Fifteen Challenges in Establishing a Multidisciplinary Research Program on eHealth Research in a University Setting: A Case Study

PubMed Central

Johansson, Birgitta; Held, Claes; Sjöström, Jonas; Lindahl Norberg, Annika; Hovén, Emma; Sanderman, Robbert; van Achterberg, Theo; von Essen, Louise

2017-01-01

Background U-CARE is a multidisciplinary eHealth research program that involves the disciplines of caring science, clinical psychology, health economics, information systems, and medical science. It was set up from scratch in a university setting in 2010, funded by a governmental initiative. While establishing the research program, many challenges were faced. Systematic documentation of experiences from establishing new research environments is scarce. Objective The aim of this paper was to describe the challenges of establishing a publicly funded multidisciplinary eHealth research environment. Methods Researchers involved in developing the research program U-CARE identified challenges in the formal documentation and by reflecting on their experience of developing the program. The authors discussed the content and organization of challenges into themes until consensus was reached. Results The authors identified 15 major challenges, some general to establishing a new research environment and some specific for multidisciplinary eHealth programs. The challenges were organized into 6 themes: Organization, Communication, Implementation, Legislation, Software development, and Multidisciplinarity. Conclusions Several challenges were faced during the development of the program and several accomplishments were made. By sharing our experience, we hope to help other research groups embarking on a similar journey to be prepared for some of the challenges they are likely to face on their way. PMID:28536090

Multidisciplinary Optimization of a Transport Aircraft Wing using Particle Swarm Optimization

NASA Technical Reports Server (NTRS)

Sobieszczanski-Sobieski, Jaroslaw; Venter, Gerhard

2002-01-01

The purpose of this paper is to demonstrate the application of particle swarm optimization to a realistic multidisciplinary optimization test problem. The paper's new contributions to multidisciplinary optimization is the application of a new algorithm for dealing with the unique challenges associated with multidisciplinary optimization problems, and recommendations as to the utility of the algorithm in future multidisciplinary optimization applications. The selected example is a bi-level optimization problem that demonstrates severe numerical noise and has a combination of continuous and truly discrete design variables. The use of traditional gradient-based optimization algorithms is thus not practical. The numerical results presented indicate that the particle swarm optimization algorithm is able to reliably find the optimum design for the problem presented here. The algorithm is capable of dealing with the unique challenges posed by multidisciplinary optimization as well as the numerical noise and truly discrete variables present in the current example problem.

Multi-disciplinary interoperability challenges (Ian McHarg Medal Lecture)

NASA Astrophysics Data System (ADS)

Annoni, Alessandro

2013-04-01

Global sustainability research requires multi-disciplinary efforts to address the key research challenges to increase our understanding of the complex relationships between environment and society. For this reason dependence on ICT systems interoperability is rapidly growing but, despite some relevant technological improvement is observed, in practice operational interoperable solutions are still lacking. Among the causes is the absence of a generally accepted definition of "interoperability" in all its broader aspects. In fact the concept of interoperability is just a concept and the more popular definitions are not addressing all challenges to realize operational interoperable solutions. The problem become even more complex when multi-disciplinary interoperability is required because in that case solutions for interoperability of different interoperable solution should be envisaged. In this lecture the following definition will be used: "interoperability is the ability to exchange information and to use it". In the lecture the main challenges for addressing multi-disciplinary interoperability will be presented and a set of proposed approaches/solutions shortly introduced.

Mapping Remote and Multidisciplinary Learning Barriers: Lessons from "Challenge-Based Innovation" at CERN

ERIC Educational Resources Information Center

Jensen, Matilde Bisballe; Utriainen, Tuuli Maria; Steinert, Martin

2018-01-01

This paper presents the experienced difficulties of students participating in the multidisciplinary, remote collaborating engineering design course challenge-based innovation at CERN. This is with the aim to identify learning barriers and improve future learning experiences. We statistically analyse the rated differences between distinct design…

Postpartum hemorrhage in a Jehovah's Witness patient controlled with Tisseel, tranexamic acid, and recombinant factor VIIa.

PubMed

Arab, Tarek Samir; Al-Wazzan, Ahmad Bakr; Maslow, Ken

2010-10-01

The management of a patient refusing blood transfusion who subsequently experiences a severe postpartum hemorrhage is a particular clinical challenge. A 30-year-old nulliparous patient (who was a Jehovah's Witness) had labour induced for post-dates at 41+4 weeks' gestational age after an uncomplicated pregnancy. She delivered by Caesarean section for dystocia and suspected chorioamnionitis, and subsequently developed postpartum hemorrhage that required management with oxytocin, ergometrine, carboprost, uterine artery ligation, and Hayman compression sutures. The patient ultimately required two additional visits to the operating room, culminating in hysterectomy. Use of tranexamic acid, recombinant factor VIIa, and Tisseel was instrumental in halting the ongoing hemorrhage. Optimal management of a patient refusing administration of blood products requires a multidisciplinary approach as well as a combination of traditional and novel therapies.

Ultralow anterior resection with mechanical anastomosis in the treatment of distal third rectal cancer.

PubMed

Espín, Eloy; Sánchez García, José Luis; Vallribera, Francesc

2014-03-01

Tumors of the lower third of the rectum are a challenge for the surgeon. Among the various techniques of surgical treatment of these lesions, radical surgery and ultra low anterior anastomosis is one of the therapeutic options. This technique is a defy both in the evaluation of the potential patient as in the surgical technique. Such evaluation and treatment processes must be audited in order to keep proper quality indices both in the oncological as in their functional results. This is only possible when both the multidisciplinary and surgical teams have an adequate and ongoing specialized training and a satisfactory volume of patients treated. Details of this technique, its indications and results are reported in this paper. Copyright © 2014 Asociación Española de Cirujanos. Published by Elsevier Espana. All rights reserved.

