needs, the presentations covered a board range of topics in adjuvant development; criteria for selection of lead adjuvant candidates from an industry perspective, discovery research across Canada, bioprocessing needs and challenges, veterinary vaccines, Canadian vaccine trial capabilities, the Canadian regulatory framework and WHO formulation laboratory experience. The workshop concluded with a discussion on the opportunity to create a Canadian Adjuvant Development Network. This report details the key discussion points and steps forward identified for facilitating adjuvant development research in Canada. PMID:24192752

Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa

PubMed Central

2012-01-01

Background Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings. PMID:23126370

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa

PubMed Central

2017-01-01

Background Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. Aim This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. Setting The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. Methods The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Results Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. Conclusion South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised. PMID:28828878

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

PubMed

Mburu, Grace; George, Gavin

2017-07-31

Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

Success under duress: policies and practices managers view as keys to profitability in five California hospitals with challenging payer mix.

PubMed

Rundall, Thomas; Oberlin, Shelley; Thygesen, Brian; Janus, Katharina

2012-01-01

Hospitals with a challenging payer mix (CPM)-high proportions of uninsured and Medicaid patients and a low proportion of commercially insured patients-are an important source of care for low-income, uninsured people. Achieving profitability is difficult for CPM hospitals. From 2005 through 2008, only one-third of 67 CPM hospitals in California reported positive total margins. In-depth group interviews were completed with the management leadership teams of a diverse group of five profitable CPM hospitals to identify the management strategies and practices that the hospitals' leadership teams credited for their financial success. Twelve management policy and practice topics were identified. Four of the policies and practices that managers identified involve organizational actions to increase hospital revenue or operational efficiency. These factors are consistent with those identified in previous research. However, managers also identified eight factors not previously revealed in research on hospital profitability, including management policies and practices that establish the organizational culture, workforce, relationships, monitoring systems, and governance necessary to ensure that hospital employees and affiliated physicians support and successfully implement organizational actions necessary to achieve profitability.

ICSNPathway: identify candidate causal SNPs and pathways from genome-wide association study by one analytical framework.

PubMed

Zhang, Kunlin; Chang, Suhua; Cui, Sijia; Guo, Liyuan; Zhang, Liuyan; Wang, Jing

2011-07-01

Genome-wide association study (GWAS) is widely utilized to identify genes involved in human complex disease or some other trait. One key challenge for GWAS data interpretation is to identify causal SNPs and provide profound evidence on how they affect the trait. Currently, researches are focusing on identification of candidate causal variants from the most significant SNPs of GWAS, while there is lack of support on biological mechanisms as represented by pathways. Although pathway-based analysis (PBA) has been designed to identify disease-related pathways by analyzing the full list of SNPs from GWAS, it does not emphasize on interpreting causal SNPs. To our knowledge, so far there is no web server available to solve the challenge for GWAS data interpretation within one analytical framework. ICSNPathway is developed to identify candidate causal SNPs and their corresponding candidate causal pathways from GWAS by integrating linkage disequilibrium (LD) analysis, functional SNP annotation and PBA. ICSNPathway provides a feasible solution to bridge the gap between GWAS and disease mechanism study by generating hypothesis of SNP → gene → pathway(s). The ICSNPathway server is freely available at http://icsnpathway.psych.ac.cn/.

Feedbacks in Human-Landscape Systems

NASA Astrophysics Data System (ADS)

Chin, Anne; Florsheim, Joan L.; Wohl, Ellen; Collins, Brian D.

2014-01-01

This article identifies key questions and challenges for geomorphologists in investigating coupled feedbacks in human-landscape systems. While feedbacks occur in the absence of human influences, they are also altered by human activity. Feedbacks are a key element to understanding human-influenced geomorphic systems in ways that extend our traditional approach of considering humans as unidirectional drivers of change. Feedbacks have been increasingly identified in Earth-environmental systems, with studies of coupled human-natural systems emphasizing ecological phenomena in producing emerging concepts for social-ecological systems. Enormous gaps or uncertainties in knowledge remain with respect to understanding impact-feedback loops within geomorphic systems with significant human alterations, where the impacted geomorphic systems in turn affect humans. Geomorphology should play an important role in public policy by identifying the many diffuse and subtle feedbacks of both local- and global-scale processes. This role is urgent, while time may still be available to mitigate the impacts that limit the sustainability of human societies. Challenges for geomorphology include identification of the often weak feedbacks that occur over varied time and space scales ranging from geologic time to single isolated events and very short time periods, the lack of available data linking impact with response, the identification of multiple thresholds that trigger feedback mechanisms, the varied tools and metrics needed to represent both physical and human processes, and the need to collaborate with social scientists with expertise in the human causes of geomorphic change, as well as the human responses to such change.

A quantitative metric to identify critical elements within seafood supply networks.

PubMed

Plagányi, Éva E; van Putten, Ingrid; Thébaud, Olivier; Hobday, Alistair J; Innes, James; Lim-Camacho, Lilly; Norman-López, Ana; Bustamante, Rodrigo H; Farmery, Anna; Fleming, Aysha; Frusher, Stewart; Green, Bridget; Hoshino, Eriko; Jennings, Sarah; Pecl, Gretta; Pascoe, Sean; Schrobback, Peggy; Thomas, Linda

2014-01-01

A theoretical basis is required for comparing key features and critical elements in wild fisheries and aquaculture supply chains under a changing climate. Here we develop a new quantitative metric that is analogous to indices used to analyse food-webs and identify key species. The Supply Chain Index (SCI) identifies critical elements as those elements with large throughput rates, as well as greater connectivity. The sum of the scores for a supply chain provides a single metric that roughly captures both the resilience and connectedness of a supply chain. Standardised scores can facilitate cross-comparisons both under current conditions as well as under a changing climate. Identification of key elements along the supply chain may assist in informing adaptation strategies to reduce anticipated future risks posed by climate change. The SCI also provides information on the relative stability of different supply chains based on whether there is a fairly even spread in the individual scores of the top few key elements, compared with a more critical dependence on a few key individual supply chain elements. We use as a case study the Australian southern rock lobster Jasus edwardsii fishery, which is challenged by a number of climate change drivers such as impacts on recruitment and growth due to changes in large-scale and local oceanographic features. The SCI identifies airports, processors and Chinese consumers as the key elements in the lobster supply chain that merit attention to enhance stability and potentially enable growth. We also apply the index to an additional four real-world Australian commercial fishery and two aquaculture industry supply chains to highlight the utility of a systematic method for describing supply chains. Overall, our simple methodological approach to empirically-based supply chain research provides an objective method for comparing the resilience of supply chains and highlighting components that may be critical.

A Quantitative Metric to Identify Critical Elements within Seafood Supply Networks

PubMed Central

Plagányi, Éva E.; van Putten, Ingrid; Thébaud, Olivier; Hobday, Alistair J.; Innes, James; Lim-Camacho, Lilly; Norman-López, Ana; Bustamante, Rodrigo H.; Farmery, Anna; Fleming, Aysha; Frusher, Stewart; Green, Bridget; Hoshino, Eriko; Jennings, Sarah; Pecl, Gretta; Pascoe, Sean; Schrobback, Peggy; Thomas, Linda

2014-01-01

A theoretical basis is required for comparing key features and critical elements in wild fisheries and aquaculture supply chains under a changing climate. Here we develop a new quantitative metric that is analogous to indices used to analyse food-webs and identify key species. The Supply Chain Index (SCI) identifies critical elements as those elements with large throughput rates, as well as greater connectivity. The sum of the scores for a supply chain provides a single metric that roughly captures both the resilience and connectedness of a supply chain. Standardised scores can facilitate cross-comparisons both under current conditions as well as under a changing climate. Identification of key elements along the supply chain may assist in informing adaptation strategies to reduce anticipated future risks posed by climate change. The SCI also provides information on the relative stability of different supply chains based on whether there is a fairly even spread in the individual scores of the top few key elements, compared with a more critical dependence on a few key individual supply chain elements. We use as a case study the Australian southern rock lobster Jasus edwardsii fishery, which is challenged by a number of climate change drivers such as impacts on recruitment and growth due to changes in large-scale and local oceanographic features. The SCI identifies airports, processors and Chinese consumers as the key elements in the lobster supply chain that merit attention to enhance stability and potentially enable growth. We also apply the index to an additional four real-world Australian commercial fishery and two aquaculture industry supply chains to highlight the utility of a systematic method for describing supply chains. Overall, our simple methodological approach to empirically-based supply chain research provides an objective method for comparing the resilience of supply chains and highlighting components that may be critical. PMID:24633147

Public perceptions and information gaps in solar energy in Texas

NASA Astrophysics Data System (ADS)

Rai, Varun; Beck, Ariane L.

2015-07-01

Studying the behavioral aspects of the individual decision-making process is important in identifying and addressing barriers in the adoption of residential solar photovoltaic (PV). However, there is little systematic research focusing on these aspects of residential PV in Texas, an important, large, populous state, with a range of challenges in the electricity sector including increasing demand, shrinking reserve margins, constrained water supply, and challenging emissions reduction targets under proposed federal regulations. This paper aims to address this gap through an empirical investigation of a new survey-based dataset collected in Texas on solar energy perceptions and behavior. The results of this analysis offer insights into the perceptions and motivations influencing intentions and behavior toward solar energy in a relatively untapped market and help identify information gaps that could be targeted to alleviate key barriers to adopting solar, thereby enabling significant emissions reductions in the residential sector in Texas.

Learning organisations: the challenge of finding a safe space in a climate of accountability.

PubMed

McKee, Anne

2017-03-01

The effects of health policy reforms over a twenty-five year period have changed the NHS as a place in which to work and learn. Some of these changes have had unintentional consequences for learning in the workplace. A recent King's Fund contribution to quality improvement debates included an extensive review of NHS policies encouraging change 'from within' the NHS and renewed calls to develop learning organisations there. I draw upon an action research project designed to develop learning organisations in primary care to locate quality improvement debates amid the realities of practice. The project identified key challenges primary care practices encountered to protect time and space for this form of work based learning, even when they recognised the need for it and wanted to engage in it. Implications for policy makers, primary care practices and health professional educationalists are identified.

Relaunching a national social marketing campaign: expectations and challenges for the "new" ParticipACTION.

PubMed

Faulkner, Guy; McCloy, Cora; Plotnikoff, Ronald C; Tremblay, Mark S

2011-07-01

ParticipACTION is a Canadian physical activity communications and social marketing organization that has been relaunched in 2007 after a 6-year hiatus. The purpose of this study is to qualitatively identify and describe the expectations and challenges the relaunch of the new ParticipACTION may present for existing physical activity organizations. Using a purposeful sampling strategy, the authors conduct semistructured telephone interviews with 49 key informants representing a range of national, provincial, and local organizations with a mandate to promote physical activity. Overall, there is strong support in seeing ParticipACTION relaunched. However, organizational expectations and/or their ideal vision for it are mixed. Organizations envision and support its performing an overarching social marketing and advocacy role, and in providing tools and resources that supplement existing organizational activities. Four major organizational challenges are identified concerning overlapping mandates, partnership and leadership concerns, competition for funding, and capacity concerns. Social marketing initiatives, such as ParticipACTION, may not be able to maximize their impact unless they address the expectations and concerns of competing organizations with a mandate to promote physical activity.

Specialty pharmacy cost management strategies of private health care payers.

PubMed

Stern, Debbie; Reissman, Debi

2006-01-01

The rate of increase in spending on specialty pharmaceuticals is outpacing by far the rate of increase in spending for other drugs. To explore the strategies payers are using in response to challenges related to coverage, cost, clinical management, and access of specialty pharmaceuticals and to describe the potential implications for key stakeholders, including patients, physicians, and health care purchasers. Sources of information were identified in the course of providing consulting services in the subject area of specialty pharmaceuticals to health plans, pharmacy benefit managers, employers, and pharmaceutical manufacturers. Specialty pharmaceuticals represent the fastest growing segment of drug spending due to new product approvals, high unit costs, and increasing use. Health care payers are faced with significant challenges related to coverage, cost, clinical management, and access. A variety of short- and long-term strategies have been employed to address these challenges. Current management techniques for specialty pharmaceuticals often represent a stop-gap approach for controlling rising drug costs. Optimum cost and care management methods will evolve as further research identifies the true clinical and economic value of various specialty pharmaceuticals.

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

PubMed Central

Bednarz, Hedi; Schim, Stephanie; Doorenbos, Ardith

2010-01-01

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

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

PubMed

Bednarz, Hedi; Schim, Stephanie; Doorenbos, Ardith

2010-05-01

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

Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals.

PubMed

Kaji, Aiko; Thi, Sein Sein; Smith, Terrence; Charunwatthana, Prakaykaew; Nosten, Francois H

2015-10-09

Myanmar and Thailand belong to the top 22 high burden countries for tuberculosis (TB). Health care organizations play an essential role in addressing TB control in the two bridging border jurisdictions, Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. However, health professionals face difficulties in TB control effort due to the nature of fluid population movements, resource constraints and ambiguous mechanisms to implement collaboration along the border. The purpose of this study is to identify the challenges to TB control among Myanmar migrants faced by stakeholders, focusing on the area of collaboration and interaction along the border. The study conducted in-depth interviews with health policy makers and health care providers responsible for developing and implementing policies and TB programs in Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. The participants included members of government organizations, United Nations agencies, community based organizations, and international NGO. One or two key stakeholders from each organization were approached to participate in the study. We gathered baseline information to identify TB policies and programs available on websites, brochures, and publications. Observations including field notes were made on site. The data transcriptions were coded for qualitative data analysis. Coding also developed categories that led to key themes. A total of 31 respondents (18 in Thailand and 13 in Myanmar) participated in the study. The main theme reported by participants was challenges in limited corroboration and coordination among stakeholders. Unstructured information sharing and lack of communication hindered the stakeholders from engaging in TB control. The respondents stressed that referral mechanisms across the border need to be strengthened. Other challenges were associated with increasing loss to follow up and subsequent MDR cases, constraints of service delivery, shortage of human resources, limited staff capacities within organizations and poor socioeconomic status of patients. Health professionals face many challenges in effectively addressing TB control. Addressing the insufficient coordination and collaboration by strengthening bi-national collaborative mechanisms among health care organizations is an essential step in reducing the burden of disease. Additional support and resources from governmental and non-governmental agencies will be required to address the challenges.

Identifying Challenges to the Integration of Computer-Based Surveillance Information Systems in a Large City Health Department: A Case Study.

PubMed

Jennings, Jacky M; Stover, Jeffrey A; Bair-Merritt, Megan H; Fichtenberg, Caroline; Munoz, Mary Grace; Maziad, Rafiq; Ketemepi, Sherry Johnson; Zenilman, Jonathan

2009-01-01

Integrated infectious disease surveillance information systems have the potential to provide important new surveillance capacities and business efficiencies for local health departments. We conducted a case study at a large city health department of the primary computer-based infectious disease surveillance information systems during a 10-year period to identify the major challenges for information integration across the systems. The assessment included key informant interviews and evaluations of the computer-based surveillance information systems used for acute communicable diseases, human immunodeficiency virus/acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis. Assessments were conducted in 1998 with a follow-up in 2008. Assessments specifically identified and described the primary computer-based surveillance information system, any duplicative information systems, and selected variables collected. Persistent challenges to information integration across the information systems included the existence of duplicative data systems, differences in the variables used to collect similar information, and differences in basic architecture. The assessments identified a number of challenges for information integration across the infectious disease surveillance information systems at this city health department. The results suggest that local disease control programs use computer-based surveillance information systems that were not designed for data integration. To the extent that integration provides important new surveillance capacities and business efficiencies, we recommend that patient-centric information systems be designed that provide all the epidemiologic, clinical, and research needs in one system. In addition, the systems should include a standard system of elements and fields across similar surveillance systems.

Five challenges to reconcile agricultural land use and forest ecosystem services in Southeast Asia.

PubMed

Carrasco, L R; Papworth, S K; Reed, J; Symes, W S; Ickowitz, A; Clements, T; Peh, K S-H; Sunderland, T

2016-10-01

Southeast Asia possesses the highest rates of tropical deforestation globally and exceptional levels of species richness and endemism. Many countries in the region are also recognized for their food insecurity and poverty, making the reconciliation of agricultural production and forest conservation a particular priority. This reconciliation requires recognition of the trade-offs between competing land-use values and the subsequent incorporation of this information into policy making. To date, such reconciliation has been relatively unsuccessful across much of Southeast Asia. We propose an ecosystem services (ES) value-internalization framework that identifies the key challenges to such reconciliation. These challenges include lack of accessible ES valuation techniques; limited knowledge of the links between forests, food security, and human well-being; weak demand and political will for the integration of ES in economic activities and environmental regulation; a disconnect between decision makers and ES valuation; and lack of transparent discussion platforms where stakeholders can work toward consensus on negotiated land-use management decisions. Key research priorities to overcome these challenges are developing easy-to-use ES valuation techniques; quantifying links between forests and well-being that go beyond economic values; understanding factors that prevent the incorporation of ES into markets, regulations, and environmental certification schemes; understanding how to integrate ES valuation into policy making processes, and determining how to reduce corruption and power plays in land-use planning processes. © 2016 Society for Conservation Biology.

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers

PubMed Central

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N.

2018-01-01

Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These “positive deviant” practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Participants: Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Methods: Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Results: Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient–provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. Conclusion: We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access. PMID:29552599

Preventing Unintended Disclosure of Personally Identifiable Data Following Anonymisation.

PubMed

Smith, Chris

2017-01-01

Errors and anomalies during the capture and processing of health data have the potential to place personally identifiable values into attributes of a dataset that are expected to contain non-identifiable values. Anonymisation focuses on those attributes that have been judged to enable identification of individuals. Attributes that are judged to contain non-identifiable values are not considered, but may be included in datasets that are shared by organisations. Consequently, organisations are at risk of sharing datasets that unintendedly disclose personally identifiable values through these attributes. This would have ethical and legal implications for organisations and privacy implications for individuals whose personally identifiable values are disclosed. In this paper, we formulate the problem of unintended disclosure following anonymisation, describe the necessary steps to address this problem, and discuss some key challenges to applying these steps in practice.

Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders.

PubMed

Coronado, Gloria D; Schneider, Jennifer L; Petrik, Amanda; Rivelli, Jennifer; Taplin, Stephen; Green, Beverly B

2017-09-01

Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1 year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates. We used the Consolidated Framework for Implementation Research to thematically analyze the content of meeting discussions and identify anticipated and experienced challenges. Common early concerns were patients' access to colonoscopy, patients' low awareness of CRC screening, time burden on clinic staff to carry out the STOP CRC program, inability to accurately identify eligible patients, and incompatibility of the program's approach with the patient population or organizational culture. Once the program was rolled out, time burden remained a primary concern and new organizational capacity and EMR issues were raised (e.g., EMR staffing resources and turnover in key leadership positions). Cited program successes were improved CRC screening processes and rates, more patients reached, reduced costs, and improved patient awareness, engagement, or satisfaction. These findings may inform any clinic considering mailed fecal testing programs and future pragmatic research efforts in community health centers.

Improving local health through community health workers in Cambodia: challenges and solutions.

PubMed

Ozano, Kim; Simkhada, Padam; Thann, Khem; Khatri, Rose

2018-01-06

Volunteer community health workers (CHWs) are an important link between the public health system and the community. The 'Community Participation Policy for Health' in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives. Qualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres. Findings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers. The fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently, the health of community members. CHWs presented with the opportunity to share learning and develop ideas in a supportive environment would benefit health initiatives.

Grand challenges for integrated USGS science—A workshop report

USGS Publications Warehouse

Jenni, Karen E.; Goldhaber, Martin B.; Betancourt, Julio L.; Baron, Jill S.; Bristol, R. Sky; Cantrill, Mary; Exter, Paul E.; Focazio, Michael J.; Haines, John W.; Hay, Lauren E.; Hsu, Leslie; Labson, Victor F.; Lafferty, Kevin D.; Ludwig, Kristin A.; Milly, Paul C. D.; Morelli, Toni L.; Morman, Suzette A.; Nassar, Nedal T.; Newman, Timothy R.; Ostroff, Andrea C.; Read, Jordan S.; Reed, Sasha C.; Shapiro, Carl D.; Smith, Richard A.; Sanford, Ward E.; Sohl, Terry L.; Stets, Edward G.; Terando, Adam J.; Tillitt, Donald E.; Tischler, Michael A.; Toccalino, Patricia L.; Wald, David J.; Waldrop, Mark P.; Wein, Anne; Weltzin, Jake F.; Zimmerman, Christian E.

2017-06-30

Executive SummaryThe U.S. Geological Survey (USGS) has a long history of advancing the traditional Earth science disciplines and identifying opportunities to integrate USGS science across disciplines to address complex societal problems. The USGS science strategy for 2007–2017 laid out key challenges in disciplinary and interdisciplinary arenas, culminating in a call for increased focus on a number of crosscutting science directions. Ten years on, to further the goal of integrated science and at the request of the Executive Leadership Team (ELT), a workshop with three dozen invited scientists spanning different disciplines and career stages in the Bureau convened on February 7–10, 2017, at the USGS John Wesley Powell Center for Analysis and Synthesis in Fort Collins, Colorado.The workshop focused on identifying “grand challenges” for integrated USGS science. Individual participants identified nearly 70 potential grand challenges before the workshop and through workshop discussions. After discussion, four overarching grand challenges emerged:Natural resource security,Societal risk from existing and emerging threats,Smart infrastructure development, andAnticipatory science for changing landscapes.Participants also identified a “comprehensive science challenge” that highlights the development of integrative science, data, models, and tools—all interacting in a modular framework—that can be used to address these and other future grand challenges:Earth Monitoring, Analyses, and Projections (EarthMAP)EarthMAP is our long-term vision for an integrated scientific framework that spans traditional scientific boundaries and disciplines, and integrates the full portfolio of USGS science: research, monitoring, assessment, analysis, and information delivery.The Department of Interior, and the Nation in general, have a vast array of information needs. The USGS meets these needs by having a broadly trained and agile scientific workforce. Encouraging and supporting cross-discipline engagement would position the USGS to tackle complex and multifaceted scientific and societal challenges in the 21st Century.

What guidance is available for researchers conducting overviews of reviews of healthcare interventions? A scoping review and qualitative metasummary.

PubMed

Pollock, Michelle; Fernandes, Ricardo M; Becker, Lorne A; Featherstone, Robin; Hartling, Lisa

2016-11-14

Overviews of reviews (overviews) compile data from multiple systematic reviews to provide a single synthesis of relevant evidence for decision-making. Despite their increasing popularity, there is limited methodological guidance available for researchers wishing to conduct overviews. The objective of this scoping review is to identify and collate all published and unpublished documents containing guidance for conducting overviews examining the efficacy, effectiveness, and/or safety of healthcare interventions. Our aims were to provide a map of existing guidance documents; identify similarities, differences, and gaps in the guidance contained within these documents; and identify common challenges involved in conducting overviews. We conducted an iterative and extensive search to ensure breadth and comprehensiveness of coverage. The search involved reference tracking, database and web searches (MEDLINE, EMBASE, DARE, Scopus, Cochrane Methods Studies Database, Google Scholar), handsearching of websites and conference proceedings, and contacting overview producers. Relevant guidance statements and challenges encountered were extracted, edited, grouped, abstracted, and presented using a qualitative metasummary approach. We identified 52 guidance documents produced by 19 research groups. Relatively consistent guidance was available for the first stages of the overview process (deciding when and why to conduct an overview, specifying the scope, and searching for and including systematic reviews). In contrast, there was limited or conflicting guidance for the latter stages of the overview process (quality assessment of systematic reviews and their primary studies, collecting and analyzing data, and assessing quality of evidence), and many of the challenges identified were also related to these stages. An additional, overarching challenge identified was that overviews are limited by the methods, reporting, and coverage of their included systematic reviews. This compilation of methodological guidance for conducting overviews of healthcare interventions will facilitate the production of future overviews and can help authors address key challenges they are likely to encounter. The results of this project have been used to identify areas where future methodological research is required to generate empirical evidence for overview methods. Additionally, these results have been used to update the chapter on overviews in the next edition of the Cochrane Handbook for Systematic Reviews of Interventions.

