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

An Interactive Multimedia Dichotomous Key for Teaching Plant Identification

ERIC Educational Resources Information Center

Jacquemart, Anne-Laure; Lhoir, Pierre; Binard, Fabian; Descamps, Charlotte

2016-01-01

Teaching plant identification includes demonstrating how to use dichotomous keys; this requires knowledge of numerous botanical terms and can be challenging, confusing and frustrating for students. Here, we developed a multimedia tool to help students (1) learn botanical terms, (2) practice, train and test their knowledge of plant identification…

Listening for Prescriptions: A National Consultation on Pharmaceutical Policy Issues

PubMed Central

Morgan, Steve; Cunningham, Colleen M.

2010-01-01

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

RSA-Based Password-Authenticated Key Exchange, Revisited

NASA Astrophysics Data System (ADS)

Shin, Seonghan; Kobara, Kazukuni; Imai, Hideki

The RSA-based Password-Authenticated Key Exchange (PAKE) protocols have been proposed to realize both mutual authentication and generation of secure session keys where a client is sharing his/her password only with a server and the latter should generate its RSA public/private key pair (e, n), (d, n) every time due to the lack of PKI (Public-Key Infrastructures). One of the ways to avoid a special kind of off-line (so called e-residue) attacks in the RSA-based PAKE protocols is to deploy a challenge/response method by which a client verifies the relative primality of e and φ(n) interactively with a server. However, this kind of RSA-based PAKE protocols did not give any proof of the underlying challenge/response method and therefore could not specify the exact complexity of their protocols since there exists another security parameter, needed in the challenge/response method. In this paper, we first present an RSA-based PAKE (RSA-PAKE) protocol that can deploy two different challenge/response methods (denoted by Challenge/Response Method1 and Challenge/Response Method2). The main contributions of this work include: (1) Based on the number theory, we prove that the Challenge/Response Method1 and the Challenge/Response Method2 are secure against e-residue attacks for any odd prime e (2) With the security parameter for the on-line attacks, we show that the RSA-PAKE protocol is provably secure in the random oracle model where all of the off-line attacks are not more efficient than on-line dictionary attacks; and (3) By considering the Hamming weight of e and its complexity in the. RSA-PAKE protocol, we search for primes to be recommended for a practical use. We also compare the RSA-PAKE protocol with the previous ones mainly in terms of computation and communication complexities.

Behaviour change for better health: nutrition, hygiene and sustainability.

PubMed

Newson, Rachel S; Lion, Rene; Crawford, Robert J; Curtis, Valerie; Elmadfa, Ibrahim; Feunekes, Gerda I J; Hicks, Cheryl; van Liere, Marti; Lowe, C Fergus; Meijer, Gert W; Pradeep, B V; Reddy, K Srinath; Sidibe, Myriam; Uauy, Ricardo

2013-01-01

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled 'Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability'. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today's environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes - particularly in developing and emerging countries - imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public-private partnerships.

Behaviour change for better health: nutrition, hygiene and sustainability

PubMed Central

2013-01-01

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled ‘Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability’. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today’s environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes – particularly in developing and emerging countries – imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public–private partnerships. PMID:23530770

Blended Learning in Higher Education: Current and Future Challenges in Surveying Education

ERIC Educational Resources Information Center

El-Mowafy, Ahmed; Kuhn, Michael; Snow, Tony

2013-01-01

The development of a blended learning approach to enhance surveying education is discussed. The need for this learning strategy is first investigated based on a major review of the surveying course, including analysis of its content, benchmarking with key national and international universities, and surveys of key stakeholders. Appropriate blended…

Challenges in conducting a community-based influenza vaccine trial in a rural community in northern India.

PubMed

Kumar, Rakesh; Amarchand, Ritvik; Narayan, Venkatesh Vinayak; Saha, Siddhartha; Lafond, Kathryn E; Kapoor, Suresh K; Dar, Lalit; Jain, Seema; Krishnan, Anand

2018-04-04

Evidence on influenza vaccine effectiveness from low and middle countries (LMICs) is limited due to limited institutional capacities; lack of adequate resources; and lack of interest by ministries of health for influenza vaccine introduction. There are concerns that the highest ethical standards will be compromised during trials in LMICs leading to mistrust of clinical trials. These factors pose regulatory and operational challenges to researchers in these countries. We conducted a community-based vaccine trial to assess the efficacy of live attenuated influenza vaccine and inactivated influenza vaccine in rural north India. Key regulatory challenges included obtaining regulatory approvals, reporting of adverse events, and compensating subjects for trial-related injuries; all of which were required to be completed in a timely fashion. Key operational challenges included obtaining audio-visual consent; maintaining a low attrition rate; and administering vaccines during a narrow time period before the influenza season, and under extreme heat. We overcame these challenges through advanced planning, and sustaining community engagement. We adapted the trial procedures to cope with field conditions by conducting mock vaccine camps; and planned for early morning vaccination to mitigate threats to the cold chain. These lessons may help investigators to confront similar challenges in other LMICs.

The Challenges and Future of Public Higher Education Leadership in Kenya

ERIC Educational Resources Information Center

Odhiambo, George

2014-01-01

This article discusses some of the key challenges and points of tension pertaining to leadership in higher education in Kenya. Effective leadership approaches are discussed including an exploration of why effective leadership is more important in Kenyan public higher education now than ever. Given the complex context within which public higher…

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

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

Shared Electronic Health Record Systems: Key Legal and Security Challenges.

PubMed

Christiansen, Ellen K; Skipenes, Eva; Hausken, Marie F; Skeie, Svein; Østbye, Truls; Iversen, Marjolein M

2017-11-01

Use of shared electronic health records opens a whole range of new possibilities for flexible and fruitful cooperation among health personnel in different health institutions, to the benefit of the patients. There are, however, unsolved legal and security challenges. The overall aim of this article is to highlight legal and security challenges that should be considered before using shared electronic cooperation platforms and health record systems to avoid legal and security "surprises" subsequent to the implementation. Practical lessons learned from the use of a web-based ulcer record system involving patients, community nurses, GPs, and hospital nurses and doctors in specialist health care are used to illustrate challenges we faced. Discussion of possible legal and security challenges is critical for successful implementation of shared electronic collaboration systems. Key challenges include (1) allocation of responsibility, (2) documentation routines, (3) and integrated or federated access control. We discuss and suggest how challenges of legal and security aspects can be handled. This discussion may be useful for both current and future users, as well as policy makers.

Freshness-Preserving Non-Interactive Hierarchical Key Agreement Protocol over WHMS

PubMed Central

Kim, Hyunsung

2014-01-01

The digitization of patient health information (PHI) for wireless health monitoring systems (WHMSs) has brought many benefits and challenges for both patients and physicians. However, security, privacy and robustness have remained important challenges for WHMSs. Since the patient's PHI is sensitive and the communication channel, i.e., the Internet, is insecure, it is important to protect them against unauthorized entities, i.e., attackers. Otherwise, failure to do so will not only lead to the compromise of a patient's privacy, but will also put his/her life at risk. This paper proposes a freshness-preserving non-interactive hierarchical key agreement protocol (FNKAP) for WHMSs. The FNKAP is based on the concept of the non-interactive identity-based key agreement for communication efficiency. It achieves patient anonymity between a patient and physician, session key secrecy and resistance against various security attacks, especially including replay attacks. PMID:25513824

Freshness-preserving non-interactive hierarchical key agreement protocol over WHMS.

PubMed

Kim, Hyunsung

2014-12-10

The digitization of patient health information (PHI) for wireless health monitoring systems (WHMSs) has brought many benefits and challenges for both patients and physicians. However, security, privacy and robustness have remained important challenges for WHMSs. Since the patient's PHI is sensitive and the communication channel, i.e., the Internet, is insecure, it is important to protect them against unauthorized entities, i.e., attackers. Otherwise, failure to do so will not only lead to the compromise of a patient's privacy, but will also put his/her life at risk. This paper proposes a freshness-preserving non-interactive hierarchical key agreement protocol (FNKAP) for WHMSs. The FNKAP is based on the concept of the non-interactive identity-based key agreement for communication efficiency. It achieves patient anonymity between a patient and physician, session key secrecy and resistance against various security attacks, especially including replay attacks.

Challenges and Opportunities for School Improvement: Recommendations for Urban School Principals

ERIC Educational Resources Information Center

Dolph, David

2017-01-01

Insofar as urban school systems that are often identified as ineffective include such a large segment of U.S. P-12 students, it is vital to improve academic success. To provide context, the article first discusses key challenges facing urban schools. Second, the article identifies and briefly reviews a variety of approaches to reform models often…

Evolution of the Intelligent Telecommunications Network.

ERIC Educational Resources Information Center

Mayo, John S.

1982-01-01

Discusses the evolution of the nationwide telecommunications network, including key technologies (transistors, communications satellites, and lasers), putting these technologies together, current and future services, and challenges for the future. (JN)

Thermal and Power Challenges in High Performance Computing Systems

NASA Astrophysics Data System (ADS)

Natarajan, Venkat; Deshpande, Anand; Solanki, Sudarshan; Chandrasekhar, Arun

2009-05-01

This paper provides an overview of the thermal and power challenges in emerging high performance computing platforms. The advent of new sophisticated applications in highly diverse areas such as health, education, finance, entertainment, etc. is driving the platform and device requirements for future systems. The key ingredients of future platforms are vertically integrated (3D) die-stacked devices which provide the required performance characteristics with the associated form factor advantages. Two of the major challenges to the design of through silicon via (TSV) based 3D stacked technologies are (i) effective thermal management and (ii) efficient power delivery mechanisms. Some of the key challenges that are articulated in this paper include hot-spot superposition and intensification in a 3D stack, design/optimization of thermal through silicon vias (TTSVs), non-uniform power loading of multi-die stacks, efficient on-chip power delivery, minimization of electrical hotspots etc.

Monitoring biological diversity: strategies, tools, limitations, and challenges

USGS Publications Warehouse

Beever, E.A.

2006-01-01

Monitoring is an assessment of the spatial and temporal variability in one or more ecosystem properties, and is an essential component of adaptive management. Monitoring can help determine whether mandated environmental standards are being met and can provide an early-warning system of ecological change. Development of a strategy for monitoring biological diversity will likely be most successful when based upon clearly articulated goals and objectives and may be enhanced by including several key steps in the process. Ideally, monitoring of biological diversity will measure not only composition, but also structure and function at the spatial and temporal scales of interest. Although biodiversity monitoring has several key limitations as well as numerous theoretical and practical challenges, many tools and strategies are available to address or overcome such challenges; I summarize several of these. Due to the diversity of spatio-temporal scales and comprehensiveness encompassed by existing definitions of biological diversity, an effective monitoring design will reflect the desired sampling domain of interest and its key stressors, available funding, legal requirements, and organizational goals.

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

Morrison-Saunders, Angus, E-mail: a.morrison-saunders@murdoch.edu.au; North-West University; Pope, Jenny, E-mail: jenny@integral-sustainability.net

This paper conceptualises what sustainability assessment follow-up might entail for three models of sustainability assessment: EIA-driven integrated assessment, objectives-led integrated assessment and the contribution to sustainability model. The first two are characterised by proponent monitoring and evaluation of individual impacts and indicators while the latter takes a holistic view based around focused sustainability criteria relevant to the context. The implications of three sustainability challenges on follow-up are also examined: contested time horizons and value changes, trade-offs, and interdisciplinarity. We conclude that in order to meet these challenges some form of adaptive follow-up is necessary and that the contribution to sustainabilitymore » approach is the best approach. -- Highlights: • We explore sustainability follow-up for three different sustainability models. • Long-time frames require adaptive follow-up and are a key follow-up challenge. • Other key challenges include interdisciplinarity, and trade-offs. • Sustainability follow-up should be a direction of travel and not an outcome. • Only the follow-up for contribution to sustainability model addresses sustainability challenges sufficiently.« less

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

PubMed Central

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

2017-01-01

Abstract 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. PMID:28369396

Whose Job Is It? Key Challenges and Future Directions for Online Accessibility in US Institutions of Higher Education

ERIC Educational Resources Information Center

Linder, Kathryn E.; Fontaine-Rainen, Danielle L.; Behling, Kirsten

2015-01-01

This article reports on a national study conducted in the United States on the current institutional practices, structures, resources and policies that are needed to ensure online accessibility for all students at colleges and universities. Key findings include the need to better articulate who is responsible for online accessibility initiatives…

Adult Learning: A Key for the 21st Century. CONFINTEA V Background Papers (Hamburg, Germany, July 14-18, 1997).

ERIC Educational Resources Information Center

Adult Education and Development, 1997

1997-01-01

The following papers are included: "Foreword" (Jakob Horn, Paul Belanger); "Internationalization and Globalization" (Ove Korsgaard); "Adult Learning and the Challenges of the 21st Century" (Marc-Laurent Hazoume); "Diversity in Adult Education: Some Key Concepts in Minority and Indigenous Issues" (Linda King de Jardon); "The Culture of Peace: The…

Speed-Accuracy Tradeoffs in Speech Production

DTIC Science & Technology

2017-06-01

imaging data of speech production. A theoretical framework for considering Fitts’ law in the domain of speech production is elucidated. Methodological ...articulatory kinematics conform to Fitts’ law. A second, associated goal is to address the methodological challenges inherent in performing Fitts-style...analysis on rtMRI data of speech production. Methodological challenges include segmenting continuous speech into specific motor tasks, defining key

Implementation of an inter-agency transition model for youth with spina bifida.

PubMed

Lindsay, S; Cruickshank, H; McPherson, A C; Maxwell, J

2016-03-01

To address gaps in transfer of care and transition support, a paediatric hospital and adult community health care centre partnered to implement an inter-agency transition model for youth with spina bifida. Our objective was to understand the enablers and challenges experienced in the implementation of the model. Using a descriptive, qualitative design, we conducted semi-structured interviews, in-person or over the phone, with 12 clinicians and nine key informants involved in implementing the spina bifida transition model. We recruited all 21 participants from an urban area of Ontario, Canada. Clinicians and key informants experienced several enablers and challenges in implementing the spina bifida transition model. Enablers included dedicated leadership, advocacy, funding, inter-agency partnerships, cross-appointed staff and gaps in co-ordinated care to connect youth to adult services. Challenges included gaps in the availability of adult specialty services, limited geographical catchment of adult services, limited engagement of front-line staff, gaps in communication and role clarity. Although the transition model has realized some initial successes, there are still many challenges to overcome in transferring youth with spina bifida to adult health care and transitioning to adulthood. © 2015 John Wiley & Sons Ltd.

Applying health economics for policy decision making: do devices differ from drugs?

PubMed

Sorenson, Corinna; Tarricone, Rosanna; Siebert, Markus; Drummond, Michael

2011-05-01

Medical devices pose unique challenges for economic evaluation and associated decision-making processes that differ from pharmaceuticals. We highlight and discuss these challenges in the context of cardiac device therapy, based on a systematic review of relevant economic evaluations. Key challenges include practical difficulties in conducting randomized clinical trials, allowing for a 'learning curve' and user characteristics, accounting for the wider organizational impacts of introducing new devices, and allowing for variations in product characteristics and prices over time.

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 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.

Global Antimicrobial Stewardship: A Closer Look at the Formidable Implementation Challenges

PubMed Central

Tiong, John J. L.; Loo, Jason S. E.; Mai, Chun-Wai

2016-01-01

Antimicrobial stewardship (AMS) has been touted as one of the key strategies required in tackling worldwide escalation of antibiotic resistance. Although AMS has optimized antibiotic usage and reduced the incidence of resistance development in some regions, its full global potential has been curtailed by various AMS-impeding factors. This article seeks to highlight in a detailed perspective, the key challenges that hamper global AMS endeavors, some of which include the paucity of effective implementation strategies that cater for the challenging settings of developing nations, the slow response of governments, uncoordinated AMS activities as well as implementation fragmentation across different sectors and countries. The authors of this article call upon all stakeholders to pay attention to these seemingly obvious but often under-addressed problems. If left unresolved, this may render all current and future AMS initiatives pointless. PMID:27899924

Challenges for fuel cells as stationary power resource in the evolving energy enterprise

NASA Astrophysics Data System (ADS)

Rastler, Dan

The primary market challenges for fuel cells as stationary power resources in evolving energy markets are reviewed. Fuel cell power systems have significant barriers to overcome in their anticipated role as decentralized energy power systems. Market segments for fuel cells include combined heat and power; low-cost energy, premium power; peak shaving; and load management and grid support. Understanding the role and fit of fuel cell systems in evolving energy markets and the highest value applications are a major challenge for developers and government funding organizations. The most likely adopters of fuel cell systems and the challenges facing each adopter in the target market segment are reviewed. Adopters include generation companies, utility distribution companies, retail energy service providers and end-users. Key challenges include: overcoming technology risk; achieving retail competitiveness; understanding high value markets and end-user needs; distribution and service channels; regulatory policy issues; and the integration of these decentralized resources within the electrical distribution system.

Overview of Variable-Speed Power-Turbine Research

NASA Technical Reports Server (NTRS)

Welch, Gerard E.

2011-01-01

The vertical take-off and landing (VTOL) and high-speed cruise capability of the NASA Large Civil Tilt-Rotor (LCTR) notional vehicle is envisaged to enable increased throughput in the national airspace. A key challenge of the LCTR is the requirement to vary the main rotor speeds from 100% at take-off to near 50% at cruise as required to minimize mission fuel burn. The variable-speed power-turbine (VSPT), driving a fixed gear-ratio transmission, provides one approach for effecting this wide speed variation. The key aerodynamic and rotordynamic challenges of the VSPT were described in the FAP Conference presentation. The challenges include maintaining high turbine efficiency at high work factor, wide (60 deg.) of incidence variation in all blade rows due to the speed variation, and operation at low Reynolds numbers (with transitional flow). The PT -shaft of the VSPT must be designed for safe operation in the wide speed range required, and therefore poses challenges associated with rotordynamics. The technical challenges drive research activities underway at NASA. An overview of the NASA SRW VSPT research activities was provided. These activities included conceptual and preliminary aero and mechanical (rotordynamics) design of the VSPT for the LCTR application, experimental and computational research supporting the development of incidence tolerant blading, and steps toward component-level testing of a variable-speed power-turbine of relevance to the LCTR application.

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.

Methodological Challenges in Studies Examining the Effects of Breakfast on Cognitive Performance and Appetite in Children and Adolescents.

PubMed

Adolphus, Katie; Bellissimo, Nick; Lawton, Clare L; Ford, Nikki A; Rains, Tia M; Totosy de Zepetnek, Julia; Dye, Louise

2017-01-01

Breakfast is purported to confer a number of benefits on diet quality, health, appetite regulation, and cognitive performance. However, new evidence has challenged the long-held belief that breakfast is the most important meal of the day. This review aims to provide a comprehensive discussion of the key methodological challenges and considerations in studies assessing the effect of breakfast on cognitive performance and appetite control, along with recommendations for future research. This review focuses on the myriad challenges involved in studying children and adolescents specifically. Key methodological challenges and considerations include study design and location, sampling and sample section, choice of objective cognitive tests, choice of objective and subjective appetite measures, merits of providing a fixed breakfast compared with ad libitum, assessment and definition of habitual breakfast consumption, transparency of treatment condition, difficulty of isolating the direct effects of breakfast consumption, untangling acute and chronic effects, and influence of confounding variables. These methodological challenges have hampered a clear substantiation of the potential positive effects of breakfast on cognition and appetite control and contributed to the debate questioning the notion that breakfast is the most important meal of the day. © 2017 American Society for Nutrition.

Methodological Challenges in Studies Examining the Effects of Breakfast on Cognitive Performance and Appetite in Children and Adolescents123

PubMed Central

Bellissimo, Nick; Ford, Nikki A; Rains, Tia M

2017-01-01

Breakfast is purported to confer a number of benefits on diet quality, health, appetite regulation, and cognitive performance. However, new evidence has challenged the long-held belief that breakfast is the most important meal of the day. This review aims to provide a comprehensive discussion of the key methodological challenges and considerations in studies assessing the effect of breakfast on cognitive performance and appetite control, along with recommendations for future research. This review focuses on the myriad challenges involved in studying children and adolescents specifically. Key methodological challenges and considerations include study design and location, sampling and sample section, choice of objective cognitive tests, choice of objective and subjective appetite measures, merits of providing a fixed breakfast compared with ad libitum, assessment and definition of habitual breakfast consumption, transparency of treatment condition, difficulty of isolating the direct effects of breakfast consumption, untangling acute and chronic effects, and influence of confounding variables. These methodological challenges have hampered a clear substantiation of the potential positive effects of breakfast on cognition and appetite control and contributed to the debate questioning the notion that breakfast is the most important meal of the day. PMID:28096143

Cunning Plan--How Will We Ever Manage to Teach All That?! A Cunning Plan for Building Useful Knowledge at Key Stage 3 and Transferring it to Key Stage 4

ERIC Educational Resources Information Center

Carr, Elizabeth

2016-01-01

Planning to deliver the new GCSE [General Certificate of Secondary Education] specifications presents a challenge and an opportunity to any history department, whatever their previous specification. The sweep of history that students will now study at GCSE is much broader than "Modern World" departments are used to; including a medieval…

DOD Financial Management: Effect of Continuing Weaknesses on Management and Operations and Status of Key Challenges

DTIC Science & Technology

2014-05-13

the information needed to effectively (1) manage its assets, (2) assess program performance and make budget decisions , (3) make cost- effective ... decision making, including the information needed to effectively (1) manage its assets, (2) assess program performance and make budget decisions , (3...incorporating key elements of a comprehensive management approach , such as a complete analysis of the return on investment, quantitatively -defined goals

Electronic Ramp to Success: Designing Campus Web Pages for Users with Disabilities.

ERIC Educational Resources Information Center

Coombs, Norman

2002-01-01

Discusses key issues in addressing the challenge of Web accessibility for people with disabilities, including tools for Web authoring, repairing, and accessibility validation, and relevant legal issues. Presents standards for Web accessibility, including the Section 508 Standards from the Federal Access Board, and the World Wide Web Consortium's…

Access to a Schoolwide Thinking Curriculum: Leadership Challenges and Solutions.

ERIC Educational Resources Information Center

Morocco, Catherine Cobb; Walker, Andrea; Lewis, Leslie R.

2003-01-01

This article discusses how an urban middle school designed to reflect a Schools for Thought model has demonstrated that urban schools can achieve excellent results on statewide testing for all students, including those with disabilities. Key school features are highlighted, including the use of "cross-talk" to stimulate discussion and student…

NASA and the challenge of ISDN: The role of satellites in an ISDN world

NASA Technical Reports Server (NTRS)

Byerly, Radford; Barnes, Frank; Codding, George; Hofgard, Jefferson

1988-01-01

To understand what role satellites may play in Integrated Services Digital Network (ISDN), it is necessary to understand the concept of ISDN, including key organizations involved, the current status of key standards recommendations, and domestic and international progress implementation of ISDN. Each of these areas are explained. A summary of the technical performance criteria for ISDN, current standards for satellites in ISDN, key players in the ISDN environment, and what steps can be taken to encourage application of satellites in ISDN are also covered.

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

PubMed

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

2014-01-01

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

Data Access, Interoperability and Sustainability: Key Challenges for the Evolution of Science Capabilities

NASA Astrophysics Data System (ADS)

Walton, A. L.

2015-12-01

In 2016, the National Science Foundation (NSF) will support a portfolio of activities and investments focused upon challenges in data access, interoperability, and sustainability. These topics are fundamental to science questions of increasing complexity that require multidisciplinary approaches and expertise. Progress has become tractable because of (and sometimes complicated by) unprecedented growth in data (both simulations and observations) and rapid advances in technology (such as instrumentation in all aspects of the discovery process, together with ubiquitous cyberinfrastructure to connect, compute, visualize, store, and discover). The goal is an evolution of capabilities for the research community based on these investments, scientific priorities, technology advances, and policies. Examples from multiple NSF directorates, including investments by the Advanced Cyberinfrastructure Division, are aimed at these challenges and can provide the geosciences research community with models and opportunities for participation. Implications for the future are highlighted, along with the importance of continued community engagement on key issues.

Challenges and perspectives in quantitative NMR.

PubMed

Giraudeau, Patrick

2017-01-01

This perspective article summarizes, from the author's point of view at the beginning of 2016, the major challenges and perspectives in the field of quantitative NMR. The key concepts in quantitative NMR are first summarized; then, the most recent evolutions in terms of resolution and sensitivity are discussed, as well as some potential future research directions in this field. A particular focus is made on methodologies capable of boosting the resolution and sensitivity of quantitative NMR, which could open application perspectives in fields where the sample complexity and the analyte concentrations are particularly challenging. These include multi-dimensional quantitative NMR and hyperpolarization techniques such as para-hydrogen-induced polarization or dynamic nuclear polarization. Because quantitative NMR cannot be dissociated from the key concepts of analytical chemistry, i.e. trueness and precision, the methodological developments are systematically described together with their level of analytical performance. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Mars Design Reference Architecture 5.0 Study: Executive Summary

NASA Technical Reports Server (NTRS)

Drake, Bret G.

2008-01-01

The NASA Mars Design Reference Architecture 5.0 Study seeks to update its long term goals and objective for human exploration missions; flight and surface systems for human missions and supporting infrastructure; operational concept for human and robotic exploration of Mars; key challenges including risk and cost drivers; and, its development schedule options. It additionally seeks to assess strategic linkages between lunar and Mars strategies and develop and understanding of methods for reducing the cost/risk of human Mars missions through investment in research, technology development, and synergy with other exploration plans. Recommendations are made regarding conjunction class (long-stay) missions which are seen as providing the best balance of cost, risk, and performance. Additionally, this study reviews entry, descent, and landing challenges; in-space transportation systems; launch vehicle and Orion assessments; risk and risk mitigation; key driving requirements and challenges; and, lunar linkages.

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

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.

National health inequality monitoring: current challenges and opportunities.

PubMed

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Schlotheuber, Anne; Boerma, Ties

National health inequality monitoring needs considerably more investment to realize equity-oriented health improvements in countries, including advancement towards the Sustainable Development Goals. Following an overview of national health inequality monitoring and the associated resource requirements, we highlight challenges that countries may encounter when setting up, expanding or strengthening national health inequality monitoring systems, and discuss opportunities and key initiatives that aim to address these challenges. We provide specific proposals on what is needed to ensure that national health inequality monitoring systems are harnessed to guide the reduction of health inequalities.

Schools as Sites for Recruiting Participants and Implementing Research.

PubMed

Bartlett, Robin; Wright, Tiffany; Olarinde, Tia; Holmes, Tara; Beamon, Emily R; Wallace, Debra

2017-01-01

Schools can be a valuable resource for recruitment of participants for research involving children, adolescents, and parents. Awareness of the benefits and challenges of working with schools can assist researchers in developing effective school partnerships. This article discusses the advantages of conducting research within the school system as well as the challenges that may also arise. Such challenges include developing key contacts, building relationships, logistical arrangements, and facilitating trust in the research topic and team. Suggestions for strategies to forge successful collaborative relationships with schools are provided.

Medical Support for Aircraft Disaster Search and Recovery Operations at Sea: the RSN Experience.

PubMed

Teo, Kok Ann Colin; Chong, Tse Feng Gabriel; Liow, Min Han Lincoln; Tang, Kong Choong

2016-06-01

The maritime environment presents a unique set of challenges to search and recovery (SAR) operations. There is a paucity of information available to guide provision of medical support for SAR operations for aircraft disasters at sea. The Republic of Singapore Navy (RSN) took part in two such SAR operations in 2014 which showcased the value of a military organization in these operations. Key considerations in medical support for similar operations include the resultant casualty profile and challenges specific to the maritime environment, such as large distances of area of operations from land, variable sea states, and space limitations. Medical support planning can be approached using well-established disaster management life cycle phases of preparedness, mitigation, response, and recovery, which all are described in detail. This includes key areas of dedicated training and exercises, force protection, availability of air assets and chamber support, psychological care, and the forensic handling of human remains. Relevant lessons learned by RSN from the Air Asia QZ8501 search operation are also included in the description of these key areas. Teo KAC , Chong TFG , Liow MHL , Tang KC . Medical support for aircraft disaster search and recovery operations at sea: the RSN experience. Prehosp Disaster Med. 2016; 31(3):294-299.

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.

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.

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

Beyond Barriers: Encouraging Teacher Use of Feedback Resources. A Report from the Teacher Feedback Resources Project

ERIC Educational Resources Information Center

Morgan, Nicholas; Killion, Joellen

2018-01-01

This report investigates factors that drive teachers to embrace or challenge the use of products and services designed to support improvements in practice. Key elements of the study include: (1) Technology-based resources studied include those designed for video observations, peer feedback and collaboration, online professional learning, and…

Parenting.

ERIC Educational Resources Information Center

Ziff, Barry, Ed.; Hostettler, Karen, Ed.

1989-01-01

The newsletter of the California Association for the Gifted includes the following brief articles on parenting: "Your Challenge, Their Lives" (Barry Ziff); "Courage to Be Who I Am, Unafraid" (Elizabeth Meckstroth); "Attribution: A Key to Encouraging More Responsible Behavior in the Gifted" (Saundra Sparling); "A Parent's Perspective" (Carolyn…

How To Stay Stuck in the Wrong Career.

ERIC Educational Resources Information Center

Ibarra, Herminia

2002-01-01

An effective midlife career change is challenging to bring about successfully. Identity and its relationship to work are key factors. A three-point plan to a successful career change includes the following: know thyself, consult trusted advisors, and think big. (JOW)

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.

Case Study: The Role of eLearning in Midwifery Pre-Service Education in Ghana.

PubMed

Appiagyei, Martha; Trump, Alison; Danso, Evans; Yeboah, Alex; Searle, Sarah; Carr, Catherine

The issues and challenges of implementing eLearning in pre-service health education were explored through a pilot study conducted in six nurse-midwifery education programs in Ghana. Case-based, interactive computer mediated eLearning modules, targeted to basic emergency and obstetrical signal functions, were delivered both online and offline using a free-for-use eLearning platform, skoool HE(®). Key success factors included broad stakeholder support, an established curriculum and student and tutor interest. Challenges included infrastructure limitations, large class sizes and added workloads for tutors and information technology staff. National scale up is planned.

Hospital Decontamination: What Nurses Need to Know.

PubMed

Cox, Brent

2016-12-01

Incidents involving the release of hazardous materials challenge medical providers with safely, quickly, and correctly removing contaminants from the victim. While doing so, the safety of the first receiver, current patients, bystanders, as well as the victim all have to be considered. Key challenges with hospital decontamination include, but are not limited to, selection of team members, training protocols, employee turnover, and funding. Best practices, based on the available literature and evidence, include administration buy-in and support; strong policy and procedure documentation; equipment maintenance programs; and team member recruitment, retention, and education. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

VAST Challenge 2014: The Kronos Incident

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

Whiting, Mark A.; Cook, Kristin A.; Grinstein, Georges

2014-10-31

The 2014 IEEE Visual Analytics Science and Technology (VAST) Challenge presented researchers with a single fictitious scenario: the disappearance of staff members of the GASTech oil and gas company on location on the island of Kronos. A group named the Protectors of Kronos (POK) was the prime suspect in the disappearance. Three mini-challenges and a grand challenge were offered. Mini-challenge 1 included multiple types of text data for participants to provide a timeline of key events and characterize the POK, mini-challenge 2 focused on individuals’ movement and financial data for participants to provide patterns of daily life, and mini-challenge 3more » featured real-time streaming social media and emergency service data for participants to provide hostage and kidnapper information. The grand challenge asked the participants to integrate results and generate a synopsis of events. The VAST Challenge received 73 submissions from 13 countries« less

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Engineering the System and Technical Integration

NASA Technical Reports Server (NTRS)

Blair, J. C.; Ryan, R. S.; Schutzenhofer, L. A.

2011-01-01

Approximately 80% of the problems encountered in aerospace systems have been due to a breakdown in technical integration and/or systems engineering. One of the major challenges we face in designing, building, and operating space systems is: how is adequate integration achieved for the systems various functions, parts, and infrastructure? This Contractor Report (CR) deals with part of the problem of how we engineer the total system in order to achieve the best balanced design. We will discuss a key aspect of this question - the principle of Technical Integration and its components, along with management and decision making. The CR will first provide an introduction with a discussion of the Challenges in Space System Design and meeting the challenges. Next is an overview of Engineering the System including Technical Integration. Engineering the System is expanded to include key aspects of the Design Process, Lifecycle Considerations, etc. The basic information and figures used in this CR were presented in a NASA training program for Program and Project Managers Development (PPMD) in classes at Georgia Tech and at Marshall Space Flight Center (MSFC). Many of the principles and illustrations are extracted from the courses we teach for MSFC.

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, ...

Second Chances

ERIC Educational Resources Information Center

Boyd, Karen Anne

2007-01-01

Accommodating change in existing buildings on a college campus or in a school district is challenging, but manageable. The key to successful adaptive reuse is thoughtful and thorough decision-making. Why consider recycling existing buildings? There are many reasons, including limited institutional resources, the increasing cost of new…

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

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.

Big Data Provenance: Challenges, State of the Art and Opportunities.

PubMed

Wang, Jianwu; Crawl, Daniel; Purawat, Shweta; Nguyen, Mai; Altintas, Ilkay

2015-01-01

Ability to track provenance is a key feature of scientific workflows to support data lineage and reproducibility. The challenges that are introduced by the volume, variety and velocity of Big Data, also pose related challenges for provenance and quality of Big Data, defined as veracity. The increasing size and variety of distributed Big Data provenance information bring new technical challenges and opportunities throughout the provenance lifecycle including recording, querying, sharing and utilization. This paper discusses the challenges and opportunities of Big Data provenance related to the veracity of the datasets themselves and the provenance of the analytical processes that analyze these datasets. It also explains our current efforts towards tracking and utilizing Big Data provenance using workflows as a programming model to analyze Big Data.

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

How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach

PubMed Central

Forberger, Sarah; Bammann, Karin; Bauer, Jürgen; Boll, Susanne; Bolte, Gabriele; Brand, Tilman; Hein, Andreas; Koppelin, Frauke; Lippke, Sonia; Meyer, Jochen; Pischke, Claudia R.; Voelcker-Rehage, Claudia; Zeeb, Hajo

2017-01-01

The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that the network has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets. PMID:28375177

How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach.

PubMed

Forberger, Sarah; Bammann, Karin; Bauer, Jürgen; Boll, Susanne; Bolte, Gabriele; Brand, Tilman; Hein, Andreas; Koppelin, Frauke; Lippke, Sonia; Meyer, Jochen; Pischke, Claudia R; Voelcker-Rehage, Claudia; Zeeb, Hajo

2017-04-04

The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that thenetwork has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets.

Challenges of Applying a Comprehensive Model of Intervention Fidelity

PubMed Central

Bosak, Kelly; Pozehl, Bunny; Yates, Bernice

2014-01-01

Applying a comprehensive model of fidelity to interventions delivered by Information and Communication Technology (ICT) has multiple challenges. Fidelity must be considered in the design, implementation, evaluation, and reporting of the intervention. The fidelity strategies must address the unique aspects of the technology, including training providers to instruct participants to use the technology and to provide standardized feedback, rather than deliver the intervention in-person. Other challenges include the nonspecific effects resulting from participants accessing unintended content in interventions delivered by the Internet. ICT allows participant receipt and enactment of intervention skills to be assessed by electronic evidence, rather than in-person observation. Interventions using ICT, such as the Internet are unique, and there is less control of participant interaction with various electronic components. Monitoring participant use and providing standardized feedback for receipt and enactment of intervention skills is key to ensuring intervention fidelity. The final challenges involve evaluating and reporting fidelity. PMID:21474676

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.

Evidence-based Controls for Epidemics Using Spatio-temporal Stochastic Model as a Bayesian Framwork

USDA-ARS?s Scientific Manuscript database

The control of highly infectious diseases of agricultural and plantation crops and livestock represents a key challenge in epidemiological and ecological modelling, with implemented control strategies often being controversial. Mathematical models, including the spatio-temporal stochastic models con...

Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: a qualitative investigation.

PubMed

Petersen, I; Bhana, A; Myeza, N; Alicea, S; John, S; Holst, H; McKay, M; Mellins, C

2010-08-01

While the roll-out of antiretroviral therapy in South Africa should lead to a reduction in mother to child transmission, mortality and orphaning, it will also be accompanied by a large number of children entering adolescence and adulthood with a chronic infectious disease. Adolescence is a particularly vulnerable period for HIV-infected people in relation to mental health problems and engagement in high-risk behaviours, including non-compliance with medical treatment. The goal of this qualitative study was to develop an understanding of the psychosocial challenges as well as protective influences promoting socio-emotional coping in HIV+ adolescents in order to inform mental health promotion and HIV prevention programming for this population in South Africa. In-depth qualitative interviews were conducted with HIV+ adolescents (25) and caregivers of HIV+ children (15) at a large HIV/AIDS Clinic in South Africa. Data were analysed thematically using NVivo8 software. Psycho-social challenges for adolescents included dealing with loss of biological parents in the case of orphans; coming to terms with their HIV+ status including identity difficulties; external stigma and discrimination; and disclosure difficulties. For caregivers, disclosure and lack of financial, family and social support emerged as key challenges. Medication, HIV information, a future orientation and social support was identified as important for coping and general well-being of adolescents, with financial and social support emerging as key for promoting supportive caregiving contexts. While HIV+ adolescents in South Africa experience similar concerns to those in high-income countries, socio-emotional coping may be compromised by increased levels of loss due to the late roll-out of ARVS and challenges to caregiving contexts including poverty, stigma and minimally supported foster care arrangements. There is a need for mental health promotion programmes for adolescents to adopt an ecological approach, strengthening protective influences at the individual, interpersonal, community and policy levels.

Challenges and opportunities in healthcare volunteer management: insights from volunteer administrators.