Medical and surgical management of perianal Crohn’s disease

PubMed Central

Adegbola, Samuel O.; Pisani, Anthea; Sahnan, Kapil; Tozer, Phil; Ellul, Pierre; Warusavitarne, Janindra

2018-01-01

Crohn’s disease is increasingly thought to encompass multiple possible phenotypes. Perianal manifestations account for one such phenotype and represent an independent disease modifier. In its more severe form, perianal Crohn’s disease confers a higher risk of a severe and disabling disease course, relapses, hospital admissions and operations. This, in turn, imposes a considerable burden and disability on patients. Identification of the precise manifestation is important, as management is nuanced, with both medical and surgical components, and is best undertaken in a multidisciplinary setting for both diagnosis and ongoing treatment. The introduction of biologic medication has heralded a significant addition to the management of fistulizing perianal Crohn’s disease in particular, albeit with modest results. It remains a very challenging condition to treat and further work is required to optimize management in this group of patients. PMID:29507460

Nursing implications of personalized and precision medicine.

PubMed

Vorderstrasse, Allison A; Hammer, Marilyn J; Dungan, Jennifer R

2014-05-01

Identify and discuss the nursing implications of personalized and precision oncology care. PubMed, CINAHL. The implications in personalized and precision cancer nursing care include interpretation and clinical use of novel and personalized information including genetic testing; patient advocacy and support throughout testing, anticipation of results and treatment; ongoing chronic monitoring; and support for patient decision-making. Attention must also be given to the family and ethical implications of a personalized approach to care. Nurses face increasing challenges and opportunities in communication, support, and advocacy for patients given the availability of advanced testing, care and treatment in personalized and precision medicine. Nursing education and continuing education, clinical decision support, and health systems changes will be necessary to provide personalized multidisciplinary care to patients, in which nurses play a key role. Copyright © 2014 Elsevier Inc. All rights reserved.

Network for Early Onset Cystic Kidney Diseases—A Comprehensive Multidisciplinary Approach to Hereditary Cystic Kidney Diseases in Childhood

PubMed Central

König, Jens Christian; Titieni, Andrea; Konrad, Martin; Bergmann, C.

2018-01-01

Hereditary cystic kidney diseases comprise a complex group of genetic disorders representing one of the most common causes of end-stage renal failure in childhood. The main representatives are autosomal recessive polycystic kidney disease, nephronophthisis, Bardet–Biedl syndrome, and hepatocyte nuclear factor-1beta nephropathy. Within the last years, genetic efforts have brought tremendous progress for the molecular understanding of hereditary cystic kidney diseases identifying more than 70 genes. Yet, genetic heterogeneity, phenotypic variability, a lack of reliable genotype–phenotype correlations and the absence of disease-specific biomarkers remain major challenges for physicians treating children with cystic kidney diseases. To tackle these challenges comprehensive scientific approaches are urgently needed that match the ongoing “revolution” in genetics and molecular biology with an improved efficacy of clinical data collection. Network for early onset cystic kidney diseases (NEOCYST) is a multidisciplinary, multicenter collaborative combining a detailed collection of clinical data with translational scientific approaches addressing the genetic, molecular, and functional background of hereditary cystic kidney diseases. Consisting of seven work packages, including an international registry as well as a biobank, NEOCYST is not only dedicated to current scientific questions, but also provides a platform for longitudinal clinical surveillance and provides precious sources for high-quality research projects and future clinical trials. Funded by the German Federal Government, the NEOCYST collaborative started in February 2016. Here, we would like to introduce the rationale, design, and objectives of the network followed by a short overview on the current state of progress. PMID:29497606

Network for Early Onset Cystic Kidney Diseases-A Comprehensive Multidisciplinary Approach to Hereditary Cystic Kidney Diseases in Childhood.

PubMed

König, Jens Christian; Titieni, Andrea; Konrad, Martin

2018-01-01

Hereditary cystic kidney diseases comprise a complex group of genetic disorders representing one of the most common causes of end-stage renal failure in childhood. The main representatives are autosomal recessive polycystic kidney disease, nephronophthisis, Bardet-Biedl syndrome, and hepatocyte nuclear factor-1beta nephropathy. Within the last years, genetic efforts have brought tremendous progress for the molecular understanding of hereditary cystic kidney diseases identifying more than 70 genes. Yet, genetic heterogeneity, phenotypic variability, a lack of reliable genotype-phenotype correlations and the absence of disease-specific biomarkers remain major challenges for physicians treating children with cystic kidney diseases. To tackle these challenges comprehensive scientific approaches are urgently needed that match the ongoing "revolution" in genetics and molecular biology with an improved efficacy of clinical data collection. Network for early onset cystic kidney diseases (NEOCYST) is a multidisciplinary, multicenter collaborative combining a detailed collection of clinical data with translational scientific approaches addressing the genetic, molecular, and functional background of hereditary cystic kidney diseases. Consisting of seven work packages, including an international registry as well as a biobank, NEOCYST is not only dedicated to current scientific questions, but also provides a platform for longitudinal clinical surveillance and provides precious sources for high-quality research projects and future clinical trials. Funded by the German Federal Government, the NEOCYST collaborative started in February 2016. Here, we would like to introduce the rationale, design, and objectives of the network followed by a short overview on the current state of progress.

Use of Multi-Disciplinary Projects To Develop Competence.

ERIC Educational Resources Information Center

Trotman-Dickenson, Danusia

1992-01-01

Undergraduate technology and business students at the Polytechnic of Wales (United Kingdom) participated in multi-disciplinary team projects to experience real life business challenges and develop competences that employers expect in professionals. Lists characteristics of successful multi-disciplinary projects, discusses cost and industry…

RFID-Based Multidisciplinary Educational Platform to Improve the Engineering and Technology Curriculums

ERIC Educational Resources Information Center

Yelamarthi, Kumar

2012-01-01

Multidisciplinary projects involving electrical engineering (EE), mechanical engineering (ME), and computer engineering (CE) students are both exciting and difficult to conceptualize. Answering this challenge, this paper presents a multidisciplinary educational platform on radio frequency identification-based assistive devices. The combination of…

Challenges And Lessons Learned From Communities Using Evidence To Adopt Strategies To Improve Healthy Food Environments.