Techniques for identifying cross-disciplinary and 'hard-to-detect' evidence for systematic review.

PubMed

O'Mara-Eves, Alison; Brunton, Ginny; McDaid, David; Kavanagh, Josephine; Oliver, Sandy; Thomas, James

2014-03-01

Driven by necessity in our own complex review, we developed alternative systematic ways of identifying relevant evidence where the key concepts are generally not focal to the primary studies' aims and are found across multiple disciplines-that is, hard-to-detect evidence. Specifically, we sought to identify evidence on community engagement in public health interventions that aim to reduce health inequalities. Our initial search strategy used text mining to identify synonyms for the concept 'community engagement'. We conducted a systematic search for reviews on public health interventions, supplemented by searches of trials databases. We then used information in the reviews' evidence tables to gather more information about the included studies than was evident in the primary studies' own titles or abstracts. We identified 319 primary studies cited in reviews after full-text screening. In this paper, we retrospectively reflect on the challenges and benefits of the approach taken. We estimate that more than a quarter of the studies that were identified would have been missed by typical searching and screening methods. This identification strategy was highly effective and could be useful for reviews of broad research questions, or where the key concepts are unlikely to be the main focus of primary research. Copyright © 2013 John Wiley & Sons, Ltd.

University of Texas MD Anderson Cancer Center: High-Throughput Screening Identifying Driving Mutations in Endometrial Cancer | Office of Cancer Genomics

Cancer.gov

Recent advances in next-generation sequencing technology have enabled the unprecedented characterization of a full spectrum of somatic alterations in cancer genomes. Given the large numbers of somatic mutations typically detected by this approach, a key challenge in the downstream analysis is to distinguish “drivers” that functionally contribute to tumorigenesis from “passengers” that occur as the consequence of genomic instability.

The prospect of using large eddy and detached eddy simulations in engineering design, and the research required to get there

PubMed Central

Larsson, Johan; Wang, Qiqi

2014-01-01

In this paper, we try to look into the future to envision how large eddy and detached eddy simulations will be used in the engineering design process about 20–30 years from now. Some key challenges specific to the engineering design process are identified, and some of the critical outstanding problems and promising research directions are discussed. PMID:25024421

Automated Monitoring of Pipeline Rights-of-Way

NASA Technical Reports Server (NTRS)

Frost, Chard Ritchie

2010-01-01

NASA Ames Research Center and the Pipeline Research Council International, Inc. have partnered in the formation of a research program to identify and develop the key technologies required to enable automated detection of threats to gas and oil transmission and distribution pipelines. This presentation describes the Right-of-way Automated Monitoring (RAM) program and highlights research successes to date, continuing challenges to implementing the RAM objectives, and the program's ongoing work and plans.

Lean Six Sigma Challenges and Opportunities

DTIC Science & Technology

2008-02-13

five key stages: Define, Measure, Analyze, Improve, and Control ( DMAIC ). During the ‘Define’ stage, participants identify the process that will be...that wastes time and effort. 4 The ‘Measure’ stage of DMAIC documents the measure of time or quantity of activities that occur at this stage of...chosen to be implemented. In the final ‘Control’ stage of the DMAIC methodology, the purpose is to ensure that benefits from the improved process

The Future of Home Health Care

PubMed Central

Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

2016-01-01

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

Numerical simulation of turbulent combustion: Scientific challenges

NASA Astrophysics Data System (ADS)

Ren, ZhuYin; Lu, Zhen; Hou, LingYun; Lu, LiuYan

2014-08-01

Predictive simulation of engine combustion is key to understanding the underlying complicated physicochemical processes, improving engine performance, and reducing pollutant emissions. Critical issues as turbulence modeling, turbulence-chemistry interaction, and accommodation of detailed chemical kinetics in complex flows remain challenging and essential for high-fidelity combustion simulation. This paper reviews the current status of the state-of-the-art large eddy simulation (LES)/prob-ability density function (PDF)/detailed chemistry approach that can address the three challenging modelling issues. PDF as a subgrid model for LES is formulated and the hybrid mesh-particle method for LES/PDF simulations is described. Then the development need in micro-mixing models for the PDF simulations of turbulent premixed combustion is identified. Finally the different acceleration methods for detailed chemistry are reviewed and a combined strategy is proposed for further development.

Toward Impactful Collaborations on Computing and Mental Health

PubMed Central

Dinakar, Karthik; Picard, Rosalind; Christensen, Helen; Torous, John

2018-01-01

We describe an initiative to bring mental health researchers, computer scientists, human-computer interaction researchers, and other communities together to address the challenges of the global mental ill health epidemic. Two face-to-face events and one special issue of the Journal of Medical Internet Research were organized. The works presented in these events and publication reflect key state-of-the-art research in this interdisciplinary collaboration. We summarize the special issue articles and contextualize them to present a picture of the most recent research. In addition, we describe a series of collaborative activities held during the second symposium and where the community identified 5 challenges and their possible solutions. PMID:29426812

Designing Biomimetic Materials from Marine Organisms.

PubMed

Nichols, William T

2015-01-01

Two biomimetic design approaches that apply biological solutions to engineering problems are discussed. In the first case, motivation comes from an engineering problem and the key challenge is to find analogous biological functions and map them into engineering materials. We illustrate with an example of water pollution remediation through appropriate design of a biomimetic sponge. In the second case, a biological function is already known and the challenge is to identify the appropriate engineering problem. We demonstrate the biological approach with marine diatoms that control energy and materials at their surface providing inspiration for a number of engineering applications. In both cases, it is essential to select materials and structures at the nanoscale to control energy and materials flows at interfaces.

Qualitative analysis of round-table discussions on the business case and procurement challenges for hospital electronic prescribing systems.

PubMed

Cresswell, Kathrin M; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W; Sheikh, Aziz

2013-01-01

There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing "wants" and aspirations from organizational "needs". Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management.

Toward sustainable environmental quality: Identifying priority research questions for Latin America.

PubMed

Furley, Tatiana Heid; Brodeur, Julie; Silva de Assis, Helena C; Carriquiriborde, Pedro; Chagas, Katia R; Corrales, Jone; Denadai, Marina; Fuchs, Julio; Mascarenhas, Renata; Miglioranza, Karina Sb; Miguez Caramés, Diana Margarita; Navas, José Maria; Nugegoda, Dayanthi; Planes, Estela; Rodriguez-Jorquera, Ignacio Alejandro; Orozco-Medina, Martha; Boxall, Alistair Ba; Rudd, Murray A; Brooks, Bryan W

2018-05-01

The Global Horizon Scanning Project (GHSP) is an innovative initiative that aims to identify important global environmental quality research needs. Here we report 20 key research questions from Latin America (LA). Members of the Society of Environmental Toxicology and Chemistry (SETAC) LA and other scientists from LA were asked to submit research questions that would represent priority needs to address in the region. One hundred questions were received, then partitioned among categories, examined, and some rearranged during a workshop in Buenos Aires, Argentina. Twenty priority research questions were subsequently identified. These research questions included developing, improving, and harmonizing across LA countries methods for 1) identifying contaminants and degradation products in complex matrices (including biota); 2) advancing prediction of contaminant risks and effects in ecosystems, addressing lab-to-field extrapolation challenges, and understanding complexities of multiple stressors (including chemicals and climate change); and 3) improving management and regulatory tools toward achieving sustainable development. Whereas environmental contaminants frequently identified in these key questions were pesticides, pharmaceuticals, endocrine disruptors or modulators, plastics, and nanomaterials, commonly identified environmental challenges were related to agriculture, urban effluents, solid wastes, pulp and paper mills, and natural extraction activities. Several interesting research topics included assessing and preventing pollution impacts on conservation protected areas, integrating environment and health assessments, and developing strategies for identification, substitution, and design of less hazardous chemicals (e.g., green chemistry). Finally, a recurrent research need included developing an understanding of differential sensitivity of regional species and ecosystems to environmental contaminants and other stressors. Addressing these critical questions will support development of long-term strategic research efforts to advance more sustainable environmental quality and protect public health and the environment in LA. Integr Environ Assess Manag 2018;14:344-357. © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC). © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Toward sustainable environmental quality: Identifying priority research questions for Latin America

PubMed Central

Furley, Tatiana Heid; Brodeur, Julie; Silva de Assis, Helena C; Carriquiriborde, Pedro; Chagas, Katia R; Corrales, Jone; Denadai, Marina; Fuchs, Julio; Mascarenhas, Renata; Miglioranza, Karina SB; Miguez Caramés, Diana Margarita; Navas, José Maria; Nugegoda, Dayanthi; Planes, Estela; Rodriguez‐Jorquera, Ignacio Alejandro; Orozco‐Medina, Martha; Boxall, Alistair BA; Rudd, Murray A

2018-01-01

ABSTRACT The Global Horizon Scanning Project (GHSP) is an innovative initiative that aims to identify important global environmental quality research needs. Here we report 20 key research questions from Latin America (LA). Members of the Society of Environmental Toxicology and Chemistry (SETAC) LA and other scientists from LA were asked to submit research questions that would represent priority needs to address in the region. One hundred questions were received, then partitioned among categories, examined, and some rearranged during a workshop in Buenos Aires, Argentina. Twenty priority research questions were subsequently identified. These research questions included developing, improving, and harmonizing across LA countries methods for 1) identifying contaminants and degradation products in complex matrices (including biota); 2) advancing prediction of contaminant risks and effects in ecosystems, addressing lab‐to‐field extrapolation challenges, and understanding complexities of multiple stressors (including chemicals and climate change); and 3) improving management and regulatory tools toward achieving sustainable development. Whereas environmental contaminants frequently identified in these key questions were pesticides, pharmaceuticals, endocrine disruptors or modulators, plastics, and nanomaterials, commonly identified environmental challenges were related to agriculture, urban effluents, solid wastes, pulp and paper mills, and natural extraction activities. Several interesting research topics included assessing and preventing pollution impacts on conservation protected areas, integrating environment and health assessments, and developing strategies for identification, substitution, and design of less hazardous chemicals (e.g., green chemistry). Finally, a recurrent research need included developing an understanding of differential sensitivity of regional species and ecosystems to environmental contaminants and other stressors. Addressing these critical questions will support development of long‐term strategic research efforts to advance more sustainable environmental quality and protect public health and the environment in LA. Integr Environ Assess Manag 2018;14:344–357. © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC) PMID:29469193

A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia.

PubMed

Janamian, Tina; Jackson, Claire L; Glasson, Nicola; Nicholson, Caroline

2014-08-04

To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. Systematic review of peer-reviewed literature. PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012. Studies of any type were included if they defined PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model. One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness. Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identified related to: challenges with the transformation process; difficulties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insufficient resources and infrastructure within practices; and inadequate measures of performance. This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.

Rescheduling nursing shifts: scoping the challenge and examining the potential of mathematical model based tools.

PubMed

Clark, Alistair; Moule, Pam; Topping, Annie; Serpell, Martin

2015-05-01

To review research in the literature on nursing shift scheduling / rescheduling, and to report key issues identified in a consultation exercise with managers in four English National Health Service trusts to inform the development of mathematical tools for rescheduling decision-making. Shift rescheduling is unrecognised as an everyday time-consuming management task with different imperatives from scheduling. Poor rescheduling decisions can have quality, cost and morale implications. A systematic critical literature review identified rescheduling issues and existing mathematic modelling tools. A consultation exercise with nursing managers examined the complex challenges associated with rescheduling. Minimal research exists on rescheduling compared with scheduling. Poor rescheduling can result in greater disruption to planned nursing shifts and may impact negatively on the quality and cost of patient care, and nurse morale and retention. Very little research examines management challenges or mathematical modelling for rescheduling. Shift rescheduling is a complex and frequent management activity that is more challenging than scheduling. Mathematical modelling may have potential as a tool to support managers to minimise rescheduling disruption. The lack of specific methodological support for rescheduling that takes into account its complexity, increases the likelihood of harm for patients and stress for nursing staff and managers. © 2013 John Wiley & Sons Ltd.

Genetic Simulation Tools for Post-Genome Wide Association Studies of Complex Diseases

PubMed Central

Amos, Christopher I.; Bafna, Vineet; Hauser, Elizabeth R.; Hernandez, Ryan D.; Li, Chun; Liberles, David A.; McAllister, Kimberly; Moore, Jason H.; Paltoo, Dina N.; Papanicolaou, George J.; Peng, Bo; Ritchie, Marylyn D.; Rosenfeld, Gabriel; Witte, John S.

2014-01-01

Genetic simulation programs are used to model data under specified assumptions to facilitate the understanding and study of complex genetic systems. Standardized data sets generated using genetic simulation are essential for the development and application of novel analytical tools in genetic epidemiology studies. With continuing advances in high-throughput genomic technologies and generation and analysis of larger, more complex data sets, there is a need for updating current approaches in genetic simulation modeling. To provide a forum to address current and emerging challenges in this area, the National Cancer Institute (NCI) sponsored a workshop, entitled “Genetic Simulation Tools for Post-Genome Wide Association Studies of Complex Diseases” at the National Institutes of Health (NIH) in Bethesda, Maryland on March 11-12, 2014. The goals of the workshop were to: (i) identify opportunities, challenges and resource needs for the development and application of genetic simulation models; (ii) improve the integration of tools for modeling and analysis of simulated data; and (iii) foster collaborations to facilitate development and applications of genetic simulation. During the course of the meeting the group identified challenges and opportunities for the science of simulation, software and methods development, and collaboration. This paper summarizes key discussions at the meeting, and highlights important challenges and opportunities to advance the field of genetic simulation. PMID:25371374

An examination of automation and robotics in the context of Space Station operations

NASA Technical Reports Server (NTRS)

Criswell, David R.; Lee, Douglas S.; Ragusa, James; Starks, Scott A.; Woodruff, John; Paules, Granville

1988-01-01

A NASA-sponsored review of Space Station automation and robotics (A&R) applications from an operations and utilization perspective is presented. The goals of the A&R panel and this report are to identify major suggestions for advanced A&R operations application in Space Station as well as key technologies that have emerged or gained prominence since the completion of previous reports; to review and incorporate the range of possible Space Station A&R applications into a framework for evaluation of A&R opportunities; and to propose incentives for the government, work packages, and subcontractors to more aggressively identify, evaluate, and incorporate advanced A&R in Space Station Operations. The suggestions for A&R focused on narrow objectives using a conservative approach tuned to Space Station at IOC and limiting the Station's growth capabilities. A more aggressive stance is to identify functional needs over the Program's life, exploit and leverage available technology, and develop the key advanced technologies permitting effective use of A&R. The challenge is to systematically identify candidate functions to be automated, provide ways to create solutions resulting in savings or increased capabilities, and offer incentives that will promote the automation.

Screening of broad spectrum natural pesticides against conserved target arginine kinase in cotton pests by molecular modeling.

PubMed

Sakthivel, Seethalakshmi; Habeeb, S K M; Raman, Chandrasekar

2018-03-12

Cotton is an economically important crop and its production is challenged by the diversity of pests and related insecticide resistance. Identification of the conserved target across the cotton pest will help to design broad spectrum insecticide. In this study, we have identified conserved sequences by Expressed Sequence Tag profiling from three cotton pests namely Aphis gossypii, Helicoverpa armigera, and Spodoptera exigua. One target protein arginine kinase having a key role in insect physiology and energy metabolism was studied further using homology modeling, virtual screening, molecular docking, and molecular dynamics simulation to identify potential biopesticide compounds from the Zinc natural database. We have identified four compounds having excellent inhibitor potential against the identified broad spectrum target which are highly specific to invertebrates.

Threats to family planning services in Michigan: organizational responses to economic and political challenges.

PubMed

Dalton, Vanessa K; Jacobson, Peter D; Berson-Grand, Julie; Weisman, Carol S

2005-01-01

Title X is the only federal funding specifically for contraception and family planning services. This study identifies the threats and challenges Title X family planning organizations face in Michigan, and examines organizational responses to these challenges. We hypothesized that organizational responses to current challenges, including recent legislation, would differ between organizational types. We used a multiple case study design to examine safety net providers that received Title X funding in 2001. Cases were selected to represent economic and geographic diversity and included a mix of population densities. Key informants at each organization participated in face-to-face, semistructured interviews. Interviews collected data on current challenges, organizational planning processes, and organizational responses. All Title X organizations reported significant challenges, including rising costs, increasing need, and inadequate funding. Private organizations were more concerned about political challenges, especially recent Michigan legislation, than health departments. Organizational type was associated with the type of response. Health departments tended to close clinics or cut services, whereas private organizations recruited insured populations and increased patient fees. Based on these findings, the family planning safety net in Michigan appears to be undergoing significant change. These changes may decrease the availability of affordable family planning services in Michigan.

EnergyPlus Run Time Analysis

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

Hong, Tianzhen; Buhl, Fred; Haves, Philip

2008-09-20

EnergyPlus is a new generation building performance simulation program offering many new modeling capabilities and more accurate performance calculations integrating building components in sub-hourly time steps. However, EnergyPlus runs much slower than the current generation simulation programs. This has become a major barrier to its widespread adoption by the industry. This paper analyzed EnergyPlus run time from comprehensive perspectives to identify key issues and challenges of speeding up EnergyPlus: studying the historical trends of EnergyPlus run time based on the advancement of computers and code improvements to EnergyPlus, comparing EnergyPlus with DOE-2 to understand and quantify the run time differences,more » identifying key simulation settings and model features that have significant impacts on run time, and performing code profiling to identify which EnergyPlus subroutines consume the most amount of run time. This paper provides recommendations to improve EnergyPlus run time from the modeler?s perspective and adequate computing platforms. Suggestions of software code and architecture changes to improve EnergyPlus run time based on the code profiling results are also discussed.« less

Innovations in non-communicable diseases management in ASEAN: a case series.

PubMed

Lim, Jeremy; Chan, Melissa M H; Alsagoff, Fatimah Z; Ha, Duc

2014-01-01

Non-communicable diseases (NCDs) are reaching epidemic proportions worldwide and present an unprecedented challenge to economic and social development globally. In Southeast Asia, the challenges are exacerbated by vastly differing levels of health systems development and funding availability. In addressing the burden of NCDs, ASEAN nations need to fundamentally re-examine how health care services are structured and delivered and discover new models as undiscerning application of models from other geographies with different cultures and resources will be problematic. We sought to examine cases of innovation and identify critical success factors in NCD management in ASEAN. A qualitative design, focusing on in-depth interviews and site visits to explore the meanings and perceptions of participants regarding innovations in NCD against the backdrop of the overall context of delivering health care within the country's context was adopted. In total 12 case studies in six ASEAN countries were analysed. Primary interventions accounted for five of the total cases, whereas secondary interventions comprised four, and tertiary interventions three. Five core themes contributing to successful innovation for NCD management were identified. They include: 1) encourage better outcomes through leadership and support, 2) strengthen inter-disciplinary partnership, 3) community ownership is key, 4) recognise the needs of the people and what appeals to them, and 5) raise awareness through capacity building and increasing health literacy. Innovation is vital in enabling ASEAN nations to successfully address the growing crisis of NCDs. More of the same or wholesale transfers of developed world models will be ineffective and lead to financially unsustainable programmes or programmes lacking appropriate human capital. The case studies have demonstrated the transformative impact of innovation and identified key factors in successful implementation. Beyond pilot success, the bigger challenge is scaling up. Medical technologies are crucial but insufficient; passionate and engaged leaders and communities enabled by enlightened policy makers and funding agencies matter more.

Why the MDGs need good governance in pharmaceutical systems to promote global health.

PubMed

Kohler, Jillian Clare; Mackey, Tim Ken; Ovtcharenko, Natalia

2014-01-21

Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why. Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward. Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and responded to with global cooperation and innovation to establish localized and evidence-based metrics for good governance to promote global pharmaceutical safety.

Innovations in non-communicable diseases management in ASEAN: a case series

PubMed Central

Lim, Jeremy; Chan, Melissa M. H.; Alsagoff, Fatimah Z.; Ha, Duc

2014-01-01

Background Non-communicable diseases (NCDs) are reaching epidemic proportions worldwide and present an unprecedented challenge to economic and social development globally. In Southeast Asia, the challenges are exacerbated by vastly differing levels of health systems development and funding availability. In addressing the burden of NCDs, ASEAN nations need to fundamentally re-examine how health care services are structured and delivered and discover new models as undiscerning application of models from other geographies with different cultures and resources will be problematic. Objective We sought to examine cases of innovation and identify critical success factors in NCD management in ASEAN. Design A qualitative design, focusing on in-depth interviews and site visits to explore the meanings and perceptions of participants regarding innovations in NCD against the backdrop of the overall context of delivering health care within the country's context was adopted. Results In total 12 case studies in six ASEAN countries were analysed. Primary interventions accounted for five of the total cases, whereas secondary interventions comprised four, and tertiary interventions three. Five core themes contributing to successful innovation for NCD management were identified. They include: 1) encourage better outcomes through leadership and support, 2) strengthen inter-disciplinary partnership, 3) community ownership is key, 4) recognise the needs of the people and what appeals to them, and 5) raise awareness through capacity building and increasing health literacy. Conclusions Innovation is vital in enabling ASEAN nations to successfully address the growing crisis of NCDs. More of the same or wholesale transfers of developed world models will be ineffective and lead to financially unsustainable programmes or programmes lacking appropriate human capital. The case studies have demonstrated the transformative impact of innovation and identified key factors in successful implementation. Beyond pilot success, the bigger challenge is scaling up. Medical technologies are crucial but insufficient; passionate and engaged leaders and communities enabled by enlightened policy makers and funding agencies matter more. PMID:25249061

Why the MDGs need good governance in pharmaceutical systems to promote global health

PubMed Central

2014-01-01

Background Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why. Discussion Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward. Summary Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and responded to with global cooperation and innovation to establish localized and evidence-based metrics for good governance to promote global pharmaceutical safety. PMID:24447600

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

Nekoogar, F; Dowla, F

An IAEA Technical Meeting on Techniques for IAEA Verification of Enrichment Activities identified 'smart tags' as a technology that should be assessed for tracking and locating UF6 cylinders. Although there is vast commercial industry working on RFID systems, the vulnerabilities of commercial products are only beginning to emerge. Most of the commercially off-the-shelf (COTS) RFID systems operate in very narrow frequency bands, making them vulnerable to detection, jamming and tampering and also presenting difficulties when used around metals (i.e. UF6 cylinders). Commercial passive RFID tags have short range, while active RFID tags that provide long ranges have limited lifetimes. Theremore » are also some concerns with the introduction of strong (narrowband) radio frequency signals around radioactive and nuclear materials. Considering the shortcomings of commercial RFID systems, in their current form, they do not offer a promising solution for continuous monitoring and tracking of UF6 cylinders. In this paper, we identify the key challenges faced by commercial RFID systems for monitoring UF6 cylinders, and introduce an ultra-wideband approach for tag/reader communications that addresses most of the identified challenges for IAEA safeguards applications.« less

The World Report on Disability and its implications for rehabilitation psychology.

PubMed

MacLachlan, Malcolm; Mannan, Hasheem

2014-05-01

This study reviewed the World Report on Disability (World Health Organization & World Bank, 2011) and explored its implications for rehabilitation psychology. Key findings and recommendations were identified within the World Report and issues that are salient to the profession, practice and research within rehabilitation psychology were highlighted. The World Report has a particular emphasis on disability in low-income countries, where the majority of people with disabilities live. Despite the origins and development of rehabilitation psychology within high-income countries, the profession has much to contribute to addressing many of the challenges identified in the World Report. Specific targeted contributions might include addressing the human resources for health crisis in rehabilitation; developing prosocial and community-based interventions and programs; helping to identify and overcome difficulties to accessing health care; refining the measurement and classification of disability; and strengthening research, policy and advocacy for and with people with disabilities. The World Report on Disability presents exciting and challenging opportunities that exist for rehabilitation psychology practitioners and researchers, and for the profession itself. (c) 2014 APA, all rights reserved.

Hypothetical scenario exercises to improve planning and readiness for drinking water quality management during extreme weather events.