PubMed

Rogers, Sean E; Rogers, Carmen M; Boyd, Karen D

2013-01-01

Volunteer administrators from 105 hospitals in five states in the northeast and southern United States provided open-ended survey responses about what they perceived to be the most pressing challenges and opportunities facing healthcare volunteer management. Taken together, these 105 hospitals used a total of 39,008 volunteers and 5.3 million volunteer hours during a 12-month period between 2010 and 2011. A qualitative content analysis of administrator responses suggests that primary challenges include volunteer recruitment and retention, administrative issues, and operational difficulties brought about by the current economic crisis. Key opportunities include more explicitly linking the volunteer function to hospital outcomes and community impact, expanding volunteer recruitment pools and roles and jobs, and developing organizational support for volunteers and making the volunteer management function more efficient and effective.

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.

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.

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

NASA Technical Reports Server (NTRS)

Des Marais, David J. (Editor)

1997-01-01

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

Advances and challenges in sustainable tourism toward a green economy.

PubMed

Pan, Shu-Yuan; Gao, Mengyao; Kim, Hyunook; Shah, Kinjal J; Pei, Si-Lu; Chiang, Pen-Chi

2018-09-01

This paper provides an overview of the interrelationships between tourism and sustainability from a cross-disciplinary perspective. The current challenges and barriers in the tourism sustainability, such as high energy use, extensive water consumption and habitat destruction, are first reviewed. Then the key cross-disciplinary elements in sustainable tourism, including green energy, green transportation, green buildings, green infrastructure, green agriculture and smart technologies, are discussed. To overcome the challenges and barriers, a few implementation strategies on achieving sustainable tourism from the aspects of policy/regulation, institution, finance, technology and culture are proposed, along with the framework and details of a key performance indicator system. Finally, prospects of the potential for tourism to contribute to the transformative changes, e.g., a green economy system, are illustrated. This paper shine a light on issues of importance within sustainable tourism and encourage researchers from different disciplines in investigating the inter-relationships among community/culture, environment/ecology, and energy/water/food more broadly. Copyright © 2018 Elsevier B.V. All rights reserved.

From Assets to Investors.

ERIC Educational Resources Information Center

Kaye, Beverly; Jordan-Evans, Sharon

2003-01-01

A group of global talent leaders met to discuss, benchmark, debate, and collaborate on how to hire and retain talent and determined that organizations would benefit by viewing employees as investors, not just assets. Key factors include challenging and exciting work, career growth and development, good supervisors and coworkers, and fair…

Application of a framework for extrapolating chemical effects across species in pathways controlled by estrogen receptor-á

EPA Science Inventory

Cross-species extrapolation of toxicity data from limited surrogate test organisms to all wildlife with potential of chemical exposure remains a key challenge in ecological risk assessment. A number of factors affect extrapolation, including the chemical exposure, pharmacokinetic...

Parental Involvement in Norwegian Schools

ERIC Educational Resources Information Center

Paulsen, Jan Merok

2012-01-01

This article examines findings on key challenges of school-parent relations in Norway. The review is based on recent large-scale studies on several issues, including formalized school-parent cooperation, parental involvement in the pedagogical discourse, and teacher perspectives on the parents' role in the school community. Findings suggest a…

The Task before Us: A QuEST Reader.

ERIC Educational Resources Information Center

American Federation of Teachers, Washington, DC.

This publication presents a collection of articles about education drawn from magazines, journals, books, and reports. The collection includes 13 selections touching on key educational issues, challenging ideas, and proposals for change: (1) "First Born, Fast Grown: The Manful Life of Nicholas" (Isabel Wilkerson); (2) "Putting…

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…

Big Data Provenance: Challenges, State of the Art and Opportunities

PubMed Central

Wang, Jianwu; Crawl, Daniel; Purawat, Shweta; Nguyen, Mai; Altintas, Ilkay

2017-01-01

Ability to track provenance is a key feature of scientific workflows to support data lineage and reproducibility. The challenges that are introduced by the volume, variety and velocity of Big Data, also pose related challenges for provenance and quality of Big Data, defined as veracity. The increasing size and variety of distributed Big Data provenance information bring new technical challenges and opportunities throughout the provenance lifecycle including recording, querying, sharing and utilization. This paper discusses the challenges and opportunities of Big Data provenance related to the veracity of the datasets themselves and the provenance of the analytical processes that analyze these datasets. It also explains our current efforts towards tracking and utilizing Big Data provenance using workflows as a programming model to analyze Big Data. PMID:29399671

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.

Health literacy, health communication challenges, and cancer screening among rural native Hawaiian and Filipino women.

PubMed

Sentell, Tetine; Dela Cruz, May Rose; Heo, Hyun-Hee; Braun, Kathryn L

2013-06-01

Native Hawaiians and Filipinos are disproportionately impacted by cancer and are less likely to participate in cancer screening than whites. Limited information exists about health information pathways and health communication challenges as they relate to cancer screening in these groups. Six focus groups (n=77) of Native Hawaiian and Filipino women age 40+years were conducted to investigate these research gaps. Participants noted many health information challenges. Challenges were both practical and interpersonal and included both written and oral health communication. Practical challenges included "big" words, complexity of terms, and lack of plain English. Interpersonal issues included doctors rushing, doctors not assessing comprehension, and doctors treating respondents as patients not people. Women noted that they would often not ask questions even when they knew they did not understand because they did not want the provider to think negatively of them. Overarching themes to improve cancer communication gaps included: (1) the importance of family and community in health information dissemination, (2) the key role women play in interpreting health information for others, (3) the importance of personal experience and relationships to the salience of health information, and (4) the desire for local cultural relevance in health communication. Findings are discussed in light of the 2010 National Action Plan for Health Literacy.

Health literacy, health communication challenges, and cancer screening among rural Native Hawaiian and Filipino Women

PubMed Central

Sentell, Tetine; Cruz, May Rose Dela; Heo, Hyun Hee; Braun, Kathryn

2013-01-01

Native Hawaiians and Filipinos are disproportionately impacted by cancer, and are less likely to participate in cancer screening than whites. Limited information exists about health information pathways and health communication challenges as they relate to cancer screening in these groups. Six focus groups (n=77) of Native Hawaiian and Filipino women age 40+ years were conducted to investigate these research gaps. Participants noted many health information challenges. Challenges were both practical and interpersonal and included both written and oral health communication. Practical challenges included “big” words, complexity of terms, and lack of plain English. Interpersonal issues included doctors rushing, doctors not assessing comprehension, and doctors treating respondents as patients not people. Women noted that they would often not ask questions even when they knew they did not understand because they did not want the provider to think negatively of them. Overarching themes to improve cancer communication gaps included: (1) the importance of family and community in health information dissemination; (2) the key role women play in interpreting health information for others; (3) the importance of personal experience and relationships to the salience of health information; and (4) the desire for local cultural relevance in health communication. Findings are discussed in light of the 2010 National Action Plan for Health Literacy. PMID:23536194

2014 Runtime Systems Summit. Runtime Systems Report

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

Sarkar, Vivek; Budimlic, Zoran; Kulkani, Milind

2016-09-19

This report summarizes runtime system challenges for exascale computing, that follow from the fundamental challenges for exascale systems that have been well studied in past reports, e.g., [6, 33, 34, 32, 24]. Some of the key exascale challenges that pertain to runtime systems include parallelism, energy efficiency, memory hierarchies, data movement, heterogeneous processors and memories, resilience, performance variability, dynamic resource allocation, performance portability, and interoperability with legacy code. In addition to summarizing these challenges, the report also outlines different approaches to addressing these significant challenges that have been pursued by research projects in the DOE-sponsored X-Stack and OS/R programs. Sincemore » there is often confusion as to what exactly the term “runtime system” refers to in the software stack, we include a section on taxonomy to clarify the terminology used by participants in these research projects. In addition, we include a section on deployment opportunities for vendors and government labs to build on the research results from these projects. Finally, this report is also intended to provide a framework for discussing future research and development investments for exascale runtime systems, and for clarifying the role of runtime systems in exascale software.« less

Exposure to air pollution interacts with obesogenic nutrition to induce tissue-specific response patterns.

PubMed

Pardo, Michal; Kuperman, Yael; Levin, Liron; Rudich, Assaf; Haim, Yulia; Schauer, James J; Chen, Alon; Rudich, Yinon

2018-04-20

Obesity and exposure to particular matter (PM) have become two leading global threats to public health. However, the exact mechanisms and tissue-specificity of their health effects are largely unknown. Here we investigate whether a metabolic challenge (early nutritional obesity) synergistically interacts with an environmental challenge (PM exposure) to alter genes representing key response pathways, in a tissue-specific manner. Mice subjected to 7 weeks obesogenic nutrition were exposed every other day during the final week and a half to aqueous extracts of PM collected in the city of London (UK). The expression of 61 selected genes representing key response pathways were investigated in lung, liver, white and brown adipose tissues. Principal component analysis (PCA) revealed distinct patterns of expression changes between the 4 tissues, particularly in the lungs and the liver. Surprisingly, the lung responded to the nutrition challenge. The response of these organs to the PM challenge displayed opposite patterns for some key genes, in particular, those related to the Nrf2 pathway. While the contribution to the variance in gene expression changes in mice exposed to the combined challenge were largely similar among the tissues in PCA1, PCA2 exhibited predominant contribution of inflammatory and oxidative stress responses to the variance in the lungs, and a greater contribution of autophagy genes and MAP kinases in adipose tissues. Possible involvement of alterations in DNA methylation was demonstrated by cell-type-specific responses to a methylation inhibitor. Correspondingly, the DNA methyltransferase Dnmt3a2 increased in the lungs but decreased in the liver, demonstrating potential tissue-differential synergism between nutritional and PM exposure. The results suggest that urban PM, containing dissolved metals, interacts with obesogenic nutrition to regulate diverse response pathways including inflammation and oxidative stress, in a tissue-specific manner. Tissue-differential effects on DNA methylation may underlie tissue-specific responses to key stress-response genes such as catalase and Nrf2. Copyright © 2018 Elsevier Ltd. All rights reserved.

Indigenous Health Workforce Development: challenges and successes of the Vision 20:20 programme.

PubMed

Curtis, Elana; Reid, Papaarangi

2013-01-01

There are significant health workforce inequities that exist internationally. The shortage of indigenous health professionals within Australia and New Zealand requires action across multiple sectors, including health and education. This article outlines the successes and challenges of the University of Auckland's Vision 20:20 programme, which aims to improve indigenous Māori and Pacific health workforce development via recruitment, bridging/foundation and tertiary retention support interventions within the Faculty of Medical and Health Sciences (FMHS). Seven years of student data (2005-2011) are presented for undergraduate Student Pass Rate (SPR) by ethnicity and Certificate in Health Sciences (CertHSc) SPR, enrolments and completions by ethnicity. Four key areas of development are described: (i) student selection and pathway planning; (ii) foundation programme refinement; (iii) academic/pastoral support; and (iv) re-development of the indigenous recruitment model. Key programme developments have had a positive impact on basic student data outcomes. The FMHS undergraduate SPR increased from 89% in 2005 to 94% in 2011 for Māori and from 81% in 2005 to 87% in 2011 for Pacific. The CertHSc SPR increased from 52% in 2005 to 92% in 2011 with a greater proportion of Māori and Pacific enrolments achieving completion over time (18-76% for Māori and 29-74% for Pacific). Tertiary institutions have the potential to make an important contribution to indigenous health workforce development. Key challenges remain including secondary school feeder issues, equity funding, programme evaluation, post-tertiary specialist workforce development and retention in Aotearoa, New Zealand. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Challenges in the Accurate Surveillance of Booster Seat and Bicycle Helmet Usage by Children: Lessons from the Field

PubMed Central

Pankratz, Curt; Warda, Lynne; Piotrowski, Caroline

2016-01-01

Motor vehicle collisions and bicycle collisions and falls are a leading cause of death by preventable injury for children. In order to design, implement and evaluate campaigns and programs aimed at improving child safety, accurate surveillance is needed. This paper examined the challenges that confront efforts to collect surveillance data relevant to child traffic safety, including observation, interview, and focus group methods. Strategies to address key challenges in order to improve the efficiency and accuracy of surveillance methods were recommended. The potential for new technology to enhance existing surveillance methods was also explored. PMID:27399749

Leadership and Strategic Management: Keys to Institutional Priorities and Planning

ERIC Educational Resources Information Center

Taylor, James S.; de Lourdes Machado, Maria; Peterson, Marvin W.

2008-01-01

Allocating and managing resources have always been important cornerstones of institutional leadership. Institutional resources include financial, physical and human components. Even in the best of times, it is a challenge to do this effectively. In times of diminished and shrinking resources, distributing these precious commodities across the…

Performance Indicators in Math: Implications for Brief Experimental Analysis of Academic Performance

ERIC Educational Resources Information Center

VanDerheyden, Amanda M.; Burns, Matthew K.

2009-01-01

Brief experimental analysis (BEA) can be used to specify intervention characteristics that produce positive learning gains for individual students. A key challenge to the use of BEA for intervention planning is the identification of performance indicators (including topography of the skill, measurement characteristics, and decision criteria) that…

Seeking Excellence in Counselor Education: One School's Journey

ERIC Educational Resources Information Center

Sheehan, Timothy J.

2003-01-01

Assuring learning outcomes that result in expert alcohol and drug dependency counseling is a continuous challenge for educators. Working systemically to craft a solid vision for the future, the Hazelden Foundation developed a graduate school for the sole purpose of educating highly skilled clinicians. Key ingredients included building a…

Biodiversity in the city: key challenges for urban green space management

Treesearch

Myla F.J. Aronson; Christopher A. Lepczyk; Karl L. Evans; Mark A. Goddard; Susannah B. Lerman; J. Scott MacIvor; Charles H. Nilon; Timothy Vargo

2017-01-01

Cities play important roles in the conservation of global biodiversity, particularly through the planning and management of urban green spaces (UGS). However, UGS management is subject to a complex assortment of interacting social, cultural, and economic factors, including governance, economics, social networks, multiple stakeholders, individual preferences, and social...

Making Performance Assessments a Part of Accountability

ERIC Educational Resources Information Center

Haun, Billy

2018-01-01

The purpose of this commentary is to describe recent efforts in Virginia to develop and use performance assessments, including the challenges that emerged during this process and key considerations for states that integrate performance assessment into their systems. Performance assessments can play an important role in preparing students for…

Reflections on Deaf Education: Perspectives of Deaf Senior Citizens

ERIC Educational Resources Information Center

Roberson, Len; Shaw, Sherry

2015-01-01

Parents with deaf children face many challenges in making educational choices, developing language and a sense of belonging. Other key aspects of life including concept development and social competency are also critical decision points faced by parents. Developing language, whether it is through spoken or signed modalities, is of utmost…

Keys to success for data-driven decision making: Lessons from participatory monitoring and collaborative adaptive management

USDA-ARS?s Scientific Manuscript database

Recent years have witnessed a call for evidence-based decisions in conservation and natural resource management, including data-driven decision-making. Adaptive management (AM) is one prevalent model for integrating scientific data into decision-making, yet AM has faced numerous challenges and limit...

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…

Coping with Economic Uncertainty: Focus on Key Risks Essential

ERIC Educational Resources Information Center

Sander, Laura

2009-01-01

During this period of continued economic uncertainty, higher-education institutions are facing a variety of challenges that by now are very familiar to governing boards and institutional leaders, including poor investment returns, reduced liquidity, limited choices in how they structure debt issues, and threats to flexibility in tuition pricing.…

Day-by-Day: Higher Education in Afghanistan

ERIC Educational Resources Information Center

Roof, David J.

2015-01-01

This paper examines higher education in Afghanistan. Based on qualitative research, including interviews with key policymakers and stakeholders, the paper examines the primary issues, challenges, progress, and future vision for higher education in the country. The research reveals that one of the most significant issues in the country in the…

Challenges and Opportunities in the Provision of Surgical Care in Vanuatu: A Mixed Methods Analysis.

PubMed

Young, S; Perry, W R G; Leodoro, B; Nosa, V; Bissett, I; Windsor, J A; Dare, A J

2016-08-01

The Pacific island nation of Vanuatu faces a number of challenges in delivering surgical care to its population. We aimed to understand and document the barriers, opportunities and required actions to improve surgical care in the country using a mixed methods analysis which incorporated the perspectives of local health stakeholders. A baseline quantitative assessment of surgical capacity in Vanuatu was carried out using the WHO situational analysis tool. Twenty semi-structured interviews were then conducted on the two main islands (Efate and Espiritu Santo) with surgeons, allied health staff, health managers, policy-makers and other key stakeholders, using a grounded theory qualitative case study methodology. Initial informants were identified by purposive sampling followed by snowball sampling until theoretical saturation was reached. Interviews were open and axially coded with subsequent thematic analysis. Vanuatu faces deficits in surgical infrastructure, equipment and human resources, especially in the rural provinces. Geographic isolation, poverty and culture-including the use of traditional medicine and low health literacy-all act as barriers to patients accessing timely surgical care. Issues with governance, human resourcing and perioperative care were commonly identified by stakeholders as key challenges facing surgical services. Increasing outreach clinics, developing efficient referral systems, building provincial surgical capacity and undertaking locally led research were identified as key actions that can improve surgical care. Documenting locally identified challenges and opportunities for surgical care in Vanuatu is an important first step towards developing formal strategies for improving surgical services at the country level.

Key Action Items for the Stem Cell Field: Looking Ahead to 2014

PubMed Central

Knoepfler, Paul S.

2013-01-01

Abstract The stem cell field is at a critical juncture in late 2013. We find ourselves buoyed by building momentum for both transformative basic science discoveries and clinical translation of stem cells. Cellular reprogramming has given the field exciting new avenues as well. The overall prospect of novel stem cell–based therapies becoming a reality for patients in the coming years has never seemed higher. At the same time, we face serious challenges. Some of these challenges, such as stem cell tourism, are familiar to us, although even those are evolving in ways that require adaptability and action by the stem cell field. Other new challenges are also emerging, including an urgent need for formal physician training in stem cells, regulatory compliance balanced with innovation and U.S. Food and Drug Administration reform, and savvy educational outreach. Looking ahead to 2014, both the challenges and opportunities for the stem cell field require a proactive, thoughtful approach to maximize the potential for a positive impact from stem cell advances. In this study, I discuss the key action items for the field as we look ahead to the coming year and beyond. PMID:24147571

Key action items for the stem cell field: looking ahead to 2014.

PubMed

Knoepfler, Paul S

2013-12-01

The stem cell field is at a critical juncture in late 2013. We find ourselves buoyed by building momentum for both transformative basic science discoveries and clinical translation of stem cells. Cellular reprogramming has given the field exciting new avenues as well. The overall prospect of novel stem cell-based therapies becoming a reality for patients in the coming years has never seemed higher. At the same time, we face serious challenges. Some of these challenges, such as stem cell tourism, are familiar to us, although even those are evolving in ways that require adaptability and action by the stem cell field. Other new challenges are also emerging, including an urgent need for formal physician training in stem cells, regulatory compliance balanced with innovation and U.S. Food and Drug Administration reform, and savvy educational outreach. Looking ahead to 2014, both the challenges and opportunities for the stem cell field require a proactive, thoughtful approach to maximize the potential for a positive impact from stem cell advances. In this study, I discuss the key action items for the field as we look ahead to the coming year and beyond.

Getting governance right for a sustainable regionalised business model.

PubMed

Laurence, Caroline O; Black, Linda E; Rowe, Mark; Pearce, Rod

2011-06-06

The 1998 Ministerial Review of General Practice Training identified several areas for improvement that led to major changes in the provision of general practice training, including the establishment of General Practice Education and Training (GPET) and the regionalisation of training. The regionalised training business model has been in place for nearly 10 years, and several key organisations have been involved in its evolution, including the Australian Government, speciality colleges, GPET and regionalised training providers. Both the college-focused and regionalised-focused models have had some successes. These include recognition and support of general practice as a vocational specialty, increased numbers of junior doctors undertaking placements in general practice, and increased numbers of registrars training in rural areas. This period has also seen changes in the governance and decision-making processes with creation of a new framework that is inclusive of all the key players in the new regionalised training system. The future holds challenges for the regionalised training business model as the general practice education and training landscape becomes more complex. The framework in the current model will provide a base to help meet these challenges and allow for further sustainable expansion.

An overview of LLNL high-energy short-pulse technology for advanced radiography of laser fusion experiments

NASA Astrophysics Data System (ADS)

Barty, C. P. J.; Key, M.; Britten, J.; Beach, R.; Beer, G.; Brown, C.; Bryan, S.; Caird, J.; Carlson, T.; Crane, J.; Dawson, J.; Erlandson, A. C.; Fittinghoff, D.; Hermann, M.; Hoaglan, C.; Iyer, A.; Jones, L., II; Jovanovic, I.; Komashko, A.; Landen, O.; Liao, Z.; Molander, W.; Mitchell, S.; Moses, E.; Nielsen, N.; Nguyen, H.-H.; Nissen, J.; Payne, S.; Pennington, D.; Risinger, L.; Rushford, M.; Skulina, K.; Spaeth, M.; Stuart, B.; Tietbohl, G.; Wattellier, B.

2004-12-01

The technical challenges and motivations for high-energy, short-pulse generation with NIF and possibly other large-scale Nd : glass lasers are reviewed. High-energy short-pulse generation (multi-kilojoule, picosecond pulses) will be possible via the adaptation of chirped pulse amplification laser techniques on NIF. Development of metre-scale, high-efficiency, high-damage-threshold final optics is a key technical challenge. In addition, deployment of high energy petawatt (HEPW) pulses on NIF is constrained by existing laser infrastructure and requires new, compact compressor designs and short-pulse, fibre-based, seed-laser systems. The key motivations for HEPW pulses on NIF is briefly outlined and includes high-energy, x-ray radiography, proton beam radiography, proton isochoric heating and tests of the fast ignitor concept for inertial confinement fusion.

Management of failed periodontal surgical intervention for a furcal lesion with a nonsurgical endodontic approach

PubMed Central

Asgary, Saeed

2014-01-01

As long as the prognosis of teeth remains a matter of concern, the endodontic-periodontal relationship will be considered a challenge for the clinician. Many etiologic factors, including bacteria, fungi, and viruses, plus other contributing factors, such as trauma, root resorptions/perforations, and dental malformations, play a role in the co-occurrence of endodontic and periodontal lesions. Whatever the cause, a correct diagnosis on which to base the treatment plan is the key to successful maintenance of the tooth. This article reports the successful endodontic management of a furcation lesion in a mandibular molar that was nonresponsive to a previous periodontal surgical graft. The case had presented a diagnostic challenge for the clinicians, and this article reviews the key points that can lead to a correct diagnosis and treatment planning. PMID:24790924

Enhancing audiovisual experience with haptic feedback: a survey on HAV.

PubMed

Danieau, F; Lecuyer, A; Guillotel, P; Fleureau, J; Mollet, N; Christie, M

2013-01-01

Haptic technology has been widely employed in applications ranging from teleoperation and medical simulation to art and design, including entertainment, flight simulation, and virtual reality. Today there is a growing interest among researchers in integrating haptic feedback into audiovisual systems. A new medium emerges from this effort: haptic-audiovisual (HAV) content. This paper presents the techniques, formalisms, and key results pertinent to this medium. We first review the three main stages of the HAV workflow: the production, distribution, and rendering of haptic effects. We then highlight the pressing necessity for evaluation techniques in this context and discuss the key challenges in the field. By building on existing technologies and tackling the specific challenges of the enhancement of audiovisual experience with haptics, we believe the field presents exciting research perspectives whose financial and societal stakes are significant.

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

The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand.

PubMed

Turner, Nikki M; Charania, Nadia A; Chong, Angela; Stewart, Joanna; Taylor, Lynn

2017-01-01

Immunisation coverage rates vary considerably at the local level across New Zealand and challenges remain with effectively translating best available research evidence into public health practice. This study aimed to translate best practices from high performing general practices into strategies to improve childhood immunisation coverage among low performing practices. An intervention study was undertaken of general practices with low immunisation coverage rates and a high percentage of the enrolled population being of Māori ethnicity. Intervention groups received customised action plans and support for a 12 month period while control groups received 'business as usual' support. Structured interviews were conducted with key informants from all participating practices to understand current aspects related to childhood immunisation delivery and surveys were conducted to understand how the intervention worked. Collected data were thematically analysed. Ten sites were randomised to either intervention ( n  = 6) or control group ( n  = 4). Positive aspects of childhood immunisation delivery included high prioritisation at the practice and staff being pro-immunisation and knowledgeable. Key challenges experienced included inaccurate family contact information and discrepancies with referral processes to other providers. Other challenges noted were building rapport with families and vaccine hesitancy. The action plans included various strategies aimed to improve processes at the practice, contact and engagement with parents, and partnership development with local service providers. Creating customised action plans and providing support to providers were considered as helpful approaches when attempting to improve childhood immunisation coverage rates. Our study supports the notion that one strategy will not solely by itself improve childhood immunisation rates and highlights the importance of having a toolkit of strategies from which to draw from.

A Future Large-Aperture UVOIR Space Observatory: Key Technologies and Capabilities

NASA Technical Reports Server (NTRS)

Bolcar, Matthew Ryan; Stahle, Carl M.; Balasubramaniam, Kunjithapatham; Clampin, Mark; Feinberg, Lee D.; Mosier, Gary E.; Quijada, Manuel A.; Rauscher, Bernard J.; Redding, David C.; Rioux, Norman M.;

The challenges in defining and measuring diagnostic error.

PubMed

Zwaan, Laura; Singh, Hardeep

2015-06-01

Diagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In this paper, we synthesize these discussions and outline key research challenges in operationalizing the definition and measurement of diagnostic error. Some of these challenges include 1) difficulties in determining error when the disease or diagnosis is evolving over time and in different care settings, 2) accounting for a balance between underdiagnosis and overaggressive diagnostic pursuits, and 3) determining disease diagnosis likelihood and severity in hindsight. We also build on these discussions to describe how some of these challenges can be addressed while conducting research on measuring diagnostic error.

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.

Setting up a clinical trial for a novel disease: a case study of the Doxycycline for the Treatment of Nodding Syndrome Trial – challenges, enablers and lessons learned

PubMed Central

Anguzu, Ronald; Akun, Pamela R; Ogwang, Rodney; Shour, Abdul Rahman; Sekibira, Rogers; Ningwa, Albert; Nakamya, Phellister; Abbo, Catherine; Mwaka, Amos D; Opar, Bernard; Idro, Richard

2018-01-01

ABSTRACT A large amount of preparation goes into setting up trials. Different challenges and lessons are experienced. Our trial, testing a treatment for nodding syndrome, an acquired neurological disorder of unknown cause affecting thousands of children in Eastern Africa, provides a unique case study. As part of a study to determine the aetiology, understand pathogenesis and develop specific treatment, we set up a clinical trial in a remote district hospital in Uganda. This paper describes our experiences and documents supportive structures (enablers), challenges faced and lessons learned during set-up of the trial. Protocol development started in September 2015 with phased recruitment of a critical study team. The team spent 12 months preparing trial documents, procurement and training on procedures. Potential recruitment sites were pre-visited, and district and local leaders met as key stakeholders. Key enablers were supportive local leadership and investment by the district and Ministry of Health. The main challenges were community fears about nodding syndrome, adverse experiences of the community during previous research and political involvement. Other challenges included the number and delays in protocol approvals and lengthy procurement processes. This hard-to-reach area has frequent power and Internet fluctuations, which may affect cold chains for study samples, communication and data management. These concerns decreased with a pilot community engagement programme. Experiences and lessons learnt can reduce the duration of processes involved in trial-site set-up. A programme of community engagement and local leader involvement may be key to the success of a trial and in reducing community opposition towards participation in research. PMID:29382251

Setting up a clinical trial for a novel disease: a case study of the Doxycycline for the Treatment of Nodding Syndrome Trial - challenges, enablers and lessons learned.

PubMed

Anguzu, Ronald; Akun, Pamela R; Ogwang, Rodney; Shour, Abdul Rahman; Sekibira, Rogers; Ningwa, Albert; Nakamya, Phellister; Abbo, Catherine; Mwaka, Amos D; Opar, Bernard; Idro, Richard

2018-01-01

A large amount of preparation goes into setting up trials. Different challenges and lessons are experienced. Our trial, testing a treatment for nodding syndrome, an acquired neurological disorder of unknown cause affecting thousands of children in Eastern Africa, provides a unique case study. As part of a study to determine the aetiology, understand pathogenesis and develop specific treatment, we set up a clinical trial in a remote district hospital in Uganda. This paper describes our experiences and documents supportive structures (enablers), challenges faced and lessons learned during set-up of the trial. Protocol development started in September 2015 with phased recruitment of a critical study team. The team spent 12 months preparing trial documents, procurement and training on procedures. Potential recruitment sites were pre-visited, and district and local leaders met as key stakeholders. Key enablers were supportive local leadership and investment by the district and Ministry of Health. The main challenges were community fears about nodding syndrome, adverse experiences of the community during previous research and political involvement. Other challenges included the number and delays in protocol approvals and lengthy procurement processes. This hard-to-reach area has frequent power and Internet fluctuations, which may affect cold chains for study samples, communication and data management. These concerns decreased with a pilot community engagement programme. Experiences and lessons learnt can reduce the duration of processes involved in trial-site set-up. A programme of community engagement and local leader involvement may be key to the success of a trial and in reducing community opposition towards participation in research.

Experimental quantum key distribution with simulated ground-to-satellite photon losses and processing limitations

NASA Astrophysics Data System (ADS)

Bourgoin, Jean-Philippe; Gigov, Nikolay; Higgins, Brendon L.; Yan, Zhizhong; Meyer-Scott, Evan; Khandani, Amir K.; Lütkenhaus, Norbert; Jennewein, Thomas

2015-11-01

Quantum key distribution (QKD) has the potential to improve communications security by offering cryptographic keys whose security relies on the fundamental properties of quantum physics. The use of a trusted quantum receiver on an orbiting satellite is the most practical near-term solution to the challenge of achieving long-distance (global-scale) QKD, currently limited to a few hundred kilometers on the ground. This scenario presents unique challenges, such as high photon losses and restricted classical data transmission and processing power due to the limitations of a typical satellite platform. Here we demonstrate the feasibility of such a system by implementing a QKD protocol, with optical transmission and full post-processing, in the high-loss regime using minimized computing hardware at the receiver. Employing weak coherent pulses with decoy states, we demonstrate the production of secure key bits at up to 56.5 dB of photon loss. We further illustrate the feasibility of a satellite uplink by generating a secure key while experimentally emulating the varying losses predicted for realistic low-Earth-orbit satellite passes at 600 km altitude. With a 76 MHz source and including finite-size analysis, we extract 3374 bits of a secure key from the best pass. We also illustrate the potential benefit of combining multiple passes together: while one suboptimal "upper-quartile" pass produces no finite-sized key with our source, the combination of three such passes allows us to extract 165 bits of a secure key. Alternatively, we find that by increasing the signal rate to 300 MHz it would be possible to extract 21 570 bits of a secure finite-sized key in just a single upper-quartile pass.

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.

Keys to successful organ procurement: An experience-based review of clinical practices at a high-performing health-care organization

PubMed Central

Wojda, Thomas R.; Stawicki, Stanislaw P.; Yandle, Kathy P.; Bleil, Maria; Axelband, Jennifer; Wilde-Onia, Rebecca; Thomas, Peter G.; Cipolla, James; Hoff, William S.; Shultz, Jill

2017-01-01

Organ procurement (OP) from donors after brain death and circulatory death represents the primary source of transplanted organs. Despite favorable laws and regulations, OP continues to face challenges for a number of reasons, including institutional, personal, and societal barriers. This focused review presents some of the key components of a successful OP program at a large, high-performing regional health network. This review focuses on effective team approaches, aggressive resuscitative strategies, optimal communication, family support, and community outreach efforts. PMID:28660162

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.

Physical Layer Secret-Key Generation Scheme for Transportation Security Sensor Network

PubMed Central

Yang, Bin; Zhang, Jianfeng

2017-01-01

Wireless Sensor Networks (WSNs) are widely used in different disciplines, including transportation systems, agriculture field environment monitoring, healthcare systems, and industrial monitoring. The security challenge of the wireless communication link between sensor nodes is critical in WSNs. In this paper, we propose a new physical layer secret-key generation scheme for transportation security sensor network. The scheme is based on the cooperation of all the sensor nodes, thus avoiding the key distribution process, which increases the security of the system. Different passive and active attack models are analyzed in this paper. We also prove that when the cooperative node number is large enough, even when the eavesdropper is equipped with multiple antennas, the secret-key is still secure. Numerical results are performed to show the efficiency of the proposed scheme. PMID:28657588

Physical Layer Secret-Key Generation Scheme for Transportation Security Sensor Network.

PubMed

Yang, Bin; Zhang, Jianfeng

2017-06-28

Wireless Sensor Networks (WSNs) are widely used in different disciplines, including transportation systems, agriculture field environment monitoring, healthcare systems, and industrial monitoring. The security challenge of the wireless communication link between sensor nodes is critical in WSNs. In this paper, we propose a new physical layer secret-key generation scheme for transportation security sensor network. The scheme is based on the cooperation of all the sensor nodes, thus avoiding the key distribution process, which increases the security of the system. Different passive and active attack models are analyzed in this paper. We also prove that when the cooperative node number is large enough, even when the eavesdropper is equipped with multiple antennas, the secret-key is still secure. Numerical results are performed to show the efficiency of the proposed scheme.

Human Mars Surface Science Operations

NASA Technical Reports Server (NTRS)

Bobskill, Marianne R.; Lupisella, Mark L.

2014-01-01

Human missions to the surface of Mars will have challenging science operations. This paper will explore some of those challenges, based on science operations considerations as part of more general operational concepts being developed by NASA's Human Spaceflight Architecture (HAT) Mars Destination Operations Team (DOT). The HAT Mars DOT has been developing comprehensive surface operations concepts with an initial emphasis on a multi-phased mission that includes a 500-day surface stay. This paper will address crew science activities, operational details and potential architectural and system implications in the areas of (a) traverse planning and execution, (b) sample acquisition and sample handling, (c) in-situ science analysis, and (d) planetary protection. Three cross-cutting themes will also be explored in this paper: (a) contamination control, (b) low-latency telerobotic science, and (c) crew autonomy. The present traverses under consideration are based on the report, Planning for the Scientific Exploration of Mars by Humans1, by the Mars Exploration Planning and Analysis Group (MEPAG) Human Exploration of Mars-Science Analysis Group (HEM-SAG). The traverses are ambitious and the role of science in those traverses is a key component that will be discussed in this paper. The process of obtaining, handling, and analyzing samples will be an important part of ensuring acceptable science return. Meeting planetary protection protocols will be a key challenge and this paper will explore operational strategies and system designs to meet the challenges of planetary protection, particularly with respect to the exploration of "special regions." A significant challenge for Mars surface science operations with crew is preserving science sample integrity in what will likely be an uncertain environment. Crewed mission surface assets -- such as habitats, spacesuits, and pressurized rovers -- could be a significant source of contamination due to venting, out-gassing and cleanliness levels associated with crew presence. Low-latency telerobotic science operations has the potential to address a number of contamination control and planetary protection issues and will be explored in this paper. Crew autonomy is another key cross-cutting challenge regarding Mars surface science operations, because the communications delay between earth and Mars could as high as 20 minutes one way, likely requiring the crew to perform many science tasks without direct timely intervention from ground support on earth. Striking the operational balance between crew autonomy and earth support will be a key challenge that this paper will address.

Challenges to implementing Gavi's health system strengthening support in Chad and Cameroon: results from a mixed-methods evaluation.

PubMed

Dansereau, Emily; Miangotar, Yodé; Squires, Ellen; Mimche, Honoré; El Bcheraoui, Charbel

2017-11-16

Since 2005, Gavi has provided health system strengthening (HSS) grants to address bottlenecks affecting immunization services. This study is the first to evaluate the Gavi HSS implementation process in either Cameroon or Chad, two countries with significant health system challenges and poor achievement on the child and maternal health Millennium Development Goals. We triangulated quantitative and qualitative data including financial records, document review, field visit questionnaires, and key informant interviews (KII) with representatives from the Ministries of Health, Gavi, and other partners. We conducted a Root Cause Analysis of key implementation challenges, guided by the Consolidated Framework for Implementation Research. We conducted 124 field visits and 43 KIIs in Cameroon, and 57 field visits and 39 KIIs in Chad. Cameroon's and Chad's HSS programs were characterized by delayed disbursements, significant deviations from approved expenditures, and reprogramming of funds. Nearly a year after the programs were intended to be complete, many district and facility-level activities were only partially implemented and significant funds remained unabsorbed. Root causes of these challenges included unpredictable Gavi processes and disbursements, poor communication between the countries and Gavi, insufficient country planning without adequate technical assistance, lack of country staff and leadership, and weak country systems to manage finances and promote institutional memory. Though Chad and Cameroon both critically needed support to strengthen their weak health systems, serious challenges drastically limited implementation of their Gavi HSS programs. Implementation of future HSS programs in these and similar settings can be improved by transparent and reliable procedures and communication from Gavi, proposals that account for countries' programmatic capacity and the potential for delayed disbursements, implementation practices that foster learning and adaptation, and an early emphasis on developing managerial and other human resources.

New York State Forum for Information Resource Management: 1998-1999 Annual Report.

ERIC Educational Resources Information Center

New York State Forum for Information Resource Management.

This annual report of the New York State Forum for Information Resource Management begins with a section that summarizes key activities for 1998-99, including partnerships with other organizations, sessions on the use of information in government and information security, programs on the challenges of electronic commerce for government,…

Supporting the Transition of Sophomores, Transfers, and Seniors: Opportunities for Residence Life Professionals

ERIC Educational Resources Information Center

Kranzow, Jeannine; Foote, Stephanie M.; Hinkle, Sara E.