PubMed

Willems Van Dijk, Julie A; Catlin, Bridget; Cofsky, Abbey; Carroll, Carrie

2015-11-01

Communities across the United States are increasingly tackling the complex task of changing their local environments and cultures to improve access to and consumption of healthy food. Communities that have received the Robert Wood Johnson Foundation Culture of Health Prize have deployed numerous evidence-informed strategies to enhance their local food environments. Their experiences can provide lessons for other communities working to improve health. In this article we examine how the prize-winning communities worked in a multidisciplinary collective manner to implement evidence-based strategies, deployed suites of strategies to expand the reach of food-related work, balanced evidence against innovation, and measured their own progress. Most of the communities also faced challenges in using evidence effectively to implement strategies to promote healthy food environments. Policy makers can accelerate the adoption of evidence-informed approaches related to food and health by embedding them in program standards and funding requirements. Establishing opportunities for ongoing training to enhance community practitioners' evaluation skills and collaborative leadership would also improve the effectiveness of community implementation of these strategies. Project HOPE—The People-to-People Health Foundation, Inc.

A Case Study of a Co-Instructed Multidisciplinary Senior Capstone Project in Sustainability

ERIC Educational Resources Information Center

Rhee, Jinny; Oyamot, Clifton; Parent, David; Speer, Leslie; Basu, Anuradha; Gerston, Larry

2014-01-01

As societal challenges involving sustainable development increase, the need to effectively integrate this inherently multidisciplinary topic into existing curricula becomes more pressing. Multidisciplinary, team-taught, project-based instruction has shown effectiveness in teaching teamwork, communication, and life-long learning skills, and…

RoboCup: Multi-disciplinary Senior Design Project.

ERIC Educational Resources Information Center

Elder, Kevin Lee

A cross-college team of educators has developed a collaborative, multi-disciplinary senior design course at Ohio University. This course offers an attractive opportunity for students from a variety of disciplines to work together in a learning community to accomplish a challenging task. It provides a novel multi-disciplinary learning environment…

Fifteen Challenges in Establishing a Multidisciplinary Research Program on eHealth Research in a University Setting: A Case Study.

PubMed

Grönqvist, Helena; Olsson, Erik Martin Gustaf; Johansson, Birgitta; Held, Claes; Sjöström, Jonas; Lindahl Norberg, Annika; Hovén, Emma; Sanderman, Robbert; van Achterberg, Theo; von Essen, Louise

2017-05-23

U-CARE is a multidisciplinary eHealth research program that involves the disciplines of caring science, clinical psychology, health economics, information systems, and medical science. It was set up from scratch in a university setting in 2010, funded by a governmental initiative. While establishing the research program, many challenges were faced. Systematic documentation of experiences from establishing new research environments is scarce. The aim of this paper was to describe the challenges of establishing a publicly funded multidisciplinary eHealth research environment. Researchers involved in developing the research program U-CARE identified challenges in the formal documentation and by reflecting on their experience of developing the program. The authors discussed the content and organization of challenges into themes until consensus was reached. The authors identified 15 major challenges, some general to establishing a new research environment and some specific for multidisciplinary eHealth programs. The challenges were organized into 6 themes: Organization, Communication, Implementation, Legislation, Software development, and Multidisciplinarity. Several challenges were faced during the development of the program and several accomplishments were made. By sharing our experience, we hope to help other research groups embarking on a similar journey to be prepared for some of the challenges they are likely to face on their way. ©Helena Grönqvist, Erik Martin Gustaf Olsson, Birgitta Johansson, Claes Held, Jonas Sjöström, Annika Lindahl Norberg, Emma Hovén, Robbert Sanderman, Theo van Achterberg, Louise von Essen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.05.2017.

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

NASA Technical Reports Server (NTRS)

Samareh, Jamshid A.

2000-01-01

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

32 CFR 199.6 - TRICARE-authorized providers.

Code of Federal Regulations, 2013 CFR

2013-07-01

... itemized fully and sufficiently descriptive for the CHAMPUS to make a determination of benefits. (B... evaluate all functions of the RTC and contribute to an ongoing process of program improvement. The clinical... multidisciplinary safety committee. (8) Facility evaluation. The RTC annually evaluates accomplishment of the goals...

32 CFR 199.6 - TRICARE-authorized providers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... itemized fully and sufficiently descriptive for the CHAMPUS to make a determination of benefits. (B... evaluate all functions of the RTC and contribute to an ongoing process of program improvement. The clinical... multidisciplinary safety committee. (8) Facility evaluation. The RTC annually evaluates accomplishment of the goals...

32 CFR 199.6 - TRICARE-authorized providers.

Code of Federal Regulations, 2011 CFR

2011-07-01

... itemized fully and sufficiently descriptive for the CHAMPUS to make a determination of benefits. (B... evaluate all functions of the RTC and contribute to an ongoing process of program improvement. The clinical... multidisciplinary safety committee. (8) Facility evaluation. The RTC annually evaluates accomplishment of the goals...

32 CFR 199.6 - TRICARE-authorized providers.

Code of Federal Regulations, 2012 CFR

2012-07-01

... itemized fully and sufficiently descriptive for the CHAMPUS to make a determination of benefits. (B... evaluate all functions of the RTC and contribute to an ongoing process of program improvement. The clinical... multidisciplinary safety committee. (8) Facility evaluation. The RTC annually evaluates accomplishment of the goals...

32 CFR 199.6 - TRICARE-authorized providers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... itemized fully and sufficiently descriptive for the CHAMPUS to make a determination of benefits. (B... evaluate all functions of the RTC and contribute to an ongoing process of program improvement. The clinical... multidisciplinary safety committee. (8) Facility evaluation. The RTC annually evaluates accomplishment of the goals...

Mini Lessons from FDA.