PubMed

Deere, Daniel; Leusch, Frederic D L; Humpage, Andrew; Cunliffe, David; Khan, Stuart J

2017-03-15

Two hypothetical scenario exercises were designed and conducted to reflect the increasingly extreme weather-related challenges faced by water utilities as the global climate changes. The first event was based on an extreme flood scenario. The second scenario involved a combination of weather events, including a wild forest fire ('bushfire') followed by runoff due to significant rainfall. For each scenario, a panel of diverse personnel from water utilities and relevant agencies (e.g. health departments) formed a hypothetical water utility and associated regulatory body to manage water quality following the simulated extreme weather event. A larger audience participated by asking questions and contributing key insights. Participants were confronted with unanticipated developments as the simulated scenarios unfolded, introduced by a facilitator. Participants were presented with information that may have challenged their conventional experiences regarding operational procedures in order to identify limitations in current procedures, assumptions, and readily available information. The process worked toward the identification of a list of specific key lessons for each event. At the conclusion of each simulation a facilitated discussion was used to establish key lessons of value to water utilities in preparing them for similar future extreme events. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using scenarios of North Slope energy and resource development to assess research and monitoring needs

NASA Astrophysics Data System (ADS)

Payne, J. F.

2016-12-01

Significant Arctic environmental and socio-economic change has been observed on the North Slope of Alaska, presenting challenges for resident communities and management agencies that need to adapt to future changes that are difficult to model or predict. Continued climate change coupled with new or modified energy development could substantially alter the landscape and ecosystem in the future. The North Slope Science Initiative (NSSI) recognized the value of using a participatory scenarios process to consider plausible future energy and resource development scenarios through the year 2040 to help identify and prioritize research and monitoring needs on the North Slope. The scenarios process engaged diverse stakeholders, including subject matter experts and local knowledge holders. Through identification and ranking of key drivers and uncertainties relevant to the focus of the study, a series of spatially explicit scenarios was developed, analyzed in terms of low, medium and high development activities. Climate change and economic factors were key drivers affecting plausible energy development scenarios. The implications from each of the scenarios were then used to identify important research and monitoring activities and their relevant spatial scales. The scenarios project identified over 40 research and monitoring needs. The top five research needs addressed data gaps and key concerns related to how the scenarios could affect: hunting and trapping on land, health and community well-being, permafrost and hydrology, marine mammal subsistence and potential marine oil spills. The use of a participatory scenarios process was essential for identifying a range of plausible energy and resource development scenarios using a framework that involved a systematic assessment of complex interacting drivers of change, consideration of key uncertainties, and transparency throughout the project.

Novel ways to explore surgical interventions in randomised controlled trials: applying case study methodology in the operating theatre.

PubMed

Blencowe, Natalie S; Blazeby, Jane M; Donovan, Jenny L; Mills, Nicola

2015-12-28

Multi-centre randomised controlled trials (RCTs) in surgery are challenging. It is particularly difficult to establish standards of surgery and ensure that interventions are delivered as intended. This study developed and tested methods for identifying the key components of surgical interventions and standardising interventions within RCTs. Qualitative case studies of surgical interventions were undertaken within the internal pilot phase of a surgical RCT for obesity (the By-Band study). Each case study involved video data capture and non-participant observation of gastric bypass surgery in the operating theatre and interviews with surgeons. Methods were developed to transcribe and synchronise data from video recordings with observational data to identify key intervention components, which were then explored in the interviews with surgeons. Eight qualitative case studies were undertaken. A novel combination of video data capture, observation and interview data identified variations in intervention delivery between surgeons and centres. Although surgeons agreed that the most critical intervention component was the size and shape of the gastric pouch, there was no consensus regarding other aspects of the procedure. They conceded that evidence about the 'best way' to perform bypass was lacking and, combined with the pragmatic nature of the By-Band study, agreed that strict standardisation of bypass might not be required. This study has developed and tested methods for understanding how surgical interventions are designed and delivered delivered in RCTs. Applying these methods more widely may help identify key components of interventions to be delivered by surgeons in trials, enabling monitoring of key components and adherence to the protocol. These methods are now being tested in the context of other surgical RCTs. Current Controlled Trials ISRCTN00786323 , 05/09/2011.

Ethical challenges for accountable care organizations: a structured review.

PubMed

DeCamp, Matthew; Farber, Neil J; Torke, Alexia M; George, Maura; Berger, Zackary; Keirns, Carla C; Kaldjian, Lauris C

2014-10-01

Accountable care organizations (ACOs) are proliferating as a solution to the cost crisis in American health care, and already involve as many as 31 million patients. ACOs hold clinicians, group practices, and in many circumstances hospitals financially accountable for reducing expenditures and improving their patients' health outcomes. The structure of health care affects the ethical issues arising in the practice of medicine; therefore, like all health care organizational structures, ACOs will experience ethical challenges. No framework exists to assist key ACO stakeholders in identifying or managing these challenges. We conducted a structured review of the medical ACO literature using qualitative content analysis to inform identification of ethical challenges for ACOs. Our analysis found infrequent discussion of ethics as an explicit concern for ACOs. Nonetheless, we identified nine critical ethical challenges, often described in other terms, for ACO stakeholders. Leaders could face challenges regarding fair resource allocation (e.g., about fairly using ACOs' shared savings), protection of professionals' ethical obligations (especially related to the design of financial incentives), and development of fair decision processes (e.g., ensuring that beneficiary representatives on the ACO board truly represent the ACO's patients). Clinicians could perceive threats to their professional autonomy (e.g., through cost control measures), a sense of dual or conflicted responsibility to their patients and the ACO, or competition with other clinicians. For patients, critical ethical challenges will include protecting their autonomy, ensuring privacy and confidentiality, and effectively engaging them with the ACO. ACOs are not inherently more or less "ethical" than other health care payment models, such as fee-for-service or pure capitation. ACOs' nascent development and flexibility in design, however, present a time-sensitive opportunity to ensure their ethical operation, promote their success, and refine their design and implementation by identifying, managing, and conducting research into the ethical issues they might face.

Global-to-local policy transfer in the introduction of new molecular tuberculosis diagnostics in South Africa.

PubMed

Colvin, C J; Leon, N; Wills, C; van Niekerk, M; Bissell, K; Naidoo, P

2015-11-01

Lack of innovation in diagnostics has contributed to tuberculosis (TB) remaining a global health challenge. It is critical to understand how new diagnostic technologies are translated into policies and how these are implemented. To examine policy transfer for two rapid molecular diagnostic tests, GenoType(®) MDRTBplus and Xpert(®) MTB/RIF, to understand policy development, uptake and implementation in South Africa. A policy transfer analysis framework integrating the key dimensions of policy transfer into one coherent model was used. Two phases of key informant interviews were undertaken with a wide range of stakeholders. Both tests were developed through innovative partnerships and responded to urgent public health needs. GenoType was introduced through a process that was more inclusive than that for Xpert. National policy and planning processes were opaque for both tests. Their implementation, maintenance and expansion suffered from poor communication and coordination, insufficient attention to resource implications, technical challenges and a lack of broader health systems thinking. Our analysis identified the risks and benefits of partnerships for technological innovation, the complex intersections between global and national actors and the impact of health systems on policy transfer, and the risks of rescue- and technology-focused thinking in addressing public health challenges.

Moving Towards a Common Ground and Flight Data Systems Architecture for NASA's Exploration Missions

NASA Technical Reports Server (NTRS)

Rader. Steve; Kearney, Mike; McVittie, Thom; Smith, Dan

2006-01-01

The National Aeronautics and Space Administration has embarked on an ambitious effort to return man to the moon and then on to Mars. The Exploration Vision requires development of major new space and ground assets and poses challenges well beyond those faced by many of NASA's recent programs. New crewed vehicles must be developed. Compatible supply vehicles, surface mobility modules and robotic exploration capabilities will supplement the manned exploration vehicle. New launch systems will be developed as well as a new ground communications and control infrastructure. The development must take place in a cost-constrained environment and must advance along an aggressive schedule. Common solutions and system interoperability and will be critical to the successful development of the Exploration data systems for this wide variety of flight and ground elements. To this end, NASA has assembled a team of engineers from across the agency to identify the key challenges for Exploration data systems and to establish the most beneficial strategic approach to be followed. Key challenges and the planned NASA approach for flight and ground systems will be discussed in the paper. The described approaches will capitalize on new technologies, and will result in cross-program interoperability between spacecraft and ground systems, from multiple suppliers and agencies.

A means of improving public health in low- and middle-income countries? Benefits and challenges of international public-private partnerships.

PubMed

Kostyak, L; Shaw, D M; Elger, B; Annaheim, B

2017-08-01

In the last two decades international public-private partnerships have become increasingly important to improving public health in low- and middle-income countries. Governments realize that involving the private sector in projects for financing, innovation, development, and distribution can make a valuable contribution to overcoming major health challenges. Private-public partnerships for health can generate numerous benefits but may also raise some concerns. To guide best practice for public-private partnerships for health to maximize benefits and minimize risks, the first step is to identify potential benefits, challenges, and motives. We define motives as the reasons why private partners enter partnerships with a public partner. We conducted a systematic review of the literature using the PRISMA guidelines. We reviewed the literature on the benefits and challenges of public-private partnerships for health in low- and middle-income countries provided by international pharmaceutical companies and other health-related companies. We provide a description of these benefits, challenges, as well as of motives of private partners to join partnerships. An approach of systematic categorization was used to conduct this research. We identified six potential benefits, seven challenges, and three motives. Our main finding was a significant gap in the available academic literature on this subject. Further empirical research using both qualitative and quantitative approaches is required. From the limited information that is readily available, we conclude that public-private partnerships for health imply several benefits but with some noticeable and crucial limitations. In this article, we provide a description of these benefits and challenges, discuss key themes, and conclude that empirical research is required to determine the full extent of the challenges addressed in the literature. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Public participation GIS: a method for identifying ecosystems services

USGS Publications Warehouse

Brown, Greg; Montag, Jessica; Lyon, Katie

2012-01-01

This study evaluated the use of an Internet-based public participation geographic information system (PPGIS) to identify ecosystem services in Grand County, Colorado. Specific research objectives were to examine the distribution of ecosystem services, identify the characteristics of participants in the study, explore potential relationships between ecosystem services and land use and land cover (LULC) classifications, and assess the methodological strengths and weakness of the PPGIS approach for identifying ecosystem services. Key findings include: (1) Cultural ecosystem service opportunities were easiest to identify while supporting and regulatory services most challenging, (2) participants were highly educated, knowledgeable about nature and science, and have a strong connection to the outdoors, (3) some LULC classifications were logically and spatially associated with ecosystem services, and (4) despite limitations, the PPGIS method demonstrates potential for identifying ecosystem services to augment expert judgment and to inform public or environmental policy decisions regarding land use trade-offs.

The Use of Key Informant Method for Identifying Children with Blindness and Severe Visual Impairment in Developing Countries.

PubMed

du Toit, Rènée; Courtright, Paul; Lewallen, Susan

2017-06-01

An estimated 19 million children are visually impaired; of these, 1.4 million are irreversibly blind. A key challenge is to identify them early in life to benefit maximally from visual rehabilitation, and/or treatment. This aggregative review and structured literature analysis summarizes evidence of what it is about the key informant (KI) approach that works to identify children with blindness or severe visual impairment (B/SVI) in the community (for whom, to what extent, in what circumstances, in what respect, how and why). Peer-reviewed (PubMed, hand search) and grey literature (Google, World Health Organization website, academic theses, direct requests) were included, and methods and criteria used for identification, productivity (number of children referred per KI), accuracy of referrals (positive predictive value, PPV), age of children with B/SVI, KI definition, sex, information about cost and comparisons aggregated. We included 31 documents describing 22 unique KI programs. Mostly KIs identified children with B/SVI in 1-3 weeks, i.e. "campaign mode." In 60%, KIs were community volunteers, others formal health sector workers (FHSW). Around 0.02-1.56 children per KI (median = 0.25) were successfully recruited. PPV ranged from 12 to 66%. In two studies comparing FHSWs and community KIs, the latter were 8 and 10 times more productive. KIs working in campaign mode may provide an effective approach to identifying children with B/SVI in communities. Including identification of ocular problems and/or other impairments has been recommended. Research on factors that influence effectiveness and on whether KIs continue to contribute could inform programs.

Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies.

PubMed

Rai, Sharan K; Choi, Hyon K; Choi, Sally H J; Townsend, Anne F; Shojania, Kam; De Vera, Mary A

2018-04-17

Gout care remains highly suboptimal, contributing to an increased global disease burden. To understand barriers to gout care, our aim was to provide a systematic review and thematic synthesis of qualitative studies worldwide reporting provider and patient perspectives and experiences with management. We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies of provider and patient perspectives on gout management. We used thematic synthesis to combine the included studies and identify key themes across studies. We included 20 studies that reported the experiences and perspectives of 480 gout patients and 120 providers spanning five different countries across three continents. We identified three predominant provider themes: knowledge gaps and management approaches; perceptions and beliefs about gout patients; and system barriers to optimal gout care (e.g. time constraints and a lack of incentives). We also identified four predominant themes among gout patients: limited gout knowledge; interactions with health-care providers; attitudes towards and experiences with taking medication; and practical barriers to long-term medication use. Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.

Physical activity in culturally and linguistically diverse migrant groups to Western society: a review of barriers, enablers and experiences.

PubMed

Caperchione, Cristina M; Kolt, Gregory S; Mummery, W Kerry

2009-01-01

A close examination of epidemiological data reveals burdens of disease particular to culturally and linguistically diverse (CALD) migrants, as these individuals adjust to both culture and modernization gaps. Despite the increased risk of hypertension, diabetes mellitus, overweight/obesity and cardiovascular disease, individuals from CALD groups are less likely to be proactive in accessing healthcare or undertaking preventative measures to ensure optimal health outcomes. The purpose of this paper is to review literature that outlines the barriers, challenges and enablers of physical activity in CALD groups who have recently migrated to Western society, and to identify key strategies to increase physical activity participation for these individuals. Electronic and manual literature searches were used to identify 57 publications that met the inclusion criteria. Findings from the review indicate that migration to Western societies has a detrimental effect on the health status and health behaviours of CALD groups as they assimilate to their new surroundings, explore different cultures and customs, and embrace a new way of life. In particular, there is evidence that physical inactivity is common in migrant CALD groups, and is a key contributing risk factor to chronic disease for these individuals. Challenges and barriers that limit physical activity participation in CALD groups include: cultural and religious beliefs, issues with social relationships, socioeconomic challenges, environmental barriers, and perceptions of health and injury. Strategies that may assist with overcoming these challenges and barriers consist of the need for cultural sensitivity, the provision of education sessions addressing health behaviours, encouraging participation of individuals from the same culture, exploration of employment situational variables, and the implementation of 'Health Action Zones' in CALD communities. This information will inform and support the development of culturally appropriate programmes designed to positively influence the physical activity behaviours of individuals from CALD populations.

Diagnosing climate change impacts and identifying adaptation strategies by involving key stakeholder organisations and farmers in Sikkim, India: Challenges and opportunities.

PubMed

Azhoni, Adani; Goyal, Manish Kumar

2018-06-01

Narrowing the gap between research, policy making and implementing adaptation remains a challenge in many parts of the world where climate change is likely to severely impact water security. This research aims to narrow this gap by matching the adaptation strategies being framed by policy makers to that of the perspectives of development agencies, researchers and farmers in the Himalayan state of Sikkim in India. Our case study examined the perspectives of various stakeholders for climate change impacts, current adaptation strategies, knowledge gaps and adaptation barriers, particularly in the context of implementing the Sikkim State Action Plan on Climate Change through semi-structured interviews carried out with decision makers in the Sikkim State Government, researchers, consultants, local academia, development agencies and farmers. Using Stakeholders Network Analysis tools, this research unravels the complexities of perceiving climate change impacts, identifying strategies, and implementing adaptation. While farmers are less aware about the global phenomenon of climate change impacts for water security, their knowledge of the local conditions and their close interaction with the State Government Agriculture Department provides them opportunities. Although important steps are being initiated through the Sikkim State Action Plan on Climate Change it is yet to deliver effective means of adaptation implementation and hence, strengthening the networks of close coordination between the various implementing agencies will pay dividends. Knowledge gaps and the need for capacity building identified in this research, based on the understandings of key stakeholders are highly relevant to both the research community and for informing policy. Copyright © 2018 Elsevier B.V. All rights reserved.

Depressed Mothers as Informants on Child Behavior: Methodological Issues

PubMed Central

Ordway, Monica Roosa

2011-01-01

Mothers with depressive symptoms more frequently report behavioral problems among their children than non-depressed mothers leading to a debate regarding the accuracy of depressed mothers as informants of children’s behavior. The purpose of this integrative review was to identify methodological challenges in research related to the debate. Data were extracted from 43 papers (6 theoretical, 36 research reports, and 1 instrument scoring manual). The analysis focused on the methodologies considered when using depressed mothers as informants. Nine key themes were identified and I concluded that researchers should incorporate multiple informants, identify the characteristics of maternal depression, and incorporate advanced statistical methodology. The use of a conceptual framework to understand informant discrepancies within child behavior evaluations is suggested for future research. PMID:21964958

Improving Access to Human Milk in the NICU (and Beyond).

PubMed

Szulecki, Diane

2016-06-01

As part of its Raise the Voice campaign to showcase nurses who are key players in transforming health care, the American Academy of Nursing has identified nurses they call edge runners-"practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges." This is the sixth in AJN's series of profiles of these nursing innovators. Read and be proud of what nurses can accomplish.

University of Texas MD Anderson Cancer Center (UT-MDACC): High-Throughput Screening Identifying Driving Mutations in Endometrial Cancer | Office of Cancer Genomics

Cancer.gov

Recent advances in next-generation sequencing technology have enabled the unprecedented characterization of a full spectrum of somatic alterations in cancer genomes. Given the large numbers of somatic mutations typically detected by this approach, a key challenge in the downstream analysis is to distinguish “drivers” that functionally contribute to tumorigenesis from “passengers” that occur as the consequence of genomic instability.

Challenges and possible solutions to colorectal cancer screening for the underserved.

PubMed

Gupta, Samir; Sussman, Daniel A; Doubeni, Chyke A; Anderson, Daniel S; Day, Lukejohn; Deshpande, Amar R; Elmunzer, B Joseph; Laiyemo, Adeyinka O; Mendez, Jeanette; Somsouk, Ma; Allison, James; Bhuket, Taft; Geng, Zhuo; Green, Beverly B; Itzkowitz, Steven H; Martinez, Maria Elena

2014-04-01

Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and racial/ethnic minority groups. Increasing screening rates among underserved populations will reduce the US burden of CRC. In this commentary focusing on underserved populations, we highlight the public health impact of CRC screening, list key challenges to screening the underserved, and review promising approaches to boost screening rates. We identify four key policy and research priorities to increase screening among underserved populations: 1) actively promote the message, "the best test is the one that gets done"; 2) develop and implement methods to identify unscreened individuals within underserved population groups for screening interventions; 3) develop and implement approaches for organized screening delivery; and 4) fund and enhance programs and policies that provide access to screening, diagnostic follow-up, and CRC treatment for underserved populations. This commentary represents the consensus of a diverse group of experts in cancer control and prevention, epidemiology, gastroenterology, and primary care from across the country who formed the Coalition to Boost Screening among the Underserved in the United States. The group was organized and held its first annual working group meeting in conjunction with the World Endoscopy Organization's annual Colorectal Cancer Screening Committee meeting during Digestive Disease Week 2012 in San Diego, California.

Branding strategies discussed by the experts. Trends that will shape strategy in 1998.

PubMed

Windhorst, C E

1998-02-01

This month the focus is on branding. The Alliance Advisory Council's discussion of this topic, led by Joel English (a senior vice president with BVK/McDonald, Milwaukee, WI), identifies the key issues on branding as: 1) the debate between the local and regional nature of healthcare delivery, and the need to provide customers with the trust and security of a larger entity behind the individual provider; 2) the challenge of identifying and agreeing on a consistent message for all parts of the system; and 3) the difficulty of keeping the promise implied by a brand across these many components.

Important issues in the justification of a control treatment in paediatric drug trials.

PubMed

Kelly, Lauren E; Davies, Elin Haf; Saint-Raymond, Agnes; Tomasi, Paolo; Offringa, Martin

2016-10-01

The value of comparative effectiveness trials in informing clinical and policy decisions depends heavily on the choice of control arm (comparator). Our objective is to identify challenges in comparator reasoning and to determine justification criteria for selecting a control arm in paediatric clinical trials. A literature search was completed to identify existing sources of guidance on comparator selection. Subsequently, we reviewed a randomly selected sample of comparators selected for paediatric investigation plans (PIPs) adopted by the Paediatric Committee of the European Medicines Agency in 2013. We gathered descriptive information and evaluated their review process to identify challenges and compromises between regulators and sponsors with regard to the selection of the comparator. A tool to help investigators justify the selection of active controls and placebo arms was developed using the existing literature and empirical data. Justifying comparator selection was a challenge in 28% of PIPs. The following challenging paediatric issues in the decision-making process were identified: use of off-label medications as comparators, ethical and safe use of placebo, duration of placebo use, an undefined optimal dosing strategy, lack of age-appropriate safety and efficacy data, and drug dosing not supported by extrapolation of safety/efficacy evidence from other populations. In order to generate trials that will inform clinical decision-making and support marketing authorisations, researchers must systemically and transparently justify their selection of the comparator arm for their study. This report highlights key areas for justification in the choice of comparator in paediatric clinical trials. 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/

Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study.

PubMed

Wright, Adam; Sittig, Dean F; Ash, Joan S; Erickson, Jessica L; Hickman, Trang T; Paterno, Marilyn; Gebhardt, Eric; McMullen, Carmit; Tsurikova, Ruslana; Dixon, Brian E; Fraser, Greg; Simonaitis, Linas; Sonnenberg, Frank A; Middleton, Blackford

2015-11-01

To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Extinction vulnerability of coral reef fishes.

PubMed

Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron Macneil, M; McClanahan, Tim R; Ohman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

2011-04-01

With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate. © 2011 Blackwell Publishing Ltd/CNRS.

Extinction vulnerability of coral reef fishes

PubMed Central

Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron MacNeil, M; McClanahan, Tim R; Öhman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

2011-01-01

With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate. PMID:21320260

CHALLENGES IN THE MANAGEMENT OF GLAUCOMA IN A DEVELOPING COUNTRY; A QUALITATIVE STUDY OF PROVIDERS' PERSPECTIVES.

PubMed

Adekoya, B J; Adepoju, F G; Moshood, K F; Balarabe, A H

2015-01-01

Glaucoma management is challenging to patients as well as to the eye care providers. The study is aimed at describing the challenges faced by providers using qualitative methods. In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres offering medical and surgical glaucoma services in Lagos state, Nigeria, according to established qualitative methods. This was done using semi-structured, open ended questions to explore the providers' perspective on glaucoma burden, challenges in the management, surgery for glaucoma, acceptance of glaucoma surgery by patients, and recommendations for improving glaucoma services. The discussions were recorded with the aid of a micro-cassette recorder. Familiarisation was done to identify key ideas in the data, then, the main themes and sub-themes were identified. Quotes that reflect the themes and sub-themes were then identified in the data. In-depth interviews were conducted with a total of 11 ophthalmologists and resident doctors in training. Majority were of the opinion that glaucoma is a significant burden constituting about 35% of outpatient visits. Identified patient related challenges include; late presentation, lack of glaucoma awareness, delay in referral from optometrists, and poor compliance with medications. Shortages in needed equipment were also identified. Availability, affordability and counterfeiting of drugs were the major challenges related to medical treatment. Majority of the participants agreed that surgery should be offered to the patients as soon as the diagnosis of glaucoma is made. However, continuous monitoring of the patient on medical treatment is another line of option for them in early cases; if they are convinced the patients will be compliant. Some respondents considered the current number of glaucoma surgeries as adequate, while some think otherwise. Reasons put forward for reluctance to offer glaucoma surgery include; late presentation, lack of patient satisfaction, complications of surgery, and negative publicity. Even though the challenges in the management of glaucoma in developing countries are many, they are not insurmountable. There is need for concerted and integrated efforts involving all cadres of eye care practitioners, patients, institutions and governments to address this important eye disease. Improved awareness, provision of adequate equipment, availability and affordability of medications, need for training and retraining of eye care providers are all important measures that can lead to better management of the glaucoma patient.