2015-01-01

College students transitioning to their sophomore year, those transferring to a new institution, and seniors transitioning out of higher education face various challenges and struggles. The literature on the transitions associated with these student populations indicates that they need sustained support in a few key areas that include student and…

Police Encounters with People with Intellectual Disability: Prevalence, Characteristics and Challenges

ERIC Educational Resources Information Center

Henshaw, M.; Thomas, S.

2012-01-01

Background: This study investigated the experiences and perceptions of operational members of Victoria Police in relation to their contacts with people with intellectual disability (ID). Key interests for exploration included how frequently and in what context police reported coming into contact with people with ID, how they made this…

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.…

Public Policy in Gifted Education

ERIC Educational Resources Information Center

Gallagher, James J., Ed; Reis, Sally M., Ed.

2004-01-01

Raising some of the most challenging questions in the field, this call-to-arms focuses on the important services gifted programs provide, the potential crisis gifted educators face, and what must be done to keep the gifted child movement alive and well. Key features include: (1) James J. Gallagher's unflinching account of the issues that continue…

User Information Needs: The Challenge and a Response.

ERIC Educational Resources Information Center

Goodman, A. F.; Jones, S.O.

Described are the aims, goals, and methods of literature search of the Mechanized Library Information System serving West Coast locations of the McDonnell Douglas Corporation. Brief reports on two pilot programs, one on information awareness, and the other on a capability profile system for locating key personnel, are included. The first program…

Education for Diversity: The Role of Networking in Resisting Disabled People's Marginalisation in Bangladesh

ERIC Educational Resources Information Center

Miles, Susie; Fefoame, Gertrude Oforiwa; Mulligan, Diane; Haque, Zakia

2012-01-01

This article examines the role networking has played, at local and national levels, in facilitating communication between key actors involved in challenging the marginalisation of disabled people from education and from wider Bangladeshi society. Efforts to promote awareness of the importance of including disabled children in their local schools…

Acting Out! Combating Homophobia through Teacher Activism. Practitioner Inquiry Series

ERIC Educational Resources Information Center

Blackburn, Mollie V., Ed.; Clark, Caroline T., Ed.; Kenney, Lauren M., Ed.; Smith, Jill M., Ed.

2009-01-01

In this volume, teachers from urban, suburban, and rural districts join together in a teacher inquiry group to challenge homophobia and heterosexism in schools and classrooms. To create safe learning environments for all students they address key topics, including seizing teachable moments, organizing faculty, deciding whether to come out in the…

It's a Puzzle: A Self-Organizing Activity

ERIC Educational Resources Information Center

McCollum, Janet; Barber, Catherine R.

2017-01-01

Helping students connect abstract concepts to concrete situations is often a challenge. Students who are unable to make the basic connections are at risk of spending the semester and beyond misunderstanding key points and their application. In this article, we provide a framework that includes debriefing, bridge building, and assimilation to help…

Changes and Challenges: Key Issues for Scottish Rural Schools and Communities

ERIC Educational Resources Information Center

Dowling, Jennie

2009-01-01

Education in rural Scottish schools has changed rapidly over the past 15 years. These changes include the implementation of national curriculum and assessment guidelines, increased parental influence and a shift from local authority based management to more locally based schemes. During the 1990s, research in the field focused largely on learning…

Teacher Education in Bhutan: Highlights and Challenges for Reform

ERIC Educational Resources Information Center

VanBalkom, W. Duffie; Sherman, Ann

2010-01-01

Bhutan is embarking on a comprehensive education reform process, with teachers and teacher education at the centre of a number of initiatives. This study describes the current state of affairs based on interviews with key informants and semi-structured focus groups in Bhutan. Several major themes emerged, including issues of quality of students…

Structured Work Systems: Supporting Meaningful Engagement in Preschool Settings for Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Carnahan, Christina; Harte, Helene; Schumacher Dyke, Karin; Hume, Kara; Borders, Christy

2011-01-01

Key characteristics of autism include differences in communication, social interaction, and restricted or repetitive activities and interests (American Psychiatric Association, 2000). Because of these differences, active engagement is challenging for many young children with autism spectrum disorders (ASD). However, such engagement in a variety of…

A Case Study of Multimethod Evaluation of Complex School Mental Health Promotion and Prevention: The Mindmatters Evaluation Suite

ERIC Educational Resources Information Center

Rowling, Louise; Mason, Jo

2005-01-01

There are a number of challenges and debates surrounding the implementation of mental health interventions in schools. These include recognising the complexity of influencing factors and the interdependency of key components; the critical importance of monitoring school-based implementation in particular contexts; employing multimethod evaluation…

Compact fusion energy based on the spherical tokamak

NASA Astrophysics Data System (ADS)

Sykes, A.; Costley, A. E.; Windsor, C. G.; Asunta, O.; Brittles, G.; Buxton, P.; Chuyanov, V.; Connor, J. W.; Gryaznevich, M. P.; Huang, B.; Hugill, J.; Kukushkin, A.; Kingham, D.; Langtry, A. V.; McNamara, S.; Morgan, J. G.; Noonan, P.; Ross, J. S. H.; Shevchenko, V.; Slade, R.; Smith, G.

2018-01-01

Tokamak Energy Ltd, UK, is developing spherical tokamaks using high temperature superconductor magnets as a possible route to fusion power using relatively small devices. We present an overview of the development programme including details of the enabling technologies, the key modelling methods and results, and the remaining challenges on the path to compact fusion.

Packaging of silicon photonic devices: from prototypes to production

NASA Astrophysics Data System (ADS)

Morrissey, Padraic E.; Gradkowski, Kamil; Carroll, Lee; O'Brien, Peter

2018-02-01

The challenges associated with the photonic packaging of silicon devices is often underestimated and remains technically challenging. In this paper, we review some key enabling technologies that will allow us to overcome the current bottleneck in silicon photonic packaging; while also describing the recent developments in standardisation, including the establishment of PIXAPP as the worlds first open-access PIC packaging and assembly Pilot Line. These developments will allow the community to move from low volume prototype photonic packaged devices to large scale volume manufacturing, where the full commercialisation of PIC technology can be realised.

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.

Public health preparedness: evolution or revolution?

PubMed

Lurie, Nicole; Wasserman, Jeffrey; Nelson, Christopher D

2006-01-01

The recent emphasis on preparedness has created heightened expectations and has raised questions about the extent to which U.S. public health systems have evolved in recent years. This paper describes how public health preparedness is transforming public health agencies. Key signs of change include new partnerships, changes in the workforce, new technologies, and evolving organizational structures. Each of these elements has had some positive impact on public health; however, integration of preparedness with other public health functions remains challenging. The preparedness mission has also raised challenges in the areas of leadership, governance, quality, and accountability.

Progress in satellite quantum key distribution

NASA Astrophysics Data System (ADS)

Bedington, Robert; Arrazola, Juan Miguel; Ling, Alexander

2017-08-01

Quantum key distribution (QKD) is a family of protocols for growing a private encryption key between two parties. Despite much progress, all ground-based QKD approaches have a distance limit due to atmospheric losses or in-fibre attenuation. These limitations make purely ground-based systems impractical for a global distribution network. However, the range of communication may be extended by employing satellites equipped with high-quality optical links. This manuscript summarizes research and development which is beginning to enable QKD with satellites. It includes a discussion of protocols, infrastructure, and the technical challenges involved with implementing such systems, as well as a top level summary of on-going satellite QKD initiatives around the world.

The carrot and the stick? Strategies to improve compliance with college campus tobacco policies

PubMed Central

Fallin-Bennett, Amanda; Roditis, Maria; Glantz, Stanton A.

2017-01-01

Objective Tobacco-free policies are being rapidly adopted nationwide, yet compliance with these policies remains a challenge. This study explored college campus key informants’ experiences with tobacco policies, and their perceived benefits, drawbacks, and outcomes. Participants The sample for this study was 68 key informants representing 16 different California universities with varying tobacco policies (no smoking indoors and within 20 feet of entrances, designated smoking areas, 100% smoke-free, and 100% tobacco-free). Methods Qualitative, descriptive study. Semistructured interviews were transcribed verbatim and analyzed using content analysis. Results Strategies to improve compliance ranged from a social approach to a heavy focus on punitive enforcement. Key informants from campuses using a social approach alone reported barriers to improving compliance, including a perceived lack of efficacy of the approach. However, these campuses found it challenging to incorporate enforcement through campus police or security. Conclusions College campus decision makers should explore using a combined approach (social approach as well as formal enforcement), with enforcement primarily the responsibility of nonpolice university channels (eg, Student Affairs, employee supervisors). PMID:27869568

Key ecological challenges for closed systems facilities

NASA Astrophysics Data System (ADS)

Nelson, Mark; Dempster, William F.; Allen, John P.

2013-07-01

Closed ecological systems are desirable for a number of purposes. In space life support systems, material closure allows precious life-supporting resources to be kept inside and recycled. Closure in small biospheric systems facilitates detailed measurement of global ecological processes and biogeochemical cycles. Closed testbeds facilitate research topics which require isolation from the outside (e.g. genetically modified organisms; radioisotopes) so their ecological interactions and fluxes can be studied separate from interactions with the outside environment. But to achieve and maintain closure entails solving complex ecological challenges. These challenges include being able to handle faster cycling rates and accentuated daily and seasonal fluxes of critical life elements such as carbon dioxide, oxygen, water, macro- and mico-nutrients. The problems of achieving sustainability in closed systems for life support include how to handle atmospheric dynamics including trace gases, producing a complete human diet, recycling nutrients and maintaining soil fertility, the maintenance of healthy air and water and preventing the loss of critical elements from active circulation. In biospheric facilities, the challenge is also to produce analogues to natural biomes and ecosystems, studying processes of self-organization and adaptation in systems that allow specification or determination of state variables and cycles which may be followed through all interactions from atmosphere to soils. Other challenges include the dynamics and genetics of small populations, the psychological challenges for small isolated human groups and backup technologies and strategic options which may be necessary to ensure long-term operation of closed ecological systems.

Life Support Requirements and Challenges for NASA's Constellation Program

NASA Technical Reports Server (NTRS)

Carasquillo, Robyn

2007-01-01

NASA's Constellation Program, which includes the mission objectives of establishing a permanently-manned lunar Outpost, and the exploration of Mars, poses new and unique challenges for human life support systems that will require solutions beyond the Shuttle and International Space Station state of the art systems. In particular, the requirement to support crews for 210 days duration at the lunar outpost with limited resource resupply capability wilt require closed-loop regenerative life support systems with minimal expendables. Planetary environmental conditions such as lunar dust and extreme temperatures, as well as the capability to support frequent and extended-duration EVA's will be particularly challenging. This presentation will summarize the key program and mission life support requirements for the Constellation Program and the unique challenges they present for technology and architecture development.

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

Addressing the psychosocial and communication challenges posed by radiological/nuclear terrorism: key developments since NCRP Report No. 138.

PubMed

Becker, Steven M

2005-11-01

One of the most innovative aspects of NCRP Report No. 138 (Management of Terrorist Incidents Involving Radioactive Material) was the high priority it accorded to psychosocial and communication issues. While previous discussions of radiological and nuclear terrorism had occasionally referred to these topics, NCRP Report No. 138 was the first report of its kind to recognize the profound challenges posed by these issues and to place them at the heart of preparedness and response efforts. In the years since the report's release, a host of important developments have taken place in relation to psychosocial and communication issues. This paper reviews key changes and advances in five broad areas: (1) training exercises, (2) policy and guidance development, (3) findings on hospital and clinician needs, (4) survey research on public perceptions of radiological terrorism, and (5) risk communication for radiological and nuclear terrorism situations. The article concludes with a discussion of continuing psychosocial and communication challenges, including critical areas needing further attention as the nation moves to meet the threat of terrorism involving radioactive materials.

Surgical center: challenges and strategies for nurses in managerial activities.

PubMed

Martins, Fabiana Zerbieri; Dall'Agnoll, Clarice Maria

2017-02-23

Analyze the challenges and strategies of nurses performing managerial activities in a surgical center. Exploratory, descriptive study with a qualitative approach, involving six nurses by means of the Focus Group Technique, between April and August 2013. Data were submitted to thematic content analysis. The main challenges noted were deficiency of material resources, communication noise, adequacy of personnel downsizing, and relationships with the multidisciplinary team. Key strategies include construction of co-management spaces to promote integration among professionals, conflict resolution and exchange of knowledge. Managerial activities involve the promotion of dialogic moments to coordinate the different processes in the surgical center to provide inputs to expand safety and quality of services provided.

Photonic integrated circuits: new challenges for lithography

NASA Astrophysics Data System (ADS)

Bolten, Jens; Wahlbrink, Thorsten; Prinzen, Andreas; Porschatis, Caroline; Lerch, Holger; Giesecke, Anna Lena

2016-10-01

In this work routes towards the fabrication of photonic integrated circuits (PICs) and the challenges their fabrication poses on lithography, such as large differences in feature dimension of adjacent device features, non-Manhattan-type features, high aspect ratios and significant topographic steps as well as tight lithographic requirements with respect to critical dimension control, line edge roughness and other key figures of merit not only for very small but also for relatively large features, are highlighted. Several ways those challenges are faced in today's low-volume fabrication of PICs, including the concept multi project wafer runs and mix and match approaches, are presented and possible paths towards a real market uptake of PICs are discussed.

Mask manufacturing of advanced technology designs using multi-beam lithography (part 2)

NASA Astrophysics Data System (ADS)

Green, Michael; Ham, Young; Dillon, Brian; Kasprowicz, Bryan; Hur, Ik Boum; Park, Joong Hee; Choi, Yohan; McMurran, Jeff; Kamberian, Henry; Chalom, Daniel; Klikovits, Jan; Jurkovic, Michal; Hudek, Peter

2016-09-01

As optical lithography is extended into 10nm and below nodes, advanced designs are becoming a key challenge for mask manufacturers. Techniques including advanced optical proximity correction (OPC) and Inverse Lithography Technology (ILT) result in structures that pose a range of issues across the mask manufacturing process. Among the new challenges are continued shrinking sub-resolution assist features (SRAFs), curvilinear SRAFs, and other complex mask geometries that are counter-intuitive relative to the desired wafer pattern. Considerable capability improvements over current mask making methods are necessary to meet the new requirements particularly regarding minimum feature resolution and pattern fidelity. Advanced processes using the IMS Multi-beam Mask Writer (MBMW) are feasible solutions to these coming challenges. In this paper, Part 2 of our study, we further characterize an MBMW process for 10nm and below logic node mask manufacturing including advanced pattern analysis and write time demonstration.

Beyond Fossil Fuels: Options and Challenges

NASA Astrophysics Data System (ADS)

Thompson, Levi T.

2007-05-01

Securing our nation’s energy supply is arguably the most important challenge we face. The source and amount of energy that is available impacts nearly every aspect of our lives including our mobility, health and welfare. Presently, the U.S. depends heavily on foreign energy resources. For example, in 2006, nearly 60 percent of the crude oil consumed in the U.S. was imported; approximately one-quarter of this oil comes from the Persian Gulf. With growing demands from emerging economies, declining environmental quality and potential for global conflict, there is a pressing need to develop a more sustainable energy strategy. This presentation will review options for a sustainable energy economy including the use of hydrogen and fuel cells, and describe some of the key challenges To cite this abstract, use the following reference: http://meetings.aps.org/link/BAPS.2007.OSS07.A1.2

Clinical application of next-generation sequencing for Mendelian diseases.

PubMed

Jamuar, Saumya Shekhar; Tan, Ene-Choo

2015-06-16

Over the past decade, next-generation sequencing (NGS) has led to an exponential increase in our understanding of the genetic basis of Mendelian diseases. NGS allows for the analysis of multiple regions of the genome in one single reaction and has been shown to be a cost-effective and efficient tool in investigating patients with Mendelian diseases. More recently, NGS has been successfully deployed in the clinics, with a reported diagnostic yield of ~25 %. However, recommendations on clinical implementation of NGS are still evolving with numerous key challenges that impede the widespread use of genetics in everyday medicine. These challenges include when to order, on whom to order, what type of test to order, and how to interpret and communicate the results, including incidental findings, to the patient and family. In this review, we discuss these challenges and suggest guidelines on implementing NGS in the routine clinical workflow.

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.

In-Space Assembly Capability Assessment for Potential Human Exploration and Science Applications

NASA Technical Reports Server (NTRS)

Jefferies, Sharon A.; Jones, Christopher A.; Arney, Dale C.; Stillwagen, Frederic H.; Chai, Patrick R.; Hutchinson, Craig D.; Stafford, Matthew A.; Moses, Robert W.; Dempsey, James A.; Rodgers, Erica M.;

Dental Education Required for the Changing Health Care Environment.

PubMed

Fontana, Margherita; González-Cabezas, Carlos; de Peralta, Tracy; Johnsen, David C

2017-08-01

To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra- and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

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

PubMed

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

2012-12-01

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

International Space Station Passive Thermal Control System Analysis, Top Ten Lessons-Learned

NASA Technical Reports Server (NTRS)

Iovine, John

2011-01-01

The International Space Station (ISS) has been on-orbit for over 10 years, and there have been numerous technical challenges along the way from design to assembly to on-orbit anomalies and repairs. The Passive Thermal Control System (PTCS) management team has been a key player in successfully dealing with these challenges. The PTCS team performs thermal analysis in support of design and verification, launch and assembly constraints, integration, sustaining engineering, failure response, and model validation. This analysis is a significant body of work and provides a unique opportunity to compile a wealth of real world engineering and analysis knowledge and the corresponding lessons-learned. The analysis lessons encompass the full life cycle of flight hardware from design to on-orbit performance and sustaining engineering. These lessons can provide significant insight for new projects and programs. Key areas to be presented include thermal model fidelity, verification methods, analysis uncertainty, and operations support.

Information filtering via a scaling-based function.

PubMed

Qiu, Tian; Zhang, Zi-Ke; Chen, Guang

2013-01-01

Finding a universal description of the algorithm optimization is one of the key challenges in personalized recommendation. In this article, for the first time, we introduce a scaling-based algorithm (SCL) independent of recommendation list length based on a hybrid algorithm of heat conduction and mass diffusion, by finding out the scaling function for the tunable parameter and object average degree. The optimal value of the tunable parameter can be abstracted from the scaling function, which is heterogeneous for the individual object. Experimental results obtained from three real datasets, Netflix, MovieLens and RYM, show that the SCL is highly accurate in recommendation. More importantly, compared with a number of excellent algorithms, including the mass diffusion method, the original hybrid method, and even an improved version of the hybrid method, the SCL algorithm remarkably promotes the personalized recommendation in three other aspects: solving the accuracy-diversity dilemma, presenting a high novelty, and solving the key challenge of cold start problem.

A Blueprint for Innovation to Achieve Health System Transformation.

PubMed

Snowdon, Anne W

2017-01-01

Global health systems are challenged by escalating costs and growing demands for care created by the demands of aging populations and rising rates of chronic illness which place unsustainable pressure on health systems to meet population health needs. To overcome these challenges, transformational change is needed to strengthen health system performance and sustainability. Innovation is widely viewed as the strategy to drive transformational change in health systems; yet to date, innovation has lacked a clearly defined focus or agenda to achieve transformation. An actionable innovation agenda is needed to achieve transformational change for health systems. The key conditions for success as an innovation strategy are examined, including clearly defined innovation objectives, key milestones, and actionable steps every system stakeholder must pursue in order to guide the innovation agenda and ultimately accelerate the transformational changes needed for a sustainable healthcare system that delivers value to populations.

Advanced visualization platform for surgical operating room coordination: distributed video board system.

PubMed

Hu, Peter F; Xiao, Yan; Ho, Danny; Mackenzie, Colin F; Hu, Hao; Voigt, Roger; Martz, Douglas

2006-06-01

One of the major challenges for day-of-surgery operating room coordination is accurate and timely situation awareness. Distributed and secure real-time status information is key to addressing these challenges. This article reports on the design and implementation of a passive status monitoring system in a 19-room surgical suite of a major academic medical center. Key design requirements considered included integrated real-time operating room status display, access control, security, and network impact. The system used live operating room video images and patient vital signs obtained through monitors to automatically update events and operating room status. Images were presented on a "need-to-know" basis, and access was controlled by identification badge authorization. The system delivered reliable real-time operating room images and status with acceptable network impact. Operating room status was visualized at 4 separate locations and was used continuously by clinicians and operating room service providers to coordinate operating room activities.

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.

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.

Key challenges in the development and implementation of telehealth projects.

PubMed

Joseph, Victor; West, Robert M; Shickle, Darren; Keen, Justin; Clamp, Susan

2011-01-01

A literature review was carried out to identify the key challenges in the implementation of telehealth. This was followed by a survey of organisations in England involved in telehealth projects in order to understand the challenges they faced. Ten of the 13 health or local authority organisations surveyed had telehealth projects and three were at the planning stage. The analysis revealed seven key challenges facing implementers of telehealth in England. Based on the findings from the literature review and the survey, a model was constructed and a checklist drawn up. The model contained the following elements: identifying issues, needs and partners; producing a strategy; securing funding; implementing changes; and monitoring and evaluating a telehealth project. The checklist was validated by using key informants from the organisations originally surveyed. The checklist may be useful to guide telehealth development and implementation in the future.

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

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.

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

Optimizing the management of depression: primary care experience.

PubMed

Cameron, Catherine; Habert, Jeff; Anand, Leena; Furtado, Melissa

2014-12-01

This article is intended to identify some of the most important challenges faced by family physicians when treating MDD and to provide practical solutions. Key issues, reviewed from a primary care view point will include: treating to remission (and not just response), identification of high-risk groups, diagnosis, acute treatment approaches (including pharmacotherapy and the management of related side effects), the use of psychotherapy and somatic therapies, assessment of the adequacy of treatment including the assessment of remission, response measurement, optimal follow-up care throughout the phase of treatment, the key components of patient education and strategies for partial/limited response to the first-line antidepressant (switching, augmentation and combination strategies), how to provide support for improved treatment adherence, and approaches to prevent the recurrence of depressive episodes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

First Year Chemistry Laboratory Courses for Distance Learners: Development and Transfer Credit Acceptance

ERIC Educational Resources Information Center

Brewer, Sharon E.; Cinel, Bruno; Harrison, Michelle; Mohr, Christina L.

2013-01-01

In delivering chemistry courses by distance, a key challenge is to offer the learner an authentic and meaningful laboratory experience that still provides the rigour required to continue on in science. To satisfy this need, two distance general chemistry laboratory courses appropriate for Bachelor of Science (B.Sc.) students, including chemistry…

Impact and Challenge R&D in the FY 1983 Budget. Colloquium Proceedings (Washington, D.C. June 23-24, 1982).

ERIC Educational Resources Information Center

Teich, Albert H., Ed.; Weinberg, Jill P., Ed.

Provided are papers and speeches presented at the Seventh Annual American Association for the Advancement of Science (AAAS) Colloquium on Research and Development (R&D) Policy. Presenters included key representatives of Congress, the Reagan administration, government agencies, and those involved in industry and university R&D. Major areas…

Two-Dimensional Work: Workplace Literacy in the Aged Care and Call Centre Industries

ERIC Educational Resources Information Center

Waterhouse, Peter; Virgona, Crina

2004-01-01

A key challenge of Australia's vocational education and training (VET) system is to serve the broad needs of individuals, communities, and industries. This includes the provision of literacy and generic skills which meet the needs of all groups. This study investigates and documents workplace literacy in aged care facilities and call centres,…

Now More than Ever: Building and Sustaining Capacity for School-Located Vaccination Initiatives

ERIC Educational Resources Information Center

Kuehnert, Paul

2010-01-01

The fall 2009 campaign to vaccinate high-risk U.S. residents against the 2009 H1N1 influenza virus presented three key challenges that had significant impact on the effectiveness of campaigns conducted by local health departments (LHDs), schools, and other community partners. These issues included those of communication and trust, both between…

Communicating Our Science to Our Customers: Drug Discovery in Five Simple Experiments.

PubMed

Pearson, Lesley-Anne; Foley, David William

2017-02-09

The complexities of modern drug discovery-an interdisciplinary process that often takes years and costs billions-can be extremely challenging to explain to a public audience. We present details of a 30 minute demonstrative lecture that uses well-known experiments to illustrate key concepts in drug discovery including synthesis, assay and metabolism.

Straight A's: Public Education Policy and Progress. Volume 11, Number 13

ERIC Educational Resources Information Center

Amos, Jason, Ed.

2011-01-01

"Straight A's: Public Education Policy and Progress" is a biweekly newsletter that focuses on education news and events both in Washington, DC and around the country. The following articles are included in this issue: (1) Wave Goodbye to Waivers?: Key House Republicans Challenge Duncan's Plan to Grant Waivers to NCLB Requirements; (2)…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

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

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,…

Comparing ecosystem and soil respiration: Review and key challenges of tower-based and soil mesurements

USDA-ARS?s Scientific Manuscript database

The net ecosystem exchange (NEE) is the difference between ecosystem CO2 assimilation and CO2 losses to the atmosphere. Ecosystem respiration (Reco), the efflux of CO2 from the ecosystem to the atmosphere, includes the soil-to-atmosphere carbon flux (i.e., soil respiration; Rsoil) and aboveground pl...

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.

Vaccine instability in the cold chain: mechanisms, analysis and formulation strategies.

PubMed

Kumru, Ozan S; Joshi, Sangeeta B; Smith, Dawn E; Middaugh, C Russell; Prusik, Ted; Volkin, David B

2014-09-01

Instability of vaccines often emerges as a key challenge during clinical development (lab to clinic) as well as commercial distribution (factory to patient). To yield stable, efficacious vaccine dosage forms for human use, successful formulation strategies must address a combination of interrelated topics including stabilization of antigens, selection of appropriate adjuvants, and development of stability-indicating analytical methods. This review covers key concepts in understanding the causes and mechanisms of vaccine instability including (1) the complex and delicate nature of antigen structures (e.g., viruses, proteins, carbohydrates, protein-carbohydrate conjugates, etc.), (2) use of adjuvants to further enhance immune responses, (3) development of physicochemical and biological assays to assess vaccine integrity and potency, and (4) stabilization strategies to protect vaccine antigens and adjuvants (and their interactions) during storage. Despite these challenges, vaccines can usually be sufficiently stabilized for use as medicines through a combination of formulation approaches combined with maintenance of an efficient cold chain (manufacturing, distribution, storage and administration). Several illustrative case studies are described regarding mechanisms of vaccine instability along with formulation approaches for stabilization within the vaccine cold chain. These include live, attenuated (measles, polio) and inactivated (influenza, polio) viral vaccines as well as recombinant protein (hepatitis B) vaccines. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

SMAP Instrument Mechanical System Engineering

NASA Technical Reports Server (NTRS)

Slimko, Eric; French, Richard; Riggs, Benjamin

2013-01-01

The Soil Moisture Active Passive (SMAP) mission, scheduled for launch by the end of 2014, is being developed to measure the soil moisture and soil freeze/thaw state on a global scale over a three-year period. The accuracy, resolution, and global coverage of SMAP measurements are invaluable across many science and applications disciplines including hydrology, climate, carbon cycle, and the meteorological, environment, and ecology applications communities. The SMAP observatory is composed of a despun bus and a spinning instrument platform that includes both a deployable 6 meter aperture low structural frequency Astromesh reflector and a spin control system. The instrument section has engendered challenging mechanical system issues associated with the antenna deployment, flexible antenna pointing in the context of a multitude of disturbances, spun section mass properties, spin control system development, and overall integration with the flight system on both mechanical and control system levels. Moreover, the multitude of organizations involved, including two major vendors providing the spin subsystem and reflector boom assembly plus the flight system mechanical and guidance, navigation, and control teams, has led to several unique system engineering challenges. Capturing the key physics associated with the function of the flight system has been challenging due to the many different domains that are applicable. Key interfaces and operational concepts have led to complex negotiations because of the large number of organizations that integrate with the instrument mechanical system. Additionally, the verification and validation concerns associated with the mechanical system have had required far-reaching involvement from both the flight system and other subsystems. The SMAP instrument mechanical systems engineering issues and their solutions are described in this paper.

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.

Cranberries and lower urinary tract infection prevention

PubMed Central

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

2012-01-01

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

Securing electronic health records with novel mobile encryption schemes.

PubMed

Weerasinghe, Dasun; Elmufti, Kalid; Rajarajan, Muttukrishnan; Rakocevic, Veselin

2007-01-01

Mobile devices have penetrated the healthcare sector due to their increased functionality, low cost, high reliability and easy-to-use nature. However, in healthcare applications the privacy and security of the transmitted information must be preserved. Therefore applications require a concrete security framework based on long-term security keys, such as the security key that can be found in a mobile Subscriber Identity Module (SIM). The wireless nature of communication links in mobile networks presents a major challenge in this respect. This paper presents a novel protocol that will send the information securely while including the access privileges to the authorized recipient.

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.

Antibody–Drug Conjugates for Cancer Therapy

PubMed Central

Parslow, Adam C.; Parakh, Sagun; Lee, Fook-Thean; Gan, Hui K.; Scott, Andrew M.

2016-01-01

Antibody–drug conjugates (ADCs) take advantage of the specificity of a monoclonal antibody to deliver a linked cytotoxic agent directly into a tumour cell. The development of these compounds provides exciting opportunities for improvements in patient care. Here, we review the key issues impacting on the clinical success of ADCs in cancer therapy. Like many other developing therapeutic classes, there remain challenges in the design and optimisation of these compounds. As the clinical applications for ADCs continue to expand, key strategies to improve patient outcomes include better patient selection for treatment and the identification of mechanisms of therapy resistance. PMID:28536381

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.

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

NASA Astrophysics Data System (ADS)

Davis, Sara Allison

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

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.

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).

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.

Dental implants modified with drug releasing titania nanotubes: therapeutic potential and developmental challenges.

PubMed

Gulati, Karan; Ivanovski, Sašo

2017-08-01

The transmucosal nature of dental implants presents a unique therapeutic challenge, requiring not only rapid establishment and subsequent maintenance of osseointegration, but also the formation of resilient soft tissue integration. Key challenges in achieving long-term success are sub-optimal bone integration in compromised bone conditions and impaired trans-mucosal tissue integration in the presence of a persistent oral microbial biofilm. These challenges can be targeted by employing a drug-releasing implant modification such as TiO 2 nanotubes (TNTs), engineered on titanium surfaces via electrochemical anodization. Areas covered: This review focuses on applications of TNT-based dental implants towards achieving optimal therapeutic efficacy. Firstly, the functions of TNT implants will be explored in terms of their influence on osseointegration, soft tissue integration and immunomodulation. Secondly, the developmental challenges associated with such implants are reviewed including sterilization, stability and toxicity. Expert opinion: The potential of TNTs is yet to be fully explored in the context of the complex oral environment, including appropriate modulation of alveolar bone healing, immune-inflammatory processes, and soft tissue responses. Besides long-term in vivo assessment under masticatory loading conditions, investigating drug-release profiles in vivo and addressing various technical challenges are required to bridge the gap between research and clinical dentistry.

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).

A Multi-organisational Approach to Service Delivery

NASA Astrophysics Data System (ADS)

Purchase, Valerie; Mills, John; Parry, Glenn

Who is involved in delivering a service? There has been growing recognition in a wide variety of contexts that service is increasingly being delivered by multi-rather than single-organisational entities. Such recognition is evident not only in our experience but in a number of areas of literature including strategy development, core competence analysis, operations and supply chain management, and is reflected in and further facilitated by ICT developments. Customers have always been involved in some degree in the process of value delivery and such involvement is increasing to include complex co-creation of value. Such interactions are challenging when they involve individual customers, however, this becomes ever more challenging when the 'customer' is another organisation or when there are multiple 'customers'. Within this chapter we will consider some of the key drivers for a multi-organisational approach to service delivery; examine the ways in which the parties involved in service co-creation have expanded to include multiple service providers and customers; and finally, identify some of the challenges created by a multi-organisational approach to service delivery.

Lessons from the field: the conduct of randomized controlled trials in Botswana.

PubMed

Bonsu, Janice M; Frasso, Rosemary; Curry, Allison E

2017-10-27

The conduct of randomized controlled trials (RCTs) in low-resource settings may present unique financial, logistic, and process-related challenges. Middle-income countries that have comparable disease burdens to low-income countries, but greater availability of resources, may be conducive settings for RCTs. Indeed, the country of Botswana is experiencing a rapid increase in the conduct of RCTs. Our objective was to explore the experiences of individuals conducting RCTs in Botswana to gain an understanding of the challenges and adaptive strategies to their work. We conducted in-depth interviews with 14 national and international individuals working on RCTs in Botswana. Participants included principal investigators, research coordinators, lab technicians, research assistants, and other healthcare professionals. Interviews were audiotaped, transcribed verbatim, and coded for thematic analysis. Five primary themes were identified: ethics board relationships (including delays in the process); research staff management (including staff attrition and career development); study recruitment and retention (including the use of reimbursements); resource availability (including challenges accessing laboratory equipment); and capacity-building (including issues of exporting locally sourced samples). These themes were explored to discuss key challenges and adaptive strategies. This study offers a first-hand account of individuals engaged in conducting RCTs in Botswana, a nation that is experiencing a rapid increase in research activities. Findings provide a foundational understanding for researchers in Botswana and trial managers in similar settings when planning RCTs so that the conduct of research does not outpace the ability to manage, support, and regulate it.

Facing the Challenges--Using Information and Communications Technology To Support Teaching and Learning.

ERIC Educational Resources Information Center

Heaney, Liam

2003-01-01

This article explores some of the key issues associated with the use of information and communications technology (ICT) in the classroom. To illustrate ICT integration, a teaching project on dinosaurs, which has been developed with students ages 10-11, is presented. A detailed scheme of work and lesson plans is included. (Contains 4 references.)…

Renewing Quality Assurance at a Time of Turbulence: An Attempt to Reenergise Quality in Australian Higher Education

ERIC Educational Resources Information Center

Shah, Mahsood; Nair, Chenicheri Sid

2011-01-01

The renewal of quality assurance in Australian higher education comes at a time when the higher education sectors in Australia and around the world are experiencing a number of key challenges. These include: ongoing decline in public funding of universities; the massification of higher education and demand for it during global recession;…

Boundary organizations as an approach to overcoming science-delivery barriers in landscape conservation: a Caribbean case study

Treesearch

K.R. Jacobs; L. Nicholson; B.A. Murry; Marixa Maldonado; William Gould

2016-01-01

Throughout the Caribbean, conservation is ecologically, politically, and socially challenging due to a number of factors including globalization, climate change, loss of biodiversity, and the spread of invasive species. Relationships between organizations and institutions that govern the region’s natural and cultural resources are key to conservation success as...

The States and School Finance--After Rodriguez. A Background Paper for the National Governors' Conference and the National Legislative Conference.

ERIC Educational Resources Information Center

Education Commission of the States, Denver, CO. Dept. of Research and Information Services.

This publication examines a number of key issues and recent trends related to the general topic of school finance. Chapter 1 reviews several significant court cases challenging state school finance systems, including San Antonio Independent School District v. Rodriguez, Robinson v. Cahill, and Serrano v. Priest. Chapter 2 describes major new…

Directionally Solidified Eutectic Ceramics for Multifunctional Aerospace Applications

DTIC Science & Technology

2009-06-01

Solidified Alumina - Titania Composites", Key Engineering Materials, 290 (2005) pp 199 - 202. PEER REVIEWED CONFERENCE PROCEEDINGS 22. A. Sayir, S...RESPONSIBLE PERSON 19b. TELEPHONE NUMBER (Include area code) 1 Progress Report for 2006 For the Grant Directionally Solidified Eutectic Ceramics ...incorporating structural ceramics in future aerospace applications: (1) the challenges associated with ceramics are improving strength, toughness and

Keys to Success with Autistic Children: Structure, Predictability, and Consistency Are Essential for Students on the Autism Spectrum

ERIC Educational Resources Information Center

Iseminger, Scott H.

2009-01-01

Early childhood and elementary music teachers face particular challenges when including children with special needs in the music classroom. Children with autism act out and misbehave not because they are autistic, but because their fears and anxieties are so great. Knowing that children with autism and other neurological disorders have distinct…

On "Stepping Back and Letting Go": The Role of Control in the Success or Failure of Social Studies Simulations

ERIC Educational Resources Information Center

Wright-Maley, Cory

2015-01-01

This comparative case study presents one key challenge that 2 experienced teachers faced when using simulations: control. Simulations are activities that place high demands on teachers, including the ability to anticipate pitfalls in advance, act in multiple capacities, shape the direction of the activity without unduly interfering, and to be…

Using Direct Observation to Assist in Eligibility Decisions and Intervention Planning: The Scales for Assessing Emotional Disturbance-2 Observation Form

ERIC Educational Resources Information Center

Nordness, Philip D.; Epstein, Michael H.; Cullinan, Douglas

2013-01-01

A key issue in using the federal definition of emotional disturbance (ED) is the challenge of measuring five characteristics of ED (Epstein, Nordness, Cullinan, & Hertzog, 2002). Stated briefly, these five characteristics include: (1) an inability to learn; (2) relationship problems; (3) inappropriate behavior; (4) unhappiness or depression;…

Clinical ethics revisited

PubMed Central

Singer, Peter A; Pellegrino, Edmund D; Siegler, Mark

2001-01-01

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems. PMID:11346456

Retaining Low-Income Residents in the Workforce: Lessons from the Annie E. Casey Jobs Initiative.

ERIC Educational Resources Information Center

Giloth, Bob; Gewirtz, Susan

Annie E. Casey Jobs Initiative sites recognize the challenge that long-term retention poses in today's labor market for low-income residents. They have developed key elements of an operational definition of retention, including the following: no limitation to one job, but only very limited gaps between jobs; and jobs in construction or other…

Investing in People: Building Social Capital. Profiles of Excellence in Business and Education Leadership.