ERIC Educational Resources Information Center

Food and Drug Administration (DHEW), Washington, DC.

Eight self-contained lessons present information about topics of current interest in the Food and Drug Administration. Multidisciplinary in nature, the lessons can be integrated into ongoing activities in elementary or secondary level reading, math, language arts, social studies, science, art, health, consumer education, and home economics. The…

Advances in Understanding of Penile Carcinogenesis: The Search for Actionable Targets

PubMed Central

Chaing, Sharon; Azizi, Mounsif; Kidd, Laura C.; Kim, Patricia; Spiess, Philippe E.

2017-01-01

Penile cancer (PeCa) is a rare malignancy with potentially devastating effects. Squamous cell carcinoma is the most common variant with distinct precancerous lesions before development into invasive disease. Involvement of the inguinal lymph nodes is the most important prognostic factor in PeCa, and once disease is present outside the groin, prognosis is poor. Metastatic PeCa is challenging to treat and often requires multidisciplinary approaches in management. Due to its rarity, molecular understanding of the disease continues to be limited with most studies based on small, single center series. Thus far, it appears PeCa has diverse mechanisms of carcinogenesis affecting similar molecular pathways. In this review, we evaluate the current landscape of the molecular carcinogenesis of PeCa and explore ongoing research on potential actionable targets of therapy. The emergence of anti-epidermal growth factor receptor (EGFR) and other immunotherapeutic strategies may improve outcomes for PeCa patients. PMID:28813024

[Community dentistry in practice: four decades of activity among the Ethiopian community].

PubMed

Vered, Y; Sgan-Cohen, H D; Zini, A; Livny, A; Mann, J

2013-04-01

The immigration absorption of the Ethiopian community poses a great Zionist challenge to the State of Israel. The Department of Community Dentistry established a long and ongoing relationship with this unique population on a variety of levels. We revealed an alarming deterioration of their oral health status since their arrival to Israel. Concurrently, we explored the association between oral health and psychosocial variables among these immigrants. Accordingly, we implemented a holistic community oral health care program (prevention, treatment, dental, medical, social, psychological), with the participation of a multidisciplinary team of Ethiopian born professionals. In addition, as part of the integration process in the Israeli society and workplace, our department educated and trained individuals of this community as dental assistants and dental hygienists in courses held at the Hadassah Medical Organization. We strongly believe that this model of relationship and support should be implemented on a national level.

Training Multidisciplinary Biomedical Informatics Students: Three Years of Experience

PubMed Central

van Mulligen, Erik M.; Cases, Montserrat; Hettne, Kristina; Molero, Eva; Weeber, Marc; Robertson, Kevin A.; Oliva, Baldomero; de la Calle, Guillermo; Maojo, Victor

2008-01-01

Objective The European INFOBIOMED Network of Excellence 1 recognized that a successful education program in biomedical informatics should include not only traditional teaching activities in the basic sciences but also the development of skills for working in multidisciplinary teams. Design A carefully developed 3-year training program for biomedical informatics students addressed these educational aspects through the following four activities: (1) an internet course database containing an overview of all Medical Informatics and BioInformatics courses, (2) a BioMedical Informatics Summer School, (3) a mobility program based on a ‘brokerage service’ which published demands and offers, including funding for research exchange projects, and (4) training challenges aimed at the development of multi-disciplinary skills. Measurements This paper focuses on experiences gained in the development of novel educational activities addressing work in multidisciplinary teams. The training challenges described here were evaluated by asking participants to fill out forms with Likert scale based questions. For the mobility program a needs assessment was carried out. Results The mobility program supported 20 exchanges which fostered new BMI research, resulted in a number of peer-reviewed publications and demonstrated the feasibility of this multidisciplinary BMI approach within the European Union. Students unanimously indicated that the training challenge experience had contributed to their understanding and appreciation of multidisciplinary teamwork. Conclusion The training activities undertaken in INFOBIOMED have contributed to a multi-disciplinary BMI approach. It is our hope that this work might provide an impetus for training efforts in Europe, and yield a new generation of biomedical informaticians. PMID:18096914

Exploring Electrochromics: A Series of Eye-Catching Experiments to Introduce Students to Multidisciplinary Research

ERIC Educational Resources Information Center

Small, Leo J.; Wolf, Steven; Spoerke, Erik D.

2014-01-01

Introducing students to a multidisciplinary research laboratory presents challenges in terms of learning specific technical skills and concepts but also with respect to integrating different technical elements to form a coherent picture of the research. Here we present a multidisciplinary series of experiments we have developed in the Electronic,…

Responding to the Challenge of Survival: Multidisciplinary Language Courses

ERIC Educational Resources Information Center

Champagne, Roland A.

1978-01-01

Multidisciplinary language courses offer hope for integrating language courses into a university undergraduate curriculum. Such courses use a target language, such as French, to explore problems in another discipline. (Author)

The Use of Psychotropic Medication for People with Intellectual Disabilities and Behaviours That Challenge in the Context of a Community Multidisciplinary Team Approach

ERIC Educational Resources Information Center

Niven, Abigail; Goodey, Rebecca; Webb, Alison; Shankar, Rohit

2018-01-01

Background: The use of psychotropic medication to manage challenging behaviours of people with intellectual disabilities is a contentious issue which NHS England has now focused on. This paper looks to evaluate this within the multidisciplinary context. Method: Records of clients (n = 106) open to a Community Intellectual Disabilities team for…

The opportunities and obstacles in developing a vascular birthmark database for clinical and research use.