Cultural Challenges Faced by American Mission Control Personnel Working with International Partners

NASA Technical Reports Server (NTRS)

Clement, J. L.; Ritsher, J. B.

2006-01-01

Operating the International Space Station (ISS) involves an indefinite, continuous series of long-duration international missions, and this requires an unprecedented degree of cooperation across multiple sites, organizations, and nations. Both junior and senior mission control personnel have had to find ways to address the cultural challenges inherent in such work, but neither have had systematic training in how to do so. The goals of this study were to identify and evaluate the major cultural challenges faced by ISS mission control personnel and to highlight the approaches that they have found most effective to surmount these challenges. We pay particular attention to the approaches successfully employed by the senior personnel and the training needs identified by the junior personnel. We also evaluate the extent to which the identified approaches and needs are consistent across the two samples. METHODS: Participants included a sample of 14 senior ISS flight controllers and a contrasting sample of 12 more junior controllers. All participants were mission operations specialists chosen on the basis of having worked extensively with international partners. Data were collected using a semi-structured qualitative interview and content analyzed using an iterative process with multiple coders and consensus meetings to resolve discrepancies. RESULTS: The senior respondents had substantial consensus on several cultural challenges and on key strategies for dealing with them, and they offered a wide range of specific tactics for implementing these strategies. Data from the junior respondents will be presented for the first time at the meeting. DISCUSSION: Although specific to American ISS personnel, our results are consistent with recent management, cultural, and aerospace research on other populations. We aim to use our results to improve training for current and future mission control personnel working in international or multicultural mission operations teams.

Schools for health, education and development: a call for action.

PubMed

Tang, Kwok-Cho; Nutbeam, Don; Aldinger, Carmen; St Leger, Lawrence; Bundy, Donald; Hoffmann, Anna Maria; Yankah, Ekua; McCall, Doug; Buijs, Goof; Arnaout, Said; Morales, Sofialeticia; Robinson, Faye; Torranin, Charuaypon; Drake, Lesley; Abolfotouh, Mostafa; Whitman, Cheryl Vince; Meresman, Sergio; Odete, Cossa; Joukhadar, Abdul-Halim; Avison, Claire; Wright, Cream; Huerta, Franscico; Munodawafa, Davison; Nyamwaya, David; Heckert, Karen

2009-03-01

In 2007, the World Health Organization, together with United Nations and international organization as well as experts, met to draw upon existing evidence and practical experience from regions, countries and individual schools in promoting health through schools. The goal of the meeting was to identify current and emerging global factors affecting schools, and to help them respond more effectively to health, education and development opportunities. At the meeting, a Statement was developed describing effective approaches and strategies that can be adopted by schools to promote health, education and development. Five key challenges were identified. These described the need to continue building evidence and capturing practical experience in school health; the importance of improving implementation processes to ensure optimal transfer of evidence into practice; the need to alleviating social and economic disadvantage in access to and successful completion of school education; the opportunity to harness media influences for positive benefit, and the continuing challenge to improve partnerships among different sectors and organizations. The participants also identified a range of actions needed to respond to these challenges, highlighting the need for action by local school communities, governments and international organizations to invest in quality education, and to increase participation of children and young people in school education. This paper describes the rationale for and process of the meeting and the development of the Statement and outlines some of the most immediate efforts made to implement the actions identified in the Statement. It also suggests further joint actions required for the implementation of the Statement.

Post-disaster Gulf Coast Recovery Using Telehealth

PubMed Central

Kim, Thomas J.; Eastburn, Sasha L.; Icenogle, Marjorie L.; Slagle, Michelle; Nuriddin, Azizeh H.; Brantley, Katrina M.; Foreman, Rachel D.; Buckner, Ayanna V.

2013-01-01

Abstract Objective: The Gulf Coast continues to struggle with service need far outpacing available resources. Since 2005, the Regional Coordinating Center for Hurricane Response (RCC) at Morehouse School of Medicine, Atlanta, GA, has supported telehealth solutions designed to meet high service needs (e.g., psychiatry) within primary care and other healthcare organizations. The overall RCC vision is to support autonomous, useful, and sustainable telehealth programs towards mitigating unmet disaster-related needs. Subjects and Methods: To assess Gulf Coast telehealth experiences, we conducted semistructured interviews with both regional key informants and national organizations with Gulf Coast recovery interests. Using qualitative-descriptive analysis, interview transcripts were analyzed to identify shared development themes. Results: Thirty-eight key informants were interviewed, representing a 77.6% participation rate among organizations engaged by the RCC. Seven elements critical to telehealth success were identified: Funding, Regulatory, Workflow, Attitudes, Personnel, Technology, and Evaluation. These key informant accounts reveal shared insights with telehealth regarding successes, challenges, and recommendations. Conclusions: The seven elements critical to telehealth success both confirm and organize development principles from a diverse collective of healthcare stakeholders. The structured nature of these insights suggests a generalizable framework upon which other organizations might develop telehealth strategies toward addressing high service needs with limited resources. PMID:23427981

Challenges in conducting post-authorisation safety studies (PASS): A vaccine manufacturer's view.

PubMed

Cohet, Catherine; Rosillon, Dominique; Willame, Corinne; Haguinet, Francois; Marenne, Marie-Noëlle; Fontaine, Sandrine; Buyse, Hubert; Bauchau, Vincent; Baril, Laurence

2017-05-25

Post-authorisation safety studies (PASS) of vaccines assess or quantify the risk of adverse events following immunisation that were not identified or could not be estimated pre-licensure. The aim of this perspective paper is to describe the authors' experience in the design and conduct of twelve PASS that contributed to the evaluation of the benefit-risk of vaccines in real-world settings. We describe challenges and learnings from selected PASS of rotavirus, malaria, influenza, human papillomavirus and measles-mumps-rubella-varicella vaccines that assessed or identified potential or theoretical risks, which may lead to changes to risk management plans and/or to label updates. Study settings include the use of large healthcare databases and de novo data collection. PASS methodology is influenced by the background incidence of the outcome of interest, vaccine uptake, availability and quality of data sources, identification of the at-risk population and of suitable comparators, availability of validated case definitions, and the frequent need for case ascertainment in large databases. Challenges include the requirement for valid exposure and outcome data, identification of, and access to, adequate data sources, and mitigating limitations including bias and confounding. Assessing feasibility is becoming a key step to confirm that study objectives can be met in a timely manner. PASS provide critical information for regulators, public health agencies, vaccine manufacturers and ultimately, individuals. Collaborative approaches and synergistic efforts between vaccine manufacturers and key stakeholders, such as regulatory and public health agencies, are needed to facilitate access to data, and to drive optimal study design and implementation, with the aim of generating robust evidence. Copyright © 2017 GSK Biologicals SA. Published by Elsevier Ltd.. All rights reserved.

Female Physicians and the Future of Endocrinology.

PubMed

Pelley, Elaine; Danoff, Ann; Cooper, David S; Becker, Carolyn

2016-01-01

Given that approximately 70% of current endocrinology fellows are women, female physicians will compose the majority of the future endocrinology workforce. This gender shift partly reflects an apparent waning of interest in endocrinology among male trainees. It also coincides with a projected shortage of endocrinologists overall. Female physicians face unique challenges in the workplace. To continue to attract trainees to the specialty and support their success, it is imperative that these challenges be recognized, understood, and addressed. A PubMed search using the terms "female physician" and "physician gender" covering the years 2000-2015 was performed. Additional references were identified through review of the citations of the retrieved articles. The following topics were identified as key to understanding the impact of this gender shift: professional satisfaction, work-life balance, income, parenthood, academic success, and patient satisfaction. Several changes can be predicted to occur as endocrinology becomes a female-predominant specialty. Although professional satisfaction should remain stable, increased burnout rates are likely. Work-life balance challenges will likely be magnified. The combined effects of occupational gender segregation and a gender pay gap are predicted to negatively impact salaries of endocrinologists of both genders. The underrepresentation of women in academic leadership may mean a lesser voice for endocrinology in this arena. Finally, gender biases evident in patient satisfaction measures--commonly used as proxies for quality of care--may disproportionately impact endocrinology. Endocrinology is predicted to become the most female-predominant subspecialty of internal medicine. The specialty of endocrinology should take a lead role in advocating for changes that support the success of female physicians. Strengthening and supporting the physician workforce can only serve to attract talented physicians of both genders to the specialty, which will be key to meeting the needs of the increasing numbers of patients with endocrine disorders.

A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

PubMed

Goharinezhad, Salime; Maleki, Mohammadreza; Baradaran, Hamid Reza; Ravaghi, Hamid

2016-01-01

With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities' job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

Predicting Key Events in the Popularity Evolution of Online Information.

PubMed

Hu, Ying; Hu, Changjun; Fu, Shushen; Fang, Mingzhe; Xu, Wenwen

2017-01-01

The popularity of online information generally experiences a rising and falling evolution. This paper considers the "burst", "peak", and "fade" key events together as a representative summary of popularity evolution. We propose a novel prediction task-predicting when popularity undergoes these key events. It is of great importance to know when these three key events occur, because doing so helps recommendation systems, online marketing, and containment of rumors. However, it is very challenging to solve this new prediction task due to two issues. First, popularity evolution has high variation and can follow various patterns, so how can we identify "burst", "peak", and "fade" in different patterns of popularity evolution? Second, these events usually occur in a very short time, so how can we accurately yet promptly predict them? In this paper we address these two issues. To handle the first one, we use a simple moving average to smooth variation, and then a universal method is presented for different patterns to identify the key events in popularity evolution. To deal with the second one, we extract different types of features that may have an impact on the key events, and then a correlation analysis is conducted in the feature selection step to remove irrelevant and redundant features. The remaining features are used to train a machine learning model. The feature selection step improves prediction accuracy, and in order to emphasize prediction promptness, we design a new evaluation metric which considers both accuracy and promptness to evaluate our prediction task. Experimental and comparative results show the superiority of our prediction solution.

Predicting Key Events in the Popularity Evolution of Online Information

PubMed Central

Fu, Shushen; Fang, Mingzhe; Xu, Wenwen

2017-01-01

The popularity of online information generally experiences a rising and falling evolution. This paper considers the “burst”, “peak”, and “fade” key events together as a representative summary of popularity evolution. We propose a novel prediction task—predicting when popularity undergoes these key events. It is of great importance to know when these three key events occur, because doing so helps recommendation systems, online marketing, and containment of rumors. However, it is very challenging to solve this new prediction task due to two issues. First, popularity evolution has high variation and can follow various patterns, so how can we identify “burst”, “peak”, and “fade” in different patterns of popularity evolution? Second, these events usually occur in a very short time, so how can we accurately yet promptly predict them? In this paper we address these two issues. To handle the first one, we use a simple moving average to smooth variation, and then a universal method is presented for different patterns to identify the key events in popularity evolution. To deal with the second one, we extract different types of features that may have an impact on the key events, and then a correlation analysis is conducted in the feature selection step to remove irrelevant and redundant features. The remaining features are used to train a machine learning model. The feature selection step improves prediction accuracy, and in order to emphasize prediction promptness, we design a new evaluation metric which considers both accuracy and promptness to evaluate our prediction task. Experimental and comparative results show the superiority of our prediction solution. PMID:28046121

Challenges in physician supply planning: the case of Belgium.

PubMed

Stordeur, Sabine; Léonard, Christian

2010-12-08

Planning human resources for health (HRH) is a complex process for policy-makers and, as a result, many countries worldwide swing from surplus to shortage. In-depth case studies can help appraising the challenges encountered and the solutions implemented. This paper has two objectives: to identify the key challenges in HRH planning in Belgium and to formulate recommendations for an effective HRH planning, on the basis of the Belgian case study and lessons drawn from an international benchmarking. In Belgium, a numerus clausus set up in 1997 and effective in 2004, aims to limit the total number of physicians working in the curative sector. The assumption of a positive relationship between physician densities and health care utilization was a major argument in favor of medical supply restrictions. This new regulation did not improve recurrent challenges such as specialty imbalances, with uncovered needs particularly among general practitioners, and geographical maldistribution. New difficulties also emerged. In particular, limiting national training of HRH turned out to be ineffective within the open European workforce market. The lack of integration of policies affecting HRH was noteworthy. We described in the paper what strategies were developed to address those challenges in Belgium and in neighboring countries. Planning the medical workforce involves determining the numbers, mix, and distribution of health providers that will be required at some identified future point in time. To succeed in their task, health policy planners have to take a broader perspective on the healthcare system. Focusing on numbers is too restrictive and adopting innovative policies learned from benchmarking without integration and coordination is unfruitful. Evolving towards a strategic planning is essential to control the effects of the complex factors impacting on human resources. This evolution requires an effective monitoring of all key factors affecting supply and demand, a dynamic approach, and a system-level perspective, considering all healthcare professionals, and integrating manpower planning with workforce development. To engage in an evidence-based action, policy-makers need a global manpower picture, from their own country and abroad, as well as reliable and comparable manpower databases allowing proper analysis and planning of the workforce.

Challenges in physician supply planning: the case of Belgium

PubMed Central

2010-01-01

Introduction Planning human resources for health (HRH) is a complex process for policy-makers and, as a result, many countries worldwide swing from surplus to shortage. In-depth case studies can help appraising the challenges encountered and the solutions implemented. This paper has two objectives: to identify the key challenges in HRH planning in Belgium and to formulate recommendations for an effective HRH planning, on the basis of the Belgian case study and lessons drawn from an international benchmarking. Case description In Belgium, a numerus clausus set up in 1997 and effective in 2004, aims to limit the total number of physicians working in the curative sector. The assumption of a positive relationship between physician densities and health care utilization was a major argument in favor of medical supply restrictions. This new regulation did not improve recurrent challenges such as specialty imbalances, with uncovered needs particularly among general practitioners, and geographical maldistribution. New difficulties also emerged. In particular, limiting national training of HRH turned out to be ineffective within the open European workforce market. The lack of integration of policies affecting HRH was noteworthy. We described in the paper what strategies were developed to address those challenges in Belgium and in neighboring countries. Discussion and evaluation Planning the medical workforce involves determining the numbers, mix, and distribution of health providers that will be required at some identified future point in time. To succeed in their task, health policy planners have to take a broader perspective on the healthcare system. Focusing on numbers is too restrictive and adopting innovative policies learned from benchmarking without integration and coordination is unfruitful. Evolving towards a strategic planning is essential to control the effects of the complex factors impacting on human resources. This evolution requires an effective monitoring of all key factors affecting supply and demand, a dynamic approach, and a system-level perspective, considering all healthcare professionals, and integrating manpower planning with workforce development. Conclusion To engage in an evidence-based action, policy-makers need a global manpower picture, from their own country and abroad, as well as reliable and comparable manpower databases allowing proper analysis and planning of the workforce. PMID:21138596

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

PubMed

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

2012-07-01

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

DOE Big Idea Summit III: Solving the Information Technology Challenge Beyond Moore's Law: A New Path to Scaling.

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

McCormick, Frederick B.; Shalf, John; Mitchell, Alan

This report captures the initial conclusions of the DOE seven National Lab team collaborating on the “Solving the Information Technology Energy Challenge Beyond Moore’s Law” initiative from the DOE Big Idea Summit III held in April of 2016. The seven Labs held a workshop in Albuquerque, NM in late July 2016 and gathered 40 researchers into 5 working groups: 4 groups spanning the levels of the co-design framework shown below, and a 5th working group focused on extending and advancing manufacturing approaches and coupling their constraints to all of the framework levels. These working groups have identified unique capabilities withinmore » the Labs to support the key challenges of this Beyond Moore’s Law Computing (BMC) vision, as well as example first steps and potential roadmaps for technology development.« less

From Rosalind Franklin to Barack Obama: Data Sharing Challenges and Solutions in Genomics and Personalised Medicine

PubMed Central

Lawler, Mark; Maughan, Tim

2017-01-01

The collection, storage and use of genomic and clinical data from patients and healthy individuals is a key component of personalised medicine enterprises such as the Precision Medicine Initiative, the Cancer Moonshot and the 100,000 Genomes Project. In order to maximise the value of this data, it is important to embed a culture within the scientific, medical and patient communities that supports the appropriate sharing of genomic and clinical information. However, this aspiration raises a number of ethical, legal and regulatory challenges that need to be addressed. The Global Alliance for Genomics and Health, a worldwide coalition of researchers, healthcare professionals, patients and industry partners, is developing innovative solutions to support the responsible and effective sharing of genomic and clinical data. This article identifies the challenges that a data sharing culture poses and highlights a series of practical solutions that will benefit patients, researchers and society. PMID:28517986

From Rosalind Franklin to Barack Obama: Data Sharing Challenges and Solutions in Genomics and Personalised Medicine.

PubMed

Lawler, Mark; Maughan, Tim

2017-04-01

The collection, storage and use of genomic and clinical data from patients and healthy individuals is a key component of personalised medicine enterprises such as the Precision Medicine Initiative, the Cancer Moonshot and the 100,000 Genomes Project. In order to maximise the value of this data, it is important to embed a culture within the scientific, medical and patient communities that supports the appropriate sharing of genomic and clinical information. However, this aspiration raises a number of ethical, legal and regulatory challenges that need to be addressed. The Global Alliance for Genomics and Health, a worldwide coalition of researchers, healthcare professionals, patients and industry partners, is developing innovative solutions to support the responsible and effective sharing of genomic and clinical data. This article identifies the challenges that a data sharing culture poses and highlights a series of practical solutions that will benefit patients, researchers and society.

HIV/AIDS vaccines for Africa: scientific opportunities, challenges and strategies

PubMed Central

Chin'ombe, Nyasha; Ruhanya, Vurayai

2015-01-01

More than decades have already elapsed since human immunodeficiency virus (HIV) was identified as the causative agent of acquired immunodeficiency syndrome (AIDS). The HIV has since spread to all parts of the world with devastating effects. In sub-saharan Africa, the HIV/AIDS epidemic has reached unprecedented proportions. Safe, effective and affordable HIV/AIDS vaccines for Africans are therefore urgently needed to contain this public health problem. Although, there are challenges, there are also scientific opportunities and strategies that can be exploited in the development of HIV/AIDS vaccines for Africa. The recent RV144 Phase III trial in Thailand has demonstrated that it is possible to develop a vaccine that can potentially elicit modest protective immunity against HIV infection. The main objective of this review is to outline the key scientific opportunities, challenges and strategies in HIV/AIDS vaccine development in Africa. PMID:26185576

Closing the Gap: Supporting Patients’ Transition to Self-Management after Hospitalization

PubMed Central

Pollack, Ari H; Backonja, Uba; Miller, Andrew D.; Mishra, Sonali R.; Khelifi, Maher; Kendall, Logan; Pratt, Wanda

2016-01-01

Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs. PMID:27500285

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

PubMed Central

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

2012-01-01

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

Assessing organizational change in multisector community health alliances.

PubMed

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

2015-02-01

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

Herbal medicine research and global health: an ethical analysis.

PubMed

Tilburt, Jon C; Kaptchuk, Ted J

2008-08-01

Governments, international agencies and corporations are increasingly investing in traditional herbal medicine research. Yet little literature addresses ethical challenges in this research. In this paper, we apply concepts in a comprehensive ethical framework for clinical research to international traditional herbal medicine research. We examine in detail three key, underappreciated dimensions of the ethical framework in which particularly difficult questions arise for international herbal medicine research: social value, scientific validity and favourable risk-benefit ratio. Significant challenges exist in determining shared concepts of social value, scientific validity and favourable risk-benefit ratio across international research collaborations. However, we argue that collaborative partnership, including democratic deliberation, offers the context and process by which many of the ethical challenges in international herbal medicine research can, and should be, resolved. By "cross-training" investigators, and investing in safety-monitoring infrastructure, the issues identified by this comprehensive framework can promote ethically sound international herbal medicine research that contributes to global health.

An experimental comparison of online object-tracking algorithms

NASA Astrophysics Data System (ADS)

Wang, Qing; Chen, Feng; Xu, Wenli; Yang, Ming-Hsuan

2011-09-01

This paper reviews and evaluates several state-of-the-art online object tracking algorithms. Notwithstanding decades of efforts, object tracking remains a challenging problem due to factors such as illumination, pose, scale, deformation, motion blur, noise, and occlusion. To account for appearance change, most recent tracking algorithms focus on robust object representations and effective state prediction. In this paper, we analyze the components of each tracking method and identify their key roles in dealing with specific challenges, thereby shedding light on how to choose and design algorithms for different situations. We compare state-of-the-art online tracking methods including the IVT,1 VRT,2 FragT,3 BoostT,4 SemiT,5 BeSemiT,6 L1T,7 MILT,8 VTD9 and TLD10 algorithms on numerous challenging sequences, and evaluate them with different performance metrics. The qualitative and quantitative comparative results demonstrate the strength and weakness of these algorithms.

Overview of the critical disaster management challenges faced during Van 2011 earthquakes.

PubMed

Tolon, Mert; Yazgan, Ufuk; Ural, Derin N; Goss, Kay C

2014-01-01

On October 23, 2011, a M7.2 earthquake caused damage in a widespread area in the Van province located in eastern Turkey. This strong earthquake was followed by a M5.7 earthquake on November 9, 2011. This sequence of damaging earthquakes led to 644 fatalities. The management during and after these earthquake disaster imposed many critical challenges. In this article, an overview of these challenges is presented based on the observations by the authors in the aftermath of this disaster. This article presents the characteristics of 2011 Van earthquakes. Afterward, the key information related to the four main phases (ie, preparedness, mitigation, response, and recovery) of the disaster in Van is presented. The potential strategies that can be taken to improve the disaster management practice are identified, and a set of recommendations are proposed to improve the existing situation.

Insuring continuity of care for chronic disease patients after a disaster: key preparedness elements

PubMed Central

Arrieta, Martha I.; Foreman, Rachel D.; Crook, Errol D.; Icenogle, Marjorie L.

2009-01-01

Background Care for patients with chronic diseases is a challenge after a disaster. This is particularly true for individuals from health disparate populations as they are less likely to evacuate, have less financial resources and often depend on resource-strapped institutions for their care. The specific aim of the study presented here was to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi. Methods Focusing on agencies providing care to health disparate populations, a qualitative methodology was employed using in-depth interviews with health and social service providers. Participants identified key elements essential to disaster preparedness. Results Pre-disaster issues were patient education and preparedness, evacuation, special needs shelters and health care provider preparedness. Post-disaster issues were communication, volunteer coordination and donation management. Conclusions Lessons learned from those on the ground administering healthcare during disasters should inform future disaster preparations. Furthermore, the methodological approach used in this study engendered collaboration between healthcare institutions and may enhance future inter-agency disaster preparedness. PMID:18703906

dataMares - An online platform for the fast, effective dissemination of science

NASA Astrophysics Data System (ADS)

Johnson, A. F.; Aburto-Oropeza, O.; Moreno-Báez, M.; Giron-Nava, A.; Lopez-Sagástegui, R.; Lopez-Sagástegui, C.

2016-02-01

One of the current challenges in public policy development, especially related to natural resource management and conservation, is that there are very few tools that help easily identify and incorporate relevant scientific findings and data into public policy. This can also lead to a repetition of research efforts and the collect of information that in some cases might already exist. The key to addressing this challenge is to develop collaborative research tools, which can be used by different sectors of society including key stakeholder groups, managers, policy makers and the public. Here we present an "open science" platform capable of handling large data and disseminating results to a wide audience quickly. dataMares uses business intelligence software to allow the dynamic presentation of data quickly to a range of users online. dataMares provides Robust and up-to-date scientific information for decision-makers, resource managers, conservation practitioners, fishers, community members, and regional and national level decision-makers in a nutshell. It can also be used in the training of young scientists and allows quick and open connections with the journalism industry.