ERIC Educational Resources Information Center

Larsen, Ralph S.

One of the challenges that faces business and education leaders today is creating an environment in their workplaces and classrooms that is conducive to the "New Realities of Learning." Social capital is a third asset that should be added to the list of key competitive advantages that includes knowledge and human capital. Social capital…

Attitudes of Serbian and Slovenian Student Teachers towards Causes of Learning Underachievement amongst Roma Pupils

ERIC Educational Resources Information Center

Macura-Milovanovic, Suncica; Pecek, Mojca

2013-01-01

The task of initial teacher education is to prepare student teachers (ST) to accept responsibility for improving the education of all pupils, including Roma pupils. Thus, knowledge of ST's attitudes regarding such pupils at the onset of initial teacher education is a key for the creation of teacher education programmes that challenge implicit…

Pubertal Development and Behavior: Hormonal Activation of Social and Motivational Tendencies

ERIC Educational Resources Information Center

Forbes, Erika E.; Dahl, Ronald E.

2010-01-01

Adolescence is a time of dramatic changes including rapid physical growth, the onset of sexual maturation, the activation of new drives and motivations, and a wide array of social and affective changes and challenges. This review focuses on behavioral changes in this interval and is organized by the claim that a key set of these adolescent changes…

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

Mentoring health researchers globally: Diverse experiences, programmes, challenges and responses.

PubMed

Cole, Donald C; Johnson, Nancy; Mejia, Raul; McCullough, Hazel; Turcotte-Tremblay, Anne-Marie; Barnoya, Joaquin; Falabella Luco, María Soledad

2016-10-01

Mentoring experiences and programmes are becoming increasingly recognised as important by those engaged in capacity strengthening in global health research. Using a primarily qualitative study design, we studied three experiences of mentorship and eight mentorship programmes for early career global health researchers based in high-income and low- and middle-income countries. For the latter, we drew upon programme materials, existing unpublished data and more formal mixed-method evaluations, supplemented by individual email questionnaire responses. Research team members wrote stories, and the team assembled and analysed them for key themes. Across the diverse experiences and programmes, key emergent themes included: great mentors inspire others in an inter-generational cascade, mentorship is transformative in personal and professional development and involves reciprocity, and finding the right balance in mentoring relationships and programmes includes responding creatively to failure. Among the challenges encountered were: struggling for more level playing fields for new health researchers globally, changing mindsets in institutions that do not have a culture of mentorship and building collaboration not competition. Mentoring networks spanning institutions and countries using multiple virtual and face-to-face methods are a potential avenue for fostering organisational cultures supporting quality mentorship in global health research.

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

Mentoring health researchers globally: Diverse experiences, programmes, challenges and responses

PubMed Central

Cole, Donald C.; Johnson, Nancy; Mejia, Raul; McCullough, Hazel; Turcotte-Tremblay, Anne-Marie; Barnoya, Joaquin; Falabella Luco, (María) Soledad

2016-01-01

ABSTRACT Mentoring experiences and programmes are becoming increasingly recognised as important by those engaged in capacity strengthening in global health research. Using a primarily qualitative study design, we studied three experiences of mentorship and eight mentorship programmes for early career global health researchers based in high-income and low- and middle-income countries. For the latter, we drew upon programme materials, existing unpublished data and more formal mixed-method evaluations, supplemented by individual email questionnaire responses. Research team members wrote stories, and the team assembled and analysed them for key themes. Across the diverse experiences and programmes, key emergent themes included: great mentors inspire others in an inter-generational cascade, mentorship is transformative in personal and professional development and involves reciprocity, and finding the right balance in mentoring relationships and programmes includes responding creatively to failure. Among the challenges encountered were: struggling for more level playing fields for new health researchers globally, changing mindsets in institutions that do not have a culture of mentorship and building collaboration not competition. Mentoring networks spanning institutions and countries using multiple virtual and face-to-face methods are a potential avenue for fostering organisational cultures supporting quality mentorship in global health research. PMID:26234691

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.

Development of a Faith-Based Stress Management Intervention in a Rural African American Community.

PubMed

Bryant, Keneshia; Moore, Todd; Willis, Nathaniel; Hadden, Kristie

2015-01-01

Faith-based mental health interventions developed and implemented using a community-based participatory research (CBPR) approach hold promise for reaching rural African Americans and addressing health disparities. To describe the development, challenges, and lessons learned from the Trinity Life Management, a faith-based stress management intervention in a rural African American faith community. The researchers used a CBPR approach by partnering with the African American faith community to develop a stress management intervention. Development strategies include working with key informants, focus groups, and a community advisory board (CAB). The community identified the key concepts that should be included in a stress management intervention. The faith-based "Trinity Life Management" stress management intervention was developed collaboratively by a CAB and an academic research team. The intervention includes stress management techniques that incorporate Biblical principles and information about the stress-distress-depression continuum.

Evidence-based guidelines for supportive care of patients with Ebola virus disease.

PubMed

Lamontagne, François; Fowler, Robert A; Adhikari, Neill K; Murthy, Srinivas; Brett-Major, David M; Jacobs, Michael; Uyeki, Timothy M; Vallenas, Constanza; Norris, Susan L; Fischer, William A; Fletcher, Thomas E; Levine, Adam C; Reed, Paul; Bausch, Daniel G; Gove, Sandy; Hall, Andrew; Shepherd, Susan; Siemieniuk, Reed A; Lamah, Marie-Claude; Kamara, Rashida; Nakyeyune, Phiona; Soka, Moses J; Edwin, Ama; Hazzan, Afeez A; Jacob, Shevin T; Elkarsany, Mubarak Mustafa; Adachi, Takuya; Benhadj, Lynda; Clément, Christophe; Crozier, Ian; Garcia, Armando; Hoffman, Steven J; Guyatt, Gordon H

2018-02-17

The 2013-16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients' reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief. Copyright © 2018 Elsevier Ltd. All rights reserved.

Defining the road ahead: thinking strategically in the new era of health care reform.

PubMed

Pudlowski, Edward M

2011-01-01

Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.

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.

Batteries for electric and hybrid-electric vehicles.

PubMed

Cairns, Elton J; Albertus, Paul

2010-01-01

Batteries have powered vehicles for more than a century, but recent advances, especially in lithium-ion (Li-ion) batteries, are bringing a new generation of electric-powered vehicles to the market. Key barriers to progress include system cost and lifetime, and derive from the difficulty of making a high-energy, high-power, and reversible electrochemical system. Indeed, although humans produce many mechanical and electrical systems, the number of reversible electrochemical systems is very limited. System costs may be brought down by using cathode materials less expensive than those presently employed (e.g., sulfur or air), but reversibility will remain a key challenge. Continued improvements in the ability to synthesize and characterize materials at desired length scales, as well as to use computations to predict new structures and their properties, are facilitating the development of a better understanding and improved systems. Battery research is a fascinating area for development as well as a key enabler for future technologies, including advanced transportation systems with minimal environmental impact.

Institutional design and organizational practice for universal coverage in lesser-developed countries: challenges facing the Lao PDR.

PubMed

Ahmed, Shakil; Annear, Peter Leslie; Phonvisay, Bouaphat; Phommavong, Chansaly; Cruz, Valeria de Oliveira; Hammerich, Asmus; Jacobs, Bart

2013-11-01

There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund- and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the time-scale appropriate for achieving universal coverage. Copyright © 2013 Elsevier Ltd. All rights reserved.

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.

Future perspectives on nonmedical prescribing

PubMed Central

Stewart, Derek; Jebara, Tesnime; Cunningham, Scott; Awaisu, Ahmed; Pallivalapila, Abdulrouf; MacLure, Katie

2017-01-01

Many countries have implemented nonmedical prescribing (NMP) and many others are scoping prescribing practices with a view to developing NMP. This paper provides a future perspective on NMP in light of findings of an umbrella review of aspects of NMP. This is followed by coverage of the Scottish Government strategy of pharmacist prescribing and finally, consideration of two key challenges. The review identified seven systematic reviews of influences on prescribing decision-making, processes of prescribing, and barriers and facilitators to implementation. Decision making was reported as complex with many, and often conflicting, influences. Facilitators of NMP included perceived improved patient care and professional autonomy, while barriers included lack of defined roles and resource pressures. Three systematic reviews explored patient outcomes that were noted to be equivalent or better to physician prescribing. In particular, a Cochrane review of 46 studies of clinical, patient-reported, and resource-use outcomes of NMP compared with medical prescribing showed positive intervention-group effects. Despite positive findings, authors highlighted high bias, poor definition and description of ‘prescribing’ and the ‘prescribing process’ and difficulty in separating NMP effects from the contributions of other healthcare team members. While evidence of benefit and safety is essential to inform practice, for NMP to be implemented and sustained on a large scale, there needs to be clear commitment at the highest level. The approach being taken by the Scottish Government to pharmacist prescribing implementation may inform developments in other professions and countries. The vision is that by 2023, all pharmacists providing pharmaceutical care will be pharmacist-independent prescribers. There are, however, challenges to implementing NMP into working practice; two key challenges are the need for sustainable models of care and evaluation research. These challenges could be met by considering the theoretical basis for implementation, and robust and rigorous evaluation. PMID:28607668

Sources, factors, mechanisms and possible solutions to pollutants in marine ecosystems.

PubMed

Mostofa, Khan M G; Liu, Cong-Qiang; Vione, Davide; Gao, Kunshan; Ogawa, Hiroshi

2013-11-01

Algal toxins or red-tide toxins produced during algal blooms are naturally-derived toxic emerging contaminants (ECs) that may kill organisms, including humans, through contaminated fish or seafood. Other ECs produced either naturally or anthropogenically ultimately flow into marine waters. Pharmaceuticals are also an important pollution source, mostly due to overproduction and incorrect disposal. Ship breaking and recycle industries (SBRIs) can also release various pollutants and substantially deteriorate habitats and marine biodiversity. Overfishing is significantly increasing due to the global food crisis, caused by an increasing world population. Organic matter (OM) pollution and global warming (GW) are key factors that exacerbate these challenges (e.g. algal blooms), to which acidification in marine waters should be added as well. Sources, factors, mechanisms and possible remedial measures of these challenges to marine ecosystems are discussed, including their eventual impact on all forms of life including humans. Copyright © 2013 Elsevier Ltd. All rights reserved.

Culture as a variable in neuroscience and clinical neuropsychology: A comprehensive review

PubMed Central

Wajman, José Roberto; Bertolucci, Paulo Henrique Ferreira; Mansur, Letícia Lessa; Gauthier, Serge

2015-01-01

Culture is a dynamic system of bidirectional influences among individuals and their environment, including psychological and biological processes, which facilitate adaptation and social interaction. One of the main challenges in clinical neuropsychology involves cognitive, behavioral and functional assessment of people with different sociocultural backgrounds. In this review essay, examining culture from a historical perspective to ethical issues in cross-cultural research, including the latest significant and publications, the authors sought to explore the main features related to cultural variables in neuropsychological practice and to debate the challenges found regarding the operational methods currently in use. Literature findings suggest a more comprehensive approach in cognitive and behavioral neuroscience, including an interface between elementary disciplines and applied neuropsychology. Thus, as a basis for discussion on this issue, the authors analyzed key-topics related to the study of new trends in sociocultural neuroscience and the application of their concepts from a clinical perspective. PMID:29213964

Nanoplasmonics: a frontier of photovoltaic solar cells

NASA Astrophysics Data System (ADS)

Gu, Min; Ouyang, Zi; Jia, Baohua; Stokes, Nicholas; Chen, Xi; Fahim, Narges; Li, Xiangping; Ventura, Michael James; Shi, Zhengrong

2012-12-01

Nanoplasmonics recently has emerged as a new frontier of photovoltaic research. Noble metal nanostructures that can concentrate and guide light have demonstrated great capability for dramatically improving the energy conversion efficiency of both laboratory and industrial solar cells, providing an innovative pathway potentially transforming the solar industry. However, to make the nanoplasmonic technology fully appreciated by the solar industry, key challenges need to be addressed; including the detrimental absorption of metals, broadband light trapping mechanisms, cost of plasmonic nanomaterials, simple and inexpensive fabrication and integration methods of the plasmonic nanostructures, which are scalable for full size manufacture. This article reviews the recent progress of plasmonic solar cells including the fundamental mechanisms, material fabrication, theoretical modelling and emerging directions with a distinct emphasis on solutions tackling the above-mentioned challenges for industrial relevant applications.

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.

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.

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.

Discovery of innovative therapeutics: today's realities and tomorrow's vision. 2. Pharma's challenges and their commitment to innovation.

PubMed

Abou-Gharbia, Magid; Childers, Wayne E

2014-07-10

The pharmaceutical industry is facing enormous challenges, including reduced efficiency, stagnant success rate, patent expirations for key drugs, fierce price competition from generics, high regulatory hurdles, and the industry's perceived tarnished image. Pharma has responded by embarking on a range of initiatives. Other sectors, including NIH, have also responded. Academic drug discovery groups have appeared to support the transition of innovative academic discoveries and ideas into attractive drug discovery opportunities. Part 1 of this two-part series discussed the criticisms that have been leveled at the pharmaceutical industry over the past 3 decades and summarized the supporting data for and against these criticisms. This second installment will focus on the current challenges facing the pharmaceutical industry and Pharma's responses, focusing on the industry's changing perspective and new business models for coping with the loss of talent and declining clinical pipelines as well as presenting some examples of recent drug discovery successes.

Scalable privacy-preserving data sharing methodology for genome-wide association studies: an application to iDASH healthcare privacy protection challenge.

PubMed

Yu, Fei; Ji, Zhanglong

2014-01-01

In response to the growing interest in genome-wide association study (GWAS) data privacy, the Integrating Data for Analysis, Anonymization and SHaring (iDASH) center organized the iDASH Healthcare Privacy Protection Challenge, with the aim of investigating the effectiveness of applying privacy-preserving methodologies to human genetic data. This paper is based on a submission to the iDASH Healthcare Privacy Protection Challenge. We apply privacy-preserving methods that are adapted from Uhler et al. 2013 and Yu et al. 2014 to the challenge's data and analyze the data utility after the data are perturbed by the privacy-preserving methods. Major contributions of this paper include new interpretation of the χ2 statistic in a GWAS setting and new results about the Hamming distance score, a key component for one of the privacy-preserving methods.

Scalable privacy-preserving data sharing methodology for genome-wide association studies: an application to iDASH healthcare privacy protection challenge

PubMed Central

2014-01-01

In response to the growing interest in genome-wide association study (GWAS) data privacy, the Integrating Data for Analysis, Anonymization and SHaring (iDASH) center organized the iDASH Healthcare Privacy Protection Challenge, with the aim of investigating the effectiveness of applying privacy-preserving methodologies to human genetic data. This paper is based on a submission to the iDASH Healthcare Privacy Protection Challenge. We apply privacy-preserving methods that are adapted from Uhler et al. 2013 and Yu et al. 2014 to the challenge's data and analyze the data utility after the data are perturbed by the privacy-preserving methods. Major contributions of this paper include new interpretation of the χ2 statistic in a GWAS setting and new results about the Hamming distance score, a key component for one of the privacy-preserving methods. PMID:25521367

Discovery of innovative therapeutics: today's realities and tomorrow's vision. 1. Criticisms faced by the pharmaceutical industry.

PubMed

Abou-Gharbia, Magid; Childers, Wayne E

2013-07-25

The pharmaceutical industry is facing enormous challenges, including reduced efficiency, declining innovation, key patent expirations, fierce price competition from generics, high regulatory hurdles, and a tarnished image. There is a clear need for change in the paradigms designed to address these challenges. Pharma has responded by embarking on a range of initiatives. However, along the way the industry has accrued critics whose accusations have tainted its reputation. The first part of this two-part series will discuss the criticisms that have been leveled at the pharmaceutical industry and summarize the supporting data for and against these criticisms. The second installment will focus on the current challenges facing the pharmaceutical industry and Pharma's responses to address these challenges. It will describe the industry's changing perspective and new business models for coping with the recent loss of talent and declining clinical pipelines as well as present some examples of recent drug discovery successes.

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.

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…

Best practices for using natural experiments to evaluate retail food and beverage policies and interventions.

PubMed

Taillie, Lindsey Smith; Grummon, Anna H; Fleischhacker, Sheila; Grigsby-Toussaint, Diana S; Leone, Lucia; Caspi, Caitlin Eicher

2017-12-01

Policy and programmatic change in the food retail setting, including excise taxes on beverages with added-caloric sweeteners, new supermarkets in food deserts, and voluntary corporate pledges, often require the use of natural experimental evaluation for impact evaluation when randomized controlled trials are not possible. Although natural experimental studies in the food retail setting provide important opportunities to test how nonrandomized interventions affect behavioral and health outcomes, researchers face several key challenges to maintaining strong internal and external validity when conducting these studies. Broadly, these challenges include 1) study design and analysis; 2) selection of participants, selection of measures, and obtainment of data; and 3) real-world considerations. This article addresses these challenges and different approaches to meeting them. Case studies are used to illustrate these approaches and to highlight advantages and disadvantages of each approach. If the trade-offs required to address these challenges are carefully considered, thoughtful natural experimental evaluations can minimize bias and provide critical information about the impacts of food retail interventions to a variety of stakeholders, including the affected population, policymakers, and food retailers. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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.

Defining teaching hospitals' GME strategy in response to new financial and market challenges.

PubMed

Wray, J L; Sadowski, S M

1998-04-01

The authors present an overview of current graduate medical education (GME) issues, particularly the financial challenges to teaching hospitals resulting from the Balanced Budget and Tax Payer Relief Acts of 1997 and other recent market-driven factors. They describe in detail the nature of Medicare GME payments before and after the 1997 legislation, with specific examples, and explain the negative financial impact of the legislation and aspects of the legislation that are designed to alleviate that impact. Other factors influencing GME program size and composition are also discussed, including oversupplies or shortages of physicians, the concern that teaching hospitals are using public funds to train international medical graduates, changing training requirements, etc. The authors also describe a recent consulting assignment during which they assisted a major teaching hospital to develop a GME strategy that was responsive to the organization's mission and patients and that took into account future GME financing challenges. Detailed explanations are given of how the consultants analyzed the hospital's GME programs and finances, developed and ranked key institution-specific program criteria (strategic, organizational and operational, and financial), and, in consultation with all key stakeholders, formulated a GME strategy specific to the institution's needs. The authors conclude by cautioning that each institution's GME strategy will be different, but that it is important for institutions to develop such strategies to better face future challenges.

Translating the Science of Measuring Ecosystems at a National Scale: Developing NEON's Online Learning Portal

NASA Astrophysics Data System (ADS)

Wasser, L. A.; Gram, W.; Goehring, L.

2014-12-01

"Big Data" are becoming increasingly common in many fields. The National Ecological Observatory Network (NEON) will be collecting data over the 30 years, using consistent, standardized methods across the United States. These freely available new data provide an opportunity for increased understanding of continental- and global scale processes such as changes in vegetation structure and condition, biodiversity and landuse. However, while "big data" are becoming more accessible and available, integrating big data into the university courses is challenging. New and potentially unfamiliar data types and associated processing methods, required to work with a growing diversity of available data, may warrant time and resources that present a barrier to classroom integration. Analysis of these big datasets may further present a challenge given large file sizes, and uncertainty regarding best methods to properly statistically summarize and analyze results. Finally, teaching resources, in the form of demonstrative illustrations, and other supporting media that might help teach key data concepts, take time to find and more time to develop. Available resources are often spread widely across multi-online spaces. This presentation will overview the development of NEON's collaborative University-focused online education portal. Portal content will include 1) videos and supporting graphics that explain key concepts related to NEON data products including collection methods, key metadata to consider and consideration of potential error and uncertainty surrounding data analysis; and 2) packaged "lab" activities that include supporting data to be used in an ecology, biology or earth science classroom. To facilitate broad use in classrooms, lab activities will take advantage of freely and commonly available processing tools, techniques and scripts. All NEON materials are being developed in collaboration with existing labs and organizations.

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.

World pharmaceuticals--Financial Times tenth annual conference. 22-23 April 1999, London, UK.

PubMed

Muhsin, M

1999-07-01

This two-day conference was organized by The Financial Times, in association with PriceWaterhouseCoopers LLP. The general theme of the event was the state of the healthcare industry, past, present and future. The main areas covered included addressing the challenges of the 1990s, anticipating the challenges of the next decade, the changing shape of global marketing, IT in healthcare, consolidation challenges, shareholder expectations, and new strategies and technologies for growth sustenance within the industry. Key speakers within the industry addressed these issues to an audience of approximately 200 healthcare business executives. The first day was chaired by Mr Robert Cawthorn (Chairman Emeritus, Rhone-Poulenc Rorer Inc) and the second by Professor Trevor Jones (Director General, Association of the British Pharmaceutical Industry).

Growing Older With HIV/AIDS: New Public Health Challenges

PubMed Central

Cahill, Sean; Valadéz, Robert

2013-01-01

At present, the health care infrastructure is ill-equipped to handle the unique treatment and care needs of HIV-positive older adults. The long-term effects of antiretroviral use are still being discovered and have been associated with a number of comorbidities. Stigma presents challenges for those in need of services and health care, and can significantly affect mental health and treatment adherence. The training of elder service providers and health care providers in meeting the needs of HIV-positive older adults, including gay and transgender people, is needed as the population ages. HIV-related and antigay stigma should be challenged by social marketing campaigns. Continued research and key policy changes could greatly improve health outcomes for HIV-positive elderly persons by increasing access to treatment and support. PMID:23327276

Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments.

PubMed

Dougherty, Scott; Beaton, Andrea; Nascimento, Bruno R; Zühlke, Liesl J; Khorsandi, Maziar; Wilson, Nigel

2018-01-01

Rheumatic heart disease (RHD) has long receded as a significant threat to public health in high-income countries. In low-resource settings, however, the specter of RHD remains unabated, as exemplified by recent data from the Global Burden of Diseases Study. There are many complex reasons for this ongoing global disparity, including inadequate data on disease burden, challenges in effective advocacy, ongoing poverty and inequality, and weak health systems, most of which predominantly affect developing nations. In this review, we discuss how each of these acts as a core challenge in RHD prevention and control. We then examine key lessons learnt from successful control programs in the past and highlight resources that have been developed to help create strong national RHD control programs.

DCE-MRI, DW-MRI, and MRS in Cancer: Challenges and Advantages of Implementing Qualitative and Quantitative Multi-parametric Imaging in the Clinic

PubMed Central

Winfield, Jessica M.; Payne, Geoffrey S.; Weller, Alex; deSouza, Nandita M.

2016-01-01

Abstract Multi-parametric magnetic resonance imaging (mpMRI) offers a unique insight into tumor biology by combining functional MRI techniques that inform on cellularity (diffusion-weighted MRI), vascular properties (dynamic contrast-enhanced MRI), and metabolites (magnetic resonance spectroscopy) and has scope to provide valuable information for prognostication and response assessment. Challenges in the application of mpMRI in the clinic include the technical considerations in acquiring good quality functional MRI data, development of robust techniques for analysis, and clinical interpretation of the results. This article summarizes the technical challenges in acquisition and analysis of multi-parametric MRI data before reviewing the key applications of multi-parametric MRI in clinical research and practice. PMID:27748710

Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments

PubMed Central

Dougherty, Scott; Beaton, Andrea; Nascimento, Bruno R; Zühlke, Liesl J; Khorsandi, Maziar; Wilson, Nigel

2018-01-01

Rheumatic heart disease (RHD) has long receded as a significant threat to public health in high-income countries. In low-resource settings, however, the specter of RHD remains unabated, as exemplified by recent data from the Global Burden of Diseases Study. There are many complex reasons for this ongoing global disparity, including inadequate data on disease burden, challenges in effective advocacy, ongoing poverty and inequality, and weak health systems, most of which predominantly affect developing nations. In this review, we discuss how each of these acts as a core challenge in RHD prevention and control. We then examine key lessons learnt from successful control programs in the past and highlight resources that have been developed to help create strong national RHD control programs. PMID:29440834

The personal health record: consumers banking on their health.

PubMed

Ball, Marion J; Costin, Melinda Y; Lehmann, Christoph

2008-01-01

With personal health records (PHRs) acting much like ATM cards, increasingly wired consumers can "bank on health", accessing their own personal health information and a wide array of services. Consumer-owned, the PHR is dependent upon the existence of the legal electronic medical record (EMR) and interoperability. Working PHRs are in place in Veterans Health Administration, private health care institutions, and in the commercial sector. By allowing consumers to become involved in their own care, the PHR creates new roles and relationships. New tools change the clinician's workflow and thought flow, and pose new challenges for consumers. Key components of the PHR include the EMR and regional health information organizations (RHIOs); key strategies focus on human factors in successful project management. Online resources provided by the National Library of Medicine and Health On the Net help address consumer needs for information that is reliable and understandable. The growth of self-management tools adds to the challenge and the promise of PHRs for clinicians and consumers alike.

Theoretical models for coronary vascular biomechanics: Progress & challenges

PubMed Central

Waters, Sarah L.; Alastruey, Jordi; Beard, Daniel A.; Bovendeerd, Peter H.M.; Davies, Peter F.; Jayaraman, Girija; Jensen, Oliver E.; Lee, Jack; Parker, Kim H.; Popel, Aleksander S.; Secomb, Timothy W.; Siebes, Maria; Sherwin, Spencer J.; Shipley, Rebecca J.; Smith, Nicolas P.; van de Vosse, Frans N.

2013-01-01

A key aim of the cardiac Physiome Project is to develop theoretical models to simulate the functional behaviour of the heart under physiological and pathophysiological conditions. Heart function is critically dependent on the delivery of an adequate blood supply to the myocardium via the coronary vasculature. Key to this critical function of the coronary vasculature is system dynamics that emerge via the interactions of the numerous constituent components at a range of spatial and temporal scales. Here, we focus on several components for which theoretical approaches can be applied, including vascular structure and mechanics, blood flow and mass transport, flow regulation, angiogenesis and vascular remodelling, and vascular cellular mechanics. For each component, we summarise the current state of the art in model development, and discuss areas requiring further research. We highlight the major challenges associated with integrating the component models to develop a computational tool that can ultimately be used to simulate the responses of the coronary vascular system to changing demands and to diseases and therapies. PMID:21040741

Performance Analysis, Design Considerations, and Applications of Extreme-Scale In Situ Infrastructures

DOE PAGES

Ayachit, Utkarsh; Bauer, Andrew; Duque, Earl P. N.; ...

2016-11-01

A key trend facing extreme-scale computational science is the widening gap between computational and I/O rates, and the challenge that follows is how to best gain insight from simulation data when it is increasingly impractical to save it to persistent storage for subsequent visual exploration and analysis. One approach to this challenge is centered around the idea of in situ processing, where visualization and analysis processing is performed while data is still resident in memory. Our paper examines several key design and performance issues related to the idea of in situ processing at extreme scale on modern platforms: Scalability, overhead,more » performance measurement and analysis, comparison and contrast with a traditional post hoc approach, and interfacing with simulation codes. We illustrate these principles in practice with studies, conducted on large-scale HPC platforms, that include a miniapplication and multiple science application codes, one of which demonstrates in situ methods in use at greater than 1M-way concurrency.« less

Narrative Aversion: Challenges for the Illness Narrative Advocate.

PubMed

Behrendt, Kathy

2017-02-01

Engaging in self-narrative is often touted as a powerful antidote to the bad effects of illness. However, there are various examples of what may broadly be termed "aversion" to illness narrative. I group these into three kinds: aversion to certain types of illness narrative; aversion to illness narrative as a whole; and aversion to illness narrative as an essentially therapeutic endeavor. These aversions can throw into doubt the advantages claimed for the illness narrator, including the key benefits of repair to the damage illness does to identity and life-trajectory. Underlying these alleged benefits are two key presuppositions: that it is the whole of one's life that is narratively unified, and that one's identity is inextricably bound up with narrative. By letting go of these assumptions, illness narrative advocates can respond to the challenges of narrative aversions. © The Author 2016. Published by Oxford University Press, on behalf of The Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

“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

Information Filtering via a Scaling-Based Function

PubMed Central

Qiu, Tian; Zhang, Zi-Ke; Chen, Guang

2013-01-01

Finding a universal description of the algorithm optimization is one of the key challenges in personalized recommendation. In this article, for the first time, we introduce a scaling-based algorithm (SCL) independent of recommendation list length based on a hybrid algorithm of heat conduction and mass diffusion, by finding out the scaling function for the tunable parameter and object average degree. The optimal value of the tunable parameter can be abstracted from the scaling function, which is heterogeneous for the individual object. Experimental results obtained from three real datasets, Netflix, MovieLens and RYM, show that the SCL is highly accurate in recommendation. More importantly, compared with a number of excellent algorithms, including the mass diffusion method, the original hybrid method, and even an improved version of the hybrid method, the SCL algorithm remarkably promotes the personalized recommendation in three other aspects: solving the accuracy-diversity dilemma, presenting a high novelty, and solving the key challenge of cold start problem. PMID:23696829

GAIA payload module mechanical development

NASA Astrophysics Data System (ADS)

Touzeau, S.; Sein, E.; Lebranchu, C.

2017-11-01

Gaia is the European Space Agency's cornerstone mission for global space astrometry. Its goal is to make the largest, most precise three-dimensional map of our Galaxy by surveying an unprecedented number of stars. This paper gives an overview of the mechanical system engineering and verification of the payload module. This development includes several technical challenges. First of all, the very high stability performance as required for the mission is a key driver for the design, which incurs a high degree of stability. This is achieved through the extensive use of Silicon Carbide (Boostec® SiC) for both structures and mirrors, a high mechanical and thermal decoupling between payload and service modules, and the use of high-performance engineering tools. Compliance of payload mass and volume with launcher capability is another key challenge, as well as the development and manufacturing of the 3.2-meter diameter toroidal primary structure. The spacecraft mechanical verification follows an innovative approach, with direct testing on the flight model, without any dedicated structural model.

Young men's perspectives on family support and disclosure of same-sex attraction

PubMed Central

Carpineto, Julie; Kubicek, Katrina; Weiss, George; Iverson, Ellen; Kipke, Michele D

2011-01-01

Young men who have sex with men (YMSM) face myriad challenges when deciding to disclose their sexual orientation to family members. Key to this decision is consideration of how disclosure may influence the support they receive from family. This paper explores a diverse sample of YMSM’s (N = 43) perspectives on disclosure of their same-sex attractions to key family members and its impact on family support. Several stages/categories of disclosure are described and some YMSM seemed to continue to move between categories. Additionally, relationships after disclosure included negotiations between the expression of their sexual orientation and the maintenance of family support. PMID:21423842

Embedding gender equality into institutional strategy.

PubMed

Ahmed, S

2017-01-01

The SiS (Sex in Science) Programme on the WGC (Wellcome Genome Campus) was established in 2011. Key participants include the Wellcome Trust Sanger Institute, EMB-EBI (EMBL-European Bioinformatics Institute), Open Targets and Elixir. The key objectives are to catalyse cultural change, develop partnerships, communicate activities and champion our women in science work at a national and international level (http://www.sanger.ac.uk/about/sex-science). In this paper, we highlight some of the many initiatives that have taken place since 2013, to address gender inequality at the highest levels; the challenges we have faced and how we have overcome these, and the future direction of travel.

Young men's perspectives on family support and disclosure of same-sex attraction.

PubMed

Carpineto, Julie; Kubicek, Katrina; Weiss, George; Iverson, Ellen; Kipke, Michele D

2008-06-01

Young men who have sex with men (YMSM) face myriad challenges when deciding to disclose their sexual orientation to family members. Key to this decision is consideration of how disclosure may influence the support they receive from family. This paper explores a diverse sample of YMSM's (N = 43) perspectives on disclosure of their same-sex attractions to key family members and its impact on family support. Several stages/categories of disclosure are described and some YMSM seemed to continue to move between categories. Additionally, relationships after disclosure included negotiations between the expression of their sexual orientation and the maintenance of family support.

The distinction between key ideas in teaching school physics and key ideas in the discipline of physics

NASA Astrophysics Data System (ADS)

Deng, Zongyi

2001-05-01

The distinction between key ideas in teaching a high school science and key ideas in the corresponding discipline of science has been largely ignored in scholarly discourse about what science teachers should teach and about what they should know. This article clarifies this distinction through exploring how and why key ideas in teaching high school physics differ from key ideas in the discipline of physics. Its theoretical underpinnings include Dewey's (1902/1990) distinction between the psychological and the logical and Harré's (1986) epistemology of science. It analyzes how and why the key ideas in teaching color, the speed of light, and light interference at the high school level differ from the key ideas at the disciplinary level. The thesis is that key ideas in teaching high school physics can differ from key ideas in the discipline in some significant ways, and that the differences manifest Dewey's distinction. As a result, the article challenges the assumption of equating key ideas in teaching a high school science with key ideas in the corresponding discipline of science, and the assumption that having a college degree in science is sufficient to teach high school science. Furthermore, the article expands the concept of pedagogical content knowledge by arguing that key ideas in teaching high school physics constitute an essential component.

Orion Integrated Guidance, Navigation, and Control [GN and C

NASA Technical Reports Server (NTRS)

Chevray, Kay

2009-01-01

This slide presentation reviews the integrated Guidance, Navigation and Control (iGN&C) system in the design for the Orion spacecraft. Included in the review are the plans for the design and development of the external interfaces, the functional architecture, the iGN&C software, the development and validation process, and the key challenges that are involved in the development of the iGN&C system

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.;

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.

Advances in Antibody Design

PubMed Central

Tiller, Kathryn E.; Tessier, Peter M.

2017-01-01

The use of monoclonal antibodies as therapeutics requires optimizing several of their key attributes. These include binding affinity and specificity, folding stability, solubility, pharmacokinetics, effector functions, and compatibility with the attachment of additional antibody domains (bispecific antibodies) and cytotoxic drugs (antibody–drug conjugates). Addressing these and other challenges requires the use of systematic design methods that complement powerful immunization and in vitro screening methods. We review advances in designing the binding loops, scaffolds, domain interfaces, constant regions, post-translational and chemical modifications, and bispecific architectures of antibodies and fragments thereof to improve their bioactivity. We also highlight unmet challenges in antibody design that must be overcome to generate potent antibody therapeutics. PMID:26274600

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.

View from the Top: Perspectives on Women in Gastroenterology from Society Leaders.

PubMed

Schmitt, Colleen M; Allen, John I

2016-06-01

Women are making great strides at all levels of medicine, including gastroenterology. The proportion of women members in gastroenterology societies has increased nearly 2-fold and the percent of women trainees is 36%. Although there continue to be challenges for women in academic and community practice, the American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and other gastroenterology societies have dedicated substantial resources to foster careers of women in gastroenterology and develop women as leaders in our societies. This article outlines ongoing challenges for women in gastroenterology and some key initiatives addressing barriers to success. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

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.

Making interprofessional education work: the strategic roles of the academy.

PubMed

Ho, Kendall; Jarvis-Selinger, Sandra; Borduas, Francine; Frank, Blye; Hall, Pippa; Handfield-Jones, Richard; Hardwick, David F; Lockyer, Jocelyn; Sinclair, Doug; Lauscher, Helen Novak; Ferdinands, Luke; MacLeod, Anna; Robitaille, Marie-Anik; Rouleau, Michel

2008-10-01

Faculties (i.e., schools) of medicine along with their sister health discipline faculties can be important organizational vehicles to promote, cultivate, and direct interprofessional education (IPE). The authors present information they gathered in 2007 about five Canadian IPE programs to identify key factors facilitating transformational change within institutional settings toward successful IPE, including (1) how successful programs start, (2) the ways successful programs influence academia to bias toward change, and (3) the ways academia supports and perpetuates the success of programs. Initially, they examine evidence regarding key factors that facilitate IPE implementation, which include (1) common vision, values, and goal sharing, (2) opportunities for collaborative work in practice and learning, (3) professional development of faculty members, (4) individuals who are champions of IPE in practice and in organizational leadership, and (5) attention to sustainability. Subsequently, they review literature-based insights regarding barriers and challenges in IPE that must be addressed for success, including barriers and challenges (1) between professional practices, (2) between academia and the professions, and (3) between individuals and faculty members; they also discuss the social context of the participants and institutions. The authors conclude by recommending what is needed for institutions to entrench IPE into core education at three levels: micro (what individuals in the faculty can do); meso (what a faculty can promote); and macro (how academic institutions can exert its influence in the health education and practice system).

Application of Feminist Phase Theory in Educational Leadership Textbooks: A Developmental Analysis

ERIC Educational Resources Information Center

Reggio, Phyllis F.

2013-01-01

A key focus of school administration programs is to prepare educators for the challenges of urban leadership. When female school leaders aspire to leadership positions, the challenges that these issues present are often compounded by other factors such as gender stereotypes and limited opportunities. Textbooks, key tools of leadership study, that…

Notification: FY 2017 Update of Proposed Key Management Challenges and Internal Control Weaknesses Confronting the U.S. Chemical Safety and Hazard Investigation Board

EPA Pesticide Factsheets

Jan 5, 2017. The EPA OIG is beginning work to update for fiscal year 2017 its list of proposed key management challenges and internal control weaknesses confronting the U.S. Chemical Safety and Hazard Investigation Board (CSB).

The Main Belt Comets and ice in the Solar System

NASA Astrophysics Data System (ADS)

Snodgrass, Colin; Agarwal, Jessica; Combi, Michael; Fitzsimmons, Alan; Guilbert-Lepoutre, Aurelie; Hsieh, Henry H.; Hui, Man-To; Jehin, Emmanuel; Kelley, Michael S. P.; Knight, Matthew M.; Opitom, Cyrielle; Orosei, Roberto; de Val-Borro, Miguel; Yang, Bin

2017-11-01

We review the evidence for buried ice in the asteroid belt; specifically the questions around the so-called Main Belt Comets (MBCs). We summarise the evidence for water throughout the Solar System, and describe the various methods for detecting it, including remote sensing from ultraviolet to radio wavelengths. We review progress in the first decade of study of MBCs, including observations, modelling of ice survival, and discussion on their origins. We then look at which methods will likely be most effective for further progress, including the key challenge of direct detection of (escaping) water in these bodies.