PubMed

Sharma, Vishal K; Fraulin, Frankie Og; Harrop, A Robertson; McPhalen, Donald F

2011-01-01

Databases are useful tools in clinical settings. The authors review the benefits and challenges associated with the development and implementation of an efficient electronic database for the multidisciplinary Vascular Birthmark Clinic at the Alberta Children's Hospital, Calgary, Alberta. The content and structure of the database were designed using the technical expertise of a data analyst from the Calgary Health Region. Relevant clinical and demographic data fields were included with the goal of documenting ongoing care of individual patients, and facilitating future epidemiological studies of this patient population. After completion of this database, 10 challenges encountered during development were retrospectively identified. Practical solutions for these challenges are presented. THE CHALLENGES IDENTIFIED DURING THE DATABASE DEVELOPMENT PROCESS INCLUDED: identification of relevant data fields; balancing simplicity and user-friendliness with complexity and comprehensive data storage; database expertise versus clinical expertise; software platform selection; linkage of data from the previous spreadsheet to a new data management system; ethics approval for the development of the database and its utilization for research studies; ensuring privacy and limited access to the database; integration of digital photographs into the database; adoption of the database by support staff in the clinic; and maintaining up-to-date entries in the database. There are several challenges involved in the development of a useful and efficient clinical database. Awareness of these potential obstacles, in advance, may simplify the development of clinical databases by others in various surgical settings.

Oak Ridge Computerized Hierarchical Information System (ORCHIS) status report, July 1973

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

Brooks, A.A.

1974-01-01

This report summarizes the concepts, software, and contents of the Oak Ridge Computerized Hierarchical Information System. This data analysis and text processing system was developed as an integrated, comprehensive information processing capability to meet the needs of an on-going multidisciplinary research and development organization. (auth)

NCI International EBV-Gastric Cancer Consortium

Cancer.gov

A collaboration among NCI and extramural investigators, established by DCEG in 2006, that utilizes data and biospecimens from completed and ongoing case series and observational studies of gastric cancer to replicate and extend findings from previous studies hindered by small numbers of EBV-positive cases, and to stimulate multidisciplinary research in this area.

Genetic heterogeneity in cholangiocarcinoma: a major challenge for targeted therapies

PubMed Central

Brandi, Giovanni; Farioli, Andrea; Astolfi, Annalisa; Biasco, Guido; Tavolari, Simona

2015-01-01

Cholangiocarcinoma (CC) encompasses a group of related but distinct malignancies whose lack of a stereotyped genetic signature makes challenging the identification of genomic landscape and the development of effective targeted therapies. Accumulated evidences strongly suggest that the remarkable genetic heterogeneity of CC may be the result of a complex interplay among different causative factors, some shared by most human cancers while others typical of this malignancy. Currently, considerable efforts are ongoing worldwide for the genetic characterization of CC, also using advanced technologies such as next-generation sequencing (NGS). Undoubtedly this technology could offer an unique opportunity to broaden our understanding on CC molecular pathogenesis. Despite this great potential, however, the high complexity in terms of factors potentially contributing to genetic variability in CC calls for a more cautionary application of NGS to this malignancy, in order to avoid possible biases and criticisms in the identification of candidate actionable targets. This approach is further justified by the urgent need to develop effective targeted therapies in this disease. A multidisciplinary approach integrating genomic, functional and clinical studies is therefore mandatory to translate the results obtained by NGS into effective targeted therapies for this orphan disease. PMID:26142706

Qualitative study: the experience and impact of living with Behcet's syndrome.

PubMed

Tai, Vicky; Lindsay, Karen; Sims, Joanne L; McQueen, Fiona M

2017-09-22

Behcet's syndrome is a rare chronic multisystemic vasculitis of unknown aetiology, is unpredictable and can cause life-threatening complications. This qualitative study aims to explore the experiences of patients living with Behcet's syndrome in New Zealand. Eight English-speaking patients participated in in-depth semi-structured interviews about their experiences of living with Behcet's syndrome. Interviews were recorded and transcribed. Data were analysed using a general inductive thematic approach. Five themes related to the experience of Behcet's syndrome emerged from the interviews: diagnosis (diagnostic challenge and closure), impact of disease (pain, fatigue, reduced vision, fear and uncertainty), loneliness and isolation (lack of support and information, invisible illness), acquiring resilience (coping, gaining sense of control, support group) and ongoing interactions with health system (specialist care, primary care, need for multidisciplinary care, doctor-patient relationship). Behcet's syndrome patients experience difficulties in obtaining a timely and correct diagnosis and contend numerous physical and emotional challenges, often experiencing loneliness and isolation. Establishing trusting doctor-patient relationships, allowing timely access to specialist care and recruiting psychosocial supports will help patients better cope with their illness. Diagnosis and management of Behcet's syndrome requires close collaboration and communication among specialists and general practitioners and improved education on Behcet's syndrome.

International Multidisciplinary Learning: An Account of a Collaborative Effort among Three Higher Education Institutions

ERIC Educational Resources Information Center

Poh, Paul S. H.; Soetanto, Robby; Austin, Stephen; Adamu, Zulkifar A.

2014-01-01

Requiring students to complete their course assignments in partnership and in collaboration with students from other institutions is not commonplace teaching pedagogy. Even less so when they transcend disciplines and international borders. This paper presents a brief account of an ongoing collaborative effort between Ryerson University, Coventry…

Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease

PubMed Central

Walker, Craig M; Bunch, Frank T; Cavros, Nick G; Dippel, Eric J

2015-01-01

Peripheral arterial disease (PAD) is frequently diagnosed after permanent damage has occurred, resulting in a high rate of morbidity, amputation, and loss of life. Early and ongoing diagnosis and treatment is required for this progressive disease. Lifestyle modifications can prevent or delay disease progression and improve symptoms. Limb-sparing endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets, and intervention must occur as early as possible to ensure optimal clinical outcomes. An algorithm for the diagnosis and management of PAD was developed to enable a collaborative approach between the family practice and primary care physician or internist and various specialists that may include a diabetologist, endocrinologist, smoking cessation expert, hypertension and lipid specialist, endovascular interventionalist, vascular surgeon, orthopedist, neurologist, nurse practitioner, podiatrist, wound healing expert, and/or others. A multidisciplinary team working together has the greatest chance of providing optimal care for the patient with PAD and ensuring ongoing surveillance of the patient’s overall health, ultimately resulting in better quality of life and increased longevity for patients with PAD. PMID:26203234

Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results

PubMed Central

Priebe, Janosch A; Baumann, Kaja-Maria; Plidschun, Anne; Schiessl, Christine; Tölle, Thomas R

2017-01-01

Background Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. Objective The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Methods Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Results Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. Conclusions This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective RCTs will adjust for potential bias and selection effects. PMID:29203460

Multidisciplinary, Interdisciplinary, and Transdisciplinary Collaboration: Implications for Vocational Psychology

ERIC Educational Resources Information Center

Collin, Audrey

2009-01-01

The literature on interdisciplinarity identifies several forms of collaboration: multidisciplinary, transdisciplinary, and interdisciplinary (as bridge building or integration). To assist vocational psychology translate its interdisciplinary discourse into action, this paper uses that literature to identify the benefits, challenges and conditions…

Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies.