Models of Integrating Physical Therapists into Family Health Teams in Ontario, Canada: Challenges and Opportunities

PubMed Central

Mandoda, Shilpa; Landry, Michel D.

2011-01-01

ABSTRACT Purpose: To explore the potential for different models of incorporating physical therapy (PT) services within the emerging network of family health teams (FHTs) in Ontario and to identify challenges and opportunities of each model. Methods: A two-phase mixed-methods qualitative descriptive approach was used. First, FHTs were mapped in relation to existing community-based PT practices. Second, semi-structured key-informant interviews were conducted with representatives from urban and rural FHTs and from a variety of community-based PT practices. Interviews were digitally recorded, transcribed verbatim, and analyzed using a categorizing/editing approach. Results: Most participants agreed that the ideal model involves embedding physical therapists directly into FHTs; in some situations, however, partnering with an existing external PT provider may be more feasible and sustainable. Access and funding remain the key issues, regardless of the model adopted. Conclusion: Although there are differences across the urban/rural divide, there exist opportunities to enhance and optimize existing delivery models so as to improve client access and address emerging demand for community-based PT services. PMID:22654231

"How do I say that?": Using communication principles to enhance medication therapy management instruction.

PubMed

Denvir, Paul M; Cardone, Katie E; Parker, Wendy M; Cerulli, Jennifer

2018-02-01

Medication therapy management (MTM) is a comprehensive, patient-centered approach to improving medication use, reducing the risk of adverse events and improving medication adherence. Given the service delivery model and required outputs of MTM services, communication skills are of utmost importance. The objectives of this study were to identify and describe communication principles and instructional practices to enhance MTM training. Drawing on formative assessment data from interviews of both pharmacy educators and alumni, this article identifies and describes communication principles and instructional practices that pharmacy educators can use to enhance MTM training initiatives to develop student communication strategies. Analysis revealed five key communication challenges of MTM service delivery, two communication principles that pharmacy teachers and learners can use to address those challenges, and a range of specific strategies, derived from communication principles, that students can use when challenges emerge. Implications of the analysis for pharmacy educators and researchers are described. Proactive communication training provided during MTM advanced pharmacy practice experiences enabled students to apply the principles and instructional strategies to specific patient interactions during the advanced pharmacy practice experiences and in their post-graduation practice settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Challenges and Opportunities for Exploring Patient-Level Data

PubMed Central

Lopes, Pedro; Silva, Luis Bastião; Oliveira, José Luis

2015-01-01

The proper exploration of patient-level data will pave the way towards personalised medicine. To better assess the state of the art in this field we identify the challenges and uncover the opportunities for the exploration of patient-level data through the review of well-known initiatives and projects focusing on the exploration of patient-level data. These cover a broad array of topics, from genomics to patient registries up to rare diseases research, among others. For each, we identified basic goals, involved partners, defined strategies and key technological and scientific outcomes, establishing the foundation for our analysis framework with four pillars: control, sustainability, technology, and science. Substantial research outcomes have been produced towards the exploration of patient-level data. The potential behind these data will be essential to realise the personalised medicine premise in upcoming years. Hence, relevant stakeholders continually push forward new developments in this domain, bringing novel opportunities that are ripe for exploration. Despite last decade's translational research advances, personalised medicine is still far from being a reality. Patients' data underlying potential goes beyond daily clinical practice. There are miscellaneous challenges and opportunities open for the exploration of these data by academia and business stakeholders. PMID:26504779

SLE-key(®) rule-out serologic test for excluding the diagnosis of systemic lupus erythematosus: Developing the ImmunArray iCHIP(®).

PubMed

Putterman, Chaim; Wu, Alan; Reiner-Benaim, Anat; Batty, D Scott; Sanz, Ignacio; Oates, Jim; Jakobi, Keren; Petri, Michelle; Safer, Pennina; Gerwien, Robert; Sorek, Rachel; Blumenstein, Yakov; Cohen, Irun R

2016-02-01

We describe here the development, verification and validation of the SLE-key(®) rule-out test for a definitive rule-out of a diagnosis of systemic lupus erythematosus (SLE). The test uses the proprietary iCHIP(®) micro-array technology platform (Fattal et al., 2010) to identify discriminating patterns of circulating autoantibodies among SLE patients compared with self-declared healthy individuals. Given the challenges associated with the diagnosis of SLE and the healthcare costs of delayed diagnosis and misdiagnosis, a definitive rule-out test can provide significant clinical benefits to patients and potentially major cost savings to healthcare systems. Copyright © 2015 Elsevier B.V. All rights reserved.

The Future of Home Health Care: A Strategic Framework for Optimizing Value.

PubMed

Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J; McCann, Barbara A; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

2016-11-01

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on "The Future of Home Health Care," the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework.

Model-driven meta-analyses for informing health care: a diabetes meta-analysis as an exemplar.

PubMed

Brown, Sharon A; Becker, Betsy Jane; García, Alexandra A; Brown, Adama; Ramírez, Gilbert

2015-04-01

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points. © The Author(s) 2014.

MODEL-DRIVEN META-ANALYSES FOR INFORMING HEALTH CARE: A DIABETES META-ANALYSIS AS AN EXEMPLAR

PubMed Central

Brown, Sharon A.; Becker, Betsy Jane; García, Alexandra A.; Brown, Adama; Ramírez, Gilbert

2015-01-01

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points. PMID:25142707

Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015.

PubMed

Wolfe, Caitlin M; Hamblion, Esther L; Schulte, Jacqueline; Williams, Parker; Koryon, Augustine; Enders, Jonathan; Sanor, Varlee; Wapoe, Yatta; Kwayon, Dash; Blackley, David J; Laney, Anthony S; Weston, Emily J; Dokubo, Emily K; Davies-Wayne, Gloria; Wendland, Annika; Daw, Valerie T S; Badini, Mehboob; Clement, Peter; Mahmoud, Nuha; Williams, Desmond; Gasasira, Alex; Nyenswah, Tolbert G; Fallah, Mosoka

2017-06-01

Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere.

Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015

PubMed Central

Schulte, Jacqueline; Williams, Parker; Koryon, Augustine; Enders, Jonathan; Sanor, Varlee; Wapoe, Yatta; Kwayon, Dash; Blackley, David J.; Laney, Anthony S.; Weston, Emily J.; Dokubo, Emily K.; Davies-Wayne, Gloria; Wendland, Annika; Daw, Valerie T. S.; Badini, Mehboob; Clement, Peter; Mahmoud, Nuha; Williams, Desmond; Gasasira, Alex; Nyenswah, Tolbert G.; Fallah, Mosoka

2017-01-01

Background Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. Methods The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. Results 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. Conclusions The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere. PMID:28575034

Rural Health Networks and Care Coordination: Health Care Innovation in Frontier Communities to Improve Patient Outcomes and Reduce Health Care Costs

PubMed Central

Conway, Pat; Favet, Heidi; Hall, Laurie; Uhrich, Jenny; Palcher, Jeanette; Olimb, Sarah; Tesch, Nathan; York-Jesme, Margaret; Bianco, Joe

2017-01-01

Rural residents’ health is challenged by high health care costs, chronic diseases, and policy decisions affecting rural health care. This single-case, embedded design study, guided by community-based participatory research principles and using mixed methods, describes outcomes of implementation of a community care team (CCT) and care coordination to improve outcomes of patients living in a frontier community. Seventeen organizations and 165 adults identified as potential care coordination candidates constituted the target populations. Following CCT development, collaboration and cohesion increased among organizations. Patients who participated in care coordination reported similar physical and lower emotional health quality of life than national counterparts; emergency department use decreased following care coordination. Key components identified as successful in urban settings seem applicable in rural settings, with emphasis on the key role of team facilitators; need for intense care coordination for people with complex health needs, especially behavioral health needs; and access to specialty care through technology. PMID:27818417

GENOME-WIDE GENETIC INTERACTION ANALYSIS OF GLAUCOMA USING EXPERT KNOWLEDGE DERIVED FROM HUMAN PHENOTYPE NETWORKS

PubMed Central

HU, TING; DARABOS, CHRISTIAN; CRICCO, MARIA E.; KONG, EMILY; MOORE, JASON H.

2014-01-01

The large volume of GWAS data poses great computational challenges for analyzing genetic interactions associated with common human diseases. We propose a computational framework for characterizing epistatic interactions among large sets of genetic attributes in GWAS data. We build the human phenotype network (HPN) and focus around a disease of interest. In this study, we use the GLAUGEN glaucoma GWAS dataset and apply the HPN as a biological knowledge-based filter to prioritize genetic variants. Then, we use the statistical epistasis network (SEN) to identify a significant connected network of pairwise epistatic interactions among the prioritized SNPs. These clearly highlight the complex genetic basis of glaucoma. Furthermore, we identify key SNPs by quantifying structural network characteristics. Through functional annotation of these key SNPs using Biofilter, a software accessing multiple publicly available human genetic data sources, we find supporting biomedical evidences linking glaucoma to an array of genetic diseases, proving our concept. We conclude by suggesting hypotheses for a better understanding of the disease. PMID:25592582

"Asia is now the priority target for the world anti-tobacco movement": attempts by the tobacco industry to undermine the Asian anti-smoking movement

PubMed Central

Knight, J; Chapman, S

2004-01-01

Study objective: To identify and examine the strategies utilised by multinational tobacco companies to undermine and discredit key anti-tobacco activists and organisations in the Asian region. Method: A series of case studies drawing upon material gathered through systematic reviews of internal tobacco industry documents. Date sources: Tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement. Results: The industry sought to identify, monitor, and isolate key individuals and organisations. The way industry went about fulfilling this mandate in the Asian region is discussed. Industry targetted individuals and agencies along with the region's primary anti-smoking coalition. Conclusions: Attack by multinational tobacco companies is a virtual quid pro quo for any individual or agency seriously challenging industry practices and policies. Understanding their tactics allows anticipatory strategies to be developed to minimise the effectiveness of these attacks. PMID:15564217

A methodology for global-sensitivity analysis of time-dependent outputs in systems biology modelling.

PubMed

Sumner, T; Shephard, E; Bogle, I D L

2012-09-07

One of the main challenges in the development of mathematical and computational models of biological systems is the precise estimation of parameter values. Understanding the effects of uncertainties in parameter values on model behaviour is crucial to the successful use of these models. Global sensitivity analysis (SA) can be used to quantify the variability in model predictions resulting from the uncertainty in multiple parameters and to shed light on the biological mechanisms driving system behaviour. We present a new methodology for global SA in systems biology which is computationally efficient and can be used to identify the key parameters and their interactions which drive the dynamic behaviour of a complex biological model. The approach combines functional principal component analysis with established global SA techniques. The methodology is applied to a model of the insulin signalling pathway, defects of which are a major cause of type 2 diabetes and a number of key features of the system are identified.

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

PubMed

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

2007-06-01

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

N plus 3 Advanced Concept Studies for Supersonic Commercial Transport Aircraft Entering Service in the 2030-2035 Period

NASA Technical Reports Server (NTRS)

Welge, H. Robert; Bonet, John; Magee, Todd; Tompkins, Daniel; Britt, Terry R.; Nelson, Chet; Miller, Gregory; Stenson, Douglas; Staubach, J. Brent; Bala, Naushir;

Adapting bioinformatics curricula for big data.

PubMed

Greene, Anna C; Giffin, Kristine A; Greene, Casey S; Moore, Jason H

2016-01-01

Modern technologies are capable of generating enormous amounts of data that measure complex biological systems. Computational biologists and bioinformatics scientists are increasingly being asked to use these data to reveal key systems-level properties. We review the extent to which curricula are changing in the era of big data. We identify key competencies that scientists dealing with big data are expected to possess across fields, and we use this information to propose courses to meet these growing needs. While bioinformatics programs have traditionally trained students in data-intensive science, we identify areas of particular biological, computational and statistical emphasis important for this era that can be incorporated into existing curricula. For each area, we propose a course structured around these topics, which can be adapted in whole or in parts into existing curricula. In summary, specific challenges associated with big data provide an important opportunity to update existing curricula, but we do not foresee a wholesale redesign of bioinformatics training programs. © The Author 2015. Published by Oxford University Press.

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

PubMed

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

Experimental Models to Study the Role of Microbes in Host-Parasite Interactions.

PubMed

Hahn, Megan A; Dheilly, Nolwenn M

2016-01-01

Until recently, parasitic infections have been primarily studied as interactions between the parasite and the host, leaving out crucial players: microbes. The recent realization that microbes play key roles in the biology of all living organisms is not only challenging our understanding of host-parasite evolution, but it also provides new clues to develop new therapies and remediation strategies. In this paper we provide a review of promising and advanced experimental organismal systems to examine the dynamic of host-parasite-microbe interactions. We address the benefits of developing new experimental models appropriate to this new research area and identify systems that offer the best promises considering the nature of the interactions among hosts, parasites, and microbes. Based on these systems, we identify key criteria for selecting experimental models to elucidate the fundamental principles of these complex webs of interactions. It appears that no model is ideal and that complementary studies should be performed on different systems in order to understand the driving roles of microbes in host and parasite evolution.

Adapting bioinformatics curricula for big data

PubMed Central

Greene, Anna C.; Giffin, Kristine A.; Greene, Casey S.

2016-01-01

Modern technologies are capable of generating enormous amounts of data that measure complex biological systems. Computational biologists and bioinformatics scientists are increasingly being asked to use these data to reveal key systems-level properties. We review the extent to which curricula are changing in the era of big data. We identify key competencies that scientists dealing with big data are expected to possess across fields, and we use this information to propose courses to meet these growing needs. While bioinformatics programs have traditionally trained students in data-intensive science, we identify areas of particular biological, computational and statistical emphasis important for this era that can be incorporated into existing curricula. For each area, we propose a course structured around these topics, which can be adapted in whole or in parts into existing curricula. In summary, specific challenges associated with big data provide an important opportunity to update existing curricula, but we do not foresee a wholesale redesign of bioinformatics training programs. PMID:25829469

The key to successful management of STS operations: An integrated production planning system

NASA Technical Reports Server (NTRS)

Johnson, W. A.; Thomasen, C. T.

1985-01-01

Space Transportation System operations managers are being confronted with a unique set of challenges as a result of increasing flight rates, the demand for flight manifest/production schedule flexibility and an emphasis on continued cost reduction. These challenges have created the need for an integrated production planning system that provides managers with the capability to plan, schedule, status and account for an orderly flow of products and services across a large, multi-discipline organization. With increased visibility into the end-to-end production flow for individual and parallel missions in process, managers can assess the integrated impact of changes, identify and measure the interrelationships of resource, schedule, and technical performance requirements and prioritize productivity enhancements.

Moving from full-time healing work to paid employment: challenges and celebrations.

PubMed

Bergmans, Yvonne; Carruthers, Anne; Ewanchuk, Elizabeth; James, Judy; Wren, Kate; Yager, Christina

2009-01-01

The experiences and barriers associated with the return to paid employment following healing from recurrent suicide attempts related to mental illness have not been addressed in the literature to date. This paper is a collaborative case study between graduates (experts by experience) and facilitators of a psychosocial/psychoeducational group for people with recurrent suicide attempts. The journeys taken by the experts by experience are explored through thematic narrative analysis. Issues of stigma, disclosure, accommodations, maintaining wellness and coming to re-define a sense of self were consistent themes found throughout all narratives. The paper identified key areas of challenge and celebration, suggesting the need for enhanced support from health care providers, workplace managers, supervisors and colleagues for successful transitions into the workplace.

Lunar Regolith Excavation Competition

NASA Technical Reports Server (NTRS)

Liles, Cassandra

2009-01-01

The Lunar Regolith Excavation Competition is a new competition that needs graphics, logos, rules, as well as an arena. Although this is the first year of the competition, the competition is modeled after an existing competition, the Centennial Lunar Excavator Challenge. This competition however is aimed at college students. This makes the challenge identifying key aspects of the original competition and modeling them to fit into an easier task, and creating exciting advertisement that helps encourage participation. By using a youth focus group, young insight, as well as guiding advice from experts in the field, hopefully an arena can be designed and built, rules can be molded and created to fit, and alluring graphics can be printed to bring about a successful first year of the Lunar Regolith Excavation Competition.

Furthering the reliable and valid measurement of mental health screening, diagnoses, treatment and outcomes through health information technology.

PubMed

Haberer, Jessica E; Trabin, Tom; Klinkman, Michael

2013-01-01

Measurement of mental health is challenging; however, many solutions may be found through the use of health information technology. This article reviews current approaches to measuring mental health, focusing on screening, diagnosis, treatment, and outcomes. It then identifies several key areas in which health information technology may advance the field and provide reliable and valid measurements that are readily available to and manageable for providers, as well as acceptable, feasible, and sustainable for selected populations. Although new technologies must overcome many challenges, including privacy, efficiency, cost, and scalability, it is an exciting and fast-growing field with many potential applications and clinical benefit. Copyright © 2013 Elsevier Inc. All rights reserved.

Development activities, challenges and prospects for the hydropower sector in Austria

NASA Astrophysics Data System (ADS)

Wagner, Beatrice; Hauer, Christoph; Habersack, Helmut

2017-04-01

This contribution intends to give an overview of hydropower development activities in Austria and deepen the knowledge on actual strategies and planning documents. Thereby, the focus is on a climate and energy policy based perspective, also analyzing economic trends at the hydropower sector due to energy market changes in the last years. This includes a comparison with other political strategies and programs dealing with hydropower exploitation based on selected countries. With respect to technology developments, a concise review on technological innovations, such as hydrokinetic energy conversion systems, and new constructive designs of conventional hydropower plants in Austria will be given. Moreover, potential impacts on environment and aquatic ecosystems are described. Finally, key challenges and prospects will be identified and discussed.

The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist.

PubMed

Carney, Patricia A; Conry, Colleen M; Mitchell, Karen B; Ericson, Annie; Dickinson, W Perry; Martin, James C; Carek, Peter J; Douglass, Alan B; Eiff, M Patrice

2016-04-01

Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care. We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level. Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies. Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.

Facilitating central line-associated bloodstream infection prevention: a qualitative study comparing perspectives of infection control professionals and frontline staff.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L

2014-10-01

Infection control professionals (ICPs) play a critical role in implementing and managing healthcare-associated infection reduction interventions, whereas frontline staff are responsible for delivering direct and ongoing patient care. The objective of our study was to determine if ICPs and frontline staff have different perspectives about the facilitators and challenges of central line-associated bloodstream infection (CLABSI) prevention program success. We conducted key informant interviews at 8 hospitals that participated in the Agency for Healthcare Research and Quality CLABSI prevention initiative called "On the CUSP: Stop BSI." We analyzed interview data from 50 frontline nurses and 26 ICPs to identify common themes related to program facilitators and challenges. We identified 4 facilitators of CLABSI program success: education, leadership, data, and consistency. We also identified 3 common challenges: lack of resources, competing priorities, and physician resistance. However, the perspective of ICPs and frontline nurses differed. Whereas ICPs tended to focus on general descriptions, frontline staff noted program specifics and often discussed concrete examples. Our results suggest that ICPs need to take into account the perspectives of staff nurses when implementing infection control and broader quality improvement initiatives. Further, the deliberate inclusion of frontline staff in the implementation of these programs may be critical to program success. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania

PubMed Central

Sullivan, Kristen A.; O' Donnell, Karen; Cunningham, Coleen K.; Shayo, Aisa M.; Mmbaga, Blandina T.; Dow, Dorothy E.

2016-01-01

Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12–24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth. PMID:27851797

Implementing a strategy to promote lifelong learning in the primary care workforce: an evaluation of leadership roles, change management approaches, interim challenges and achievements.

PubMed

McLaren, Susan; Woods, Leslie; Boudioni, Markella; Lemma, Ferew; Tavabie, Abdol

2008-01-01

To identify and explore leadership roles and responsibilities for implementing the workforce development strategy; to identify approaches used to implement and disseminate the strategy; and to identify and explore challenges and achievements in the first 18 months following implementation. A formative evaluation with qualitative methods was used. Documentary analysis, interviews (n = 29) and two focus groups (n = 12) were conducted with a purposive sample of individuals responsible for strategy implementation. Data were transcribed and analysed thematically using framework analysis. Regional health area in Kent, Surrey and Sussex: 24 primary care trusts (PCTs) and 900 general practices. Primary care workforce tutors, lifelong learning advisors, GP tutors, patch associate GP deans and chairs of PCT education committees all had vital leadership roles, some existing and others newly developed. Approaches used to implement the strategy encompassed working within and across organisational boundaries, communication and dissemination of information. Challenges encountered by implementers were resistance to change - evident in some negative attitudes to uptake of training and development opportunities - and role diversity and influence. Achievements included successes in embedding appraisal and protected learning time, and changes in educational practices and services. The use of key leadership roles and change-management approaches had brought about early indications of positive transition in lifelong learning cultures.

Global health issues and challenges.

PubMed

Dickenson-Hazard, Nancy

2004-01-01

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

An RNAi-based chemical genetic screen identifies three small-molecule inhibitors of the Wnt/wingless signaling pathway

PubMed Central

Gonsalves, Foster C.; Klein, Keren; Carson, Brittany B.; Katz, Shauna; Ekas, Laura A.; Evans, Steve; Nagourney, Robert; Cardozo, Timothy; Brown, Anthony M. C.; DasGupta, Ramanuj

2011-01-01

Misregulated β-catenin responsive transcription (CRT) has been implicated in the genesis of various malignancies, including colorectal carcinomas, and it is a key therapeutic target in combating various cancers. Despite significant effort, successful clinical implementation of CRT inhibitory therapeutics remains a challenging goal. This is, in part, because of the challenge of identifying inhibitory compounds that specifically modulate the nuclear transcriptional activity of β-catenin while not affecting its cytoskeletal function in stabilizing adherens junctions at the cell membrane. Here, we report an RNAi-based modifier screening strategy for the identification of CRT inhibitors. Our data provide support for the specificity of these inhibitory compounds in antagonizing the transcriptional function of nuclear β-catenin. We show that these inhibitors efficiently block Wnt/β-catenin–induced target genes and phenotypes in various mammalian and cancer cell lines. Importantly, these Wnt inhibitors are specifically cytotoxic to human colon tumor biopsy cultures as well as colon cancer cell lines that exhibit deregulated Wnt signaling. PMID:21393571

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

PubMed

Stroetmann, Karl A; Middleton, Blackford

2011-01-01

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

Game playing.

PubMed

Rosin, Christopher D

2014-03-01

Game playing has been a core domain of artificial intelligence research since the beginnings of the field. Game playing provides clearly defined arenas within which computational approaches can be readily compared to human expertise through head-to-head competition and other benchmarks. Game playing research has identified several simple core algorithms that provide successful foundations, with development focused on the challenges of defeating human experts in specific games. Key developments include minimax search in chess, machine learning from self-play in backgammon, and Monte Carlo tree search in Go. These approaches have generalized successfully to additional games. While computers have surpassed human expertise in a wide variety of games, open challenges remain and research focuses on identifying and developing new successful algorithmic foundations. WIREs Cogn Sci 2014, 5:193-205. doi: 10.1002/wcs.1278 CONFLICT OF INTEREST: The author has declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website. © 2014 John Wiley & Sons, Ltd.

Challenges in Research and Health Technology Assessment of Rare Disease Technologies: Report of the ISPOR Rare Disease Special Interest Group.