Communicative challenges in the home care of older persons - a qualitative exploration.

PubMed

Sundler, Annelie J; Eide, Hilde; van Dulmen, Sandra; Holmström, Inger K

2016-10-01

To explore communicative challenges in encounters between nurse assistants and older persons during home care visits. The older population is increasing worldwide. Currently, there is a shift in care for older people from institutional care to home care. Providing home care in a person's home involves several challenges, including the complexity of communication. A descriptive observational design with a qualitative approach was used. The data consisted of audio recordings of real-life encounters during home care visits between nurse assistants and older persons, collected in 2014. A hermeneutic phenomenological analysis was conducted. Communicative challenges were identified: (a) in situations where the older persons had a different view than the nurse assistants on the care task and its content; and (b) when unexpected actions or turns occurred in the communication. Challenges included older person's existential issues, fragility and worries and concerns, which often appeared to be only vaguely expressed and difficult to verbally detect and tackle. This engendered a risk of misinterpretation or ignorance of these challenges. The findings point to the importance of communication as the key to facilitate person-centred home care. Communication training should focus more on addressing needs and existential issues in older persons. Person-centred home care for older persons needs to be addressed at both an individual and an organizational level. © 2016 John Wiley & Sons Ltd.

Studying physician-adolescent patient communication in community-based practices: recruitment challenges and solutions.

PubMed

Bodner, Michael E; Bilheimer, Alicia; Gao, Xiaomei; Lyna, Pauline; Alexander, Stewart C; Dolor, Rowena J; Østbye, Truls; Bravender, Terrill; Tulsky, James A; Graves, Sidney; Irons, Alexis; Pollak, Kathryn I

2015-11-13

Practice-based studies are needed to assess how physicians communicate health messages about weight to overweight/obese adolescent patients, but successful recruitment to such studies is challenging. This paper describes challenges, solutions, and lessons learned to recruit physicians and adolescents to the Teen Communicating Health Analyzing Talk (CHAT) study, a randomized controlled trial of a communication skills intervention for primary care physicians to enhance communication about weight with overweight/obese adolescents. A "peer-to-peer" approach was used to recruit physicians, including the use of "clinic champions" who liaised between study leaders and physicians. Consistent rapport and cooperative working relationships with physicians and clinic staff were developed and maintained. Adolescent clinic files were reviewed (HIPAA waiver) to assess eligibility. Parents could elect to opt-out for their children. To encourage enrollment, confidentiality of audio recordings was emphasized, and financial incentives were offered to all participants. We recruited 49 physicians and audio-recorded 391 of their overweight/obese adolescents' visits. Recruitment challenges included 1) physician reticence to participate; 2) variability in clinic operating procedures; 3) variability in adolescent accrual rates; 4) clinic open access scheduling; and 5) establishing communication with parents and adolescents. Key solutions included the use of a "clinic champion" to help recruit physicians, pro-active, consistent communication with clinic staff, and adapting calling times to reach parents and adolescents. Recruiting physicians and adolescents to audio-recorded, practice-based health communication studies can be successful. Anticipated challenges to recruiting can be met with advanced planning; however, optimal solutions to challenges evolve as recruitment progresses.

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.

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

PubMed

Rabbani, Fauziah; Shipton, Leah; White, Franklin; Nuwayhid, Iman; London, Leslie; Ghaffar, Abdul; Ha, Bui Thi Thu; Tomson, Göran; Rimal, Rajiv; Islam, Anwar; Takian, Amirhossein; Wong, Samuel; Zaidi, Shehla; Khan, Kausar; Karmaliani, Rozina; Abbasi, Imran Naeem; Abbas, Farhat

2016-09-07

Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.

The organisational and human resource challenges facing primary care trusts: protocol of a multiple case study

PubMed Central

2001-01-01

Background The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. Methods The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development. PMID:11737883

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

PubMed

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

2012-05-01

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

Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population.

PubMed

Nguyen, H D; Chitturi, S; Maple-Brown, L J

2016-11-01

Type 2 diabetes mellitus and other chronic cardio-metabolic conditions are significant contributors to the large disparities in life expectancy between Indigenous and non-Indigenous Australians. Type 2 diabetes is more prevalent from a young age among Indigenous Australians and is often preceded by a cluster of risk factors, including central obesity, dyslipidaemia, albuminuria and socio-economic disadvantage. Management of type 2 diabetes in Australian Indigenous peoples can be challenging in the setting of limited resources and socio-economic disadvantage. Key strategies to address these challenges include working in partnership with patients, communities and primary healthcare services (PHC, Aboriginal community controlled and government services) and working in a multidisciplinary team. Population prevention measures are required within and beyond the health system, commencing as early as possible in the life course. © 2016 Royal Australasian College of Physicians.

Current state and challenges in developing oral vaccines.

PubMed

Vela Ramirez, Julia E; Sharpe, Lindsey A; Peppas, Nicholas A

2017-05-15

While vaccination remains the most cost effective strategy for disease prevention, communicable diseases persist as the second leading cause of death worldwide. There is a need to design safe, novel vaccine delivery methods to protect against unaddressed and emerging diseases. Development of vaccines administered orally is preferable to traditional injection-based formulations for numerous reasons including improved safety and compliance, and easier manufacturing and administration. Additionally, the oral route enables stimulation of humoral and cellular immune responses at both systemic and mucosal sites to establish broader and long-lasting protection. However, oral delivery is challenging, requiring formulations to overcome the harsh gastrointestinal (GI) environment and avoid tolerance induction to achieve effective protection. Here we address the rationale for oral vaccines, including key biological and physicochemical considerations for next-generation oral vaccine design. Copyright © 2017 Elsevier B.V. All rights reserved.

Expanded Learning Time and Opportunities: Key Principles, Driving Perspectives, and Major Challenges

ERIC Educational Resources Information Center

Blyth, Dale A.; LaCroix-Dalluhn, Laura

2011-01-01

If expanded learning is going to make a real difference, then three key principles must inform how communities overcome challenges and assure equitable access to learning opportunities. Much of today's debate is framed in the language of formal education systems--students, classrooms, schools--even though part of the expansion seeks to engage a…

A critical analysis of the implementation of a legal regulated market for new psychoactive substances ("legal highs") in New Zealand.

PubMed

Rychert, Marta; Wilkins, Chris

2018-05-01

In July 2013 New Zealand passed the Psychoactive Substances Act (PSA) to establish the world's first regulated legal market for new psychoactive substances (NPS) ("legal highs"). To critically analyse the implementation of the PSA. Synthesis of findings from interviews with 30 key informants (i.e. politicians, civil servants, legal high industry actors, toxicologists, NGO representatives and drug policy academics), analysis of relevant laws and policy documents, and a review of academic and grey literature on the PSA. Key challenges experienced during the implementation of the PSA included the harmfulness of interim approved products, the slowness in withdrawing products which caused adverse effects, enforcing retail restrictions, price competition by retailers, judicial challenges by the "legal high" industry, and growing opposition to the regime from local communities and key stakeholders (including local councils). The PSA lacks a tax on products and restrictions on retail opening hours which likely contributed to the problems above. The implementation of the PSA also appeared to suffer from a rushed legislative process and resource constraints on the regulatory agency which led to delays in the development of the full regulatory framework, including the product testing requirements, and issues with enforcing retail regulation, such as the minimum age of purchase. The decline in public support for the PSA regime reflected problems with communicating the aims of the policy to the general public. The troubled implementation of the PSA underlines a number of important lessons for consideration when developing a regulated legal drug market, including advanced development of regulatory systems, ensuring the sale of low risk products, adequately resourcing regulatory agencies and related enforcement activity, detailed regulation of retail outlets, establishing price controls, and ongoing engagement with stakeholders and the general public. Copyright © 2018 Elsevier B.V. All rights reserved.

Sizing Power Components of an Electrically Driven Tail Cone Thruster and a Range Extender

NASA Technical Reports Server (NTRS)

Jansen, Ralph H.; Bowman, Cheryl; Jankovsky, Amy

2016-01-01

The aeronautics industry has been challenged on many fronts to increase efficiency, reduce emissions, and decrease dependency on carbon-based fuels. This paper provides an overview of the turboelectric and hybrid electric technologies being developed under NASA's Advanced Air Transportation Technology (AATT) Project and discusses how these technologies can impact vehicle design. The discussion includes an overview of key hybrid electric studies and technology investments, the approach to making informed investment decisions based on key performance parameters and mission studies, and the power system architectures for two candidate aircraft. Finally, the power components for a single-aisle turboelectric aircraft with an electrically driven tail cone thruster and for a hybrid-electric nine-passenger aircraft with a range extender are parametrically sized, and the sensitivity of these components to key parameters is presented.

Scaling-up HIV responses with key populations in West Africa.

PubMed

Wheeler, Tisha; Wolf, R Cameron; Kapesa, Laurent; Cheng Surdo, Alison; Dallabetta, Gina

2015-03-01

Despite decades of HIV responses in pockets of West and Central Africa (WCA), the HIV response with key populations remains an understudied area. Recently, there has been a proliferation of studies highlighting epidemiologic and behavioral data that challenge attitudes of complacency among donors and country governments uncomfortable in addressing key populations. The articles in this series highlight new studies that provide a better understanding of the epidemiologic and structural burden facing key populations in the WCA region and how to improve responses through more effective targeting. Key populations face pervasive structural barriers including institutional and sexual violence and an intersection of stigma, criminalization, and marginalization as sexual minorities. Despite decades of smaller interventions that have shown the importance of integrated services for key populations, there remains incongruent provision of outreach or testing or family planning pointing to sustained risk. There remains an incongruent resource provision for key populations where they shoulder the burden of HIV and their access to services alone could turn around HIV epidemics within the region. These proximal and distal determinants must be addressed in regional efforts, led by the community, and resourced for scale, targeting those most at risk for the acquisition and transmission of HIV. This special issue builds the knowledge base for the region focusing on interventions that remove barriers to service access including treatment uptake for those living with HIV. Better analysis and use of data for strategic planning are shown to lead to more effective targeting of prevention, care, and HIV treatment programs with key populations. These articles further demonstrate the immediate need for comprehensive action to address HIV among key populations throughout the WCA region.

Electric power restructuring in iran: achievements and challenges

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

Khosroshahi, Kaveh Aflaki; Jadid, Shahram; Shahidehpour, Mohammad

2009-03-15

Although the power market in Iran is not fully constructed, several key steps have been taken to meet privatization and restructuring objectives. The addition of a power exchange sector has placed the power market on par with that in other countries. Operational concerns that still need to be addressed include technical and non-technical losses, enhancing new investment, and providing incentives for introducing energy efficiency and promoting green power generation. (author)

Extended Deterrence and Allied Assurance: Key Concepts and Current Challenges for U.S. Policy

DTIC Science & Technology

2013-09-01

include adversary nuclear forces and stockpiles) in the pre- satellite era required a strategy using large numbers of bombers, large numbers of...radar and sensor capabilities related to TMD, activities Canberra considered important to “bolstering 59 the [U.S.-Australia] alliance.” 146 In...external attack; with potential adversaries developing anti- satellite 90 capabilities, and conducting cyber incursions and attacks against U.S. and

New on the Shelf: Teens in the Library--Summary of Key Findings from the Evaluation of Public Libraries as Partners in Youth Development, A Wallace Foundation Initiative. Chapin Hall Discussion Paper

ERIC Educational Resources Information Center

Spielberger, Julie; Horton, Carol; Michels, Lisa

2004-01-01

Public libraries that engage and employ teenagers can realize mutual benefits, including meaningful activities for young people and strengthened ties between libraries and their communities. This report summarizes both the potential benefits and challenges learned from Wallace's Public Libraries as Partners in Youth Development initiative. The…

System of Systems Technology Readiness Assessment

DTIC Science & Technology

2007-09-01

for their support and commitment to my education . Also, I would like to thank the Department of Navy for providing me the varied and challenging...they are key convergence points for SoS and there may be no opportunity for changes to the interfaces without major impact to the entire SoS. The...Architecture Working Group, 1997): • Procedures: guidance that impact system interoperability, including doctrine, mission, architectures, and standards

Implementation of Prolonged Exposure in the Army: Is Consultation Necessary for Effective Dissemination

DTIC Science & Technology

2015-10-01

study team implemented various efforts to re-educate providers regarding the goal of the study, including holding individual provider meetings...of these changes was developed in direct response to the challenges faced at Ft. Carson, but these changes required IRB approval, resulting in...constitutes a key step towards the ultimate goal of increased access to evidence-based treatment among soldiers suffering from PTSD and related

Future World of Illicit Nuclear Trade: Mitigating the Threat

DTIC Science & Technology

2013-07-29

uranium with lasers that is similar to MLIS. 3 Most of the equipment, including four carbon monoxide lasers and vacuum chambers, was delivered. But...Centrifuge Facility 43 Figure 10: Centrifuge Output vs. Goods Required 44 3b Digging Deeper: Laser Enrichment of Uranium 47 Box 3...Major Foreign Assistance to Iran’s Pre-2004 Laser Enrichment Program 50 4. Key Information: The Special Challenge of the Spread of Classified 53

Strategic Challenges of China-Africa New Partnership

DTIC Science & Technology

2007-03-30

determined to pursue its national interests that include economic growth, to support a large population and enhance its global relevance. Its rapid...economic growth has increased its hunger for energy, raw materials, market and diplomatic relevance to sustain its power. A key region that China...to eradicate poverty and place their countries …on a part of sustained economic growth...” African leaders 2 evolved the New Partnership for

An overview of space medicine.

PubMed

Hodkinson, P D; Anderton, R A; Posselt, B N; Fong, K J

2017-12-01

Space medicine is fundamental to the human exploration of space. It supports survival, function and performance in this challenging and potentially lethal environment. It is international, intercultural and interdisciplinary, operating at the boundaries of exploration, science, technology and medicine. Space medicine is also the latest UK specialty to be recognized by the Royal College of Physicians in the UK and the General Medical Council. This review introduces the field of space medicine and describes the different types of spaceflight, environmental challenges, associated medical and physiological effects, and operational medical considerations. It will describe the varied roles of the space medicine doctor, including the conduct of surgery and anaesthesia, and concludes with a vision of the future for space medicine in the UK.Space medicine doctors have a responsibility to space workers and spaceflight participants. These 'flight surgeons' are key in developing mitigation strategies to ensure the safety, health and performance of space travellers in what is an extreme and hazardous environment. This includes all phases from selection, training and spaceflight itself to post-flight rehabilitation and long-term health. The recent recognition of the speciality provides a pathway to train in this fascinating field of medicine and is a key enabler for the UK Government's commercial spaceflight ambition. © Crown copyright 2017.

BAYESIAN PROTEIN STRUCTURE ALIGNMENT.

PubMed

Rodriguez, Abel; Schmidler, Scott C

The analysis of the three-dimensional structure of proteins is an important topic in molecular biochemistry. Structure plays a critical role in defining the function of proteins and is more strongly conserved than amino acid sequence over evolutionary timescales. A key challenge is the identification and evaluation of structural similarity between proteins; such analysis can aid in understanding the role of newly discovered proteins and help elucidate evolutionary relationships between organisms. Computational biologists have developed many clever algorithmic techniques for comparing protein structures, however, all are based on heuristic optimization criteria, making statistical interpretation somewhat difficult. Here we present a fully probabilistic framework for pairwise structural alignment of proteins. Our approach has several advantages, including the ability to capture alignment uncertainty and to estimate key "gap" parameters which critically affect the quality of the alignment. We show that several existing alignment methods arise as maximum a posteriori estimates under specific choices of prior distributions and error models. Our probabilistic framework is also easily extended to incorporate additional information, which we demonstrate by including primary sequence information to generate simultaneous sequence-structure alignments that can resolve ambiguities obtained using structure alone. This combined model also provides a natural approach for the difficult task of estimating evolutionary distance based on structural alignments. The model is illustrated by comparison with well-established methods on several challenging protein alignment examples.

A harmonized segmentation protocol for hippocampal and parahippocampal subregions: why do we need one and what are the key goals?

PubMed Central

Olsen, Rosanna K.; Berron, David; Carr, Valerie A.; Stark, Craig E.L.; Amaral, Robert S.C.; Amunts, Katrin; Augustinack, Jean C.; Bender, Andrew R.; Bernstein, Jeffrey D.; Boccardi, Marina; Bocchetta, Martina; Burggren, Alison; Chakravarty, M. Mallar; Chupin, Marie; Ekstrom, Arne; de Flores, Robin; Insausti, Ricardo; Kanel, Prabesh; Kedo, Olga; Kennedy, Kristen M.; Kerchner, Geoffrey A.; LaRocque, Karen F.; Liu, Xiuwen; Maass, Anne; Malykhin, Nicolai; Mueller, Susanne G.; Ofen, Noa; Palombo, Daniela J.; Parekh, Mansi B.; Pluta, John B.; Pruessner, Jens C.; Raz, Naftali; Rodrigue, Karen M.; Schoemaker, Dorothee; Shafer, Andrea T.; Steve, Trevor A.; Suthana, Nanthia; Wang, Lei; Winterburn, Julie L.; Yassa, Michael A.; Yushkevich, Paul A.; la Joie, Renaud

2016-01-01

The advent of high-resolution magnetic resonance imaging (MRI) has enabled in vivo research in a variety of populations and diseases on the structure and function of hippocampal subfields and subdivisions of the parahippocampal gyrus. Due to the many extant and highly discrepant segmentation protocols, comparing results across studies is difficult. To overcome this barrier, the Hippocampal Subfields Group was formed as an international collaboration with the aim of developing a harmonized protocol for manual segmentation of hippocampal and parahippocampal subregions on high-resolution MRI. In this commentary we discuss the goals for this protocol and the associated key challenges involved in its development. These include differences among existing anatomical reference materials, striking the right balance between reliability of measurements and anatomical validity, and the development of a versatile protocol that can be adopted for the study of populations varying in age and health. The commentary outlines these key challenges, as well as the proposed solution of each, with concrete examples from our working plan. Finally, with two examples, we illustrate how the harmonized protocol, once completed, is expected to impact the field by producing measurements that are quantitatively comparable across labs and by facilitating the synthesis of findings across different studies. PMID:27862600

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.

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

PubMed

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

2017-07-06

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

Co-Production at the Strategic Level: Co-Designing an Integrated Care System with Lay Partners in North West London, England

PubMed Central

Morton, Michael

2016-01-01

In North West London, health and social care leaders decided to design a system of integrated care with the aim of improving the quality of care and supporting people to maintain independence and participation in their community. Patients and carers, known as ‘lay partners,’ were to be equal partners in co-production of the system. Lay partners were recruited by sending a role profile to health, social care and voluntary organisations and requesting nominations. They formed a Lay Partners Advisory Group from which pairs were allocated to system design workstreams, such as which population to focus on, financial flow, information technology and governance. A larger and more diverse Lay Partners Forum provided feedback on the emerging plans. A key outcome of this approach was the development of an integration toolkit co-designed with lay partners. Lay partners provided challenge, encouraged innovation, improved communication, and held the actions of other partners to account to ensure the vision and aims of the emerging integrated care system were met. Key lessons from the North West London experience for effective co-production include: recruiting patients and carers with experience of strategic work; commitment to the vision; willingness to challenge and to listen; strong connections within the community being served; and enough time to do the work. Including lay partners in co-design from the start, and at every level, was important. Agreeing the principles of working together, providing support and continuously recruiting lay representatives to represent their communities are keys to effective co-production. PMID:27616958

Co-Production at the Strategic Level: Co-Designing an Integrated Care System with Lay Partners in North West London, England.

PubMed

Morton, Michael; Paice, Elisabeth

2016-05-03

In North West London, health and social care leaders decided to design a system of integrated care with the aim of improving the quality of care and supporting people to maintain independence and participation in their community. Patients and carers, known as 'lay partners,' were to be equal partners in co-production of the system. Lay partners were recruited by sending a role profile to health, social care and voluntary organisations and requesting nominations. They formed a Lay Partners Advisory Group from which pairs were allocated to system design workstreams, such as which population to focus on, financial flow, information technology and governance. A larger and more diverse Lay Partners Forum provided feedback on the emerging plans. A key outcome of this approach was the development of an integration toolkit co-designed with lay partners. Lay partners provided challenge, encouraged innovation, improved communication, and held the actions of other partners to account to ensure the vision and aims of the emerging integrated care system were met. Key lessons from the North West London experience for effective co-production include: recruiting patients and carers with experience of strategic work; commitment to the vision; willingness to challenge and to listen; strong connections within the community being served; and enough time to do the work. Including lay partners in co-design from the start, and at every level, was important. Agreeing the principles of working together, providing support and continuously recruiting lay representatives to represent their communities are keys to effective co-production.

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.

Improving and Accelerating Drug Development for Nervous System Disorders

PubMed Central

Pankevich, Diana E.; Altevogt, Bruce M.; Dunlop, John; Gage, Fred H.; Hyman, Steve E.

2014-01-01

Advances in the neurosciences have placed the field in the position where it is poised to significantly reduce the burden of nervous system disorders. However, drug discovery, development and translation for nervous system disorders still pose many unique challenges. The key scientific challenges can be summarized as follows: mechanisms of disease, target identification and validation, predictive models, biomarkers for patient stratification and as endpoints for clinical trials, clear regulatory pathways, reliability and reproducibility of published data, and data sharing and collaboration. To accelerate nervous system drug development the Institute of Medicine’s Forum on Neuroscience and Nervous System Disorders has hosted a series of public workshops that brought together representatives of industry, government (including both research funding and regulatory agencies), academia, and patient groups to discuss these challenges and offer potential strategies to improve the translational neuroscience. PMID:25442933

An Overview of Science Challenges Pertaining to our Understanding of Extreme Geomagnetically Induced Currents. Chapter 8

NASA Technical Reports Server (NTRS)

Ngwira, Chigomezyo M.; Pulkkinen, Antti A.

2018-01-01

Vulnerability of man-made infrastructure to Earth-directed space weather events is a serious concern for today's technology-dependent society. Space weather-driven geomagnetically induced currents (GICs) can disrupt operation of extended electrically conducting technological systems. The threat of adverse impacts on critical technological infrastructure, like power grids, oil and gas pipelines, and communication networks, has sparked renewed interest in extreme space weather. Because extreme space weather events have low occurrence rate but potentially high impact, this presents a major challenge for our understanding of extreme GIC activity. In this chapter, we discuss some of the key science challenges pertaining to our understanding of extreme events. In addition, we present an overview of GICs including highlights of severe impacts over the last 80 years and recent U.S. Federal actions relevant to this community.

Is adaptation or transformation needed? Active nanomaterials and risk analysis

NASA Astrophysics Data System (ADS)

Kuzma, Jennifer; Roberts, John Patrick

2016-07-01

Nanotechnology has been a key area of funding and policy for the United States and globally for the past two decades. Since nanotechnology research and development became a focus and nanoproducts began to permeate the market, scholars and scientists have been concerned about how to assess the risks that they may pose to human health and the environment. The newest generation of nanomaterials includes biomolecules that can respond to and influence their environments, and there is a need to explore whether and how existing risk-analysis frameworks are challenged by such novelty. To fill this niche, we used a modified approach of upstream oversight assessment (UOA), a subset of anticipatory governance. We first selected case studies of "active nanomaterials," that are early in research and development and designed for use in multiple sectors, and then considered them under several, key risk-analysis frameworks. We found two ways in which the cases challenge the frameworks. The first category relates to how to assess risk under a narrow framing of the term (direct health and environmental harm), and the second involves the definition of what constitutes a "risk" worthy of assessment and consideration in decision making. In light of these challenges, we propose some changes for risk analysis in the face of active nanostructures in order to improve risk governance.

Stability Testing of Herbal Drugs: Challenges, Regulatory Compliance and Perspectives.

PubMed

Bansal, Gulshan; Suthar, Nancy; Kaur, Jasmeen; Jain, Astha

2016-07-01

Stability testing is an important component of herbal drugs and products (HDPs) development process. Drugs regulatory agencies across the globe have recommended guidelines for the conduct of stability studies on HDPs, which require that stability data should be included in the product registration dossier. From the scientific viewpoint, numerous chemical constituents in an herbal drug are liable to varied chemical reactions under the influence of different conditions during its shelf life. These reactions can lead to altered chemical composition of HDP and consequently altered therapeutic profile. Many reports on stability testing of HDPs have appeared in literature since the last 10 years. A review of these reports reveals that there is wide variability in temperature (-80 to 100 °C), humidity (0-100%) and duration (a few hours-36 months) for stability assessment of HDPs. Of these, only 1% studies are conducted in compliance with the regulatory guidelines for stability testing. The present review is aimed at compiling all stability testing reports, understanding key challenges in stability testing of HDPs and suggesting possible solutions for these. The key challenges are classified as chemical complexity and biochemical composition variability in raw material, selection of marker(s) and influences of enzymes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Nano/microvehicles for efficient delivery and (bio)sensing at the cellular level

PubMed Central

Esteban-Fernández de Ávila, B.; Yáñez-Sedeño, P.

2017-01-01

A perspective review of recent strategies involving the use of nano/microvehicles to address the key challenges associated with delivery and (bio)sensing at the cellular level is presented. The main types and characteristics of the different nano/microvehicles used for these cellular applications are discussed, including fabrication pathways, propulsion (catalytic, magnetic, acoustic or biological) and navigation strategies, and relevant parameters affecting their propulsion performance and sensing and delivery capabilities. Thereafter, selected applications are critically discussed. An emphasis is made on enhancing the extra- and intra-cellular biosensing capabilities, fast cell internalization, rapid inter- or intra-cellular movement, efficient payload delivery and targeted on-demand controlled release in order to greatly improve the monitoring and modulation of cellular processes. A critical discussion of selected breakthrough applications illustrates how these smart multifunctional nano/microdevices operate as nano/microcarriers and sensors at the intra- and extra-cellular levels. These advances allow both the real-time biosensing of relevant targets and processes even at a single cell level, and the delivery of different cargoes (drugs, functional proteins, oligonucleotides and cells) for therapeutics, gene silencing/transfection and assisted fertilization, while overcoming challenges faced by current affinity biosensors and delivery vehicles. Key challenges for the future and the envisioned opportunities and future perspectives of this remarkably exciting field are discussed. PMID:29147499

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

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.

Challenges in defining 'palliative care' for the purposes of clinical trials.

PubMed

Bausewein, Claudia; Higginson, Irene J

2012-12-01

Palliative care has become part of mainstream medicine with increasing evidence about the effectiveness of specialist palliative care (SPC) on patient and family outcomes. Comparison of studies testing SPC interventions is challenging as types of interventions and reporting of components of the intervention vary. In consequence, study results are difficult to interpret. There is a continuous lack of clarity in palliative care definitions. For clinical trials, multidisciplinary care, supportive care documentation, symptom assessment and symptom management are suggested as key domains. In recent studies testing palliative care as an intervention SPC physicians and palliative care nurses were core members of multiprofessional teams, but integration of other team members varied. Management of symptoms and psychosocial issues were central to SPC with various other areas described. Services were delivered by hospital and community support teams, in palliative care units, outpatient clinics and hospital. Cost information was only provided by a few studies. Due to the lack of an agreed definition of palliative care and heterogeneity in reporting of components of an SPC intervention comparison of studies remains challenging. Key aspects of palliative care interventions are incurable disease, multidisciplinary approach, focus on symptom management including standardized assessment, psychosocial and family support, and (advance) care planning. Detailed information about all aspects of the intervention should be provided.

Towards vertical integration in general practice education: literature review and discussion paper.

PubMed

O'Regan, A; Culhane, A; Dunne, C; Griffin, M; Meagher, D; McGrath, D; O'Dwyer, P; Cullen, W

2013-09-01

Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

Developing hand therapy skills in Bangladesh: experiences of Australian volunteers.

PubMed

O'Brien, Lisa; Hardman, Alison

2014-01-01

Bangladesh is a developing country whose health system is highly dependent on project funding from foreign countries. Interplast Australia & New Zealand have supported volunteer hand therapists to provide training to local staff in the management of hand injuries and burns since 2006. We aimed to explore and describe the volunteers' own experience and provide recommendations for future therapy capacity building projects in developing countries. This qualitative study involved nine volunteer therapists, who attended a focus group to discuss their experiences, including the key milestones, challenges, and progress achieved. The two authors analyzed transcripts independently and emergent themes were discussed and identified by consensus. Overall the experience was extremely positive and rewarding for volunteers. Key learnings and challenges encountered in this project were cultural differences in learning styles, the need to adapt our approach to 2 facilitate sustainable local solutions, attrition of skilled local staff, and concerns regarding volunteer health and safety. Recommendations for similar projects include allowing adequate time for in-country scoping and planning, coordination and pooling of resources, and the use of strategies that encourage the shift to confident local ownership of ongoing learning and skill development. Volunteering in a health capacity building program in developing countries can be a challenging but immensely rewarding experience. Programs designed to meet the health demands in developing countries should emphasize adequate training of professionals in the use of transferable, sustainable and cost effective techniques. Time spent in the scoping and planning phase is crucial, as is coordination of efforts and pooling of resources. 2C. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

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.

Effective pedagogies for teaching math to nursing students: a literature review.

PubMed

Hunter Revell, Susan M; McCurry, Mary K

2013-11-01

Improving mathematical competency and problem-solving skills in undergraduate nursing students has been an enduring challenge for nurse educators. A number of teaching strategies have been used to address this problem with varying degrees of success. This paper discusses a literature review which examined undergraduate nursing student challenges to learning math, methods used to teach math and problem-solving skills, and the use of innovative pedagogies for teaching. The literature was searched using the Cumulative Index of Nursing and Allied Health Literature and Education Resource Information Center databases. Key search terms included: math*, nurs*, nursing student, calculation, technology, medication administration, challenges, problem-solving, personal response system, clickers, computer and multi-media. Studies included in the review were published in English from 1990 to 2011. Results support four major themes which include: student challenges to learning, traditional pedagogies, curriculum strategies, and technology and integrative methods as pedagogy. The review concludes that there is a need for more innovative pedagogical strategies for teaching math to student nurses. Nurse educators in particular play a central role in helping students learn the conceptual basis, as well as practical hands-on methods, to problem solving and math competency. It is recommended that an integrated approach inclusive of technology will benefit students through better performance, increased understanding, and improved student satisfaction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Translating Health Services Research into Practice in the Safety Net.

PubMed

Moore, Susan L; Fischer, Ilana; Havranek, Edward P

2016-02-01

To summarize research relating to health services research translation in the safety net through analysis of the literature and case study of a safety net system. Literature review and key informant interviews at an integrated safety net hospital. This paper describes the results of a comprehensive literature review of translational science literature as applied to health care paired with qualitative analysis of five key informant interviews conducted with senior-level management at Denver Health and Hospital Authority. Results from the literature suggest that implementing innovation may be more difficult in the safety net due to multiple factors, including financial and organizational constraints. Results from key informant interviews confirmed the reality of financial barriers to innovation implementation but also implied that factors, including institutional respect for data, organizational attitudes, and leadership support, could compensate for disadvantages. Translating research into practice is of critical importance to safety net providers, which are under increased pressure to improve patient care and satisfaction. Results suggest that translational research done in the safety net can better illuminate the special challenges of this setting; more such research is needed. © Health Research and Educational Trust.

Human body motion tracking based on quantum-inspired immune cloning algorithm

NASA Astrophysics Data System (ADS)

Han, Hong; Yue, Lichuan; Jiao, Licheng; Wu, Xing

2009-10-01

In a static monocular camera system, to gain a perfect 3D human body posture is a great challenge for Computer Vision technology now. This paper presented human postures recognition from video sequences using the Quantum-Inspired Immune Cloning Algorithm (QICA). The algorithm included three parts. Firstly, prior knowledge of human beings was used, the key joint points of human could be detected automatically from the human contours and skeletons which could be thinning from the contours; And due to the complexity of human movement, a forecasting mechanism of occlusion joint points was addressed to get optimum 2D key joint points of human body; And then pose estimation recovered by optimizing between the 2D projection of 3D human key joint points and 2D detection key joint points using QICA, which recovered the movement of human body perfectly, because this algorithm could acquire not only the global optimal solution, but the local optimal solution.

Physical Unclonable Function Hardware Keys Utilizing Kirchhoff-Law Secure Key Exchange and Noise-Based Logic

NASA Astrophysics Data System (ADS)

Kish, Laszlo B.; Kwan, Chiman

Weak unclonable function (PUF) encryption key means that the manufacturer of the hardware can clone the key but not anybody else. Strong unclonable function (PUF) encryption key means that even the manufacturer of the hardware is unable to clone the key. In this paper, first we introduce an "ultra" strong PUF with intrinsic dynamical randomness, which is not only unclonable but also gets renewed to an independent key (with fresh randomness) during each use via the unconditionally secure key exchange. The solution utilizes the Kirchhoff-law-Johnson-noise (KLJN) method for dynamical key renewal and a one-time-pad secure key for the challenge/response process. The secure key is stored in a flash memory on the chip to provide tamper-resistance and nonvolatile storage with zero power requirements in standby mode. Simplified PUF keys are shown: a strong PUF utilizing KLJN protocol during the first run and noise-based logic (NBL) hyperspace vector string verification method for the challenge/response during the rest of its life or until it is re-initialized. Finally, the simplest PUF utilizes NBL without KLJN thus it can be cloned by the manufacturer but not by anybody else.

Long-Term Preservation of NASA Heliophysics Data and Access: Where We Were and Where We're Going

NASA Technical Reports Server (NTRS)

McGuire, Robert E.

2011-01-01

The importance of ensuring preservation and useful access to the unique science potential of past, present and future NASA solar and space physics (i.e. heliophysics) data has been recognized since the inception of NASA but remains challenging. In this talk, I will briefly review the history of this topic and and then discuss the present NASA model for heliophysics science data management, including key current resources for finding and using data projects like the Space Physics Data Facility. I will highlight expected future directions, building on working elements of the present program and exploiting new technology, to further improve the data environment, address existing issues and anticipate emerging challenges.

Using Patient Avatars to Promote Health Data Sharing Applications: Perspectives and Regulatory Challenges.

PubMed

Dahi, Alan; Forgó, Nikolaus; Jensen, Sarah; Stauch, Marc

2016-04-01

The potential of ICT to address problems in modern healthcare is considerable, and an ICT-driven revolution in healthcare appears imminent. Such developments maybe viewed largely in positive terms. Thus they should result in enhanced treatment and care options, empowering patients--including by permitting greater self-management of illness outside hospital, while offering economic benefits and costs savings over traditional healthcare provision. However, the new possibilities also present manifold risks, such as of data breaches, encroachments on subject autonomy, as well as of other harms. This article considers some of the key regulatory challenges against the background of the progress of the current EU Commission-sponsored 'MyHealthAvatar' project.

Retail food environments research: Promising future with more work to be done.

PubMed

Fuller, Daniel; Engler-Stringer, Rachel; Muhajarine, Nazeem

2016-06-09

As members of the scientific committee for the Food Environments in Canada conference, we reflect on the current state of food environments research in Canada. We are very encouraged that the field is growing and there have been many collaborative efforts to link researchers in Canada, including the 2015 Food Environments in Canada Symposium and Workshop. We believe there are 5 key challenges the field will need to collectively address: theory and causality; replication and extension; consideration of rural, northern and vulnerable populations; policy analysis; and intervention research. In addressing the challenges, we look forward to working together to conduct more sophisticated, complex and community-driven food environments research in the future.

AFRL Commander's Challenge 2015: stopping the active shooter

NASA Astrophysics Data System (ADS)

McIntire, John P.; Boston, Jonathan; Smith, Brandon; Swartz, Pete; Whitney-Rawls, Amy; Martinez Calderon, Julian; Magin, Jonathan

2017-05-01

In this work, we describe a rapid-innovation challenge to combat and deal with the problem of internal, insider physical threats (e.g., active shooters) and associated first-responder situation awareness on military installations. Our team's research and development effort described within focused on several key tech development areas: (1) indoor acoustical gunshot detection, (2) indoor spatial tracking of first responders, (3) bystander safety and protection, (4) two-way mass alerting capability, and (5) spatial information displays for command and control. The technological solutions were specifically designed to be innovative, low-cost, and (relatively) easy-to-implement, and to provide support across the spectrum of possible users including potential victims/bystanders, first responders, dispatch, and incident command.

PKI security in large-scale healthcare networks.

PubMed

Mantas, Georgios; Lymberopoulos, Dimitrios; Komninos, Nikos

2012-06-01

During the past few years a lot of PKI (Public Key Infrastructures) infrastructures have been proposed for healthcare networks in order to ensure secure communication services and exchange of data among healthcare professionals. However, there is a plethora of challenges in these healthcare PKI infrastructures. Especially, there are a lot of challenges for PKI infrastructures deployed over large-scale healthcare networks. In this paper, we propose a PKI infrastructure to ensure security in a large-scale Internet-based healthcare network connecting a wide spectrum of healthcare units geographically distributed within a wide region. Furthermore, the proposed PKI infrastructure facilitates the trust issues that arise in a large-scale healthcare network including multi-domain PKI infrastructures.

Materials for solar fuels and chemicals.

PubMed

Montoya, Joseph H; Seitz, Linsey C; Chakthranont, Pongkarn; Vojvodic, Aleksandra; Jaramillo, Thomas F; Nørskov, Jens K

2016-12-20

The conversion of sunlight into fuels and chemicals is an attractive prospect for the storage of renewable energy, and photoelectrocatalytic technologies represent a pathway by which solar fuels might be realized. However, there are numerous scientific challenges in developing these technologies. These include finding suitable materials for the absorption of incident photons, developing more efficient catalysts for both water splitting and the production of fuels, and understanding how interfaces between catalysts, photoabsorbers and electrolytes can be designed to minimize losses and resist degradation. In this Review, we highlight recent milestones in these areas and some key scientific challenges remaining between the current state of the art and a technology that can effectively convert sunlight into fuels and chemicals.