PubMed

Norman, Gregory J; Orton, Kristann; Wade, Amy; Morris, Andrea M; Slaboda, Jill C

2018-01-27

Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide cost-effective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S. Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S. geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC. Six practices varying in size, care team composition and location agreed to participate. At each site we conducted unstructured interviews with key informants and directly observed practices and procedures in the field and back office. The aggregated case studies revealed important issues focused on team composition, patient characteristics, use of technology and urgent care delivery. Common challenges across the practices included provider retention and unmet community demand for home-based care services. Most practices, regardless of size, faced challenges around using electronic medical records (EMRs) and scheduling systems not designed for use in a mobile practice. Although many practices offered urgent care, practices varied in the methods used to provide care including the use of community paramedics and telehealth technology. Learnings compiled from these observations can inform other HBPC practices as to potential best practices that can be implemented in an effort to improve efficiency and scalability of HBPC so that seniors with multiple chronic conditions can receive comprehensive primary care services in their homes.

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.

Multidisciplinary lung cancer meetings: improving the practice of radiation oncology and facing future challenges.

PubMed

Campbell, Belinda A; Ball, David; Mornex, Françoise

2015-02-01

Clinical guidelines widely recognize the importance of multidisciplinary meetings (MDM) in the optimal care of lung cancer patients. The published literature suggest that dedicated Lung Cancer MDM lead to increased treatment utilization rates and improved survival outcomes for patients with lung cancer. For radiation oncologists, Lung Cancer MDM have been proven to support evidence-based practice and improve the utilization of radiotherapy. Lung Cancer MDM also allow for education and promotion of specialty radiotherapy services. The fast pace of modern medicine is also presenting new challenges for the multidisciplinary lung cancer team, and technological advances are likely to lead to new changes in the structure of traditional Lung Cancer MDM. © 2015 Asian Pacific Society of Respirology.

Occupational therapy in Australian acute hospitals: A modified practice.

PubMed

Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley

2016-08-01

Ongoing changes to health-care funding Australia wide continue to influence how occupational therapists practise in acute hospitals. This study describes the practice challenges experienced by Western Australian acute care occupational therapists. Then, it explores if and how acute care occupational therapists are modifying their practice in response to these practice changes. This study used a qualitative grounded theory approach. Semi-structured interviews were completed with 13 purposively selected acute care occupational therapists from four Western Australian metropolitan hospitals. Data were analysed using a constant comparative method to provide detailed descriptions of acute care occupational therapy practice and to generate theory. Five conceptual categories were developed. The first two addressed practice challenges: pragmatic organisational influences on client care and establishing a professional identity within the multidisciplinary team. Three categories related to therapist responses are as follows: becoming the client advocate, being the facilitator and applying clinical reasoning. Finally, modified practice was identified as the core category which explains the process whereby acute care occupational therapists are ensuring they remain relevant and authentic in the acute care context. Western Australian acute care occupational therapists are practising in a highly complex health context that presents many challenges. They are responding by using a modified form of practice that ensures occupational therapy skills remain relevant within the narrow confines of this health setting. © 2016 Occupational Therapy Australia.

The future of the Amazon: new perspectives from climate, ecosystem and social sciences.

PubMed

Betts, Richard A; Malhi, Yadvinder; Roberts, J Timmons

2008-05-27

The potential loss or large-scale degradation of the tropical rainforests has become one of the iconic images of the impacts of twenty-first century environmental change and may be one of our century's most profound legacies. In the Amazon region, the direct threat of deforestation and degradation is now strongly intertwined with an indirect challenge we are just beginning to understand: the possibility of substantial regional drought driven by global climate change. The Amazon region hosts more than half of the world's remaining tropical forests, and some parts have among the greatest concentrations of biodiversity found anywhere on Earth. Overall, the region is estimated to host about a quarter of all global biodiversity. It acts as one of the major 'flywheels' of global climate, transpiring water and generating clouds, affecting atmospheric circulation across continents and hemispheres, and storing substantial reserves of biomass and soil carbon. Hence, the ongoing degradation of Amazonia is a threat to local climate stability and a contributor to the global atmospheric climate change crisis. Conversely, the stabilization of Amazonian deforestation and degradation would be an opportunity for local adaptation to climate change, as well as a potential global contributor towards mitigation of climate change. However, addressing deforestation in the Amazon raises substantial challenges in policy, governance, sustainability and economic science. This paper introduces a theme issue dedicated to a multidisciplinary analysis of these challenges.