PubMed

Nestler-Parr, Sandra; Korchagina, Daria; Toumi, Mondher; Pashos, Chris L; Blanchette, Christopher; Molsen, Elizabeth; Morel, Thomas; Simoens, Steven; Kaló, Zoltán; Gatermann, Ruediger; Redekop, William

2018-05-01

Successful development of new treatments for rare diseases (RDs) and their sustainable patient access require overcoming a series of challenges related to research and health technology assessment (HTA). These impediments, which may be unique to RDs or also apply to common diseases but are particularly pertinent in RDs, are diverse and interrelated. To develop for the first time a catalog of primary impediments to RD research and HTA, and to describe the cause and effect of individual challenges. Challenges were identified by an international 22-person expert working group and qualitative outreach to colleagues with relevant expertise. A broad range of stakeholder perspectives is represented. Draft results were presented at annual European and North American International Society for Pharmacoeconomics and Outcomes Research (ISPOR) congresses, and written comments were received by the 385-strong ISPOR Rare Disease Review Group from two rounds of review. Findings were refined and confirmed via targeted literature search. Research-related challenges linked to the low prevalence of RDs were categorized into those pertaining to disease recognition and diagnosis, evaluation of treatment effect, and patient recruitment for clinical research. HTA-related challenges were classified into issues relating to the lack of a tailored HTA method for RD treatments and uncertainty for HTA agencies and health care payers. Identifying and highlighting diverse, but interrelated, key challenges in RD research and HTA is an essential first step toward developing implementable and sustainable solutions. A collaborative multistakeholder effort is required to enable faster and less costly development of safe, efficacious, and appropriate new RD therapies that offer value for money. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Optimizing Requirements Decisions with KEYS

NASA Technical Reports Server (NTRS)

Jalali, Omid; Menzies, Tim; Feather, Martin

2008-01-01

Recent work with NASA's Jet Propulsion Laboratory has allowed for external access to five of JPL's real-world requirements models, anonymized to conceal proprietary information, but retaining their computational nature. Experimentation with these models, reported herein, demonstrates a dramatic speedup in the computations performed on them. These models have a well defined goal: select mitigations that retire risks which, in turn, increases the number of attainable requirements. Such a non-linear optimization is a well-studied problem. However identification of not only (a) the optimal solution(s) but also (b) the key factors leading to them is less well studied. Our technique, called KEYS, shows a rapid way of simultaneously identifying the solutions and their key factors. KEYS improves on prior work by several orders of magnitude. Prior experiments with simulated annealing or treatment learning took tens of minutes to hours to terminate. KEYS runs much faster than that; e.g for one model, KEYS ran 13,000 times faster than treatment learning (40 minutes versus 0.18 seconds). Processing these JPL models is a non-linear optimization problem: the fewest mitigations must be selected while achieving the most requirements. Non-linear optimization is a well studied problem. With this paper, we challenge other members of the PROMISE community to improve on our results with other techniques.

Identification of Challenges to the Availability and Accessibility of Opioids in Twelve European Countries: Conclusions from Two ATOME Six-Country Workshops.

PubMed

Linge-Dahl, Lisa; Vranken, Marjolein; Juenger, Saskia; North, Kate; Scholten, Willem; Payne, Sheila; Radbruch, Lukas

2015-12-01

Access to many controlled medicines is inadequate in a number of European countries. This leads to deficits in the treatment of moderate to severe pain as well as in opioid agonist therapy. The study objective was to elaborate the reasons for this inadequacy. The work plan of the Access to Opioid Medication in Europe (ATOME) project included two six-country workshops. These workshops comprised a national situational analysis, drafting tailor-made recommendations for improvement and developing action plans for their implementation. In total, 84 representatives of the national Ministries of Health, national controlled substances authorities, experts representing regulatory and law enforcement authorities, leading health care professionals, and patient representatives from 13 European countries participated in either one of the workshops. The delegates used breakout sessions to identify key common challenges. Content analysis was used for the evaluation of protocols and field notes. A number of challenges to opioid accessibility in the countries was identified in the domains of knowledge and educational, regulatory, legislative, as well as public awareness and training barriers that limit opioid prescription. In addition, short validity of prescriptions and bureaucratic practices resulting in overregulation impeded availability of some essential medicines. Stigmatization and criminalisation of people who use drugs remained the major impediment to increasing opioid agonist program coverage. The challenges identified during outcomes of the workshops were used as the basis for subsequent dissemination and implementation activities in the ATOME project, and in some countries the workshop proceedings already served as a stepping-stone for the first changes in regulations and legislation.

Qualitative Analysis of Round-Table Discussions on the Business Case and Procurement Challenges for Hospital Electronic Prescribing Systems

PubMed Central

Cresswell, Kathrin M.; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W.; Sheikh, Aziz

2013-01-01

Objectives There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. Materials and Methods We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. Results We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing “wants” and aspirations from organizational “needs”. Discussion and conclusions Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management. PMID:24260213

Building Public Health Ontario: experience in developing a new public health agency.

PubMed

Goel, Vivek

2012-06-05

The history and development of Ontario's new public health agency, Public Health Ontario, is explored. The governance model and organizational structure are identified along with an overview of the relationship with the Ontario Ministry of Health and Long-Term Care. The strategic mission and vision are described as are the key functions. The building of the organization through new investments and divestments is explained. The paper concludes with an overview of the challenges encountered and the opportunities ahead.

Valorisation of softwood bark through extraction of utilizable chemicals. A review.

PubMed

Jablonsky, M; Nosalova, J; Sladkova, A; Haz, A; Kreps, F; Valka, J; Miertus, S; Frecer, V; Ondrejovic, M; Sima, J; Surina, I

2017-11-01

Softwood bark is an important source for producing chemicals and materials as well as bioenergy. Extraction is regarded as a key technology for obtaining chemicals in general, and valorizing bark as a source of such chemicals in particular. In this paper, properties of 237 compounds identified in various studies dealing with extraction of softwood bark were described. Finally, some challenges and perspectives on the production of chemicals from bark are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

Key attributes of global partnerships in food and nutrition to align research agendas and improve public health.

PubMed

Bertolo, Robert F; Hentges, Eric; Makarchuk, Mary-Jo; Wiggins, Ashleigh K A; Steele, Heather; Levin, Julia; Grantham, Andrea; Gramlich, Leah; Ma, David W L

2018-07-01

Partnerships among academia, government, and industry have emerged in response to global challenges in food and nutrition. At a workshop reviewing international partnerships, we concluded that to build a partnership, partners must establish a common goal, identify barriers, and engage all stakeholders to ensure project sustainability. To be effective, partnerships must synchronize methodologies and adopt evidence-based processes, and be led by governmental or nonprofit organizations to ensure trust among partners and with the public.

Integration of analytical measurements and wireless communications--current issues and future strategies.

PubMed

Diamond, Dermot; Lau, King Tong; Brady, Sarah; Cleary, John

2008-05-15

Rapid developments in wireless communications are opening up opportunities for new ways to perform many types of analytical measurements that up to now have been restricted in scope due to the need to have access to centralised facilities. This paper will address both the potential for new applications and the challenges that currently inhibit more widespread integration of wireless communications with autonomous sensors and analytical devices. Key issues are identified and strategies for closer integration of analytical information and wireless communications systems discussed.

Building a More Diverse Workforce in HIV/AIDS Research: The Time has Come.

PubMed

Stoff, David M; Cargill, Victoria A

2016-09-01

Investigators from diverse racial and ethnic backgrounds are grossly underrepresented in the nation's biomedical research enterprise. Projections of current demographic trends suggest that population growth rates of minority populations will outpace that of the Caucasian population by 2060. Thus, this workforce will remain a poor reflection of the U.S. As a result of this underrepresentation of all sectors of the U.S. populace, the majority of the HIV research involving minority populations-those disproportionately impacted by HIV infection-will be conducted by investigators who do not resemble them. Although this does not necessarily preclude scientifically valid and important research, it produces research without the important cultural and contextual issues that can enhance the utility and generalizability of specific findings or interventions. The goal of this review is to not only raise awareness of the small numbers of minority investigators engaged in biomedical research, but also to identify the challenges to recruiting and retaining these investigators. In this article, while we discuss issues of diversity in general, the focus will be upon the mental health aspects of the HIV epidemic for illustrative purposes: to demonstrate the issues associated with enhancing investigator diversity as a strategy for remediating the chronic shortage of historically underrepresented investigators in scientific research. After presenting the magnitude of the problem and a rationale for enhancing diversity of the biomedical research workforce, we identify a number of potential reasons and challenges for the shortage of minority investigators. Aspects of the mentoring process, together with ten key suggestions, are discussed as the backdrop for the supplement papers that follow (dealing with mentoring principles, challenges, and mentoring-related issues on mentee, mentor, mentee-mentor relationship, and programs). By identifying these realities we hope to: (1) promote greater discussions of these challenges in academic institutions and settings; (2) suggest meaningful strategies to address these challenges; and (3) foster a national discussion about the long-term investment necessary for permanent change, as there are no easy 'fixes' for these challenges.

Challenges in immunisation service delivery for refugees in Australia: A health system perspective.

PubMed

Mahimbo, A; Seale, H; Smith, M; Heywood, A

2017-09-12

Refugees are at risk of being under-immunised in their countries of origin, in transit and post-resettlement in Australia. Whilst studies have focused on identifying barriers to accessibility of health services among refugees, few focus on providers' perspectives on immunisation service delivery to this group. Health service providers are well placed to provide insights into the pragmatic challenges associated with refugee health service delivery, which can be useful in identifying strategies aimed at improving immunisation coverage among this group. A qualitative study involving 30 semi-structured interviews was undertaken with key stakeholders in immunisation service delivery across all States and Territories in Australia between December 2014 and December 2015. Thematic analysis was undertaken. Variability in accessing program funding and vaccines, lack of a national policy for catch-up vaccination, unclear roles and responsibilities for catch-up, a lack of a central immunisation register and insufficient training among general practitioners were seen as the main challenges impacting on immunisation service delivery for refugees. This study provides insight into the challenges that impact on effective immunisation service delivery for refugees. Deliberate strategies such as national funding for relevant vaccines, improved data collection nationally and increased guidance for general practitioners on catch-up immunisation for refugees would help to ensure equitable access across all age groups. Copyright © 2017 Elsevier Ltd. All rights reserved.

Recommendations for sexual expression management in long-term care: a qualitative needs assessment

PubMed Central

Syme, Maggie L.; Lichtenberg, Peter; Moye, Jennifer

2017-01-01

Aims To conduct a qualitative needs assessment of Directors of Nursing regarding challenges and recommendations for addressing sexual expression and consent. Background Sexual expression management among long-term care residents is a complex issue for nursing home staff. Little guidance is available for those wanting to follow a person-centred approach. Policies and procedures are needed, and must be usable across long-term care settings. Design Qualitative design for in-depth exploration. Methods Semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013, representing a range of regions, facility sizes and resident populations. Interview questions prompted them to identify recommendations that address challenges to improving sexual expression management in long-term care settings. Results Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories. Discussion Directors of Nursing report several challenges to sexual expression management in their facilities, and perceive their current methods to be ad hoc. A proactive approach to policy and procedure development is needed. PMID:27188413

Engaging police to identify challenging school crossings and potential improvements.

PubMed

Bull, Catherine B; Von Hagen, Leigh Ann; Lubin, Andrea; Shivaraman, Gayathri; Chibbaro, Daniel

2018-04-26

This paper discusses the value of police officers as vital sources of information regarding pedestrian safety in their communities by presenting results from a survey of traffic safety police officers. The survey requested information on school crossings that the officers considered most challenging for pedestrians. Officers specified the intersections or mid-block locations with school crossings, and answered questions about elements of the locations, such as what makes the locations challenging, and what might be done to improve conditions at these locations. A key finding from the survey is the police officers' identification of challenging intersections or other crossing locations by criteria other than the occurrence of crashes, including reported pedestrian-vehicle near-miss incidents. A broad literature review of pedestrian safety studies provides context for the use of near-miss data in discussions of improvements to pedestrian crossings. Although not typically considered a primary resource for pedestrian safety information, police officers are most often very familiar with their communities, work in locations where pedestrian and motor vehicle traffic can be experienced and observed, and receive information from their staff and members of the public who use pedestrian crossings. The survey findings demonstrate that police officer insights and near-miss data may serve as important supplementary sources of information in the effort to identify locations in need of interventions before crash occurrence. Copyright © 2018 Elsevier Ltd. All rights reserved.

Factors Influencing Men Entering the Nursing Profession, and Understanding the Challenges Faced by Them: Iranian and Developed Countries’ Perspectives

PubMed Central

Zamanzadeh, Vahid; Valizadeh, Leila; Negarandeh, Reza; Monadi, Morteza; Azadi, Arman

2013-01-01

Context: Men entering the nursing profession have been investigated from several different perspectives. Due to male gender characteristics and existing public image, nursing is often not considered as a career choice by men. Whether nursing would benefit from increased number of men is a key question in the literature. The purpose of this integrative review of the literature was to identify factors influencing men to enter the nursing profession. In addition, it sought to understand the challenges they are confronted within this profession. Evidence Acquisition: A systematic search of the existing literature was performed using an Internet search with broad keywords to access related articles in both Persian and English databases. Finally, 34 studies (written between 2000 and early 2013) were selected and surveyed. Results: Most of the studies were conducted in developed counties. The review identified reasons why males choose nursing, and other challenges facing men entering and working in nursing. Themes that emerged from the literature include educational and societal barriers experienced by men in nursing, recruitment, career choice, and role strain. Conclusions: Regarding men’s influences on professional development, and also the importance of gender-based caring, policies for recruitment and retention of men in nursing must be followed hastily. However, there is a need for further research regarding the challenges faced by men entering nursing, in both Iran and other developing countries. PMID:25414879

Mind the gap: implementation challenges break the link between HIV/AIDS research and practice.

PubMed

MacCarthy, Sarah; Reisner, Sari; Hoffmann, Michael; Perez-Brumer, Amaya; Silva-Santisteban, Alfonso; Nunn, Amy; Bastos, Leonardo; Vasconcellos, Mauricio Teixeira Leite de; Kerr, Ligia; Bastos, Francisco Inácio; Dourado, Inês

2016-11-03

Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic.

Mind the gap: implementation challenges break the link between HIV/AIDS research and practice

PubMed Central

MacCarthy, Sarah; Reisner, Sari; Hoffmann, Michael; Perez-Brumer, Amaya; Silva-Santisteban, Alfonso; Nunn, Amy; Bastos, Leonardo; de Vasconcellos, Mauricio Teixeira Leite; Kerr, Ligia; Bastos, Francisco Inácio; Dourado, Inês

2018-01-01

Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic. PMID:27828609

Notification: Key Management Challenges Confronting the U.S. Chemical Safety and Hazard Investigation Board

EPA Pesticide Factsheets

June 9, 2014. The OIG is beginning work to update the fiscal year 2014 list of areas we consider to be the key management challenges confronting the U.S. Chemical Safety and Hazard Investigation Board (CSB).

Identifying nontechnical skills associated with safety in the emergency department: a scoping review of the literature.

PubMed

Flowerdew, Lynsey; Brown, Ruth; Vincent, Charles; Woloshynowych, Maria

2012-05-01

Understanding the nontechnical skills specifically applicable to the emergency department (ED) is essential to facilitate training and more broadly consider interventions to reduce error. The aim of this scoping review is to first identify and then explore in depth the nontechnical skills linked to safety in the ED. The review was conducted in 2 stages. In stage 1, online databases were searched for published empirical studies linking nontechnical skills to safety and performance in the ED. Articles were analyzed to identify key ED nontechnical skills. In stage 2, these key skills were used to generate additional key words, which enabled a second search of the literature to be undertaken and expand on the evidence available for review. In stage 1, 11 articles were retrieved for data analysis and 9 core emergency medicine nontechnical skills were identified. These were communicating, managing workload, anticipating, situational awareness, supervising and providing feedback, leadership, maintaining standards, using assertiveness, and decisionmaking. In stage 2, a secondary search, using these 9 skills and related terms, uncovered a further 21 relevant articles. Therefore, 32 articles were used to describe the main nontechnical skills linked to safety in the ED. This article highlights the challenges of reviewing a topic for which the terms are not clearly defined in the literature. A novel methodological approach is described that provides a structured and transparent process for reviewing the literature in emerging areas of interest. A series of literature reviews focusing on individual nontechnical skills will provide a clearer understanding of how the skills identified contribute to safety in the ED. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Patient-centered communication strategies for patients with aphasia: discrepancies between what patients want and what physicians do.

PubMed

Morris, Megan A; Clayman, Marla L; Peters, Kaitlin J; Leppin, Aaron L; LeBlanc, Annie

2015-04-01

Communication during clinical encounters can be challenging with patients with communication disabilities. Physicians have the potential to positively affect the encounter by using communication strategies that engage the patient in patient-centered communication. We engaged patients and their physicians in defining their preferences for patient-centered communication strategies, then evaluated the use of the identified strategies during observed clinical encounters. We video-recorded 25 clinical encounters with persons with aphasia. All encounters were previously scheduled with community physicians and a companion was present. Following each encounter, physicians completed a brief questionnaire and the person with aphasia and his or her companion participated in a video elicitation interview. While many of the communication strategies identified and described by physicians, patients and companions were similar, patients and companions identified three additional key communication strategies. These strategies included (1) using visual aids, (2) writing down key words while speaking, and (3) using gestures. In the video recorded clinical encounters, no physicians wrote down key words while speaking and only one used a visual aid during the clinical encounter. The frequency with which physicians used gestures varied greatly, even within the same patient, suggesting the use of gestures was independent of patient or companion characteristics. To maximize patient-centered communication with patients with communication disabilities, physicians should use "disability-specific" communication strategies. Our study suggests that physicians should routinely ask patients and companions about communication preferences and then incorporate identified communication strategies into their communication style. Copyright © 2015 Elsevier Inc. All rights reserved.

Molecular basis for photoreceptor outer segment architecture

PubMed Central

Goldberg, Andrew F. X.; Moritz, Orson L.; Williams, David S.

2016-01-01

To serve vision, vertebrate rod and cone photoreceptors must detect photons, convert the light stimuli into cellular signals, and then convey the encoded information to downstream neurons. Rods and cones are sensory neurons that each rely on specialized ciliary organelles to detect light. These organelles, called outer segments, possess elaborate architectures that include many hundreds of light-sensitive membranous disks arrayed one atop another in precise register. These stacked disks capture light and initiate the chain of molecular and cellular events that underlie normal vision. Outer segment organization is challenged by an inherently dynamic nature; these organelles are subject to a renewal process that replaces a significant fraction of their disks (up to ~10%) on a daily basis. In addition, a broad range of environmental and genetic insults can disrupt outer segment morphology to impair photoreceptor function and viability. In this chapter, we survey the major progress that has been made for understanding the molecular basis of outer segment architecture. We also discuss key aspects of organelle lipid and protein composition, and highlight distributions, interactions, and potential structural functions of key OS-resident molecules, including: kinesin-2, actin, RP1, prominin-1, protocadherin 21, peripherin-2/rds, rom-1, glutamic acid-rich proteins, and rhodopsin. Finally, we identify key knowledge gaps and challenges that remain for understanding how normal outer segment architecture is established and maintained. PMID:27260426

Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going?

PubMed

Lenders, Carine M; Manders, Aaron J; Perdomo, Joanna E; Ireland, Kathy A; Barlow, Sarah E

2016-06-01

Since the "2007 summary report of child and adolescent overweight and obesity treatment" published by Barlow, many obesity intervention studies have been conducted in pediatric ambulatory care. Although several meta-analyses have been published in the interim, many studies were excluded because of the focus and criteria of these meta-analyses. Therefore, the primary goal of this article was to identify randomized case-control trials conducted in the primary care setting and to report on treatment approaches, challenges, and successes. We have developed four themes for our discussion and provide a brief summary of our findings. Finally, we identified major gaps and potential solutions and describe several urgent key action items.

Overview of Megacity Air Pollutant Emissions and Impacts

NASA Astrophysics Data System (ADS)

Kolb, C. E.

2013-05-01

The urban metabolism that characterizes major cities consumes very large qualities of humanly produced and/or processed food, fuel, water, electricity, construction materials and manufactured goods, as well as, naturally provided sunlight, precipitation and atmospheric oxygen. The resulting urban respiration exhalations add large quantities of trace gas and particulate matter pollutants to urban atmospheres. Key classes of urban primary air pollutants and their sources will be reviewed and important secondary pollutants identified. The impacts of these pollutants on urban and downwind regional inhabitants, ecosystems, and climate will be discussed. Challenges in quantifying the temporally and spatially resolved urban air pollutant emissions and secondary pollutant production rates will be identified and possible measurement strategies evaluated.

Exploring family physician stress

PubMed Central

Lee, F. Joseph; Brown, Judith Belle; Stewart, Moira

2009-01-01

ABSTRACT OBJECTIVE To explore the nature of professional stress and the strategies used by family physicians to deal with this stress. DESIGN Qualitative study. SETTING Kitchener-Waterloo, Ont. PARTICIPANTS Ten key-informant family physicians. METHODS In-depth interviews were conducted with key informants. A total of 40 key informants were identified, based on selected criteria; 24 provided consent. The potential participants were rank-ordered for interviews to provide maximum variation in age, sex, and years in practice. Interviews were conducted, audiotaped, transcribed verbatim, and analyzed until thematic saturation was reached, as determined through an iterative process. This occurred after 10 in-depth interviews. Immersion and crystallization techniques were used. MAIN FINDINGS The participants described professional stresses and strategies at the personal, occupational, and health care system levels. Personal stressors included personality traits and the need to balance family and career, which were countered by biological, psychological, social, and spiritual strategies. Occupational stressors included challenging patients, high workload, time limitations, competency issues, challenges of documentation and practice management, and changing roles within the workplace. Occupational stressors were countered by strategies such as setting limits, participating in continuing medical education, soliciting support from colleagues and staff, making use of teams, improving patient-physician relationships, exploring new forms of remuneration, and scheduling appropriately. Stressors affecting the wider health care system included limited resources, imposed rules and regulations, lack of support from specialists, feeling undervalued, and financial concerns. CONCLUSION Family physicians face a multitude of challenges at personal, occupational, and health care system levels. A systems approach provides a new framework in which proactive strategies can augment more than one level of a system and, in contrast, reactive strategies can have negative inputs for different system levels. PMID:19282541

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

PubMed

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

2009-11-01

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

Cell differentiation: therapeutical challenges in diabetes.

PubMed

Roche, Enrique; Vicente-Salar, Nestor; Arribas, Maribel; Paredes, Beatriz

2012-01-01

Stem cells, derived from either embryonic or adult tissues, are considered to be potential sources of insulin-secreting cells to be transplanted into type 1 and advanced stages of type 2 diabetic patients. Many laboratories have considered this possibility, resulting in a large amount of published protocols, with a wide degree of complexity among them. Our group was the first to report that it was possible to obtain insulin-secreting cells from mouse embryonic stem cells, proving the feasibility of this new challenge. The same observation was immediately reported using human embryonic stem cells. However, the resulting cell product was not properly characterised, affecting the reproducibility of the protocol by other groups. A more elaborated protocol was developed by Lumelsky and co-workers, demonstrating that neuroectodermal cells could be an alternative source for insulin-producing cells. However, the resulting cells of this protocol produced low amounts of the hormone. This aimed other groups to perform key changes in order to improve the insulin content of the resulting cells. Recently, Baetge's group has published a new protocol based on the knowledge accumulated in pancreatic development. In this protocol, human embryonic stem cells were differentiated into islet-like structures through a five step protocol, emulating the key steps during embryonic development of the endocrine pancreas. The final cell product, however, seemed to be in an immature state, thus further improvement is required. Despite this drawback, the protocol represents the culmination of work performed by different groups and offers new research challenges for the investigators in this exciting field. Concerning adult stem cells, the possibility of identifying pancreatic precursors or of reprogramming extrapancreatic derived cells are key possibilities that may circumvent the problems that appear when using embryonic stem cells, such as immune rejection and tumour formation.