Assessing Species Diversity Using Metavirome Data: Methods and Challenges.

PubMed

Herath, Damayanthi; Jayasundara, Duleepa; Ackland, David; Saeed, Isaam; Tang, Sen-Lin; Halgamuge, Saman

2017-01-01

Assessing biodiversity is an important step in the study of microbial ecology associated with a given environment. Multiple indices have been used to quantify species diversity, which is a key biodiversity measure. Measuring species diversity of viruses in different environments remains a challenge relative to measuring the diversity of other microbial communities. Metagenomics has played an important role in elucidating viral diversity by conducting metavirome studies; however, metavirome data are of high complexity requiring robust data preprocessing and analysis methods. In this review, existing bioinformatics methods for measuring species diversity using metavirome data are categorised broadly as either sequence similarity-dependent methods or sequence similarity-independent methods. The former includes a comparison of DNA fragments or assemblies generated in the experiment against reference databases for quantifying species diversity, whereas estimates from the latter are independent of the knowledge of existing sequence data. Current methods and tools are discussed in detail, including their applications and limitations. Drawbacks of the state-of-the-art method are demonstrated through results from a simulation. In addition, alternative approaches are proposed to overcome the challenges in estimating species diversity measures using metavirome data.

Towards next generation 3D cameras

NASA Astrophysics Data System (ADS)

Gupta, Mohit

2017-03-01

We are in the midst of a 3D revolution. Robots enabled by 3D cameras are beginning to autonomously drive cars, perform surgeries, and manage factories. However, when deployed in the real-world, these cameras face several challenges that prevent them from measuring 3D shape reliably. These challenges include large lighting variations (bright sunlight to dark night), presence of scattering media (fog, body tissue), and optically complex materials (metal, plastic). Due to these factors, 3D imaging is often the bottleneck in widespread adoption of several key robotics technologies. I will talk about our work on developing 3D cameras based on time-of-flight and active triangulation that addresses these long-standing problems. This includes designing `all-weather' cameras that can perform high-speed 3D scanning in harsh outdoor environments, as well as cameras that recover shape of objects with challenging material properties. These cameras are, for the first time, capable of measuring detailed (<100 microns resolution) scans in extremely demanding scenarios with low-cost components. Several of these cameras are making a practical impact in industrial automation, being adopted in robotic inspection and assembly systems.

Getting Australia more active: challenges and opportunities for health promotion.

PubMed

Hills, A P; Street, S J; Harris, N

2014-04-01

A growing body of evidence demonstrates that regular physical activity promotes health and assists in the prevention of non-communicable diseases but this is presently curtailed by low and unhealthy participation rates in Australia and comparable industrialised countries. Compounding the problem is knowledge that physical inactivity is independently associated with poor health outcomes. Despite physical activity being described as public health's 'best bet' or 'best buy', motivating individuals and groups to adopt and maintain physical activity continues to be a major challenge for health professionals. Global advocacy for prevention efforts must be operationalised through national to local strategies to promote and support physical activity in multiple settings including the home, schools and workplace. The Australian health promotion community has and continues to play a leadership role in physical activity promotion. However, there is an urgent need to continue to promote the importance of physical activity, along with its pivotal role in the prevention of non-communicable diseases, alongside related agendas including healthy diets, tobacco control and environmental sustainability. This commentary overviews the contemporary status of physical activity promotion in Australia and identifies key challenges and opportunities moving forward.

IPECAD5--Fifth International Pharmaco-Economic Conference on Alzheimer's Disease.

PubMed

Gustavsson, A; Jonsson, L; Fillit, H; Johansson, G; Wimo, A; Winblad, B

2010-05-01

The Fifth International Pharmaco-Economic Conference on Alzheimer's Disease was held in New York, on March 27-29 in 2008. The attendees included researchers and key opinion leaders within the academia, pharmaceutical industry, patient organizations and regulatory bodies, collecting the worldwide leading expertise in Alzheimer research today. A summary of the presentations and conclusions from the discussions are presented in this publication. Pharmaco-economics need to play a leading role in developing and communicating evidence of the value of anti-dementia drugs, now and in the future. For the development of evidence, the challenges include transparency and standardization of costs of care assessment, improved diagnostics for identifying target patient groups, improved endpoints for assessing outcomes and improved models for assessing the long term consequences of competing treatment strategies. For the communication of evidence, the challenge lies in convincing decision makers to recognize the integrated burden of the disease, including its interaction with co-morbidities and burden on caregivers, and to consider the consequences of competing treatment strategies from a societal perspective.

Working Group Report: Sensors

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

Artuso, M.; et al.,

Sensors play a key role in detecting both charged particles and photons for all three frontiers in Particle Physics. The signals from an individual sensor that can be used include ionization deposited, phonons created, or light emitted from excitations of the material. The individual sensors are then typically arrayed for detection of individual particles or groups of particles. Mounting of new, ever higher performance experiments, often depend on advances in sensors in a range of performance characteristics. These performance metrics can include position resolution for passing particles, time resolution on particles impacting the sensor, and overall rate capabilities. In additionmore » the feasible detector area and cost frequently provides a limit to what can be built and therefore is often another area where improvements are important. Finally, radiation tolerance is becoming a requirement in a broad array of devices. We present a status report on a broad category of sensors, including challenges for the future and work in progress to solve those challenges.« less

Sensor Compendium - A Snowmass Whitepaper-

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

Artuso, M.; Battaglia, M.; Bolla, G.

Sensors play a key role in detecting both charged particles and photons for all three frontiers in Particle Physics. The signals from an individual sensor that can be used include ionization deposited, phonons created, or light emitted from excitations of the material. The individual sensors are then typically arrayed for detection of individual particles or groups of particles. Mounting of new, ever higher performance experiments, often depend on advances in sensors in a range of performance characteristics. These performance metrics can include position resolution for passing particles, time resolution on particles impacting the sensor, and overall rate capabilities. In additionmore » the feasible detector area and cost frequently provides a limit to what can be built and therefore is often another area where improvements are important. Finally, radiation tolerance is becoming a requirement in a broad array of devices. We present a status report on a broad category of sensors, including challenges for the future and work in progress to solve those challenges.« less

USGS: Building on leadership in mapping oceans and coasts

USGS Publications Warehouse

Myers, M.D.

2008-01-01

The US Geological Survey (USGS) offers continuously improving technologies for mapping oceans and coasts providing unique opportunity for characterizing the marine environment and to expand the understanding of coastal and ocean processes, resources, and hazards. USGS, which has been designated as a leader for mapping the Exclusive Economic Zone, has made an advanced strategic plan, Facing Tomorrow's Challenges- US Geological Survey Science in the Decade 2007 to 2017. This plan focuses on innovative and transformational themes that serve key clients and customers, expand partnerships, and have long-term national impact. The plan includes several key science directions, including Understanding Ecosystems and Predicting Ecosystem Change, Energy and Minerals for America's Future, and A National Hazards, Risk, and Resilience Assessment Program. USGS has also collaborated with diverse partners to incorporate mapping and monitoring within interdisciplinary research programs, addressing the system-scale response of coastal and marine ecosystems.

Computer vision in roadway transportation systems: a survey

NASA Astrophysics Data System (ADS)

Loce, Robert P.; Bernal, Edgar A.; Wu, Wencheng; Bala, Raja

2013-10-01

There is a worldwide effort to apply 21st century intelligence to evolving our transportation networks. The goals of smart transportation networks are quite noble and manifold, including safety, efficiency, law enforcement, energy conservation, and emission reduction. Computer vision is playing a key role in this transportation evolution. Video imaging scientists are providing intelligent sensing and processing technologies for a wide variety of applications and services. There are many interesting technical challenges including imaging under a variety of environmental and illumination conditions, data overload, recognition and tracking of objects at high speed, distributed network sensing and processing, energy sources, as well as legal concerns. This paper presents a survey of computer vision techniques related to three key problems in the transportation domain: safety, efficiency, and security and law enforcement. A broad review of the literature is complemented by detailed treatment of a few selected algorithms and systems that the authors believe represent the state-of-the-art.

Gravity Probe B data system description

NASA Astrophysics Data System (ADS)

Bennett, Norman R.

2015-11-01

The Gravity Probe B data system, developed, integrated, and tested by Lockheed Missiles & Space Company, and later Lockheed Martin Corporation, included flight and ground command, control, and communications software. The development was greatly facilitated, conceptually and by the transfer of key personnel, through Lockheed’s earlier flight and ground test software development for the Hubble Space Telescope (HST). Key design challenges included the tight mission timeline (17 months, 9 days of on-orbit operation), the need to tune the system once on-orbit, and limited 2 Kbps real-time data rates and ground asset availability. The result was a completely integrated space vehicle and Stanford mission operations center, which successfully collected and archived 97% of the ‘guide star valid’ data to support the science analysis. Lessons learned and incorporated from the HST flight software development and on-orbit support experience, and Lockheed’s independent research and development effort, will be discussed.

Developing content for an interprofessional training on fear of cancer recurrence (FCR): Key informant interviews of healthcare professionals, researchers and cancer survivors.

PubMed

Berrett-Abebe, Julie; Cadet, Tamara; Vitello, Joan; Maramaldi, Peter

2018-04-10

Growing numbers of cancer survivors are receiving healthcare through primary care practitioners, who often lack cancer-specific expertise to effectively treat survivors' concerns. Addressing that gap, this study aimed to develop content for a training on fear of cancer recurrence (FCR), a common concern in survivorship. Grounded in naturalistic inquiry, 42 key-informant interviews were conducted, transcribed, and analyzed for themes. Participants were healthcare professionals, researchers, and cancer survivors Results: Results included themes ranging from: rich conceptualizations of FCR, opportunities and challenges for addressing FCR in healthcare settings, interventions to address FCR, and important information to include in a training on FCR. This paper provides content for an interprofessional training and highlights the importance of developing trainings for interprofessional teams, given identified barriers that physicians face in addressing FCR and other psychosocial concerns of survivors in primary care.

Two-Layer 16 Tesla Cosθ Dipole Design for the FCC

DOE PAGES

Holik, Eddie Frank; Ambrosio, Giorgio; Apollinari, G.

2018-02-13

The Future Circular Collider or FCC is a study aimed at exploring the possibility to reach 100 TeV total collision energy which would require 16 tesla dipoles. Upon the conclusion of the High Luminosity Upgrade, the US LHC Accelerator Upgrade Pro-ject in collaboration with CERN will have extensive Nb3Sn magnet fabrication experience. This experience includes robust Nb3Sn conductor and insulation scheming, 2-layer cos2θ coil fabrication, and bladder-and-key structure and assembly. By making im-provements and modification to existing technology the feasibility of a two-layer 16 tesla dipole is investigated. Preliminary designs indicate that fields up to 16.6 tesla are feasible withmore » conductor grading while satisfying the HE-LHC and FCC specifications. Key challenges include accommodating high-aspect ratio conductor, narrow wedge design, Nb3Sn conductor grading, and especially quench protection of a 16 tesla device.« less

Two-Layer 16 T Cos θ Dipole Design for the FCC

DOE PAGES

Holik, Eddie Frank; Ambrosio, Giorgio; Apollinari, Giorgio

2018-02-22

Here, the Future Circular Collider or FCC is a study aimed at exploring the possibility to reach 100 TeV total collision energy which would require 16 tesla dipoles. Upon the conclusion of the High Luminosity Upgrade, the US LHC Accelerator Upgrade Pro-ject in collaboration with CERN will have extensive Nb 3Sn magnet fabrication experience. This experience includes robust Nb 3Sn conductor and insulation scheming, 2-layer cos2θ coil fabrication, and bladder-and-key structure and assembly. By making im-provements and modification to existing technology the feasibility of a two-layer 16 tesla dipole is investigated. Preliminary designs indicate that fields up to 16.6 teslamore » are feasible with conductor grading while satisfying the HE-LHC and FCC specifications. Key challenges include accommodating high-aspect ratio conductor, narrow wedge design, Nb 3Sn conductor grading, and especially quench protection of a 16 tesla device.« less

Two-Layer 16 T Cos θ Dipole Design for the FCC

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

Holik, Eddie Frank; Ambrosio, Giorgio; Apollinari, Giorgio

Here, the Future Circular Collider or FCC is a study aimed at exploring the possibility to reach 100 TeV total collision energy which would require 16 tesla dipoles. Upon the conclusion of the High Luminosity Upgrade, the US LHC Accelerator Upgrade Pro-ject in collaboration with CERN will have extensive Nb 3Sn magnet fabrication experience. This experience includes robust Nb 3Sn conductor and insulation scheming, 2-layer cos2θ coil fabrication, and bladder-and-key structure and assembly. By making im-provements and modification to existing technology the feasibility of a two-layer 16 tesla dipole is investigated. Preliminary designs indicate that fields up to 16.6 teslamore » are feasible with conductor grading while satisfying the HE-LHC and FCC specifications. Key challenges include accommodating high-aspect ratio conductor, narrow wedge design, Nb 3Sn conductor grading, and especially quench protection of a 16 tesla device.« less

Treating Substance Use Disorders in the Criminal Justice System

PubMed Central

Hiller, Matthew; Hamilton, Leah

2013-01-01

The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health. Unfortunately, a low proportion of those who could benefit from treatment actually receive it while involved in the CJS. This article presents a review of recent research on the effectiveness of major substance abuse treatment interventions used at different possible linkage points during criminal justice case processing, including diversion, jail, prison, and community supervision. This is followed by a discussion of key research and practice issues, including low rates of treatment access and under-utilization of medication-assisted treatment. Concluding comments discuss principles of effective treatment for offenders and identify key gaps in research and practice that need to be addressed to improve and expand provision of effective treatment for offenders. PMID:24132733

Summary of the 2014 Sandia V&V Challenge Workshop

DOE PAGES

Schroeder, Benjamin B.; Hu, Kenneth T.; Mullins, Joshua Grady; ...

2016-02-19

A discussion of the five responses to the 2014 Sandia Verification and Validation (V&V) Challenge Problem, presented within this special issue, is provided hereafter. Overviews of the challenge problem workshop, workshop participants, and the problem statement are also included. Brief summations of teams' responses to the challenge problem are provided. Issues that arose throughout the responses that are deemed applicable to the general verification, validation, and uncertainty quantification (VVUQ) community are the main focal point of this paper. The discussion is oriented and organized into big picture comparison of data and model usage, VVUQ activities, and differentiating conceptual themes behindmore » the teams' VVUQ strategies. Significant differences are noted in the teams' approaches toward all VVUQ activities, and those deemed most relevant are discussed. Beyond the specific details of VVUQ implementations, thematic concepts are found to create differences among the approaches; some of the major themes are discussed. Lastly, an encapsulation of the key contributions, the lessons learned, and advice for the future are presented.« less

Challenges in adapting existing clinical natural language processing systems to multiple, diverse health care settings.

PubMed

Carrell, David S; Schoen, Robert E; Leffler, Daniel A; Morris, Michele; Rose, Sherri; Baer, Andrew; Crockett, Seth D; Gourevitch, Rebecca A; Dean, Katie M; Mehrotra, Ateev

2017-09-01

Widespread application of clinical natural language processing (NLP) systems requires taking existing NLP systems and adapting them to diverse and heterogeneous settings. We describe the challenges faced and lessons learned in adapting an existing NLP system for measuring colonoscopy quality. Colonoscopy and pathology reports from 4 settings during 2013-2015, varying by geographic location, practice type, compensation structure, and electronic health record. Though successful, adaptation required considerably more time and effort than anticipated. Typical NLP challenges in assembling corpora, diverse report structures, and idiosyncratic linguistic content were greatly magnified. Strategies for addressing adaptation challenges include assessing site-specific diversity, setting realistic timelines, leveraging local electronic health record expertise, and undertaking extensive iterative development. More research is needed on how to make it easier to adapt NLP systems to new clinical settings. A key challenge in widespread application of NLP is adapting existing systems to new clinical settings. © 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

The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry

PubMed Central

2011-01-01

Background Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process. Methods Several qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey. Findings The Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted. Conclusion The state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged. PMID:21923945

The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry.

PubMed

Higashi, Hideki; Khuong, Tuan A; Ngo, Anh D; Hill, Peter S

2011-09-18

Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process. Several qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey. The Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted. The state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged.

A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities.

PubMed

Hunting, Gemma; Shahid, Nida; Sahakyan, Yeva; Fan, Iris; Moneypenny, Crystal R; Stanimirovic, Aleksandra; North, Taylor; Petrosyan, Yelena; Krahn, Murray D; Rac, Valeria E

2015-12-09

Despite research demonstrating the potential effectiveness of Telehomecare for people with Chronic Obstructive Pulmonary Disease and Heart Failure, broad-scale comprehensive evaluations are lacking. This article discusses the qualitative component of a mixed-method program evaluation of Telehomecare in Ontario, Canada. The objective of the qualitative component was to explore the multi-level factors and processes which facilitate or impede the implementation and adoption of the program across three regions where it was first implemented. The study employs a multi-level framework as a conceptual guide to explore the facilitators and barriers to Telehomecare implementation and adoption across five levels: technology, patients, providers, organizations, and structures. In-depth semi-structured interviews and ethnographic observations with program stakeholders, as well as a Telehomecare document review were used to elicit key themes. Study participants (n = 89) included patients and/or informal caregivers (n = 39), health care providers (n = 23), technicians (n = 2), administrators (n = 12), and decision makers (n = 13) across three different Local Health Integration Networks in Ontario. Key facilitators to Telehomecare implementation and adoption at each level of the multi-level framework included: user-friendliness of Telehomecare technology, patient motivation to participate in the program, support for Telehomecare providers, the integration of Telehomecare into broader health service provision, and comprehensive program evaluation. Key barriers included: access-related issues to using the technology, patient language (if not English or French), Telehomecare provider time limitations, gaps in health care provision for patients, and structural barriers to patient participation related to geography and social location. Though Telehomecare has the potential to positively impact patient lives and strengthen models of health care provision, a number of key challenges remain. As such, further implementation and expansion of Telehomecare must involve continuous assessments of what is working and not working with all stakeholders. Increased dialogue, evaluation, and knowledge translation within and across regions to understand the contextual factors influencing Telehomecare implementation and adoption is required. This can inform decision-making that better reflects and addresses the needs of all program stakeholders.

A systematic literature review of the key challenges for developing the structure of public health economic models.

PubMed

Squires, Hazel; Chilcott, James; Akehurst, Ronald; Burr, Jennifer; Kelly, Michael P

2016-04-01

To identify the key methodological challenges for public health economic modelling and set an agenda for future research. An iterative literature search identified papers describing methodological challenges for developing the structure of public health economic models. Additional multidisciplinary literature searches helped expand upon important ideas raised within the review. Fifteen articles were identified within the formal literature search, highlighting three key challenges: inclusion of non-healthcare costs and outcomes; inclusion of equity; and modelling complex systems and multi-component interventions. Based upon these and multidisciplinary searches about dynamic complexity, the social determinants of health, and models of human behaviour, six areas for future research were specified. Future research should focus on: the use of systems approaches within health economic modelling; approaches to assist the systematic consideration of the social determinants of health; methods for incorporating models of behaviour and social interactions; consideration of equity; and methodology to help modellers develop valid, credible and transparent public health economic model structures.

The national response for preventing healthcare-associated infections: infrastructure development.

PubMed

Mendel, Peter; Siegel, Sari; Leuschner, Kristin J; Gall, Elizabeth M; Weinberg, Daniel A; Kahn, Katherine L

2014-02-01

In 2009, the US Department of Health and Human Services (HHS) launched the Action Plan to Prevent Healthcare-associated Infections (HAIs). The Action Plan adopted national targets for reduction of specific infections, making HHS accountable for change across the healthcare system over which federal agencies have limited control. This article examines the unique infrastructure developed through the Action Plan to support adoption of HAI prevention practices. Interviews of federal (n=32) and other stakeholders (n=38), reviews of agency documents and journal articles (n=260), and observations of interagency meetings (n=17) and multistakeholder conferences (n=17) over a 3-year evaluation period. We extract key progress and challenges in the development of national HAI prevention infrastructure--1 of the 4 system functions in our evaluation framework encompassing regulation, payment systems, safety culture, and dissemination and technical assistance. We then identify system properties--for example, coordination and alignment, accountability and incentives, etc.--that enabled or hindered progress within each key development. The Action Plan has developed a model of interagency coordination (including a dedicated "home" and culture of cooperation) at the federal level and infrastructure for stimulating change through the wider healthcare system (including transparency and financial incentives, support of state and regional HAI prevention capacity, changes in safety culture, and mechanisms for stakeholder engagement). Significant challenges to infrastructure development included many related to the same areas of progress. The Action Plan has built a foundation of infrastructure to expand prevention of HAIs and presents useful lessons for other large-scale improvement initiatives.

The Advanced Technology Large-Aperture Space Telescope (ATLAST) Technology Roadmap

NASA Technical Reports Server (NTRS)

Stahle, Carl; Balasubramanian, K.; Bolcar, M.; Clampin, M.; Feinberg, L.; Hartman, K.; Mosier, C.; Quijada, M.; Rauscher, B.; Redding, D.;

E-DECIDER Disaster Response and Decision Support Cyberinfrastructure: Technology and Challenges

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Parker, J. W.; Pierce, M. E.; Wang, J.; Eguchi, R. T.; Huyck, C. K.; Hu, Z.; Chen, Z.; Yoder, M. R.; Rundle, J. B.; Rosinski, A.

2014-12-01

Timely delivery of critical information to decision makers during a disaster is essential to response and damage assessment. Key issues to an efficient emergency response after a natural disaster include rapidly processing and delivering this critical information to emergency responders and reducing human intervention as much as possible. Essential elements of information necessary to achieve situational awareness are often generated by a wide array of organizations and disciplines, using any number of geospatial and non-geospatial technologies. A key challenge is the current state of practice does not easily support information sharing and technology interoperability. NASA E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) has worked with the California Earthquake Clearinghouse and its partners to address these issues and challenges by adopting the XChangeCore Web Service Data Orchestration technology and participating in several earthquake response exercises. The E-DECIDER decision support system provides rapid delivery of advanced situational awareness data products to operations centers and emergency responders in the field. Remote sensing and hazard data, model-based map products, information from simulations, damage detection, and crowdsourcing is integrated into a single geospatial view and delivered through a service oriented architecture for improved decision-making and then directly to mobile devices of responders. By adopting a Service Oriented Architecture based on Open Geospatial Consortium standards, the system provides an extensible, comprehensive framework for geospatial data processing and distribution on Cloud platforms and other distributed environments. While the Clearinghouse and its partners are not first responders, they do support the emergency response community by providing information about the damaging effects earthquakes. It is critical for decision makers to maintain a situational awareness that is knowledgeable of potential and current conditions, possible impacts on populations and infrastructure, and other key information. E-DECIDER and the Clearinghouse have worked together to address many of these issues and challenges to deliver interoperable, authoritative decision support products.

Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

PubMed Central

2011-01-01

Background Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills. Conclusions Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda. PMID:21411007

Physics and the canalization of morphogenesis: a grand challenge in organismal biology

PubMed Central

von Dassow, Michelangelo; Davidson, Lance A.

2011-01-01

Morphogenesis takes place in a background of organism-to-organism and environmental variation. Therefore, a fundamental question in the study of morphogenesis is how the mechanical processes of tissue movement and deformation are affected by that variability, and in turn, how the mechanics of the system modulates phenotypic variation. We highlight a few key factors, including environmental temperature, embryo size, and environmental chemistry that might perturb the mechanics of morphogenesis in natural populations. Then we discuss several ways in which mechanics – including feedback from mechanical cues – might influence intra-specific variation in morphogenesis. To understand morphogenesis it will be necessary to consider whole-organism, environment, and evolutionary scales because these larger scales present the challenges that developmental mechanisms have evolved to cope with. Studying the variation organisms express and the variation organisms experience will aid in deciphering the causes of birth defects. PMID:21750364

Education Scholarship and its Impact on Emergency Medicine Education.

PubMed

Sherbino, Jonathan

2015-11-01

Emergency medicine (EM) education is becoming increasingly challenging as a result of changes to North American medical education and the growing complexity of EM practice. Education scholarship (ES) provides a process to develop solutions to these challenges. ES includes both research and innovation. ES is informed by theory, principles and best practices, is peer reviewed, and is disseminated and archived for others to use. Digital technologies have improved the discovery of work that informs ES, broadened the scope and timing of peer review, and provided new platforms for the dissemination and archiving of innovations. This editorial reviews key steps in raising an education innovation to the level of scholarship. It also discusses important areas for EM education scholars to address, which include the following: the delivery of competency-based medical education programs, the impact of social media on learning, and the redesign of continuing professional development.

Challenges in systematic reviews: synthesis of topics related to the delivery, organization, and financing of health care.

PubMed

Bravata, Dena M; McDonald, Kathryn M; Shojania, Kaveh G; Sundaram, Vandana; Owens, Douglas K

2005-06-21

Some important health policy topics, such as those related to the delivery, organization, and financing of health care, present substantial challenges to established methods for evidence synthesis. For example, such reviews may ask: What is the effect of for-profit versus not-for-profit delivery of care on patient outcomes? Or, which strategies are the most effective for promoting preventive care? This paper describes innovative methods for synthesizing evidence related to the delivery, organization, and financing of health care. We found 13 systematic reviews on these topics that described novel methodologic approaches. Several of these syntheses used 3 approaches: conceptual frameworks to inform problem formulation, systematic searches that included nontraditional literature sources, and hybrid synthesis methods that included simulations to address key gaps in the literature. As the primary literature on these topics expands, so will opportunities to develop additional novel methods for performing high-quality comprehensive syntheses.

Molecular-based design and emerging applications of nanoporous carbon spheres

NASA Astrophysics Data System (ADS)

Liu, Jian; Wickramaratne, Nilantha P.; Qiao, Shi Zhang; Jaroniec, Mietek

2015-08-01

Over the past decade, considerable progress has been made in the synthesis and applications of nanoporous carbon spheres ranging in size from nanometres to micrometres. This Review presents the primary techniques for preparing nanoporous carbon spheres and the seminal research that has inspired their development, presented potential applications and uncovered future challenges. First we provide an overview of the synthesis techniques, including the Stöber method and those based on templating, self-assembly, emulsion and hydrothermal carbonization, with special emphasis on the design and functionalization of nanoporous carbon spheres at the molecular level. Next, we cover the key applications of these spheres, including adsorption, catalysis, separation, energy storage and biomedicine -- all of which might benefit from the regular geometry, good liquidity, tunable porosity and controllable particle-size distribution offered by nanoporous carbon spheres. Finally, we present the current challenges and opportunities in the development and commercial applications of nanoporous carbon spheres.

Molecular-based design and emerging applications of nanoporous carbon spheres.

PubMed

Liu, Jian; Wickramaratne, Nilantha P; Qiao, Shi Zhang; Jaroniec, Mietek

2015-08-01

Over the past decade, considerable progress has been made in the synthesis and applications of nanoporous carbon spheres ranging in size from nanometres to micrometres. This Review presents the primary techniques for preparing nanoporous carbon spheres and the seminal research that has inspired their development, presented potential applications and uncovered future challenges. First we provide an overview of the synthesis techniques, including the Stöber method and those based on templating, self-assembly, emulsion and hydrothermal carbonization, with special emphasis on the design and functionalization of nanoporous carbon spheres at the molecular level. Next, we cover the key applications of these spheres, including adsorption, catalysis, separation, energy storage and biomedicine — all of which might benefit from the regular geometry, good liquidity, tunable porosity and controllable particle-size distribution offered by nanoporous carbon spheres. Finally, we present the current challenges and opportunities in the development and commercial applications of nanoporous carbon spheres.

Education Scholarship and its Impact on Emergency Medicine Education

PubMed Central

Sherbino, Jonathan

2015-01-01

Emergency medicine (EM) education is becoming increasingly challenging as a result of changes to North American medical education and the growing complexity of EM practice. Education scholarship (ES) provides a process to develop solutions to these challenges. ES includes both research and innovation. ES is informed by theory, principles and best practices, is peer reviewed, and is disseminated and archived for others to use. Digital technologies have improved the discovery of work that informs ES, broadened the scope and timing of peer review, and provided new platforms for the dissemination and archiving of innovations. This editorial reviews key steps in raising an education innovation to the level of scholarship. It also discusses important areas for EM education scholars to address, which include the following: the delivery of competency-based medical education programs, the impact of social media on learning, and the redesign of continuing professional development. PMID:26594270

Pancreatic trauma: demographics, diagnosis, and management.

PubMed

Stawicki, Stanislaw Peter; Schwab, C William

2008-12-01

Pancreatic injuries are rare, with penetrating mechanisms being causative in majority of cases. They can create major diagnostic and therapeutic challenges and require multiple diagnostic modalities, including multislice high-definition computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, ultrasonography, and at times, surgery and direct visualization of the pancreas. Pancreatic trauma is frequently associated with duodenal and other severe vascular and visceral injuries. Mortality is high and usually related to the concomitant vascular injury. Surgical management of pancreatic and pancreatic-duodenal trauma is challenging, and multiple surgical approaches and techniques have been described, up to and including pancreatic damage control and later resection and reconstruction. Wide surgical drainage is a key to any surgical trauma technique and access for enteral nutrition, or occasionally parenteral nutrition, are important adjuncts. Morbidity associated with pancreatic trauma is high and can be quite severe. Treatment of pancreatic trauma-related complications often requires a combination of interventional, endoscopic, and surgical approaches.

Work Keys USA.

ERIC Educational Resources Information Center

Work Keys USA, 1998

1998-01-01

"Work Keys" is a comprehensive program for assessing and teaching workplace skills. This serial "special issue" features 18 first-hand reports on Work Keys projects in action in states across North America. They show how the Work Keys is helping businesses and educators solve the challenge of building a world-class work force.…

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.

Space Acquisitions: Development and Oversight Challenges in Delivering Improved Space Situational Awareness Capabilities

DTIC Science & Technology

2011-05-01

information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and...OMB control number. 1 . REPORT DATE MAY 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Space...space operations depend. GAO was asked to ( 1 ) review key systems being planned and acquired to provide SSA, and their progress meeting cost

Access to capital: implications for hospital consolidation.

PubMed

Grauman, Daniel M; Harris, John M; Martin, Christine

2010-04-01

Recent economic challenges have left many independent hospitals and their boards concerned about long-term viability of their organizations as stand-alone facilities. The CFO's role should be to facilitate a candid, objective assessment of the organization's ability to continue to go it alone. Key indicators that should be considered in such an assessment include patient volume, degree of physician alignment, profitability, current debt burden, cash, available capital versus capital requirements, and credit rating changes.

Using Field and Satellite Measurements to Improve Snow and Riming Processes in Cloud Resolving Models

NASA Technical Reports Server (NTRS)

Colle, Brian A.; Molthan, Andrew L.

2013-01-01

The representation of clouds in climate and weather models is a driver in forecast uncertainty. Cloud microphysics parameterizations are challenged by having to represent a diverse range of ice species. Key characteristics of predicted ice species include habit and fall speed, and complex interactions that result from mixed-phased processes like riming. Our proposed activity leverages Global Precipitation Measurement (GPM) Mission ground validation studies to improve parameterizations

Assessment of human resources management practices in Lebanese hospitals.

PubMed

El-Jardali, Fadi; Tchaghchagian, Victoria; Jamal, Diana

2010-01-01

Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy-makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region.

Assessment of human resources management practices in Lebanese hospitals.

PubMed

El-Jardali, Fadi; Tchaghchagian, Victoria; Jamal, Diana

2009-11-12

Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region.

Assessment of human resources management practices in Lebanese hospitals

PubMed Central

2009-01-01

Background Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. Methods A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. Results A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. Conclusion To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region. PMID:19909527

Key Challenges in the Reform of Governance, Quality Assurance, and Finance in Vietnamese Higher Education--A Case Study

ERIC Educational Resources Information Center

Dao, Khanh Van

2015-01-01

Vietnam's higher education is highly centralized in terms of its governance and management. A couple of higher education reform plans have been introduced over the past decade but they seem to result in poor outcomes. This paper addresses the challenges faced in the areas of governance, quality assurance and finance by a "key" university…

Study of Health Outcomes in School Children: Key Challenges and Lessons Learned from the Framingham Schools' Natural History of Nevi Study

ERIC Educational Resources Information Center

Geller, Alan C.; Oliveria, Susan A.; Bishop, Marilyn; Buckminster, Marcia; Brooks, Katie R.; Halpern, Allan C.

2007-01-01

Background: We describe the planning, recruitment, key challenges, and lessons learned in the development of a study of the evolution of nevi (moles) among children in a school setting. Methods: This population-based study of digital photography and dermoscopy of the child's back (overview, close-up, and dermoscopic images) and genetic specimens…

From Shell Midden to Midden-Mound: The Geoarchaeology of Mound Key, an Anthropogenic Island in Southwest Florida, USA

PubMed Central

Cherkinsky, Alexander; Roberts Thompson, Amanda D.; Walker, Karen J.; Newsom, Lee A.; Savarese, Michael

2016-01-01

Mound Key was once the capital of the Calusa Kingdom, a large Pre-Hispanic polity that controlled much of southern Florida. Mound Key, like other archaeological sites along the southwest Gulf Coast, is a large expanse of shell and other anthropogenic sediments. The challenges that these sites pose are largely due to the size and areal extent of the deposits, some of which begin up to a meter below and exceed nine meters above modern sea levels. Additionally, the complex depositional sequences at these sites present difficulties in determining their chronology. Here, we examine the development of Mound Key as an anthropogenic island through systematic coring of the deposits, excavations, and intensive radiocarbon dating. The resulting data, which include the reversals of radiocarbon dates from cores and dates from mound-top features, lend insight into the temporality of site formation. We use these insights to discuss the nature and scale of human activities that worked to form this large island in the context of its dynamic, environmental setting. We present the case that deposits within Mound Key’s central area accumulated through complex processes that represent a diversity of human action including midden accumulation and the redeposition of older sediments as mound fill. PMID:27123928

The BACnet Campus Challenge - Part 1

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

Masica, Ken; Tom, Steve

Here, the BACnet protocol was designed to achieve interoperability among building automation vendors and evolve over time to include new functionality as well as support new communication technologies such as the Ethernet and IP protocols as they became prevalent and economical in the market place. For large multi-building, multi-vendor campus environments, standardizing on the BACnet protocol as an implementation strategy can be a key component in meeting the challenge of an interoperable, flexible, and scalable building automation system. The interoperability of BACnet is especially important when large campuses with legacy equipment have DDC upgrades to facilities performed over different timemore » frames and use different contractors that install equipment from different vendors under the guidance of different campus HVAC project managers. In these circumstances, BACnet can serve as a common foundation for interoperability when potential variability exists in approaches to the design-build process by numerous parties over time. Likewise, BACnet support for a range of networking protocols and technologies can be a key strategy for achieving flexible and scalable automation systems as campuses and enterprises expand networking infrastructures using standard interoperable protocols like IP and Ethernet.« less

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.

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.

Beneficial Autoimmunity at Body Surfaces – Immune Surveillance and Rapid Type 2 Immunity Regulate Tissue Homeostasis and Cancer

PubMed Central

Dalessandri, Tim; Strid, Jessica

2014-01-01

Epithelial cells (ECs) line body surface tissues and provide a physicochemical barrier to the external environment. Frequent microbial and non-microbial challenges such as those imposed by mechanical disruption, injury or exposure to noxious environmental substances including chemicals, carcinogens, ultraviolet-irradiation, or toxins cause activation of ECs with release of cytokines and chemokines as well as alterations in the expression of cell-surface ligands. Such display of epithelial stress is rapidly sensed by tissue-resident immunocytes, which can directly interact with self-moieties on ECs and initiate both local and systemic immune responses. ECs are thus key drivers of immune surveillance at body surface tissues. However, ECs have a propensity to drive type 2 immunity (rather than type 1) upon non-invasive challenge or stress – a type of immunity whose regulation and function still remain enigmatic. Here, we review the induction and possible role of type 2 immunity in epithelial tissues and propose that rapid immune surveillance and type 2 immunity are key regulators of tissue homeostasis and carcinogenesis. PMID:25101088

Seven Foundational Principles of Population Health Policy.

PubMed

Bhattacharya, Dru; Bhatt, Jay

2017-10-01

In 2016, Keyes and Galea issued 9 foundational principles of population health science and invited further deliberations by specialists to advance the field. This article presents 7 foundational principles of population health policy whose intersection with health care, public health, preventive medicine, and now population health, presents unique challenges. These principles are in response to a number of overarching questions that have arisen in over a decade of the authors' collective practice in the public and private sectors, and having taught policy within programs of medicine, law, nursing, and public health at the graduate and executive levels. The principles address an audience of practitioners and policy makers, mindful of the pressing health care challenges of our time, including: rising health-related expenditures, an aging population, workforce shortages, health disparities, and a backdrop of inequities rooted in social determinants that have not been adequately translated into formal policies or practices among the key stakeholders in population health. These principles are meant to empower stakeholders-whether it is the planner or the practitioner, the decision maker or the dedicated caregiver-and inform the development of practical tools, research, and education.