Integrating cancer survivors' experiences into UK cancer registries: design and development of the ePOCS system (electronic Patient-reported Outcomes from Cancer Survivors)

PubMed Central

Ashley, L; Jones, H; Thomas, J; Forman, D; Newsham, A; Morris, E; Johnson, O; Velikova, G; Wright, P

2011-01-01

Background: Understanding the psychosocial challenges of cancer survivorship, and identifying which patients experience ongoing difficulties, is a key priority. The ePOCS (electronic patient-reported outcomes from cancer survivors) project aims to develop and evaluate a cost-efficient, UK-scalable electronic system for collecting patient-reported outcome measures (PROMs), at regular post-diagnostic timepoints, and linking these with clinical data in cancer registries. Methods: A multidisciplinary team developed the system using agile methods. Design entailed process mapping the system's constituent parts, data flows and involved human activities, and undertaking usability testing. Informatics specialists built new technical components, including a web-based questionnaire tool and tracking database, and established component-connecting data flows. Development challenges were overcome, including patient usability and data linkage and security. Results: We have developed a system in which PROMs are completed online, using a secure questionnaire administration tool, accessed via a public-facing website, and the responses are linked and stored with clinical registry data. Patient monitoring and communications are semiautomated via a tracker database, and patient correspondence is primarily Email-based. The system is currently honed for clinician-led hospital-based patient recruitment. Conclusions: A feasibility test study is underway. Although there are possible challenges to sustaining and scaling up ePOCS, the system has potential to support UK epidemiological PROMs collection and clinical data linkage. PMID:22048035

Research Roadmap for Tuberculosis Transmission Science: Where Do We Go From Here and How Will We Know When We're There?

PubMed

Auld, Sara C; Kasmar, Anne G; Dowdy, David W; Mathema, Barun; Gandhi, Neel R; Churchyard, Gavin J; Rustomjee, Roxana; Shah, N Sarita

2017-11-03

High rates of tuberculosis transmission are driving the ongoing global tuberculosis epidemic, and there is a pressing need for research focused on understanding and, ultimately, halting transmission. The ongoing tuberculosis-human immunodeficiency virus (HIV) coepidemic and rising rates of drug-resistant tuberculosis in parts of the world add further urgency to this work. Success in this research will require a concerted, multidisciplinary effort on the part of tuberculosis scientists, clinicians, programs, and funders and must span the research spectrum from biomedical sciences to the social sciences, public health, epidemiology, cost-effectiveness analyses, and operations research. Heterogeneity of tuberculosis disease, both among individual patients and among communities, poses a substantial challenge to efforts to interrupt transmission. As such, it is likely that effective interventions to stop transmission will require a combination of approaches that will vary across different epidemiologic settings. This research roadmap summarizes key gaps in our current understanding of transmission, as laid out in the preceding articles in this series. We also hope that it will be a call to action for the global tuberculosis community to make a sustained commitment to tuberculosis transmission science. Halting transmission today is an essential step on the path to end tuberculosis tomorrow. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice.

PubMed

Peter, Jonathan Grant; Lehloenya, Rannakoe; Dlamini, Sipho; Risma, Kimberly; White, Katie D; Konvinse, Katherine C; Phillips, Elizabeth J

Most immune-mediated adverse drug reactions (IM-ADRs) involve the skin, and many have additional systemic features. Severe cutaneous adverse drug reactions (SCARs) are an uncommon, potentially life-threatening, and challenging subgroup of IM-ADRs with diverse clinical phenotypes, mechanisms, and offending drugs. T-cell-mediated immunopathology is central to these severe delayed reactions, but effector cells and cytokines differ by clinical phenotype. Strong HLA-gene associations have been elucidated for specific drug-SCAR IM-ADRs such as Stevens-Johnson syndrome/toxic epidermal necrolysis, although the mechanisms by which carriage of a specific HLA allele is necessary but not sufficient for the development of many IM-ADRs is still being defined. SCAR management is complicated by substantial short- and long-term morbidity/mortality and the potential need to treat ongoing comorbid disease with related medications. Multidisciplinary specialist teams at experienced units should care for patients. In the setting of SCAR, patient outcomes as well as preventive, diagnostic, treatment, and management approaches are often not generalizable, but rather context specific, driven by population HLA-genetics, the pharmacology and genetic risk factors of the implicated drug, severity of underlying comorbid disease necessitating ongoing treatments, and cost considerations. In this review, we update the basic and clinical science of SCAR diagnosis and management. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Severe delayed cutaneous and systemic reactions to drugs: a global perspective on the science and art of current practice

PubMed Central

Peter, Jonathan Grant; Lehloenya, Rannakoe; Dlamini, Sipho; Risma, Kimberly; White, Katie D.; Konvinse, Katherine C.; Phillips, Elizabeth J.

2017-01-01

The majority of immune-mediated adverse drug reactions (IM-ADRs) involve the skin, and many have additional systemic features. Severe cutaneous adverse drug reactions (SCAR) are an uncommon, potentially life-threatening and challenging sub-group of IM-ADRs with diverse clinical phenotypes, mechanisms and offending drugs. T-cell mediated immunopathology is central to these severe delayed reactions, but effector cells and cytokines differ by clinical phenotype. Strong HLA-gene associations have been elucidated for specific drug-SCAR IM-ADRs such as Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN); although the mechanisms by which carriage of a specific HLA allele is necessary but not sufficient for the development of many IM-ADRs is still being defined. SCAR management is complicated by substantial short and long-term morbidity/ mortality and the potential need to treat ongoing co-morbid disease with related medications. Multidisciplinary specialist teams at experienced units should care for patients. In the setting of SCAR, patient outcomes as well as preventive,diagnostic, treatment and management approaches are often not generalizable, but rather context specific, driven by population HLA-genetics, the pharmacology and genetic risk factors of the implicated drug, severity of underlying co-morbid disease necessitating ongoing treatments, and cost considerations. In this review, we update the basic and clinical science of SCAR diagnosis and management. PMID:28483310

An Evolving Identity: How Chronic Care Is Transforming What it Means to Be a Physician.

PubMed

Bogetz, Alyssa L; Bogetz, Jori F

2015-12-01

Physician identity and the professional role physicians play in health care is rapidly evolving. Over 130 million adults and children in the USA have complex and chronic diseases, each of which is shaped by aspects of the patient's social, psychological, and economic status. These patients have lifelong health care needs that require the ongoing care of multiple health care providers, access to community services, and the involvement of patients' family support networks. To date, physician professional identity formation has centered on autonomy, authority, and the ability to "heal." These notions of identity may be counterproductive in chronic disease care, which demands interdependency between physicians, their patients, and teams of multidisciplinary health care providers. Medical educators can prepare trainees for practice in the current health care environment by providing training that legitimizes and reinforces a professional identity that emphasizes this interdependency. This commentary outlines the important challenges related to this change and suggests potential strategies to reframe professional identity to better match the evolving role of physicians today.