Research Priorities in Mental Health, Justice, and Safety: A Multidisciplinary Stakeholder Report

PubMed Central

Crocker, Anne G.; Nicholls, Tonia L.; Seto, Michael C.; Roy, Laurence; Leclair, Marichelle C.; Brink, Johann; Simpson, Alexander I. F.; Côté, Gilles

2015-01-01

This paper is based on the report following the National Research Agenda Meeting on Mental Health, Justice, and Safety held in Montreal on November 19, 2014, which convened academics; health, social, and legal professionals; and people with lived experience of mental illness from across Canada. The goal was to identify research priorities addressing relevant knowledge gaps and research strategies that can translate into public policy action and improvements in evidence-based services. Participants identified key challenges: (1) inadequate identification and response to needs by civil mental health services and frontline law enforcement, (2) limited specialized resources in forensic and correctional settings, (3) fragmented care and gaps between systems, (4) limited resources for adequate community reintegration, and (5) poor knowledge transfer strategies as obstacles to evidence-based policies. Knowledge gaps were identified in epidemiology and risk reduction, frontline training and programs, forensic and correctional practices, organizations and institutions, knowledge transfer, and rehabilitation. Finally, participants identified potential sources of support to conduct real time research with regard to data collection and sharing. The findings represent a roadmap for how forensic mental health systems can best proceed to address current challenges through research and practice initiatives, drawing from lived, clinical and research experiences of a multidisciplinary group of experts. PMID:26681928

MobiPag: Integrated Mobile Payment, Ticketing and Couponing Solution Based on NFC †

PubMed Central

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Cunha, João Falcão e; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-01-01

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model. PMID:25061838

MobiPag: integrated mobile payment, ticketing and couponing solution based on NFC.

PubMed

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Falcão e Cunha, João; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-07-24

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model.

Workforce insights on how health promotion is practised in an Aboriginal Community Controlled Health Service.

PubMed

McFarlane, Kathryn; Devine, Sue; Judd, Jenni; Nichols, Nina; Watt, Kerrianne

2017-07-01

Aboriginal Community Controlled Health Services deliver holistic and culturally appropriate primary health care to over 150 communities in Australia. Health promotion is a core function of comprehensive primary health care; however, little has been published on what enables or challenges health promotion practice in an Aboriginal Community Controlled Health Service. Apunipima Cape York Health Council (Apunipima) delivers primary health care to 11 remote north Queensland communities. The workforce includes medical, allied health, Aboriginal and Torres Strait Islander health workers and health practitioners and corporate support staff. This study aimed to identify current health promotion practices at Apunipima, and the enablers and challenges identified by the workforce, which support or hinder health promotion practice. Sixty-three staff from across this workforce completed an online survey in February 2015 (42% response rate). Key findings were: (1) health promotion is delivered across a continuum of one-on-one approaches through to population advocacy and policy change efforts; (2) the attitude towards health promotion was very positive; and (3) health promotion capacity can be enhanced at both individual and organisational levels. Workforce insights have identified areas for continued support and areas that, now identified, can be targeted to strengthen the health promotion capacity of Apunipima.

Targeted physical activity messages for parents of children with disabilities: A qualitative investigation of parents' informational needs and preferences.

PubMed

Bassett-Gunter, R L; Ruscitti, R J; Latimer-Cheung, A E; Fraser-Thomas, J L

2017-05-01

Physical activity (PA) has myriad benefits for children with disabilities (CWD). Information and messaging campaigns can promote PA among CWD. The overall purpose of the study was to gain an understanding of the development of PA information and messages targeting parents of CWD. The specific objectives were to identify parents' preferences regarding PA information and messaging content and preferred methods and sources of communication. Focus groups were conducted with parents of CWD (N=28). Qualitative data were collected and transcribed. Inductive content analyses were employed to identify key themes. Three key thematic areas were identified: 1) Preferred content (e.g., targeted information, self-regulatory strategies, inclusive images), 2) Challenges (e.g., lack of information and language clarity), 3) Preferred sources (e.g., other parents, reliable organizations, central information hub). Parents' needs and preferences regarding PA information could be incorporated into campaigns to enhance parent PA support and PA among CWD. Stakeholders (e.g., PA organizations, programs and practitioners) can employ these strategies in campaigns and resources targeting parents of CWD. Research is necessary to empirically develop and evaluate PA information and messaging campaigns targeting parents of CWD. Copyright © 2017 Elsevier Ltd. All rights reserved.

How personal and standardized coordination impact implementation of integrated care.

PubMed

Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

2015-10-02

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.

Global mental health: transformative capacity building in Nicaragua

PubMed Central

Sapag, Jaime C.; Herrera, Andrés; Trainor, Ruth; Caldera, Trinidad; Khenti, Akwatu

2013-01-01

Background Mental health is increasingly recognised as integral to good public health, but this area continues to lack sufficient planning, resources, and global strategy. It is a pressing concern in Latin America, where social determinants of health aggravate existing inequities in access to health services. Nicaragua faces serious mental health needs and challenges. One key strategy for addressing gaps in mental health services is building capacity at the primary healthcare and system levels. Objective Using the framework of best practice literature, this article analyses the four-year collaborative process between the National Autonomous University of Nicaragua in León (UNAN-León) and the Centre for Addiction and Mental Health (CAMH) in Canada, which is aimed at improving mental healthcare in Nicaragua. Design Based on a critical analysis of evaluation reports, key documents, and discussion among partners, the central steps of the collaboration are analysed and main successes and challenges identified. Results A participatory needs assessment identified local strengths and weaknesses, expected outcomes regarding competencies, and possible methodologies and recommendations for the development of a comprehensive capacity-building programme. The partners delivered two international workshops on mental health and addiction with an emphasis on primary healthcare. More recently, an innovative Diploma and Master programme was launched to foster interprofessional leadership and effective action to address mental health and addiction needs. Collaborative activities have taken place in Nicaragua and Canada. Discussion To date, international collaboration between Nicaragua and CAMH has been successful in achieving the jointly defined goals. The process has led to mutual knowledge sharing, strong networking, and extensive educational opportunities. Evidence of effective and respectful global health capacity building is provided. Lessons learned and implications for global health action are identified and discussed. PMID:24088364

A case study of global health at the university: implications for research and action.

PubMed

Pinto, Andrew D; Cole, Donald C; ter Kuile, Aleida; Forman, Lisa; Rouleau, Katherine; Philpott, Jane; Pakes, Barry; Jackson, Suzanne; Muntaner, Carles

2014-01-01

Global health is increasingly a major focus of institutions in high-income countries. However, little work has been done to date to study the inner workings of global health at the university level. Academics may have competing objectives, with few mechanisms to coordinate efforts and pool resources. To conduct a case study of global health at Canada's largest health sciences university and to examine how its internal organization influences research and action. We drew on existing inventories, annual reports, and websites to create an institutional map, identifying centers and departments using the terms 'global health' or 'international health' to describe their activities. We compiled a list of academics who self-identified as working in global or international health. We purposively sampled persons in leadership positions as key informants. One investigator carried out confidential, semi-structured interviews with 20 key informants. Interview notes were returned to participants for verification and then analyzed thematically by pairs of coders. Synthesis was conducted jointly. More than 100 academics were identified as working in global health, situated in numerous institutions, centers, and departments. Global health academics interviewed shared a common sense of what global health means and the values that underpin such work. Most academics interviewed expressed frustration at the existing fragmentation and the lack of strategic direction, financial support, and recognition from the university. This hampered collaborative work and projects to tackle global health problems. The University of Toronto is not exceptional in facing such challenges, and our findings align with existing literature that describes factors that inhibit collaboration in global health work at universities. Global health academics based at universities may work in institutional siloes and this limits both internal and external collaboration. A number of solutions to address these challenges are proposed.

Responding to the Language Challenge: Kaiser Permanente's Approach

PubMed Central

Meyers, Kate; Tang, Gayle; Fernandez, Alicia

2009-01-01

Objective: To inform current debates on improving health care quality for patients with limited English proficiency by identifying the drivers and processes for one large health care delivery system's implementation of particular models, key success factors, and remaining challenges for the field. Study Design: A qualitative case study of the Kaiser Permanente (KP) San Francisco Medical Center's approach to developing linguistic access services and subsequent organizationwide initiatives. Methods: We conducted semistructured interviews with eight current and former clinical and administrative leaders from the KP San Francisco Medical Center and national headquarters. Interviews were analyzed for key themes. Results: KP San Francisco Medical Center developed linguistic and cultural services in response to a confluence of external and internal factors, including changing demographics, care quality challenges, and patient and clinician satisfaction issues. Early strategies included development of language-specific care modules focused on Chinese- and Spanish-speaking members while meeting broader linguistic access and cultural-competency needs through a centralized Multicultural Services Center. Additional approaches across KP regions have focused on improving interpreter services, optimizing use of bilingual staff, and creating a translation infrastructure to improve quality and reduce redundancy in written translation efforts. Conclusions: KP's experiences developing linguistic and cultural care and services since the 1990s provide lessons about decision-making processes and approaches that may guide other health systems, insurers, and policy makers striving to improve care quality and safety for patients with limited English proficiency. PMID:20740094

Nanotechnology on a dime: building affordable research facilities

NASA Astrophysics Data System (ADS)

DiBattista, Jeff; Clare, Donna; Lynch, David

2005-08-01

Designing buildings to house nanotechnology research presents a multitude of well-recognized challenges to architectural and engineering design teams, from environmental control to spatial arrangements to operational functionality. These technical challenges can be solved with relative ease on projects with large budgets: designers have the option of selecting leading-edge systems without undue regard for their expense. This is reflected in the construction cost of many nanotechnology research facilities that run well into the hundreds of millions of dollars. Smaller universities and other institutions need not be shut out of the nanotechnology research field simply because their construction budgets are tens of millions of dollars or less. The key to success for these less expensive projects lies with making good strategic decisions: identifying priorities for the facility in terms of what it will is--and will not--provide to the researchers. Making these strategic decisions puts bounds on the tactical, technical problems that the design team at large must address, allowing them to focus their efforts on the key areas for success. The process and challenges of this strategic decision-making process are examined, with emphasis placed on the types of decisions that must be made and the factors that must be considered when making them. Case study examples of projects undertaken at the University of Alberta are used to illustrate how strategic-level decision-making sets the stage for cutting-edge success on a modest budget.

Participant Recruitment for Studies on Disability and Work: Challenges and Solutions.

PubMed

Lysaght, Rosemary; Kranenburg, Rachelle; Armstrong, Carolyn; Krupa, Terry

2016-06-01

Purpose A number of key issues related to employment of persons with disabilities demand ongoing and effective lines of inquiry. There is evidence, however, that work researchers struggle with recruitment of participants, and that this may limit the types and appropriateness of methods selected. This two phase study sought to identify the nature of recruitment challenges in workplace-based disability research, and to identify strategies for addressing identified barriers. Methods The first phase of this study was a scoping review of the literature to identify the study designs and approaches frequently used in this field of inquiry, and the success of the various recruitment methods in use. In the second phase, we used qualitative methods to explore with employers and other stakeholders in the field their perceived challenges related to participating in disability-related research, and approaches that might address these. Results The most frequently used recruitment methods identified in the literature were non-probability approaches for qualitative studies, and sampling from existing worker databases for survey research. Struggles in participant recruitment were evidenced by the use of multiple recruitment strategies, and heavy reliance on convenience sampling. Employers cited a number of barriers to participation, including time pressures, fear of legal reprisal, and perceived lack of relevance to the organization. Conclusions Participant recruitment in disability-related research is a concern, particularly in studies that require collection of new data from organizations and individuals, and where large probability samples and/or stratified or purposeful samples are desirable. A number of strategies may contribute to improved success, including development of participatory research models that will enhance benefits and perceived benefits of workplace involvement.

Notification: Key Management Challenges Confronting the U.S. Chemical Safety and Hazard Investigation Board - FY2016

EPA Pesticide Factsheets

January 21, 2016. The EPA OIG is beginning work to update for fiscal year 2016 its list of proposed key management challenges and internal control weaknesses confronting the U.S. Chemical Safety and Hazard Investigation Board (CSB).

The anti-human trafficking collaboration model and serving victims: Providers' perspectives on the impact and experience.

PubMed

Kim, Hea-Won; Park, Taekyung; Quiring, Stephanie; Barrett, Diana

2018-01-01

A coalition model is often used to serve victims of human trafficking but little is known about whether the model is adequately meeting the needs of the victims. The purpose of this study was to examine anti-human trafficking collaboration model in terms of its impact and the collaborative experience, including challenges and lessons learned from the service providers' perspective. Mixed methods study was conducted to evaluate the impact of a citywide anti-trafficking coalition model from the providers' perspectives. Web-based survey was administered with service providers (n = 32) and focus groups were conducted with Core Group members (n = 10). Providers reported the coalition model has made important impacts in the community by increasing coordination among the key agencies, law enforcement, and service providers and improving quality of service provision. Providers identified the improved and expanded partnerships among coalition members as the key contributing factor to the success of the coalition model. Several key strategies were suggested to improve the coalition model: improved referral tracking, key partner and protocol development, and information sharing.

Identification of Crew-Systems Interactions and Decision Related Trends

NASA Technical Reports Server (NTRS)

Jones, Sharon Monica; Evans, Joni K.; Reveley, Mary S.; Withrow, Colleen A.; Ancel, Ersin; Barr, Lawrence

2013-01-01

NASA Vehicle System Safety Technology (VSST) project management uses systems analysis to identify key issues and maintain a portfolio of research leading to potential solutions to its three identified technical challenges. Statistical data and published safety priority lists from academic, industry and other government agencies were reviewed and analyzed by NASA Aviation Safety Program (AvSP) systems analysis personnel to identify issues and future research needs related to one of VSST's technical challenges, Crew Decision Making (CDM). The data examined in the study were obtained from the National Transportation Safety Board (NTSB) Aviation Accident and Incident Data System, Federal Aviation Administration (FAA) Accident/Incident Data System and the NASA Aviation Safety Reporting System (ASRS). In addition, this report contains the results of a review of safety priority lists, information databases and other documented references pertaining to aviation crew systems issues and future research needs. The specific sources examined were: Commercial Aviation Safety Team (CAST) Safety Enhancements Reserved for Future Implementation (SERFIs), Flight Deck Automation Issues (FDAI) and NTSB Most Wanted List and Open Recommendations. Various automation issues taxonomies and priority lists pertaining to human factors, automation and flight design were combined to create a list of automation issues related to CDM.

Ethical Challenges and Solutions Regarding Delirium Studies in Palliative Care

PubMed Central

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

2014-01-01

Context Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. Objectives Based on deliberations at the Studies to Understand Delirium in Palliative Care Settings (SUNDIPS) meeting and an associated literature review, this article discusses ethical issues central to the conduct of research on delirious PC patients. Methods Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. We also reviewed statements of relevance to delirium research in major national and international ethics guidelines. Results Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Proposed solutions include designing informed consent statements that are clear, concise, and free of complex phraseology; use of concise, yet accurate, capacity assessment instruments with a minimally burdensome schedule; and use of PC friendly consent models, such as facilitated, deferred, experienced, advance, and proxy models. Conclusion Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC. PMID:24388124

A qualitative study of health information technology in the Canadian public health system.

PubMed

Zinszer, Kate; Tamblyn, Robyn; Bates, David W; Buckeridge, David L

2013-05-25

Although the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system. A qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Identified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health. The application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy.

Information infrastructure for consumer health: a health information exchange stakeholder study.

PubMed

Thornewill, Judah; Dowling, Alan F; Cox, Barbara A; Esterhay, Robert J

2011-05-01

An enabling infrastructure for population-wide health information capture and transfer is beginning to emerge in the U.S. However, the essential infrastructure component that is still missing is effective health information exchange (HIE). Health record banks (HRBs) are one of several possible approaches to achieving HIE. Is the approach viable? If so, what requirements must be satisfied in order for it to succeed? The research, conducted in 2007-2008, explored HRB-related interests, concerns, benefits, payment preferences, design requirements, value propositions, and challenges for 12 healthcare stakeholder groups and the consumers they serve in a U.S. metropolitan area of 1.3 million people. A mixed-methods design was developed in a community action research context. Data were gathered and analyzed through 23 focus groups, 13 web surveys, a consumer phone survey (nonstratified random sample) and follow-up meetings. Recruiting goals for leaders representing targeted groups were achieved using a multi-channel communications strategy. Key themes were identified through data triangulation. Then, requirements, value propositions and challenges were developed through iterative processes of interaction with community members. Results include key themes, design requirements, value propositions, and challenges for 12 stakeholder groups and consumers. The research provides a framework for developing a consumer permission-driven, financially sustainable, community HRB model. However, for such a model to flourish, it will need to be part of a nationwide network of HIEs with compatible HRB approaches able to overcome a number of challenges. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Floods and droughts: friends or foes?

NASA Astrophysics Data System (ADS)

Prudhomme, Christel

2017-04-01

Water hazards are some of the biggest threats to lives and livelihoods globally, causing serious damages to society and infrastructure. But floods and droughts are an essential part of the hydrological regime that ensures fundamental ecosystem functions, providing natural ways to bring in nutrients, flush out pollutants and enabling soils, rivers and lakes natural biodiversity to thrive. Traditionally, floods and droughts are too often considered separately, with scientific advance in process understanding, modelling, statistical characterisation and impact assessment are often done independently, possibly delaying the development of innovative methods that could be applied to both. This talk will review some of the key characteristics of floods and droughts, highlighting differences and commonalties, losses and benefits, with the aim of identifying future key research challenges faced by both current and next generation of hydrologists.

Community-level climate change vulnerability research: trends, progress, and future directions

NASA Astrophysics Data System (ADS)

McDowell, Graham; Ford, James; Jones, Julie

2016-03-01

This study systematically identifies, characterizes, and critically evaluates community-level climate change vulnerability assessments published over the last 25 years (n = 274). We find that while the field has advanced considerably in terms of conceptual framing and methodological approaches, key shortcomings remain in how vulnerability is being studied at the community-level. We argue that vulnerability research needs to more critically engage with the following: methods for evaluating future vulnerability, the relevance of vulnerability research for decision-making, interdependencies between social and ecological systems, attention to researcher / subject power dynamics, critical interpretation of key terms, and consideration of the potentially positive opportunities presented by a changing climate. Addressing these research needs is necessary for generating knowledge that supports climate-affected communities in navigating the challenges and opportunities ahead.

Principles of thermoacoustic energy harvesting

NASA Astrophysics Data System (ADS)

Avent, A. W.; Bowen, C. R.

2015-11-01

Thermoacoustics exploit a temperature gradient to produce powerful acoustic pressure waves. The technology has a key role to play in energy harvesting systems. A time-line in the development of thermoacoustics is presented from its earliest recorded example in glass blowing through to the development of the Sondhauss and Rijke tubes to Stirling engines and pulse-tube cryo-cooling. The review sets the current literature in context, identifies key publications and promising areas of research. The fundamental principles of thermoacoustic phenomena are explained; design challenges and factors influencing efficiency are explored. Thermoacoustic processes involve complex multi-physical coupling and transient, highly non-linear relationships which are computationally expensive to model; appropriate numerical modelling techniques and options for analyses are presented. Potential methods of harvesting the energy in the acoustic waves are also examined.

Metabolic engineering of Saccharomyces cerevisiae for production of fatty acid-derived hydrocarbons.

PubMed

Zhang, Yiming; Nielsen, Jens; Liu, Zihe

2018-06-05

Fatty acid-derived hydrocarbons attract increasing attention as biofuels due to their immiscibility with water, high-energy content, low freezing point, and high compatibility with existing refineries and end-user infrastructures. Yeast Saccharomyces cerevisiae has advantages for production of fatty acid-derived hydrocarbons as its native routes toward fatty acid synthesis involve only a few reactions that allow more efficient conversion of carbon substrates. Here we describe major biosynthetic pathways of fatty acid-derived hydrocarbons in yeast, and summarize key metabolic engineering strategies, including enhancing precursor supply, eliminating competing pathways, and expressing heterologous pathways. With recent advances in yeast production of fatty acid-derived hydrocarbons, our review identifies key research challenges and opportunities for future optimization, and concludes with perspectives and outlooks for further research directions. © 2018 Wiley Periodicals, Inc.

Summary of Key Issues Raised in the Technology for Early Awareness of Addiction and Mental Illness (TEAAM-I) Meeting.

PubMed

Baumel, Amit; Baker, Justin; Birnbaum, Michael L; Christensen, Helen; De Choudhury, Munmun; Mohr, David C; Muench, Fred; Schlosser, Danielle; Titov, Nick; Kane, John M

2018-05-01

Technology provides an unparalleled opportunity to remove barriers to earlier identification and engagement in services for mental and addictive disorders by reaching people earlier in the course of illness and providing links to just-in-time, cost-effective interventions. Achieving this opportunity, however, requires stakeholders to challenge underlying assumptions about traditional pathways to mental health care. In this Open Forum, the authors highlight key issues discussed in the Technology for Early Awareness of Addiction and Mental Illness (TEAAM-I) meeting-held October 13-14, 2016, in New York City-that are related to three identified areas in which technology provides important and unique opportunities to advance early identification, increase service engagement, and decrease the duration of untreated mental and addictive disorders.

What do we know about the needs and challenges of health systems? A scoping review of the international literature.

PubMed

Roncarolo, Federico; Boivin, Antoine; Denis, Jean-Louis; Hébert, Rejean; Lehoux, Pascale

2017-09-08

While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries. We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.'s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis. 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category. This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps.

Grandparent caregiving among rural African Americans in a community in the American South: challenges to health and wellbeing.

PubMed

Clottey, Emmanuel N; Scott, Alison J; Alfonso, Moya L

2015-01-01

An increasing number of grandparents in rural USA are serving as primary caregivers for their grandchildren because of parental incarceration, addiction, joblessness, or illness. Low-income, African American women from the South are overrepresented in this growing population. There is a paucity of research exploring the challenges faced by rural grandparent caregivers, and past studies have not explicitly addressed the potential consequences of rural grandparent caregiving for health. The purpose of this qualitative study was to explore grandparent caregiving among rural, low-income, African American grandmothers in a community in the American South, and to identify challenges to health that arose in that context. McLeroy's social ecological model (SEM) was used to examine these challenges at multiple levels of influence. This qualitative interview-based study was conducted in a high-poverty community in rural Georgia. In-depth interviews were conducted with African American grandparent caregivers and key informants from local community-based organizations. A key informant assisted in identifying initial interview participants, and then snowball sampling was used to recruit additional participants. Interview questions were grouped under five domains (intrapersonal, interpersonal, community, organizational, and policy), according to the levels of the SEM. Iterative content analysis of interview transcripts was utilized. Transcripts were coded to identify text segments related to each domain of the SEM, which were grouped together for analysis by domain. Reflexive memo-writing aided in development of themes, and data quality was assessed using Lincoln and Guba's trustworthiness criteria. Rural African American grandparent caregivers faced a range of challenges to health. Direct physical challenges included chronic pain that interfered with sleep and daily functioning, mobility issues exacerbated by child care, and the pressure of managing their own medical conditions as well as their grandchildren's. Financial scarcity added to their vulnerability to poor health outcomes, especially when caregivers would forego purchase of medications or visits to the doctor because of expenses related to their grandchildren. In addition, lack of child care made health appointments and hospitalizations logistically difficult. Emotional strain was common as grandparent caregivers struggled to protect their grandchildren in communities where rates of drug use, HIV, and incarceration were high. Caregivers worried about their mortality and the related consequences for their grandchildren. Chronic stress, which is linked to a number of poor health outcomes, was self-reported by most rural grandparent caregivers. In this study, the challenges of rural grandparent caregiving among African American women posed multiple threats to health and wellbeing. Further research is needed, in different rural contexts and with different caregiver populations, to more thoroughly examine the health risks of grandparent caregiving. In addition, the development of multi-faceted interventions and programs will be critical to meeting the needs of rural grandparent caregivers. A few models for such programs exist, although resource shortfalls have often limited their impact.

Integrating modelling and smart sensors for environmental and human health

PubMed Central

Reis, Stefan; Seto, Edmund; Northcross, Amanda; Quinn, Nigel W.T.; Convertino, Matteo; Jones, Rod L.; Maier, Holger R.; Schlink, Uwe; Steinle, Susanne; Vieno, Massimo; Wimberly, Michael C.