The BACnet Campus Challenge - Part 1

DOE PAGES

Masica, Ken; Tom, Steve

2015-12-01

Here, the BACnet protocol was designed to achieve interoperability among building automation vendors and evolve over time to include new functionality as well as support new communication technologies such as the Ethernet and IP protocols as they became prevalent and economical in the market place. For large multi-building, multi-vendor campus environments, standardizing on the BACnet protocol as an implementation strategy can be a key component in meeting the challenge of an interoperable, flexible, and scalable building automation system. The interoperability of BACnet is especially important when large campuses with legacy equipment have DDC upgrades to facilities performed over different timemore » frames and use different contractors that install equipment from different vendors under the guidance of different campus HVAC project managers. In these circumstances, BACnet can serve as a common foundation for interoperability when potential variability exists in approaches to the design-build process by numerous parties over time. Likewise, BACnet support for a range of networking protocols and technologies can be a key strategy for achieving flexible and scalable automation systems as campuses and enterprises expand networking infrastructures using standard interoperable protocols like IP and Ethernet.« less

Blackbrush (Coleogyne ramosissima Torr.): State of our knowledge and future challenges

USGS Publications Warehouse

Pendleton, Rosemary L.; Pendleton, Burton K.; Meyer, Susan E.; Richardson, Bryce A.; Esque, Todd C.; Kitchen, Stanley G.

2015-01-01

Covering 130,000 square miles and a wide range of elevations from desert to alpine in Arizona, Utah, Colorado, and New Mexico, the Colorado Plateau has long fascinated researchers. The Colorado Plateau VI provides readers with a plethora of updates and insights into land conservation and management questions currently surrounding the region. The Colorado Plateau VI’s contributors show how new technologies for monitoring, spatial analysis, restoration, and collaboration improve our understanding, management, and conservation of outcomes at the appropriate landscape scale for the Colorado Plateau. The volume’s chapters fall into five major themes: monitoring as a key tool for addressing management challenges, restoration approaches to improving ecosystem condition and function, collaboration and organizational innovations to achieve conservation and management objectives, landscape-scale approaches to understanding, and managing key species and ecological communities. Focusing on the integration of science into resource management issues over the Colorado Plateau, this volume includes contributions from dozens of leading scholars of the region. The Colorado Plateau VI proves a valuable resource to all interested in the conservation management, natural history, and cultural biological resources of the Colorado Plateau.

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.

Understanding and Improving Recruitment to Randomised Controlled Trials: Qualitative Research Approaches.

PubMed

Elliott, Daisy; Husbands, Samantha; Hamdy, Freddie C; Holmberg, Lars; Donovan, Jenny L

2017-11-01

The importance of evidence from randomised trials is now widely recognised, although recruitment is often difficult. Qualitative research has shown promise in identifying the key barriers to recruitment, and interventions have been developed to reduce organisational difficulties and support clinicians undertaking recruitment. This article provides an introduction to qualitative research techniques and explains how this approach can be used to understand-and subsequently improve-recruitment and informed consent within a range of clinical trials. A literature search was performed using Medline, Embase, and CINAHL. All studies with qualitative research methods that focused on the recruitment activity of clinicians were included in the review. The majority of studies reported that organisational difficulties and lack of time for clinical staff were key barriers to recruitment. However, a synthesis of qualitative studies highlighted the intellectual and emotional challenges that arise when combining research with clinical roles, particularly in relation to equipoise and patient eligibility. To support recruiters to become more comfortable with the design and principles of randomised controlled trials, interventions have been developed, including the QuinteT Recruitment Intervention, which comprises in-depth investigation of recruitment obstacles in real time, followed by implementation of tailored strategies to address these challenges as the trial proceeds. Qualitative research can provide important insights into the complexities of recruitment to trials and inform the development of interventions, and provide support and training initiatives as required. Investigators should consider implementing such methods in trials expected to be challenging or recruiting below target. Qualitative research is a term used to describe a range of methods that can be implemented to understand participants' perspectives and behaviours. Data are gathered from interviews, focus groups, or observations. In this review, we demonstrate how this approach can be used to understand-and improve-recruitment to clinical trials. Taken together, our review suggests that healthcare professionals can find recruiting to trials challenging and require support with this process. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Mask manufacturing of advanced technology designs using multi-beam lithography (Part 1)

NASA Astrophysics Data System (ADS)

Green, Michael; Ham, Young; Dillon, Brian; Kasprowicz, Bryan; Hur, Ik Boum; Park, Joong Hee; Choi, Yohan; McMurran, Jeff; Kamberian, Henry; Chalom, Daniel; Klikovits, Jan; Jurkovic, Michal; Hudek, Peter

2016-10-01

As optical lithography is extended into 10nm and below nodes, advanced designs are becoming a key challenge for mask manufacturers. Techniques including advanced Optical Proximity Correction (OPC) and Inverse Lithography Technology (ILT) result in structures that pose a range of issues across the mask manufacturing process. Among the new challenges are continued shrinking Sub-Resolution Assist Features (SRAFs), curvilinear SRAFs, and other complex mask geometries that are counter-intuitive relative to the desired wafer pattern. Considerable capability improvements over current mask making methods are necessary to meet the new requirements particularly regarding minimum feature resolution and pattern fidelity. Advanced processes using the IMS Multi-beam Mask Writer (MBMW) are feasible solutions to these coming challenges. In this paper, we study one such process, characterizing mask manufacturing capability of 10nm and below structures with particular focus on minimum resolution and pattern fidelity.

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.

The laboratory workforce shortage: a managerial perspective.

PubMed

Cortelyou-Ward, Kendall; Ramirez, Bernardo; Rotarius, Timothy

2011-01-01

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

Nanotechnology: Development and challenges in Indonesia

NASA Astrophysics Data System (ADS)

Joni, I. Made; Muthukannan, Vanitha; Hermawan, Wawan; Panatarani, Camellia

2018-02-01

Nanotechnology today is regarded as a revolutionary technology that can help to address the key needs related to energy, environment, health and agriculture in developing countries. This paper is a short review on the development and challenges of nanotechnology in Indonesia. Nanotechnology offers great potential benefits, there is emerging concerns arising from its novel physicochemical properties. The main applications of nanotechnology in the different sectors which is vital and its economic impact in Indonesia is also discussed. The achievment and development of nanotechnology including synthesis and dispersion of nanoparticles (NPs) and its applications in various fields is briefly addressed in Nanotehcnology and Graphene Research Center, Universitas Padjadjaran (Unpad). Despite significant progress in developmental goals, many challenges in the development of nanotechnology proccesing need to be resolved such as support infrastructure and evolution of new form of collaborative arrangements between various sectors and policies which is emerged as an important factor enabling development.

Searching for the Impact of Participation in Health and Health Research: Challenges and Methods.

PubMed

Harris, Janet; Cook, Tina; Gibbs, Lisa; Oetzel, John; Salsberg, Jon; Shinn, Carolynne; Springett, Jane; Wallerstein, Nina; Wright, Michael

2018-01-01

Internationally, the interest in involving patients and the public in designing and delivering health interventions and researching their effectiveness is increasing. Several systematic reviews of participation in health research have recently been completed, which note a number of challenges in documenting the impact of participation. Challenges include working across stakeholders with different understandings of participation and levels of experience in reviewing; comparing heterogeneous populations and contexts; configuring findings from often thin descriptions of participation in academic papers; and dealing with different definitions of impact. This paper aims to advance methods for systematically reviewing the impact of participation in health research, drawing on recent systematic review guidance. Practical examples for dealing with issues at each stage of a review are provided based on recent experience. Recommendations for improving primary research on participation in health are offered and key points to consider during the review are summarised.

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

Canadian Academy of Sport and Exercise Medicine position statement: athletes at high altitude.

PubMed

Koehle, Michael S; Cheng, Ivy; Sporer, Benjamin

2014-03-01

Many sports incorporate training at altitude as a key component of their athlete training plan. Furthermore, many sports are required to compete at high altitude venues. Exercise at high altitude provides unique challenges to the athlete and to the sport medicine clinician working with these athletes. These challenges include altitude illness, alterations in training intensity and performance, nutritional and hydration difficulties, and challenges related to the austerity of the environment. Furthermore, many of the strategies that are typically utilized by visitors to altitude may have implications from an anti-doping point of view.This position statement was commissioned and approved by the Canadian Academy of Sport and Exercise Medicine. The purpose of this statement was to provide an evidence-based, best practices summary to assist clinicians with the preparation and management of athletes and individuals travelling to altitude for both competition and training.

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 CHALLENGING ROLE OF A READING COACH, A CAUTIONARY TALE.

PubMed

Al Otaiba, Stephanie; Hosp, John L; Smartt, Susan; Dole, Janice A

2008-04-01

The purpose of this case study is to describe the challenges one coach faced during the initial implementation of a coaching initiative involving 33 teachers in an urban, high-poverty elementary school. Reading coaches are increasingly expected to play a key role in the professional development efforts to improve reading instruction in order to improve reading achievement for struggling readers. Data sources included initial reading scores for kindergarten and first-graders, pretest and posttest scores of teachers' knowledge, a teacher survey, focus group interviews, project documents, and field notes. Data were analyzed using a mixed methods approach. Findings revealed several challenges that have important implications for research and practice: that teachers encountered new information about teaching early reading that conflicted with their current knowledge, this new information conflicted with their core reading program, teachers had differing perceptions of the role of the reading coach that affected their feelings about the project, and reform efforts are time-intensive.

Searching for the Impact of Participation in Health and Health Research: Challenges and Methods

PubMed Central

Cook, Tina; Salsberg, Jon; Shinn, Carolynne; Springett, Jane; Wallerstein, Nina; Wright, Michael

2018-01-01

Internationally, the interest in involving patients and the public in designing and delivering health interventions and researching their effectiveness is increasing. Several systematic reviews of participation in health research have recently been completed, which note a number of challenges in documenting the impact of participation. Challenges include working across stakeholders with different understandings of participation and levels of experience in reviewing; comparing heterogeneous populations and contexts; configuring findings from often thin descriptions of participation in academic papers; and dealing with different definitions of impact. This paper aims to advance methods for systematically reviewing the impact of participation in health research, drawing on recent systematic review guidance. Practical examples for dealing with issues at each stage of a review are provided based on recent experience. Recommendations for improving primary research on participation in health are offered and key points to consider during the review are summarised. PMID:29862298

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

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.

Toward Personalized Control of Human Gut Bacterial Communities.

PubMed

David, Lawrence A

2018-01-01

A key challenge in microbiology will be developing tools for manipulating human gut bacterial communities. Our ability to predict and control the dynamics of these communities is now in its infancy. To manage human gut microbiota, I am developing methods in three research domains. First, I am refining in vitro tools to experimentally study gut microbes at high throughput and in controlled settings. Second, I am adapting "big data" techniques to overcome statistical challenges confronting microbiota modeling. Third, I am testing study designs that can streamline human testing of microbiota manipulations. Assembling these methods creates new challenges, including training scientists who can work across disciplines such as engineering, ecology, and medicine. Nevertheless, I envision that overcoming these obstacles will enable my group to construct platforms that can personalize microbiota treatments, particularly ones based on diet. More broadly, I anticipate that such platforms will have applications across fields such as agriculture, biotechnology, and environmental management.

Multigenerational challenges in academic medicine: UCDavis's responses.

PubMed

Howell, Lydia Pleotis; Servis, Gregg; Bonham, Ann

2005-06-01

Academic medicine is a unique work environment, one of the few where members of four different generations regularly interact and where multigenerational teams are key to fulfilling its missions, particularly education. This can lead to increased creativity, but also to intergenerational conflict, since each generation has different values and expectations. The authors describe multigenerational challenges confronted at the University of California, Davis, School of Medicine, and that school's responses to them. These challenges include issues related to work hours, workload, compensation, evaluation for advancement, recruitment and retention, and attendance at required meetings. Awareness of the different generational qualities and values allowed the school of medicine to identify the multigenerational origin of many of these ongoing issues and challenges and to plan appropriate solutions within the Office of Academic Affairs. These include policy changes related to work-life balance, utilizing multiple faculty tracks with different roles, allowing part-time faculty appointments, creating a variety of faculty development programs geared toward different generational needs (which utilize flexible modules, menus of options, and alternative technologies for presentation), defining appropriate reward and incentives through compensations plans, and creating peer-reviewed awards. The authors conclude that these efforts mitigate conflict, promote diversity, and allow multigenerational teams to function more effectively and creatively in education, research, and clinical care. Ongoing evaluation will further refine this approach.

Challenges and Economic Implications in the Control of Foot and Mouth Disease in Sub-Saharan Africa: Lessons from the Zambian Experience

PubMed Central

Sinkala, Y.; Simuunza, M.; Pfeiffer, D. U.; Munang'andu, H. M.; Mulumba, M.; Kasanga, C. J.; Muma, J. B.; Mweene, A. S.

2014-01-01

Foot and mouth disease is one of the world's most important livestock diseases for trade. FMD infections are complex in nature and there are many epidemiological factors needing clarification. Key questions relate to the control challenges and economic impact of the disease for resource-poor FMD endemic countries like Zambia. A review of the control challenges and economic impact of FMD outbreaks in Zambia was made. Information was collected from peer-reviewed journals articles, conference proceedings, unpublished scientific reports, and personal communication with scientists and personal field experiences. The challenges of controlling FMD using mainly vaccination and movement control are discussed. Impacts include losses in income of over US$ 1.6 billion from exports of beef and sable antelopes and an annual cost of over US$ 2.7 million on preventive measures. Further impacts included unquantified losses in production and low investment in agriculture resulting in slow economic growth. FMD persistence may be a result of inadequate epidemiological understanding of the disease and ineffectiveness of the control measures that are being applied. The identified gaps may be considered in the annual appraisal of the FMD national control strategy in order to advance on the progressive control pathway. PMID:25276472

Challenges and economic implications in the control of foot and mouth disease in sub-saharan Africa: lessons from the zambian experience.

PubMed

Sinkala, Y; Simuunza, M; Pfeiffer, D U; Munang'andu, H M; Mulumba, M; Kasanga, C J; Muma, J B; Mweene, A S

2014-01-01

Foot and mouth disease is one of the world's most important livestock diseases for trade. FMD infections are complex in nature and there are many epidemiological factors needing clarification. Key questions relate to the control challenges and economic impact of the disease for resource-poor FMD endemic countries like Zambia. A review of the control challenges and economic impact of FMD outbreaks in Zambia was made. Information was collected from peer-reviewed journals articles, conference proceedings, unpublished scientific reports, and personal communication with scientists and personal field experiences. The challenges of controlling FMD using mainly vaccination and movement control are discussed. Impacts include losses in income of over US$ 1.6 billion from exports of beef and sable antelopes and an annual cost of over US$ 2.7 million on preventive measures. Further impacts included unquantified losses in production and low investment in agriculture resulting in slow economic growth. FMD persistence may be a result of inadequate epidemiological understanding of the disease and ineffectiveness of the control measures that are being applied. The identified gaps may be considered in the annual appraisal of the FMD national control strategy in order to advance on the progressive control pathway.

Operational research as implementation science: definitions, challenges and research priorities.

PubMed

Monks, Thomas

2016-06-06

Operational research (OR) is the discipline of using models, either quantitative or qualitative, to aid decision-making in complex implementation problems. The methods of OR have been used in healthcare since the 1950s in diverse areas such as emergency medicine and the interface between acute and community care; hospital performance; scheduling and management of patient home visits; scheduling of patient appointments; and many other complex implementation problems of an operational or logistical nature. To date, there has been limited debate about the role that operational research should take within implementation science. I detail three such roles for OR all grounded in upfront system thinking: structuring implementation problems, prospective evaluation of improvement interventions, and strategic reconfiguration. Case studies from mental health, emergency medicine, and stroke care are used to illustrate each role. I then describe the challenges for applied OR within implementation science at the organisational, interventional, and disciplinary levels. Two key challenges include the difficulty faced in achieving a position of mutual understanding between implementation scientists and research users and a stark lack of evaluation of OR interventions. To address these challenges, I propose a research agenda to evaluate applied OR through the lens of implementation science, the liberation of OR from the specialist research and consultancy environment, and co-design of models with service users. Operational research is a mature discipline that has developed a significant volume of methodology to improve health services. OR offers implementation scientists the opportunity to do more upfront system thinking before committing resources or taking risks. OR has three roles within implementation science: structuring an implementation problem, prospective evaluation of implementation problems, and a tool for strategic reconfiguration of health services. Challenges facing OR as implementation science include limited evidence and evaluation of impact, limited service user involvement, a lack of managerial awareness, effective communication between research users and OR modellers, and availability of healthcare data. To progress the science, a focus is needed in three key areas: evaluation of OR interventions, embedding the knowledge of OR in health services, and educating OR modellers about the aims and benefits of service user involvement.

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.

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

Annual Research Review: The Neurobiology and Physiology of Resilience and Adaptation across the Life Course

ERIC Educational Resources Information Center

Karatoreos, Ilia N.; McEwen, Bruce S.

2013-01-01

Background: Adaptation is key to survival. An organism must adapt to environmental challenges in order to be able to thrive in the environment in which they find themselves. Resilience can be thought of as a measure of the ability of an organism to adapt, and to withstand challenges to its stability. In higher animals, the brain is a key player in…

The Inter-Life Project: Researching the Potential of Art, Design and Virtual Worlds as a Vehicle for Assisting Young People with Key Life Changes and Transitions

ERIC Educational Resources Information Center

Lally, Victor; Sclater, Madeleine

2013-01-01

Careers work in the twenty-first century faces a key challenge in terms of digital technologies: to evaluate their potential for careers work in challenging settings. Given the rapidity of developments, technologies require evaluation in research innovations and naturalistic settings. Virtual worlds offer potential for careers and guidance work,…

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.

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.

Ground-based Remote Sensing for Quantifying Subsurface and Surface Co-variability to Scale Arctic Ecosystem Functioning

NASA Astrophysics Data System (ADS)

Oktem, R.; Wainwright, H. M.; Curtis, J. B.; Dafflon, B.; Peterson, J.; Ulrich, C.; Hubbard, S. S.; Torn, M. S.

2016-12-01

Predicting carbon cycling in Arctic requires quantifying tightly coupled surface and subsurface processes including permafrost, hydrology, vegetation and soil biogeochemistry. The challenge has been a lack of means to remotely sense key ecosystem properties in high resolution and over large areas. A particular challenge has been characterizing soil properties that are known to be highly heterogeneous. In this study, we exploit tightly-coupled above/belowground ecosystem functioning (e.g., the correlations among soil moisture, vegetation and carbon fluxes) to estimate subsurface and other key properties over large areas. To test this concept, we have installed a ground-based remote sensing platform - a track-mounted tram system - along a 70 m transect in the ice-wedge polygonal tundra near Barrow, Alaska. The tram carries a suite of near-surface remote sensing sensors, including sonic depth, thermal IR, NDVI and multispectral sensors. Joint analysis with multiple ground-based measurements (soil temperature, active layer soil moisture, and carbon fluxes) was performed to quantify correlations and the dynamics of above/belowground processes at unprecedented resolution, both temporally and spatially. We analyzed the datasets with particular focus on correlating key subsurface and ecosystem properties with surface properties that can be measured by satellite/airborne remote sensing over a large area. Our results provided several new insights about system behavior and also opens the door for new characterization approaches. We documented that: (1) soil temperature (at >5 cm depth; critical for permafrost thaw) was decoupled from soil surface temperature and was influenced strongly by soil moisture, (2) NDVI and greenness index were highly correlated with both soil moisture and gross primary productivity (based on chamber flux data), and (3) surface deformation (which can be measured by InSAR) was a good proxy for thaw depth dynamics at non-inundated locations.

Analysis of the policymaking process in Burkina Faso's health sector: case studies of the creation of two health system support units.

PubMed

Zida, Andre; Lavis, John N; Sewankambo, Nelson K; Kouyate, Bocar; Moat, Kaelan; Shearer, Jessica

2017-02-13

Burkina Faso has made a number of health system policy decisions to improve performance on health indicators and strengthen responsiveness to health-related challenges. These included the creation of a General Directorate of Health Information and Statistics (DGISS) and a technical unit to coordinate performance-based financing (CT-FBR). We analysed the policymaking processes associated with the establishment of these units, and documented the factors that influenced this process. We used a multiple-case study design based on Kingdon's agenda-setting model to investigate the DGISS and CT-FBR policymaking processes. Data were collected from interviews with key informants (n = 28), published literature, policy documents (including two strategic and 230 action plans), and 55 legal/regulatory texts. Interviews were analysed using thematic qualitative analysis. Data from the documentary analysis were triangulated with the qualitative interview data. Key factors influencing the policymaking processes associated with the two units involved the 'problem' (problem identification), 'policy' (formation of policy proposals), and 'politics' (political climate/change) streams, which came together in a way that resulted in proposals being placed on the decision agenda. A number of problems with Burkina Faso's health information and financing systems were identified. Policy proposals for the DGISS and CT-FBR units were developed in response to these problems, emerging from several sources including development partners. Changes in political and public service administrations (specifically the 2008 appointment of a new Minister of Health and the establishment of a new budget allocation system), with corresponding changes in the actors and interests involved, appeared key in elevating the proposals to the decision agenda. Efforts to improve performance on health indicators and strengthen responsiveness to health-related challenges need focus on the need for a compelling problem, a viable policy, and conducive politics in order to make it to the decision agenda.

The Challenges of Human Resource Management towards Organizational Effectiveness: A Comparative Study in Southern EU

ERIC Educational Resources Information Center

Stavrou-Costea, Eleni

2005-01-01

Purpose: The study aims to examine the human resource management challenges in Southern EU and their effect on organizational performance. Design/methodology/approach: First, key challenges were identified in the existing literature. Then, these challenges were matched with those reported most often in the CRANET questionnaire. These challenges…

Free-living monitoring of Parkinson's disease: Lessons from the field.

PubMed

Del Din, Silvia; Godfrey, Alan; Mazzà, Claudia; Lord, Sue; Rochester, Lynn

2016-09-01

Wearable technology comprises miniaturized sensors (eg, accelerometers) worn on the body and/or paired with mobile devices (eg, smart phones) allowing continuous patient monitoring in unsupervised, habitual environments (termed free-living). Wearable technologies are revolutionizing approaches to health care as a result of their utility, accessibility, and affordability. They are positioned to transform Parkinson's disease (PD) management through the provision of individualized, comprehensive, and representative data. This is particularly relevant in PD where symptoms are often triggered by task and free-living environmental challenges that cannot be replicated with sufficient veracity elsewhere. This review concerns use of wearable technology in free-living environments for people with PD. It outlines the potential advantages of wearable technologies and evidence for these to accurately detect and measure clinically relevant features including motor symptoms, falls risk, freezing of gait, gait, functional mobility, and physical activity. Technological limitations and challenges are highlighted, and advances concerning broader aspects are discussed. Recommendations to overcome key challenges are made. To date there is no fully validated system to monitor clinical features or activities in free-living environments. Robust accuracy and validity metrics for some features have been reported, and wearable technology may be used in these cases with a degree of confidence. Utility and acceptability appears reasonable, although testing has largely been informal. Key recommendations include adopting a multidisciplinary approach for standardizing definitions, protocols, and outcomes. Robust validation of developed algorithms and sensor-based metrics is required along with testing of utility. These advances are required before widespread clinical adoption of wearable technology can be realized. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

Beyond the rhetoric: what do we mean by a 'model of care'?

PubMed

Davidson, Patricia; Halcomb, Elizabeth; Hickman, L; Phillips, J; Graham, B

2006-01-01

Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: (1) novel pharmacological and non-pharmacological treatments; (2) changes in consumer demands and expectations; (3) fiscal and resource constraints; (4) changes in societal demographics in particular the ageing of society; (5) an increasing burden of chronic disease; (6) documentation of limitations in traditional health care delivery; (7) increased emphasis on transparency, accountability, evidence-based practice (EBP) and clinical governance structures; and (8) the increasing cultural diversity of the community. These challenges provoke discussion of potential alternative models of care, with scant reference to defining what constitutes a model of care. This paper aims to define what is meant by the term 'model of care' and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery. Searches of electronic databases, the reference lists of published materials, policy documents and the Internet were conducted using key words including 'model*', 'framework*', 'models, theoretical' and 'nursing models, theoretical'. The collated material was then analysed and synthesised into this review. This review determined that in addition to key conceptual and theoretical perspectives, quality improvement theory (eg. collaborative methodology), project management methods and change management theory inform both pragmatic and conceptual elements of a model of care. Crucial elements in changing health care delivery through the development of innovative models of care include the planning, development, implementation, evaluation and assessment of the sustainability of the new model. Regardless of whether change in health care delivery is attempted on a micro basis (eg. ward level) or macro basis (eg. national or state system) in order to achieve sustainable, effective and efficient changes a well-planned, systematic process is essential.

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

Reviewing the regulatory barriers for nanomedicine: global questions and challenges.

PubMed

Bowman, Diana M; Gatof, Jake

2015-01-01

Nanomedicine will play an increasing role in prevention and treatment across the entire healthcare spectrum. However, their precise market size, economic value and areas of application remain unclear. This opacity, including the question of what constitutes nanomedicine matters, especially when considered alongside the key regulatory questions and concerns. This article begins by placing these key questions into context in relation to the current scientific state of the art, focusing particular attention on the human health and safety context. In exploring these central questions surrounding the regulation of nanomedicine, this perspective also explores existing and suggested frameworks that aim to deal with emerging technologies more generally. It then outlines priority areas for action and general conclusions specific to nanomedicine.

Medical Logistics Lessons Observed During Operations Enduring Freedom and Iraqi Freedom.

PubMed

Dole, Mark J; Kissane, Jonathan M

2016-01-01

Medical Logistics (MEDLOG) is a function of the Army's integrated System for Health that provides the medical products and specialized logistics services required to deliver health protection and care under all operational conditions. In unified land operations, MEDLOG is an inherent function of Health Service Support (HSS), which also includes casualty care and medical evacuation. This paper focuses on a few key lessons observed during Operations Enduring Freedom and Iraqi Freedom with direct implications for the support of HSS in future operations as envisioned in the Army Operating Concept and the Joint Concept for Health Services. It also examines a few key enablers that helped mitigate these challenges that are not yet fully acknowledged in Army Medical Department doctrine, policy, and planning.

Cars, CONSORT 2010, and clinical practice.

PubMed

Williams, Hywel C

2010-03-24

Just like you would not buy a car without key information such as service history, you would not "buy" a clinical trial report without key information such as concealment of allocation. Implementation of the updated CONSORT 2010 statement enables the reader to see exactly what was done in a trial, to whom and when. A fully "CONSORTed" trial report does not necessarily mean the trial is a good one, but at least the reader can make a judgement. Clear reporting is a pre-requisite for judgement of study quality. The CONSORT statement evolves as empirical research moves on. CONSORT 2010 is even clearer than before and includes some new items with a particular emphasis on selective reporting of outcomes. The challenge is for everyone to use it.

Assessing the American Association of Neuroscience Nurses' Progress on the Institute of Medicine Report.

PubMed

Madden, Lori Kennedy; Hundley, Lynn; Summers, Debbie; Villanueva, Nancy; Walter, Suzy Mascaro

2017-06-01

The American Association of Neuroscience Nurses (AANN) has worked toward meeting the challenges and addressing the key messages from the 2010 Institute of Medicine report on the future of nursing. In 2012, AANN developed an article summarizing how the association has addressed key issues. Since that time, new recommendations have been made to advance nursing, and AANN has updated its strategic plan. The AANN has assessed organizational progress in these initiatives in a 2017 white paper. This process included review of plans since the initial report and proposal of further efforts the organization can make in shaping the future of neuroscience nursing. The purpose of this manuscript is to provide an overview of the AANN white paper.

A Journey with Elie Metchnikoff: From Innate Cell Mechanisms in Infectious Diseases to Quantum Biology

PubMed Central

Merien, Fabrice

2016-01-01

Many reviews of Elie Metchnikoff’s work have been published, all unanimously acknowledging the significant contributions of his cellular theory to the fields of immunology and infectious diseases. In 1883, he published a key paper describing phagocytic cells in frogs. His descriptions were not just about phagocytes involved in host defense, he also described how these specialized cells eliminated degenerating or dying cells of the host. This perspective focuses on key concepts developed by Metchnikoff by presenting relevant excerpts of his 1883 paper and matching these concepts with challenges of modern immunology. A new approach to macrophage polarization is included to introduce some creative thinking about the exciting emerging area of quantum biology. PMID:27379227

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.

A harmonized segmentation protocol for hippocampal and parahippocampal subregions: Why do we need one and what are the key goals?

PubMed

Wisse, Laura E M; Daugherty, Ana M; Olsen, Rosanna K; Berron, David; Carr, Valerie A; Stark, Craig E L; Amaral, Robert S C; Amunts, Katrin; Augustinack, Jean C; Bender, Andrew R; Bernstein, Jeffrey D; Boccardi, Marina; Bocchetta, Martina; Burggren, Alison; Chakravarty, M Mallar; Chupin, Marie; Ekstrom, Arne; de Flores, Robin; Insausti, Ricardo; Kanel, Prabesh; Kedo, Olga; Kennedy, Kristen M; Kerchner, Geoffrey A; LaRocque, Karen F; Liu, Xiuwen; Maass, Anne; Malykhin, Nicolai; Mueller, Susanne G; Ofen, Noa; Palombo, Daniela J; Parekh, Mansi B; Pluta, John B; Pruessner, Jens C; Raz, Naftali; Rodrigue, Karen M; Schoemaker, Dorothee; Shafer, Andrea T; Steve, Trevor A; Suthana, Nanthia; Wang, Lei; Winterburn, Julie L; Yassa, Michael A; Yushkevich, Paul A; la Joie, Renaud

2017-01-01

The advent of high-resolution magnetic resonance imaging (MRI) has enabled in vivo research in a variety of populations and diseases on the structure and function of hippocampal subfields and subdivisions of the parahippocampal gyrus. Because of the many extant and highly discrepant segmentation protocols, comparing results across studies is difficult. To overcome this barrier, the Hippocampal Subfields Group was formed as an international collaboration with the aim of developing a harmonized protocol for manual segmentation of hippocampal and parahippocampal subregions on high-resolution MRI. In this commentary we discuss the goals for this protocol and the associated key challenges involved in its development. These include differences among existing anatomical reference materials, striking the right balance between reliability of measurements and anatomical validity, and the development of a versatile protocol that can be adopted for the study of populations varying in age and health. The commentary outlines these key challenges, as well as the proposed solution of each, with concrete examples from our working plan. Finally, with two examples, we illustrate how the harmonized protocol, once completed, is expected to impact the field by producing measurements that are quantitatively comparable across labs and by facilitating the synthesis of findings across different studies. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

NATO and the Challenges of Austerity

DTIC Science & Technology

2012-01-01

Navy’s participation in operations in Libya in 2011. The The Impact of Defense Cuts on Key NATO Allies 7 elimination of the Nimrod MRA.4 maritime... Nimrod MRA. Mk2. The CSR cuts included the entire fleet of Harrier GR.9 combat aircraft. The Harrier cut has joint implications because the RAF Har- riers...overlap of its replacement. The Boeing RC-135 “Rivet Joint” signals intelligence (SIGINT) aircraft will replace the two remaining Nimrod R.1 platforms

The roles, barriers and experiences of rehabilitation therapists in disaster relief: post-earthquake Haiti 2010.

PubMed

Klappa, Susan; Audette, Jennifer; Do, Sandy

2014-01-01

This article describes the roles and experiences of rehabilitation therapists involved in disaster relief work (DRW) in Haiti after the 2010 earthquake. The results of a pilot study and phenomenological study are presented. A phenomenological study of rehabilitation providers' experiences in post-disaster relief care is presented along with preliminary pilot study results. The phenomenological study explored the experiences of therapists from a lived experience perspective through the roles they played in DRW. Participants provided disaster relief through direct patient care, adaptive equipment sourcing and allocation, education and training, community outreach and logistic or administrative duties. Barriers and challenges included: (1) emotions: ups and downs; (2) challenges: working at the edge of practice; (3) education: key to success and sustainability; (4) lessons learned: social responsibility is why we go; and (5) difficulty coming home: no one understands. Therapists play a key role in disaster relief situations. Data presented should encourage organizations to include therapists from early planning to implementation of relief services. Further studies are needed to evaluate the impact of rehabilitation interventions in disaster settings. Understanding the roles and experiences of therapists in disaster relief setting is important Certain barriers to providing care in post-disaster settings exist Those participating in disaster response should be well prepared and aware of that they might be asked to do.

Resident education in 2011: three key challenges on the road ahead.

PubMed

Van Eaton, Erik G; Tarpley, John L; Solorzano, Carmen C; Cho, Clifford S; Weber, Sharon M; Termuhlen, Paula M

2011-04-01

Two important changes in the past decade have altered the landscape of graduate medical education (GME) in the U.S. The national restrictions on trainee duty hours mandated by the Accreditation Council for Graduate Medical Education (ACGME) were the most visible and generated much controversy. Equally important is the ACGME Outcome Project, which mandates competency-based training. Both of these changes have unique implications for surgery trainees, who traditionally spent long hours caring for patients in the hospital, and who must be assessed in 2 broad domains: their medical care of pre- and postoperative patients, and their technical skill with procedures in and out of the operating room. This article summarizes 3 key challenges that lie ahead for surgical educators. First, the changes in duty hours in the past 7 years are summarized, and the conversation about added restrictions planned for July 2011 is reviewed. Next, the current state of the assessment of competency among surgical trainees is reviewed, with an outline of the challenges that need to be overcome to achieve widespread, competency-based training in surgery. Finally, the article summarizes the problems caused by increased reliance on handoffs among trainees as they compensate for decreased time in the hospital, and suggests changes that need to be made to improve safety and efficiency, including how to use handoffs as part of our educational evaluation of residents. Copyright © 2011 Mosby, Inc. All rights reserved.

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

J. Carmack; L. Braase; F. Goldner

The mission of the Advanced Fuels Campaign (AFC) is to perform Research, Development, and Demonstration (RD&D) activities for advanced fuel forms (including cladding) to enhance the performance and safety of the nation’s current and future reactors, enhance proliferation resistance of nuclear fuel, effectively utilize nuclear energy resources, and address the longer-term waste management challenges. This includes development of a state of the art Research and Development (R&D) infrastructure to support the use of a “goal oriented science based approach.” AFC uses a “goal oriented, science based approach” aimed at a fundamental understanding of fuel and cladding fabrication methods and performancemore » under irradiation, enabling the pursuit of multiple fuel forms for future fuel cycle options. This approach includes fundamental experiments, theory, and advanced modeling and simulation. One of the most challenging aspects of AFC is the management, integration, and coordination of major R&D activities across multiple organizations. AFC interfaces and collaborates with Fuel Cycle Technologies (FCT) campaigns, universities, industry, various DOE programs and laboratories, federal agencies (e.g., Nuclear Regulatory Commission [NRC]), and international organizations. Key challenges are the development of fuel technologies to enable major increases in fuel performance (safety, reliability, power and burnup) beyond current technologies, and development of characterization methods and predictive fuel performance models to enable more efficient development and licensing of advanced fuels. Challenged with the research and development of fuels for two different reactor technology platforms, AFC targeted transmutation fuel development and focused ceramic fuel development for Advanced LWR Fuels.« less

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.

Suppression of dendritic lithium growth in lithium metal-based batteries.

PubMed

Li, Linlin; Li, Siyuan; Lu, Yingying

2018-06-19

Lithium metal-based batteries offer promising prospects as alternatives to today's lithium-ion batteries, due to their ultra-high energy density. Unfortunately, the application of lithium metal is full of challenges and has puzzled researchers for more than 40 years. In this feature article, we describe the history of the development of lithium metal batteries and their existing key challenges, which include non-uniform electrodeposition, volume expansion, high reactivity of the lithium metal/unstable solid electrolyte interphase (SEI), and the shuttling of active cathode materials. Then, we focus on the growth mechanisms of uneven lithium electrodeposition and extend the discussion to the approaches to inhibit lithium dendrites. Finally, we discuss future directions that are expected to drive progress in the development of lithium metal batteries.

[Interactions between human sexual arousal and sexual desire: a challenge for social neuroscience].

PubMed

Ortigue, Stephanie; Bianchi-Demicheli, Francesco

2007-03-28

The frequent interaction and synergy between sexual arousal and sexual desire occuring during a sexual experience explains the difficulty in disentagling these two phenomena in the human sexual response. Sexual desire is defined as a goal-directed motivational state integrating the other in one's personal sphere on the basis of intentionality, rather than by instinct only. Sexual arousal includes physical manifestations and subjective perception of excitement. Interest in sexual arousal has engendered a growing body of research concerning its nature and function as well as the biological basis of the mechanisms sustaining it. Recent functional imaging has played a key role in seeking to isolate brain regions specific to sexual arousal. This field may represent a new challenge for social neuroscience.

Improving data collection processes for routine evaluation of treatment cost-effectiveness.

PubMed

Monto, Sari; Penttilä, Riku; Kärri, Timo; Puolakka, Kari; Valpas, Antti; Talonpoika, Anna-Maria

2016-04-01

The healthcare system in Finland has begun routine collection of health-related quality of life (HRQoL) information for patients in hospitals to support more systematic cost-effectiveness analysis (CEA). This article describes the systematic collection of HRQoL survey data, and addresses challenges in the implementation of patient surveys and acquisition of cost data in the case hospital. Challenges include problems with incomplete data and undefined management processes. In order to support CEA of hospital treatments, improvements are sought from the process management literature and in the observation of healthcare professionals. The article has been written from an information system and process management perspective, concluding that process ownership, automation of data collection and better staff training are keys to generating more reliable data.

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.

Venture Capital Investment in the Life Sciences in Switzerland.

PubMed

Hosang, Markus

2014-12-01

Innovation is one of the main driving factors for continuous and healthy economic growth and welfare. Switzerland as a resource-poor country is particularly dependent on innovation, and the life sciences, which comprise biotechnologies, (bio)pharmaceuticals, medical technologies and diagnostics, are one of the key areas of innovative strength of Switzerland. Venture capital financing and venture capitalists (frequently called 'VCs') and investors in public equities have played and still play a pivotal role in financing the Swiss biotechnology industry. In the following some general features of venture capital investment in life sciences as well as some opportunities and challenges which venture capital investors in Switzerland are facing are highlighted. In addition certain means to counteract these challenges including the 'Zukunftsfonds Schweiz' are discussed.

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.

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.

The European Medicines Agency's strategies to meet the challenges of Alzheimer disease.

PubMed

Haas, Manuel; Mantua, Valentina; Haberkamp, Marion; Pani, Luca; Isaac, Maria; Butlen-Ducuing, Florence; Vamvakas, Spiros; Broich, Karl

2015-04-01

Regulatory agencies have a key role in facilitating the development of new drugs for Alzheimer disease, particularly given the challenges associated with early intervention. Here, we highlight the strategies of the European Medicines Agency to help address such challenges.

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.

Key Objectives Bank: Year 9. Key Stage 3: National Strategy.

ERIC Educational Resources Information Center

Department for Education and Skills, London (England).

In each sub-section of the "Framework for Teaching English: Years 7, 8 and 9," certain key objectives are identified in boldface print. These objectives are key because they signify skills or understanding which are crucial to pupils' language development. They are challenging for the age group and are important markers of progress. This…

Empirical Analysis of Optical Attenuator Performance in Quantum Key Distribution Systems Using a Particle Model

DTIC Science & Technology

2012-03-01

EMPIRICAL ANALYSIS OF OPTICAL ATTENUATOR PERFORMANCE IN QUANTUM KEY DISTRIBUTION SYSTEMS USING A...DISTRIBUTION IS UNLIMITED AFIT/GCS/ENG/12-01 EMPIRICAL ANALYSIS OF OPTICAL ATTENUATOR PERFORMANCE IN QUANTUM KEY DISTRIBUTION SYSTEMS USING ...challenging as the complexity of actual implementation specifics are considered. Two components common to most quantum key distribution

Energy-Efficient Implementation of ECDH Key Exchange for Wireless Sensor Networks

NASA Astrophysics Data System (ADS)

Lederer, Christian; Mader, Roland; Koschuch, Manuel; Großschädl, Johann; Szekely, Alexander; Tillich, Stefan

Wireless Sensor Networks (WSNs) are playing a vital role in an ever-growing number of applications ranging from environmental surveillance over medical monitoring to home automation. Since WSNs are often deployed in unattended or even hostile environments, they can be subject to various malicious attacks, including the manipulation and capture of nodes. The establishment of a shared secret key between two or more individual nodes is one of the most important security services needed to guarantee the proper functioning of a sensor network. Despite some recent advances in this field, the efficient implementation of cryptographic key establishment for WSNs remains a challenge due to the resource constraints of small sensor nodes such as the MICAz mote. In this paper we present a lightweight implementation of the elliptic curve Diffie-Hellman (ECDH) key exchange for ZigBee-compliant sensor nodes equipped with an ATmega128 processor running the TinyOS operating system. Our implementation uses a 192-bit prime field specified by the NIST as underlying algebraic structure and requires only 5.20 ·106 clock cycles to compute a scalar multiplication if the base point is fixed and known a priori. A scalar multiplication using a random base point takes about 12.33 ·106 cycles. Our results show that a full ECDH key exchange between two MICAz motes consumes an energy of 57.33 mJ (including radio communication), which is significantly better than most previously reported ECDH implementations on comparable platforms.

Health care financing in Asia: key issues and challenges.

PubMed

Kwon, Soonman

2011-09-01

This article examines the major elements of health care financing such as financial risk protection, resource generation, resource pooling, and purchasing and payment; provides key lessons; and discusses the challenges for health care financing systems of Asian countries. With the exception of Japan, Korea, Taiwan, and Thailand, most health care systems of Asia provide very limited financial risk protection. The role of public prepaid schemes such as tax and social health insurance is minimal, and out-of-pocket payment is a major source of financing. The large informal sector is a major challenge to the extension of population coverage in many low-income countries of Asia, which must seek the optimal mix of tax subsidy and health insurance for universal coverage. Implementation of effective payment systems to control the behavior of health care providers is also a key factor in the success of health care financing reform in Asia.

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.

Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities.

PubMed

Asaria, Miqdad; Grasic, Katja; Walker, Simon

2016-02-01

This paper discusses key challenges and opportunities that arise when using linked electronic health records (EHR) in health economics and outcomes research (HEOR), with a particular focus on estimating healthcare costs. These challenges and opportunities are framed in the context of a case study modelling the costs of stable coronary artery disease in England. The challenges and opportunities discussed fall broadly into the categories of (1) handling and organising data of this size and sensitivity; (2) extracting clinical endpoints from datasets that have not been designed and collected with such endpoints in mind; and (3) the principles and practice of costing resource use from routinely collected data. We find that there are a number of new challenges and opportunities that arise when working with EHR compared with more traditional sources of data for HEOR. These call for greater clinician involvement and intelligent use of sensitivity analysis.

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.

From Assistant Teacher to Teacher: Challenges and Pathways in Situated Pre-Service Teacher Education

ERIC Educational Resources Information Center

Strangeways, Al

2017-01-01

Vocational pathways to Higher Education have a key role in opening teacher education to under-represented groups but bring with them particular challenges. Teacher educators need to address the challenges faced by these learners, of not only connecting their learning but also challenging their knowledge, and doing so in an invested work…

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.

Challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia.

PubMed

Walubita, Mulima; Sikateyo, Bornwell; Zulu, Joseph M

2018-05-02

Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.

Clinical decision-making and secondary findings in systems medicine.

PubMed

Fischer, T; Brothers, K B; Erdmann, P; Langanke, M

2016-05-21

Systems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology (especially systems biology); "big data" statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems medicine knowledge and clinicians working to apply it. This article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through "big data" approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the "death computer," to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their "quantified self." This paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care.

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.

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.

A qualitative and quantitative needs assessment of pain management for hospitalized orthopedic patients.

PubMed

Cordts, Grace A; Grant, Marian S; Brandt, Lynsey E; Mears, Simon C

2011-08-08

Despite advances in pain management, little formal teaching is given to practitioners and nurses in its use for postoperative orthopedic patients. The goal of our study was to determine the educational needs for orthopedic pain management of our residents, nurses, and physical therapists using a quantitative and qualitative assessment. The needs analysis was conducted in a 10-bed orthopedic unit at a teaching hospital and included a survey given to 20 orthopedic residents, 9 nurses, and 6 physical therapists, followed by focus groups addressing barriers to pain control and knowledge of pain management. Key challenges for nurses included not always having breakthrough pain medication orders and the gap in pain management between cessation of patient-controlled analgesia and ordering and administering oral medications. Key challenges for orthopedic residents included treating pain in patients with a history of substance abuse, assessing pain, and determining when to use long-acting vs short-acting opioids. Focus group assessments revealed a lack of training in pain management and the need for better coordination of care between nurses and practitioners and improved education about special needs groups (the elderly and those with substance abuse issues). This needs assessment showed that orthopedic residents and nurses receive little formal education on pain management, despite having to address pain on a daily basis. This information will be used to develop an educational program to improve pain management for postoperative orthopedic patients. An integrated educational program with orthopedic residents, nurses, and physical therapists would promote understanding of issues for each discipline. Copyright 2011, SLACK Incorporated.

Malaria vaccine R&D in the Decade of Vaccines: breakthroughs, challenges and opportunities.

PubMed

Birkett, Ashley J; Moorthy, Vasee S; Loucq, Christian; Chitnis, Chetan E; Kaslow, David C

2013-04-18

While recent progress has been made in reducing malaria mortality with other interventions, vaccines are still urgently needed to further reduce the incidence of clinical disease, including during pregnancy, and to provide "herd protection" by blocking parasite transmission. The most clinically advanced candidate, RTS,S, is presently undergoing Phase 3 evaluation in young African children across 13 clinical sites in eight African countries. In the 12-month period following vaccination, RTS,S conferred approximately 50% protection from clinical Plasmodium falciparum disease in children aged 5-17 months, and approximately 30% protection in children aged 6-12 weeks when administered in conjunction with Expanded Program for Immunization (EPI) vaccines. The development of more highly efficacious vaccines to prevent clinical disease caused by both P. falciparum and Plasmodium vivax, as well as vaccines to support elimination efforts by inducing immunity that blocks malaria parasite transmission, are priorities. Some key barriers to malaria vaccine development include: a paucity of well-characterized target immunogens and an absence of clear correlates of protection to enable vaccine development targeting all stages of the P. falciparum and P. vivax lifecycles; a limited number of safe and effective delivery systems, including adjuvants, that induce potent, long-lived protective immunity, be it by antibody, CD4+, and/or CD8+ T cell responses; and, for vaccines designed to provide "herd protection" by targeting sexual stage and/or mosquito antigens, the lack of a clear clinical and regulatory pathway to licensure using non-traditional endpoints. Recommendations to overcome these, and other key challenges, are suggested in this document. Copyright © 2013 Elsevier Ltd. All rights reserved.

Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon.

PubMed

Schmitt, Margaret L; Clatworthy, David; Ratnayake, Ruwan; Klaesener-Metzner, Nicole; Roesch, Elizabeth; Wheeler, Erin; Sommer, Marni

2017-01-01

There is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management). Two qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women. Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors. There is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.

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

A study of a museum-school partnership

NASA Astrophysics Data System (ADS)

Wojton, Mary Ann

Partnerships between museums and schools never have been more important than they are today. Schools, especially urban schools, are facing challenges, including low student achievement and difficulty obtaining funding. Partners can help schools overcome these challenges by sharing educational and financial resources. Nearly 11,000 American museums spend more than $1 billion annually to provide over 18 million instructional hours for k-12 educational programs such as professional development for teachers, guided field trips, and staff visits to schools. Museums would seem like natural partners for challenged urban schools. Yet museums and schools struggle to establish and maintain effective partnerships. This study examined a partnership between a science center and an urban elementary school to provide additional knowledge and resources for those in the field to overcome these challenges in order to create relationships that help students. Using qualitative methods with interpretive descriptive purposes (Erickson, 1986; Glesne, 1999; Lincoln & Guba, 2000), the research design is based on several methods of data collection, including face-to-face, semi-structured interviews; observations; written text; and field notes. Participants in this study included students, parents, teachers, school administrators and museum educators. In addition, adult representatives of community organizations were interviewed to determine the impact of the partnership on the community. The study found that an effective partnership will have four basic elements: mutual goals, communication plan, key leader support, planning and research, and four interpersonal elements: personal responsibility, honesty, communication at the intimate level, and trust. Partners may have difficulty developing these to their fullest extent due to time limitations. No partnership is perfect. By creating strong interpersonal relationships, partners can mitigate challenges caused by limited basic elements and increase the likelihood that their partnership will be effective.

Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

PubMed

Fryatt, Robert; Mills, Anne; Nordstrom, Anders

2010-01-30

Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

Advancing scoping study methodology: a web-based survey and consultation of perceptions on terminology, definition and methodological steps.

PubMed

O'Brien, Kelly K; Colquhoun, Heather; Levac, Danielle; Baxter, Larry; Tricco, Andrea C; Straus, Sharon; Wickerson, Lisa; Nayar, Ayesha; Moher, David; O'Malley, Lisa

2016-07-26

Scoping studies (or reviews) are a method used to comprehensively map evidence across a range of study designs in an area, with the aim of informing future research practice, programs and policy. However, no universal agreement exists on terminology, definition or methodological steps. Our aim was to understand the experiences of, and considerations for conducting scoping studies from the perspective of academic and community partners. Primary objectives were to 1) describe experiences conducting scoping studies including strengths and challenges; and 2) describe perspectives on terminology, definition, and methodological steps. We conducted a cross-sectional web-based survey with clinicians, educators, researchers, knowledge users, representatives from community-based organizations, graduate students, and policy stakeholders with experience and/or interest in conducting scoping studies to gain an understanding of experiences and perspectives on the conduct and reporting of scoping studies. We administered an electronic self-reported questionnaire comprised of 22 items related to experiences with scoping studies, strengths and challenges, opinions on terminology, and methodological steps. We analyzed questionnaire data using descriptive statistics and content analytical techniques. Survey results were discussed during a multi-stakeholder consultation to identify key considerations in the conduct and reporting of scoping studies. Of the 83 invitations, 54 individuals (65 %) completed the scoping questionnaire, and 48 (58 %) attended the scoping study meeting from Canada, the United Kingdom and United States. Many scoping study strengths were dually identified as challenges including breadth of scope, and iterative process. No consensus on terminology emerged, however key defining features that comprised a working definition of scoping studies included the exploratory mapping of literature in a field; iterative process, inclusion of grey literature; no quality assessment of included studies, and an optional consultation phase. We offer considerations for the conduct and reporting of scoping studies for researchers, clinicians and knowledge users engaging in this methodology. Lack of consensus on scoping terminology, definition and methodological steps persists. Reasons for this may be attributed to diversity of disciplines adopting this methodology for differing purposes. Further work is needed to establish guidelines on the reporting and methodological quality assessment of scoping studies.

Where are they now? Cash and Counseling successes and challenges over time

PubMed Central

Simon-Rusinowitz, Lori; Schwartz, Abby J.; Loughlin, Dawn; Sciegaj, Mark; Mahoney, Kevin J.; Donkoh, Yaw

2014-01-01

The positive results of the Cash & Counseling Demonstration and Evaluation (CCDE) led to the funding of a replication project that included 12 more states in 2008. Since then, the political and economic environments have changed. The authors sought to investigate how well the three original and 12 replication CCDE programs are coping with current challenges, and how their experiences may inform the growth and sustainability of emerging participant-directed programs. Semistructured telephone interviews were conducted with the 15 Cash & Counseling state program administrators. Key topics addressed included: successful aspects of state programs, biggest challenges for each program, and information program administrators would like to learn from state colleagues. Themes related to budget issues (e.g., staff shortages and program funding cuts) and non-budget related issues (e.g., understanding of program operations) emerged from the interviews. State program administrators also discussed program successes. To promote the sustainability and growth of participant-directed programs, existing participant-directed programs should be tied to national policy trends as well as review whether or not the programs address participant-directed principles. The development of new participant-directed programs should be based on other states’ experiences as discussed in this paper. PMID:25750590

Networking and training in palliative care: challenging values and changing practice.

PubMed

Leng, Mhoira Ef

2011-01-01

What make a good doctor is a question posed by the public and profession and is key when designing training programmes. The goal of training is to change practice not simply acquire knowledge yet too often curriculums and assessment focuses on knowledge and skills. Professional practice is underpinned by beliefs and values and therefore training may need to challenge deeply held values in order to result in a change in practice. Palliative care offers an opportunity to challenge values at a deeply personal level as it brings experiences of pain and suffering alongside clinical knowledge and skills. Palliative care is holistic and so real scenarios where physical, psychological, social and spiritual issues are evident can be presented in an interactive, learner centered environment. Training in ethics alongside clinical skills will assist the development of judgment which should also be assessed. Communication skills enable the clinician to hear and understand the needs and wishes of those facing life limiting illness. Training should include aspects of modeling and mentorship to demonstrate and integrate the learning with the realities of clinical practice and include those who lead and influence policy and advocacy.

Pandemic policy and planning considerations for universities: findings from a tabletop exercise.

PubMed

Beaton, Randal; Stergachis, Andy; Thompson, Jack; Osaki, Carl; Johnson, Clark; Charvat, Steven J; Marsden-Haug, Nicola

2007-12-01

The potential for a novel influenza virus to cause a pandemic represents a significant threat to global health. Planning for pandemic flu, as compared to planning for other types of hazards, presents some unique challenges to businesses, communities, and education institutions. To identify and address the challenges that may be faced by major metropolitan universities during a flu pandemic, a tabletop exercise was developed, offered, and evaluated. Its purpose was to assess existing University of Washington (UW) plans and policies for responding to an influenza pandemic. On May 31, 2006, more than 50 participants, including UW administrators and unit leaders and a number of key external partners, participated in a tabletop exercise designed to simulate all phases of an influenza pandemic. This exercise revealed existing gaps in university pandemic influenza plans and policies, including issues related to isolation and quarantine, continuity of operations, disaster mental health services, integration of volunteers into a disaster response, tracking travel of university students and personnel, communication problems, and ways to meet the needs of resident and foreign students and faculty during an outbreak. Policy and planning recommendations are offered that address each of these challenges faced by UW as well as other major research universities and colleges.

Methods in Enzymology: “Flexible backbone sampling methods to model and design protein alternative conformations”

PubMed Central

Ollikainen, Noah; Smith, Colin A.; Fraser, James S.; Kortemme, Tanja

2013-01-01

Sampling alternative conformations is key to understanding how proteins work and engineering them for new functions. However, accurately characterizing and modeling protein conformational ensembles remains experimentally and computationally challenging. These challenges must be met before protein conformational heterogeneity can be exploited in protein engineering and design. Here, as a stepping stone, we describe methods to detect alternative conformations in proteins and strategies to model these near-native conformational changes based on backrub-type Monte Carlo moves in Rosetta. We illustrate how Rosetta simulations that apply backrub moves improve modeling of point mutant side chain conformations, native side chain conformational heterogeneity, functional conformational changes, tolerated sequence space, protein interaction specificity, and amino acid co-variation across protein-protein interfaces. We include relevant Rosetta command lines and RosettaScripts to encourage the application of these types of simulations to other systems. Our work highlights that critical scoring and sampling improvements will be necessary to approximate conformational landscapes. Challenges for the future development of these methods include modeling conformational changes that propagate away from designed mutation sites and modulating backbone flexibility to predictively design functionally important conformational heterogeneity. PMID:23422426

Variable-Speed Power-Turbine Research at Glenn Research Center

NASA Technical Reports Server (NTRS)

Welch, Gerard E.; McVetta, Ashlie B.; Stevens, Mark A.; Howard, Samuel A.; Giel, Paul W.; Ameri, Ali, A.; To, Waiming; Skoch, Gary J.; Thurman, Douglas R.

2012-01-01

The main rotors of the NASA Large Civil Tilt-Rotor (LCTR) notional vehicle operate over a wide speed-range, from 100 percent at takeoff to 54 percent at cruise. The variable-speed power turbine (VSPT) offers one approach by which to effect this speed variation. VSPT aerodynamics challenges include high work factors at cruise, wide (40 to 60 ) incidence-angle variations in blade and vane rows over the speed range, and operation at low Reynolds numbers. Rotordynamics challenges include potential responsiveness to shaft modes within the 50 percent VSPT speed-range. A research effort underway at NASA Glenn Research Center, intended to address these key aerodynamic and rotordynamic challenges, is described. Conceptual design and 3-D multistage RANS and URANS analyses, conducted internally and under contract, provide expected VSPT sizing, stage-count, performance and operability information, and maps for system studies. Initial steps toward experimental testing of incidence-tolerant blading in a transonic linear cascade are described, and progress toward development/improvement of a simulation capability for multistage turbines with low Reynolds number transitional flow is summarized. Preliminary rotordynamics analyses indicate that viable concept engines with 50 percent VSPT shaft-speed range. Assessments of potential paths toward VSPT component-level testing are summarized.

A Global Capacity Building Vision for Societal Applications of Earth Observing Systems and Data: Key Questions and Recommendations

NASA Technical Reports Server (NTRS)

Hossain, Faisal; Serrat-Capdevila, Aleix; Granger, Stephanie; Thomas, Amy; Saah, David; Ganz, David; Mugo, Robinson; Murthy, M. S. R.; Ramos, Victor Hugo; Kirschbaum, Dalia;

Leadership Skills and Challenges in Hospitality Management Education

ERIC Educational Resources Information Center

Kalargyrou, Valentini

2009-01-01

Leaders in hospitality management education face diverse challenges in today's competitive and changing environment. Evolving demands from superiors, financial challenges, and faculty and students increasing demands, create a turbulent environment in which administrators must thrive. One of the keys in being effective leaders is the application of…

Documenting Sociolinguistic Variation in Lesser-Studied Indigenous Communities: Challenges and Practical Solutions

ERIC Educational Resources Information Center

Mansfield, John; Stanford, James

2017-01-01

Documenting sociolinguistic variation in lesser-studied languages presents methodological challenges, but also offers important research opportunities. In this paper we examine three key methodological challenges commonly faced by researchers who are outsiders to the community. We then present practical solutions for successful variationist…

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

The Intergenerational Legacy of Genocidal Rape: The Realities and Perspectives of Children Born of the Rwandan Genocide.

PubMed

Denov, Myriam; Woolner, Leah; Bahati, Jules Pacifique; Nsuki, Paulin; Shyaka, Obed

2017-05-01

Brutal acts of sexual violence were documented on a mass scale during the 1994 Rwandan genocide. While existing scholarship on sexual violence has significantly increased our understanding of the challenges confronting survivors, gaps in knowledge remain regarding the lived experiences of children born of genocidal rape. This study sought to explore the realities and perspectives of children born of genocidal rape, and the existing opportunities and challenges they experienced in postgenocide Rwanda. Interviews and focus groups were conducted with 60 participants born of genocidal rape in Rwanda. Findings highlight the key challenges that these youth face in the postgenocide context, including struggles with identity and belonging, ambivalence in the mother-child relationship, and a desire to learn of their biological origins and heritage. The findings suggest that children born of conflict-related sexual violence face a distinct set of challenges and needs that have yet to be formally addressed. Our findings highlight the need for the development of programs, policies, and services specific for this important, yet overlooked group of young people affected by armed conflict.

Psychosocial Challenges/Transition to Adulthood.

PubMed

Frederick, Carla

2016-08-01

Advances in the health care of individuals with cystic fibrosis have resulted in more than half of the population older than the age of 18 living longer, fuller lives. This success brings about the need for new areas of improvement and development including the mastery of transitioning from pediatric to adult health care and attention to psychosocial needs. This article reviews key components of the process of transitioning to adult care and some important psychosocial considerations. Copyright © 2016 Elsevier Inc. All rights reserved.

Future Challenges for the Arab World: The Implications of Demographic and Economic Trends

DTIC Science & Technology

2011-01-01

the reduction in U.S. consumption of fossil fuels. • In its role as a board member of both the World Bank and the International Mone - tary Fund, the...rents and utilities , thus offsetting the costs of bearing more children. The incentive structure created by these policies explain, in part, the...in sustainable water utilization on a region-wide basis. Key policy measures include setting prices so as to cover full costs of the water and to

Workplace Learning: The Role of Canadian Colleges and Institutes in Meeting Canada's Professional, Technical and Trade Skills Challenges = L'apprentissage en milieu de travail: Le role des colleges et instituts canadiens face aux defis canadiens en matiere des competences professionnels et techniques.

ERIC Educational Resources Information Center

Malcolmson, Lorna, Ed.

2002-01-01

This issue examines selected topics in vocational education in Canadian community colleges. It focuses on the central themes of community college and industry partnerships, vocational education assessment, and vocational and workplace education pedagogical models. Articles include: (1) "Industry and Colleges: Key Partners in Meeting Canada's…

Swedish Defence Acquisition Transformation - A Research Agenda

DTIC Science & Technology

2015-04-30

levels. Areas of Key Challenges That FMV Faces (Ekström, 2012, p. 39) The sourcing issues include “How should what to make, what to buy , and how...to buy , be decided?”; “How should Value-for-Money (VfM) be calculated?”; “How should risk sharing, reward sharing, and information sharing, be...to buy what is needed cost effectively— which should not be taken to mean “at least cost”—and in accordance with Defence’s quality and schedule

Chromatin versus pathogens: the function of epigenetics in plant immunity.

PubMed

Ding, Bo; Wang, Guo-Liang

2015-01-01

To defend against pathogens, plants have developed a sophisticated innate immunity that includes effector recognition, signal transduction, and rapid defense responses. Recent evidence has demonstrated that plants utilize the epigenetic control of gene expression to fine-tune their defense when challenged by pathogens. In this review, we highlight the current understanding of the molecular mechanisms of histone modifications (i.e., methylation, acetylation, and ubiquitination) and chromatin remodeling that contribute to plant immunity against pathogens. Functions of key histone-modifying and chromatin remodeling enzymes are discussed.

A Design Basis for Spacecraft Cabin Trace Contaminant Control

NASA Technical Reports Server (NTRS)

Perry, Jay L.

2009-01-01

Successful trace chemical contamination control is one of the components necessary for achieving good cabin atmospheric quality. While employing seemingly simple process technologies, sizing the active contamination control equipment must employ a reliable design basis for the trace chemical load in the cabin atmosphere. A simplified design basis that draws on experience gained from the International Space Station program is presented. The trace chemical contamination control design load refines generation source magnitudes and includes key chemical functional groups representing both engineering and toxicology challenges.

Computational Materials: Modeling and Simulation of Nanostructured Materials and Systems

NASA Technical Reports Server (NTRS)

Gates, Thomas S.; Hinkley, Jeffrey A.

2003-01-01

The paper provides details on the structure and implementation of the Computational Materials program at the NASA Langley Research Center. Examples are given that illustrate the suggested approaches to predicting the behavior and influencing the design of nanostructured materials such as high-performance polymers, composites, and nanotube-reinforced polymers. Primary simulation and measurement methods applicable to multi-scale modeling are outlined. Key challenges including verification and validation of models are highlighted and discussed within the context of NASA's broad mission objectives.

Enhancing LoRaWAN Security through a Lightweight and Authenticated Key Management Approach.

PubMed

Sanchez-Iborra, Ramon; Sánchez-Gómez, Jesús; Pérez, Salvador; Fernández, Pedro J; Santa, José; Hernández-Ramos, José L; Skarmeta, Antonio F

2018-06-05

Luckily, new communication technologies and protocols are nowadays designed considering security issues. A clear example of this can be found in the Internet of Things (IoT) field, a quite recent area where communication technologies such as ZigBee or IPv6 over Low power Wireless Personal Area Networks (6LoWPAN) already include security features to guarantee authentication, confidentiality and integrity. More recent technologies are Low-Power Wide-Area Networks (LP-WAN), which also consider security, but present initial approaches that can be further improved. An example of this can be found in Long Range (LoRa) and its layer-two supporter LoRa Wide Area Network (LoRaWAN), which include a security scheme based on pre-shared cryptographic material lacking flexibility when a key update is necessary. Because of this, in this work, we evaluate the security vulnerabilities of LoRaWAN in the area of key management and propose different alternative schemes. Concretely, the application of an approach based on the recently specified Ephemeral Diffie⁻Hellman Over COSE (EDHOC) is found as a convenient solution, given its flexibility in the update of session keys, its low computational cost and the limited message exchanges needed. A comparative conceptual analysis considering the overhead of different security schemes for LoRaWAN is carried out in order to evaluate their benefits in the challenging area of LP-WAN.

The opportunities and challenges of large-scale molecular approaches to songbird neurobiology

PubMed Central

Mello, C.V.; Clayton, D.F.

2014-01-01

High-through put methods for analyzing genome structure and function are having a large impact in song-bird neurobiology. Methods include genome sequencing and annotation, comparative genomics, DNA microarrays and transcriptomics, and the development of a brain atlas of gene expression. Key emerging findings include the identification of complex transcriptional programs active during singing, the robust brain expression of non-coding RNAs, evidence of profound variations in gene expression across brain regions, and the identification of molecular specializations within song production and learning circuits. Current challenges include the statistical analysis of large datasets, effective genome curations, the efficient localization of gene expression changes to specific neuronal circuits and cells, and the dissection of behavioral and environmental factors that influence brain gene expression. The field requires efficient methods for comparisons with organisms like chicken, which offer important anatomical, functional and behavioral contrasts. As sequencing costs plummet, opportunities emerge for comparative approaches that may help reveal evolutionary transitions contributing to vocal learning, social behavior and other properties that make songbirds such compelling research subjects. PMID:25280907

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

PubMed Central

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

2018-01-01

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

Student reflections on learning with challenging tasks: `I think the worksheets were just for practice, and the challenges were for maths'

NASA Astrophysics Data System (ADS)

Russo, James; Hopkins, Sarah

2017-09-01

The current study considered young students' (7 and 8 years old) experiences and perceptions of mathematics lessons involving challenging (i.e. cognitively demanding) tasks. We used the Constant Comparative Method to analyse the interview responses ( n = 73) regarding what work artefacts students were most proud of creating and why. Five themes emerged that characterised student reflections: enjoyment, effort, learning, productivity and meaningful mathematics. Overall, there was evidence that students embraced struggle and persisted when engaged in mathematics lessons involving challenging tasks and, moreover, that many students enjoyed the process of being challenged. In the second section of the paper, the lesson structure preferences of a subset of participants ( n = 23) when learning with challenging tasks are considered. Overall, more students preferred the teach-first lesson structure to the task-first lesson structure, primarily because it activated their cognition to prepare them for work on the challenging task. However, a substantial minority of students (42 %) instead endorsed the task-first lesson structure, with several students explaining they preferred this structure precisely because it was so cognitively demanding. Other reasons for preferring the task-first structure included that it allowed the focus of the lesson to be on the challenging task and the subsequent discussion of student work. A key implication of these combined findings is that, for many students, work on challenging tasks appeared to remain cognitively demanding irrespective of the structure of the lesson.

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.

Challenges, Realities, Strategies: The Master Plan for Florida Postsecondary Education for the 21st Century.

ERIC Educational Resources Information Center

Florida State Postsecondary Education Planning Commission, Tallahassee.

A new master plan for higher education in Florida is presented which focuses on the central challenges facing the state and its higher education institutions. The following sections address three key challenges and suggest strategies to help policymakers and governing boards promote positive change. The section on the challenge of improved use of…

Different factors influence self-reports and third-party reports of anger by adults with intellectual disabilities.

PubMed

Rose, John; Willner, Paul; Shead, Jennifer; Jahoda, Andrew; Gillespie, David; Townson, Julia; Lammie, Claire; Woodgate, Christopher; Stenfert Kroese, Biza; Felce, David; MacMahon, Pamela; Rose, Nikki; Stimpson, Aimee; Nuttall, Jacqueline; Hood, Kerenza

2013-09-01

Many people with intellectual disabilities display high levels of anger, and cognitive-behavioural anger management interventions are used routinely. However, for these methods to be used optimally, a better understanding is needed of different forms of anger assessment. The aim of this study was to investigate the relationship of a range of measures to self- and carer reports of anger expression, including instruments used to assess mental health and challenging behaviour. Adults with intellectual disabilities, who had been identified as having problems with anger control, their key-workers and home carers all rated the service users' trait anger, using parallel versions of the same instrument (the Provocation Inventory). In addition, service users completed a battery of mental health assessments (the Glasgow Depression Scale, Glasgow Anxiety Scale and Rosenberg Self-Esteem Scale), and both groups of carers completed a battery of challenging behaviour measures (the Hyperactivity and Irritability domains of the Aberrant Behavior Checklist and the Modified Overt Anger Scale). Participants had high levels of mental health problems (depression: 34%; anxiety: 73%) and severe challenging behaviour (26%). Hierarchical linear regression analysis was used to explore the extent to which anger ratings by the three groups of respondents were predicted by demographic factors, mental health measures and challenging behaviour measures. Older service users rated themselves as less angry and were also rated as less angry by home carers, but not by key-workers. More intellectually able service users were rated as more angry by both sets of carers, but not by the service users themselves. Significantly, mental health status (but not challenging behaviour) predicted service users' self-ratings of anger, whereas challenging behaviour (but not mental health status) predicted carers' ratings of service users' anger. Service users and their carers appear to use different information when rating the service users' anger. Service users' self-ratings reflect their internal emotional state and mental health, as reflected by their ratings of anxiety and depression, whereas staff rate service users' anger on the basis of overt behaviours, as measured by challenging behaviour scales. © 2013 John Wiley & Sons Ltd.

Shuttle ku-band communications/radar technical concepts

NASA Technical Reports Server (NTRS)

Griffin, J. W.; Kelley, J. S.; Steiner, A. W.; Vang, H. A.; Zrubek, W. E.; Huth, G. K.

1985-01-01

Technical data on the Shuttle Orbiter K sub u-band communications/radar system are presented. The more challenging aspects of the system design and development are emphasized. The technical problems encountered and the advancements made in solving them are discussed. The radar functions are presented first. Requirements and design/implementation approaches are discussed. Advanced features are explained, including Doppler measurement, frequency diversity, multiple pulse repetition frequencies and pulse widths, and multiple modes. The communications functions that are presented include advances made because of the requirements for multiple communications modes. Spread spectrum, quadrature phase shift keying (QPSK), variable bit rates, and other advanced techniques are discussed. Performance results and conclusions reached are outlined.

Architectures for Human Exploration of Near Earth Asteroids

NASA Technical Reports Server (NTRS)

Drake, Bret G.

2011-01-01

The presentation explores human exploration of Near Earth Asteroid (NEA) key factors including challenges of supporting humans for long-durations in deep-space, incorporation of advanced technologies, mission design constraints, and how many launches are required to conduct a round trip human mission to a NEA. Topics include applied methodology, all chemical NEA mission operations, all nuclear thermal propulsion NEA mission operations, SEP only for deep space mission operations, and SEP/chemical hybrid mission operations. Examples of mass trends between datasets are provided as well as example sensitivity of delta-v and trip home, sensitivity of number of launches and trip home, and expected targets for various transportation architectures.

Supporting Parents' Pain Care Involvement With Their Children With Acute Lymphoblastic Leukemia: A Qualitative Interpretive Description.

PubMed

Bettle, Amanda; Latimer, Margot; Fernandez, Conrad; Hughes, Jean

Children with acute lymphoblastic leukemia experience pain from the disease, treatment, and procedures. Parents can be effective in managing their child's pain, but little is systematically known about how they do this. Appreciative inquiry was used to frame the study within a strengths-based lens and interpretive descriptive methods were used to describe pain sources, parents' pain care role, and key structures supporting parents pain care involvement. Eight paediatric oncology clinic nurses and 10 parents participated. Six key themes per group were identified. Parent themes included establishing therapeutic relationships, relearning how to care for my child, overcoming challenges and recognizing pain, learning parent specific strategies, empowering to take active pain care role, and maintaining relationships. Nurse themes included establishing therapeutic relationships, preparing parents to care for their child, facilitating pain assessment, teaching parents best pain care, empowering parents, and maintaining relationships. These findings can be used to guide clinical practice and future research.

Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study

PubMed Central

2014-01-01

Background Coordination between the autonomous professional groups in midwifery and obstetrics is a key debate in the Netherlands. At the same time, it remains unclear what the current coordination challenges are. Methods To examine coordination challenges that might present a barrier to delivering optimal care, we conducted a qualitative field study focusing on midwifery and obstetric professional’s perception of coordination and on their routines. We undertook 40 interviews with 13 community midwives, 8 hospital-based midwives and 19 obstetricians (including two resident obstetricians), and conducted non-participatory observations at the worksite of these professional groups. Results We identified challenges in terms of fragmented organizational structures, different perspectives on antenatal health and inadequate interprofessional communication. These challenges limited professionals' coordinating capacity and thereby decreased their ability to provide optimal care. We also found that pregnant women needed to compensate for suboptimal coordination between community midwives and secondary caregivers by taking on an active role in facilitating communication between these professionals. Conclusions The communicative role that pregnant women play within coordination processes underlines the urgency to improve coordination. We recommend increasing multidisciplinary meetings and training, revising the financial reimbursement system, implementing a shared maternity notes system and decreasing the expertise gap between providers and clients. In the literature, communication by clients in support of coordination has been largely ignored. We suggest that studies include client communication as part of the coordination process. PMID:24731478

Real-Time Operation of the International Space Station

NASA Astrophysics Data System (ADS)

Suffredini, M. T.

2002-01-01

The International Space Station is on orbit and real-time operations are well underway. Along with the assembly challenges of building and operating the International Space Station , scientific activities are also underway. Flight control teams in three countries are working together as a team to plan, coordinate and command the systems on the International Space Station.Preparations are being made to add the additional International Partner elements including their operations teams and facilities. By October 2002, six Expedition crews will have lived on the International Space Station. Management of real-time operations has been key to these achievements. This includes the activities of ground teams in control centers around the world as well as the crew on orbit. Real-time planning is constantly challenged with balancing the requirements and setting the priorities for the assembly, maintenance, science and crew health functions on the International Space Station. It requires integrating the Shuttle, Soyuz and Progress requirements with the Station. It is also necessary to be able to respond in case of on-orbit anomalies and to set plans and commands in place to ensure the continues safe operation of the Station. Bringing together the International Partner operations teams has been challenging and intensely rewarding. Utilization of the assets of each partner has resulted in efficient solutions to problems. This paper will describe the management of the major real-time operations processes, significant achievements, and future challenges.

A decade of environmental public health tracking (2002-2012): progress and challenges.

PubMed

Kearney, Gregory D; Namulanda, Gonza; Qualters, Judith R; Talbott, Evelyn O

2015-01-01

The creation of the Centers for Disease Control and Prevention Environmental Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin. To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations. A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases. Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development. Overall, progress was reported in the areas of data linkage, data sharing, surveillance methods, and network development. Ongoing challenges included formulating better ways to establish the connections between health and the environment, such as using biomonitoring, public water systems, and private well water data. Recommendations for future efforts include use of data to inform policy and practice and use of electronic health records data for environmental health surveillance.

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.

Distinctions between fraud, bias, errors, misunderstanding, and incompetence.

PubMed

DeMets, D L

1997-12-01

Randomized clinical trials are challenging not only in their design and analysis, but in their conduct as well. Despite the best intentions and efforts, problems often arise in the conduct of trials, including errors, misunderstandings, and bias. In some instances, key players in a trial may discover that they are not able or competent to meet requirements of the study. In a few cases, fraudulent activity occurs. While none of these problems is desirable, randomized clinical trials are usually found sufficiently robust by many key individuals to produce valid results. Other problems are not tolerable. Confusion may arise among scientists, scientific and lay press, and the public about the distinctions between these areas and their implications. We shall try to define these problems and illustrate their impact through a series of examples.