2015-01-01

Sensors are becoming ubiquitous in everyday life, generating data at an unprecedented rate and scale. However, models that assess impacts of human activities on environmental and human health, have typically been developed in contexts where data scarcity is the norm. Models are essential tools to understand processes, identify relationships, associations and causality, formalize stakeholder mental models, and to quantify the effects of prevention and interventions. They can help to explain data, as well as inform the deployment and location of sensors by identifying hotspots and areas of interest where data collection may achieve the best results. We identify a paradigm shift in how the integration of models and sensors can contribute to harnessing ‘Big Data’ and, more importantly, make the vital step from ‘Big Data’ to ‘Big Information’. In this paper, we illustrate current developments and identify key research needs using human and environmental health challenges as an example. PMID:26644778

Management, Analysis, and Visualization of Experimental and Observational Data – The Convergence of Data and Computing

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

Bethel, E. Wes; Greenwald, Martin; Kleese van Dam, Kerstin

Scientific user facilities—particle accelerators, telescopes, colliders, supercomputers, light sources, sequencing facilities, and more—operated by the U.S. Department of Energy (DOE) Office of Science (SC) generate ever increasing volumes of data at unprecedented rates from experiments, observations, and simulations. At the same time there is a growing community of experimentalists that require real-time data analysis feedback, to enable them to steer their complex experimental instruments to optimized scientific outcomes and new discoveries. Recent efforts in DOE-SC have focused on articulating the data-centric challenges and opportunities facing these science communities. Key challenges include difficulties coping with data size, rate, and complexity inmore » the context of both real-time and post-experiment data analysis and interpretation. Solutions will require algorithmic and mathematical advances, as well as hardware and software infrastructures that adequately support data-intensive scientific workloads. This paper presents the summary findings of a workshop held by DOE-SC in September 2015, convened to identify the major challenges and the research that is needed to meet those challenges.« less

Management, Analysis, and Visualization of Experimental and Observational Data -- The Convergence of Data and Computing

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

Bethel, E. Wes; Greenwald, Martin; Kleese van Dam, Kersten

Scientific user facilities---particle accelerators, telescopes, colliders, supercomputers, light sources, sequencing facilities, and more---operated by the U.S. Department of Energy (DOE) Office of Science (SC) generate ever increasing volumes of data at unprecedented rates from experiments, observations, and simulations. At the same time there is a growing community of experimentalists that require real-time data analysis feedback, to enable them to steer their complex experimental instruments to optimized scientific outcomes and new discoveries. Recent efforts in DOE-SC have focused on articulating the data-centric challenges and opportunities facing these science communities. Key challenges include difficulties coping with data size, rate, and complexity inmore » the context of both real-time and post-experiment data analysis and interpretation. Solutions will require algorithmic and mathematical advances, as well as hardware and software infrastructures that adequately support data-intensive scientific workloads. This paper presents the summary findings of a workshop held by DOE-SC in September 2015, convened to identify the major challenges and the research that is needed to meet those challenges.« less

Assessment of Aerodynamic Challenges of a Variable-Speed Power Turbine for Large Civil Tilt-Rotor Application

NASA Technical Reports Server (NTRS)

Welch, Gerand E.

2010-01-01

The main rotors of the NASA Large Civil Tilt-Rotor notional vehicle operate over a wide speed-range (100% at take-off to 54% at cruise). The variable-speed power turbine, when coupled to a fixed-gear-ratio transmission, offers one approach to accomplish this speed variation. The key aero-challenges of the variable-speed power turbine are related to high work factors at cruise, where the power turbine operates at 54% of take-off speed, wide incidence variations into the vane, blade, and exit-guide-vane rows associated with the power-turbine speed change, and the impact of low aft-stage Reynolds number (transitional flow) at 28 kft cruise. Meanline and 2-D Reynolds-Averaged Navier- Stokes analyses are used to characterize the variable-speed power-turbine aerodynamic challenges and to outline a conceptual design approach that accounts for multi-point operation. Identified technical challenges associated with the aerodynamics of high work factor, incidence-tolerant blading, and low Reynolds numbers pose research needs outlined in the paper

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana.

PubMed

Mupara, Lucia U; Lubbe, Johanna C

2016-01-01

Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.

Experiencing work as a daily challenge: the case of scleroderma.

PubMed

Mendelson, Cindy; Poole, Janet L; Allaire, Saralynn

2013-01-01

Little is known about the physical and discretionary aspects of work that people with scleroderma (SSc) find difficult. This article describes the findings from a study that explored the challenges and adaptations made by individuals with SSc to continue to work. Thirty-two employed individuals with SSc participated. Participants were predominantly women (82%), white (79%), and well educated (M = 16.9 years). The average age was 47.3 years, and 60.6% were married. Mean disease duration was 9.7 years, and 56.2% had diffuse SSc. Mean years on the job was 10.2 (SD ± 8.8), and 71.9% worked at least 35 hours per week. Participants engaged in a single structured interview about work-related challenges and adaptations. Content and thematic analysis was used to identify key themes across the interviews. Employees with SSc experienced Work as a daily challenge. This central theme described the general work experience for most participants. Three subthemes described their specific experiences: The work environment: Opportunities, challenges, and accommodations; Career planning; and Supportive others. The participants were anxious to find scenarios that allowed them to continue to work. Worksite accommodations and flexibility in scheduling can make the difference between working and disability.

A Primer on Observational Measurement.

PubMed

Girard, Jeffrey M; Cohn, Jeffrey F

2016-08-01

Observational measurement plays an integral role in a variety of scientific endeavors within biology, psychology, sociology, education, medicine, and marketing. The current article provides an interdisciplinary primer on observational measurement; in particular, it highlights recent advances in observational methodology and the challenges that accompany such growth. First, we detail the various types of instrument that can be used to standardize measurements across observers. Second, we argue for the importance of validity in observational measurement and provide several approaches to validation based on contemporary validity theory. Third, we outline the challenges currently faced by observational researchers pertaining to measurement drift, observer reactivity, reliability analysis, and time/expense. Fourth, we describe recent advances in computer-assisted measurement, fully automated measurement, and statistical data analysis. Finally, we identify several key directions for future observational research to explore.

Simulation and Modeling Efforts to Support Decision Making in Healthcare Supply Chain Management

PubMed Central

Lazarova-Molnar, Sanja

2014-01-01

Recently, most healthcare organizations focus their attention on reducing the cost of their supply chain management (SCM) by improving the decision making pertaining processes' efficiencies. The availability of products through healthcare SCM is often a matter of life or death to the patient; therefore, trial and error approaches are not an option in this environment. Simulation and modeling (SM) has been presented as an alternative approach for supply chain managers in healthcare organizations to test solutions and to support decision making processes associated with various SCM problems. This paper presents and analyzes past SM efforts to support decision making in healthcare SCM and identifies the key challenges associated with healthcare SCM modeling. We also present and discuss emerging technologies to meet these challenges. PMID:24683333

At the Intersection of Networks and Highly Interactive Online Games

NASA Astrophysics Data System (ADS)

Armitage, Grenville

The game industry continues to evolves its techniques for extracting the most realistic 'immersion' experience for players given the vagaries on best-effort Internet service. A key challenge for service providers is understanding the characteristics of traffic imposed on networks by games, and their service quality requirements. Interactive online games are particularly susceptible to the side effects of other non-interactive (or delay- and loss-tolerant) traffic sharing next- generation access links. This creates challenges out toward the edges, where high-speed home LANs squeeze through broadband consumer access links to reach the Internet. In this chapter we identify a range of research work exploring many issues associated with the intersection of highly interactive games and the Internet, and hopefully stimulate some further thinking along these lines.

Big Data: Next-Generation Machines for Big Science

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

Hack, James J.; Papka, Michael E.

Addressing the scientific grand challenges identified by the US Department of Energy’s (DOE’s) Office of Science’s programs alone demands a total leadership-class computing capability of 150 to 400 Pflops by the end of this decade. The successors to three of the DOE’s most powerful leadership-class machines are set to arrive in 2017 and 2018—the products of the Collaboration Oak Ridge Argonne Livermore (CORAL) initiative, a national laboratory–industry design/build approach to engineering nextgeneration petascale computers for grand challenge science. These mission-critical machines will enable discoveries in key scientific fields such as energy, biotechnology, nanotechnology, materials science, and high-performance computing, and servemore » as a milestone on the path to deploying exascale computing capabilities.« less

Rinderpest: the veterinary perspective on eradication

PubMed Central

Roeder, Peter; Mariner, Jeffrey; Kock, Richard

2013-01-01

Rinderpest was a devastating disease of livestock responsible for continent-wide famine and poverty. Centuries of veterinary advances culminated in 2011 with the UN Food and Agriculture Organization and the World Organization for Animal Health declaring global eradication of rinderpest; only the second disease to be eradicated and the greatest veterinary achievement of our time. Conventional control measures, principally mass vaccination combined with zoosanitary procedures, led to substantial declines in the incidence of rinderpest. However, during the past decades, innovative strategies were deployed for the last mile to overcome diagnostic and surveillance challenges, unanticipated variations in virus pathogenicity, circulation of disease in wildlife populations and to service remote and nomadic communities in often-unstable states. This review provides an overview of these challenges, describes how they were overcome and identifies key factors for this success. PMID:23798687

From Theory to Practice: One Agency's Experience with Implementing an Evidence-Based Model.

PubMed

Murray, Maureen; Culver, Tom; Farmer, Betsy; Jackson, Leslie Ann; Rixon, Brian

2014-07-01

As evidence-based practice is becoming integrated into children's mental health services as a means of improving outcomes for children and youth with severe behavioral and emotional problems, therapeutic foster care (TFC) which is a specialized treatment program for such youth, is one of few community-based programs considered to be evidence-based. "Together Facing the Challenge" (TFTC) which was developed as a component of a randomized trial of TFC has been identified as an evidence-based model. We describe the experiences reported by one of the agencies that participated in our study and how they have incorporated TFTC into their on-going practice. They highlight key implementation strategies, challenges faced, and lessons learned as they moved forward towards full implementation of TFTC throughout their agency.

International practice experiences in pharmacy education.

PubMed

Cisneros, Robert M; Jawaid, Sarah Parnapy; Kendall, Debra A; McPherson, Charles E; Mu, Keli; Weston, Grady Scott; Roberts, Kenneth B

2013-11-12

To identify reasons for inclusion of international practice experiences in pharmacy curricula and to understand the related structure, benefits, and challenges related to the programs. A convenience sample of 20 colleges and schools of pharmacy in the United States with international pharmacy education programs was used. Telephone interviews were conducted by 2 study investigators. University values and strategic planning were among key driving forces in the development of programs. Global awareness and cultural competency requirements added impetus to program development. Participants' advice for creating an international practice experience program included an emphasis on the value of working with university health professions programs and established travel programs. Despite challenges, colleges and schools of pharmacy value the importance of international pharmacy education for pharmacy students as it increases global awareness of health needs and cultural competencies.

Constructing the informatics and information technology foundations of a medical device evaluation system: a report from the FDA unique device identifier demonstration.

PubMed

Drozda, Joseph P; Roach, James; Forsyth, Thomas; Helmering, Paul; Dummitt, Benjamin; Tcheng, James E

2018-02-01

The US Food and Drug Administration (FDA) has recognized the need to improve the tracking of medical device safety and performance, with implementation of Unique Device Identifiers (UDIs) in electronic health information as a key strategy. The FDA funded a demonstration by Mercy Health wherein prototype UDIs were incorporated into its electronic information systems. This report describes the demonstration's informatics architecture. Prototype UDIs for coronary stents were created and implemented across a series of information systems, resulting in UDI-associated data flow from manufacture through point of use to long-term follow-up, with barcode scanning linking clinical data with UDI-associated device attributes. A reference database containing device attributes and the UDI Research and Surveillance Database (UDIR) containing the linked clinical and device information were created, enabling longitudinal assessment of device performance. The demonstration included many stakeholders: multiple Mercy departments, manufacturers, health system partners, the FDA, professional societies, the National Cardiovascular Data Registry, and information system vendors. The resulting system of systems is described in detail, including entities, functions, linkage between the UDIR and proprietary systems using UDIs as the index key, data flow, roles and responsibilities of actors, and the UDIR data model. The demonstration provided proof of concept that UDIs can be incorporated into provider and enterprise electronic information systems and used as the index key to combine device and clinical data in a database useful for device evaluation. Keys to success and challenges to achieving this goal were identified. Fundamental informatics principles were central to accomplishing the system of systems model. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Working and caring for a child with chronic illness: A review of current literature.

PubMed

Kish, A M; Newcombe, P A; Haslam, D M

2018-05-01

Advances in medical knowledge have contributed to the increase in the number of children living with some form of long-term chronic illness or condition. As a consequence of these advancements, treatments that are more accessible and easier to administer, usually within a child's home, have been developed. However, this may mean that parents take on greater treatment responsibility and require extra time and energy to meet these tasks, additional to other responsibilities. This review paper aims to summarize and critique existing literature on working parents of children with a chronic condition, by focusing on patterns of parent work, the challenges experienced, and the flow-on consequences to well-being. Employing a narrative, meta-synthesis of the current literature, this review identified 3 key themes related to working parents of children with chronic illness. The paper first identifies that although employment is less common, these parents are not necessarily nonworking. Second, these parents experience numerous challenges including balancing work and family, time constraints, stress, and feelings of "doing it all." And third, the above challenges lead to additional impacts on parental quality of life. This review summarizes what is currently known about work patterns, challenges, and consequences in parents of children with chronic conditions. Employment is clearly impacted for these parents. Although workplace challenges have been extensively researched, other challenges (eg, personal and family) and impacts on their well-being have not. This review discusses the present standing of this research. It outlines the strengths and limitations of the current literature, makes recommendations for future research, and suggests theoretical and practical implications of the further findings. © 2018 John Wiley & Sons Ltd.

Curated Collection for Educators: Five Key Papers about the Flipped Classroom Methodology.

PubMed

King, Andrew; Boysen-Osborn, Megan; Cooney, Robert; Mitzman, Jennifer; Misra, Asit; Williams, Jennifer; Dulani, Tina; Gottlieb, Michael

2017-10-25

The flipped classroom (FC) pedagogy is becoming increasingly popular in medical education due to its appeal to the millennial learner and potential benefits in knowledge acquisition. Despite its popularity and effectiveness, the FC educational method is not without challenges. In this article, we identify and summarize several key papers relevant to medical educators interested in exploring the FC teaching methodology. The authors identified an extensive list of papers relevant to FC pedagogy via online discussions within the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. This list was augmented by an open call on Twitter (utilizing the #meded, #FOAMed, and #flippedclassroom hashtags) yielding a list of 33 papers. We then conducted a three-round modified Delphi process within the authorship group, which included both junior and senior clinician educators, to identify the most impactful papers for educators interested in FC pedagogy. The three-round modified Delphi process ranked all of the selected papers and selected the five most highly-rated papers for inclusion. The authorship group reviewed and summarized these papers with specific consideration given to their value to junior faculty educators and faculty developers interested in the flipped classroom approach. The list of papers featured in this article serves as a key reading list for junior clinician educators and faculty developers interested in the flipped classroom technique. The associated commentaries contextualize the importance of these papers for medical educators aiming to optimize their understanding and implementation of the flipped classroom methodology in their teaching and through faculty development.

Facilitating the improved management of waste in South Africa through a national waste information system

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

Godfrey, Linda

2008-07-01

Developing a waste information system (WIS) for a country is more than just about collecting routine data on waste; it is about facilitating the improved management of waste by providing timely, reliable information to the relevant role-players. It is a means of supporting the waste governance challenges facing South Africa - challenges ranging from strategic waste management issues at national government to basic operational challenges at local government. The paper addresses two hypotheses. The first is that the identified needs of government can provide a platform from which to design a national WIS framework for a developing country such asmore » South Africa, and the second is that the needs for waste information reflect greater, currently unfulfilled challenges in the sustainable management of waste. Through a participatory needs analysis process, it is shown that waste information is needed by the three spheres of government, to support amongst others, informed planning and decision-making, compliance monitoring and enforcement, community participation through public access to information, human, infrastructure and financial resource management and policy development. These needs for waste information correspond closely with key waste management challenges currently facing the country. A shift in governments approach to waste, in line with national and international policy, is evident from identified current and future waste information needs. However, the need for information on landfilling remains entrenched within government, possibly due to the poor compliance of landfill sites in South Africa and the problems around the illegal disposal of both general and hazardous waste.« less

Capacity building efforts and perceptions for wildlife surveillance to detect zoonotic pathogens: comparing stakeholder perspectives.

PubMed

Schwind, Jessica S; Goldstein, Tracey; Thomas, Kate; Mazet, Jonna A K; Smith, Woutrina A

2014-07-04

The capacity to conduct zoonotic pathogen surveillance in wildlife is critical for the recognition and identification of emerging health threats. The PREDICT project, a component of United States Agency for International Development's Emerging Pandemic Threats program, has introduced capacity building efforts to increase zoonotic pathogen surveillance in wildlife in global 'hot spot' regions where zoonotic disease emergence is likely to occur. Understanding priorities, challenges, and opportunities from the perspectives of the stakeholders is a key component of any successful capacity building program. A survey was administered to wildlife officials and to PREDICT-implementing in-country project scientists in 16 participating countries in order to identify similarities and differences in perspectives between the groups regarding capacity needs for zoonotic pathogen surveillance in wildlife. Both stakeholder groups identified some human-animal interfaces (i.e. areas of high contact between wildlife and humans with the potential risk for disease transmission), such as hunting and markets, as important for ongoing targeting of wildlife surveillance. Similarly, findings regarding challenges across stakeholder groups showed some agreement in that a lack of sustainable funding across regions was the greatest challenge for conducting wildlife surveillance for zoonotic pathogens (wildlife officials: 96% and project scientists: 81%). However, the opportunity for improving zoonotic pathogen surveillance capacity identified most frequently by wildlife officials as important was increasing communication or coordination among agencies, sectors, or regions (100% of wildlife officials), whereas the most frequent opportunities identified as important by project scientists were increasing human capacity, increasing laboratory capacity, and the growing interest or awareness regarding wildlife disease or surveillance programs (all identified by 69% of project scientists). A One Health approach to capacity building applied at local and global scales will have the greatest impact on improving zoonotic pathogen surveillance in wildlife. This approach will involve increasing communication and cooperation across ministries and sectors so that experts and stakeholders work together to identify and mitigate surveillance gaps. Over time, this transdisciplinary approach to capacity building will help overcome existing challenges and promote efficient targeting of high risk interfaces for zoonotic pathogen transmission.

Exploring the rewards and challenges of paediatric palliative care work - a qualitative study of a multi-disciplinary children's hospice care team.

PubMed

Taylor, Johanna; Aldridge, Jan

2017-12-16

Children's hospices are a key provider of palliative care for children and young people with life-limiting and life-threatening conditions. However, despite recent policy attention to the provision of paediatric palliative care, little is known about the role of children's hospice staff and the factors that may impact on their wellbeing at work. This study explored the rewards and challenges of working in a children's hospice with an aim to identify staff support and development needs. We conducted an exploratory, qualitative study involving thematic analysis of semi-structured interviews with 34 staff and three focus groups with 17 staff working in a multi-disciplinary care team in a UK children's hospice. Participants identified rewards and challenges related to the direct work of caring for children and their families; team dynamics and organisational structures; and individual resilience and job motivation. Participants described the work as emotionally intensive and multi-faceted; 'getting it right' for children was identified as a strong motivator and reward, but also a potential stressor as staff strived to maintain high standards of personalised and emotional care. Other factors were identified as both a reward and stressor, including team functioning, the allocation of work, meeting parent expectations, and the hospice environment. Many participants identified training needs for different aspects of the role to help them feel more confident and competent. Participants also expressed concerns about work-related stress, both for themselves and for colleagues, but felt unable to discuss this at work. Informal support from colleagues and group clinical reflection were identified as primary resources to reflect on and learn from work and for emotional support. However, opportunities for this were limited. Providing regular, structured, and dedicated clinical reflection provides a mechanism through which children's hospice staff can come together for support and learning, and demonstrates an organisational commitment to staff wellbeing and development. Being aware of children's hospice specific rewards and challenges can help to ensure that staff feel supported and competent in their role. Breaking down barriers to discussing work-related stress and enhancing awareness about early signs of burnout is also important.

World Health organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead.

PubMed

Tol, Wietse A; Barbui, Corrado; Bisson, Jonathan; Cohen, Judith; Hijazi, Zeinab; Jones, Lynne; de Jong, Joop T V M; Magrini, Nicola; Omigbodun, Olayinka; Seedat, Soraya; Silove, Derrick; Souza, Renato; Sumathipala, Athula; Vijayakumar, Lakshmi; Weissbecker, Inka; Zatzick, Douglas; van Ommeren, Mark

2014-12-01

Wietse Tol and colleagues discuss some of the key challenges for implementation of new WHO guidelines for stress-related mental health disorders in low- and middle-income countries. Please see later in the article for the Editors' Summary.

Key Challenges and Future Directions for Educational Research on Scientific Argumentation

ERIC Educational Resources Information Center

Henderson, J. Bryan; McNeill, Katherine L.; González-Howard, María; Close, Kevin; Evans, Mat

2018-01-01

At the 2015 "NARST: A Worldwide Organization for Improving Science Teaching and Learning Through Research" Annual International Conference, a group of scholars held an extended pre-conference workshop to discuss key challenges and future directions faced by argumentation researchers around the world. This wide-ranging group of…

Challenges and leadership strategies for managers of nurse practitioners.

PubMed

Reay, Trish; Golden-Biddle, Karen; Germann, Kathy

2003-11-01

The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role. Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies. We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are: * encourage all team members to sort out 'who does what'; * ensure that task reallocation preserves job motivating properties; * give consideration to how tasks have been allocated when issues identified as 'personal conflict' arise; * pay attention to all perspectives of the working relationships within the team; * facilitate positive relationships between team members; * lead from a 'balcony' perspective; * work with the team to develop goals that are not over focused on the nurse practitioner; * regularly share with other managers the experiences and lessons learned in introducing nurse practitioners. For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in health organizations.

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings.

PubMed

Raykar, Nakul P; Yorlets, Rachel R; Liu, Charles; Goldman, Roberta; Greenberg, Sarah L M; Kotagal, Meera; Farmer, Paul E; Meara, John G; Roy, Nobhojit; Gillies, Rowan D

2016-01-01

5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges-the specific circumstances-faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges. From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst. Providers described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient-provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences.

Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues

PubMed Central

2013-01-01

Background If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted. Methods Electronic databases and organisation websites were searched using a 22 year time horizon (1990–2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers. Results We identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist. Conclusions In this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may find it useful to think in this broader paradigm with respect to public health economics. We offer a 12 point checklist to support government, NHS commissioners and individual health economists in their consideration of economic evaluation methodology with respect to the additional challenges of applying health economics to public health. PMID:24153037

Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues.

PubMed

Edwards, Rhiannon Tudor; Charles, Joanna Mary; Lloyd-Williams, Huw

2013-10-24

If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted. Electronic databases and organisation websites were searched using a 22 year time horizon (1990-2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers. We identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist. In this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may find it useful to think in this broader paradigm with respect to public health economics. We offer a 12 point checklist to support government, NHS commissioners and individual health economists in their consideration of economic evaluation methodology with respect to the additional challenges of applying health economics to public health.

Are medical educators following General Medical Council guidelines on obesity education: if not why not?

PubMed Central

2013-01-01

Background Although the United Kingdom’s (UK’s) General Medical Council (GMC) recommends that graduating medical students are competent to discuss obesity and behaviour change with patients, it is difficult to integrate this education into existing curricula, and clinicians report being unprepared to support patients needing obesity management in practice. We therefore aimed to identify factors influencing the integration of obesity management education within medical schools. Methods Twenty-seven UK and Irish medical school educators participated in semi-structured interviews. Grounded theory principles informed data collection and analysis. Themes emerging directly from the dataset illustrated key challenges for educators and informed several suggested solutions. Results Factors influencing obesity management education included: 1) Diverse and opportunistic learning and teaching, 2) Variable support for including obesity education within undergraduate medical programmes, and 3) Student engagement in obesity management education. Findings suggest several practical solutions to identified challenges including clarifying recommended educational agendas; improving access to content-specific guidelines; and implementing student engagement strategies. Conclusions Students’ educational experiences differ due to diverse interpretations of GMC guidelines, educators’ perceptions of available support for, and student interest in obesity management education. Findings inform the development of potential solutions to these challenges which may be tested further empirically. PMID:23578257