Toward human organ printing: Charleston Bioprinting Symposium.

PubMed

Mironov, Vladimir

2006-01-01

The First Annual Charleston Bioprinting Symposium was organized by the Bioprinting Research Center of the Medical University of South Carolina (MUSC) and convened July 21, 2006, in Charleston, South Carolina. In broad terms, bioprinting is the application of rapid prototyping technology to the biomedical field. More specifically, it is defined as the layer by layer deposition of biologically relevant material. The 2006 Symposium included four sessions: Computer-aided design and Bioprinting, Bioprinting Technologies; Hydrogel for Bioprinting and, finally, a special session devoted to ongoing research projects at the MUSC Bioprinting Research Center. The Symposium highlight was the presentation of the multidisciplinary Charleston Bioengineered Kidney Project. This symposium demonstrated that bioprinting or robotic biofabrication is one of the most exciting and fast-emerging branches in the tissue engineering field. Robotic biofabrication will eventually lead to industrial production of living human organs suitable for clinical transplantation. The symposium demonstrated that although there are still many technological challenges, organ printing is a rapidly evolving feasible technology.

When Your Pregnancy Echoes Your Illness: Transition to Motherhood With Inflammatory Bowel Disease.

PubMed

Ghorayeb, Jihane; Branney, Peter; Selinger, Christian P; Madill, Anna

2018-03-01

Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept- Blurred Lines-offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Scientific Process Flowchart Assessment (SPFA): A Method for Evaluating Changes in Understanding and Visualization of the Scientific Process in a Multidisciplinary Student Population

ERIC Educational Resources Information Center

Wilson, Kristy J.; Rigakos, Bessie

2016-01-01

The scientific process is nonlinear, unpredictable, and ongoing. Assessing the nature of science is difficult with methods that rely on Likert-scale or multiple-choice questions. This study evaluated conceptions about the scientific process using student-created visual representations that we term "flowcharts." The methodology,…

Anticipating forest and range land development in central Oregon (USA) for landscape analysis, with an example application involving mule deer

Treesearch

Jeffrey D. Kline; Alissa Moses; Theresa Burcsu

2010-01-01

Forest policymakers, public lands managers, and scientists in the Pacific Northwest (USA) seek ways to evaluate the landscape-level effects of policies and management through the multidisciplinary development and application of spatially explicit methods and models. The Interagency Mapping and Analysis Project (IMAP) is an ongoing effort to generate landscape-wide...

Service-Learning: Through a Multidisciplinary Lens. Advances in Service Learning Research Series.

ERIC Educational Resources Information Center

Billig, Shelley H., Ed.; Furco, Andrew, Ed.

This document contains 11 papers on researching service learning through a multidisciplinary lens. The following papers are included: "Introduction" (Shelley H. Billig, Andrew Furco); "Stretching to Meet the Challenge: Improving the Quality of Research to Improve the Quality of Service-Learning" (Janet Eyler);…

Development of a tiered and binned genetic counseling model for informed consent in the era of multiplex testing for cancer susceptibility.

PubMed

Bradbury, Angela R; Patrick-Miller, Linda; Long, Jessica; Powers, Jacquelyn; Stopfer, Jill; Forman, Andrea; Rybak, Christina; Mattie, Kristin; Brandt, Amanda; Chambers, Rachelle; Chung, Wendy K; Churpek, Jane; Daly, Mary B; Digiovanni, Laura; Farengo-Clark, Dana; Fetzer, Dominique; Ganschow, Pamela; Grana, Generosa; Gulden, Cassandra; Hall, Michael; Kohler, Lynne; Maxwell, Kara; Merrill, Shana; Montgomery, Susan; Mueller, Rebecca; Nielsen, Sarah; Olopade, Olufunmilayo; Rainey, Kimberly; Seelaus, Christina; Nathanson, Katherine L; Domchek, Susan M

2015-06-01

Multiplex genetic testing, including both moderate- and high-penetrance genes for cancer susceptibility, is associated with greater uncertainty than traditional testing, presenting challenges to informed consent and genetic counseling. We sought to develop a new model for informed consent and genetic counseling for four ongoing studies. Drawing from professional guidelines, literature, conceptual frameworks, and clinical experience, a multidisciplinary group developed a tiered-binned genetic counseling approach proposed to facilitate informed consent and improve outcomes of cancer susceptibility multiplex testing. In this model, tier 1 "indispensable" information is presented to all patients. More specific tier 2 information is provided to support variable informational needs among diverse patient populations. Clinically relevant information is "binned" into groups to minimize information overload, support informed decision making, and facilitate adaptive responses to testing. Seven essential elements of informed consent are provided to address the unique limitations, risks, and uncertainties of multiplex testing. A tiered-binned model for informed consent and genetic counseling has the potential to address the challenges of multiplex testing for cancer susceptibility and to support informed decision making and adaptive responses to testing. Future prospective studies including patient-reported outcomes are needed to inform how to best incorporate multiplex testing for cancer susceptibility into clinical practice.Genet Med 17 6, 485-492.

The International Thymic Malignancy Interest Group thymic initiative: a state-of-the-art study of thymic malignancies.

PubMed

Detterbeck, Frank; Korst, Robert

2014-01-01

Thymic malignancies are relatively rare tumors. A general lack of knowledge, misconceptions about benignancy, confusion about the definition of terms, and variability in reporting of outcomes have further hampered progress in these diseases. The International Thymic Malignancy Interest Group has emerged to counter these challenges and has brought together a worldwide multidisciplinary community determined to improve outcomes for these patients. Although the organization is young (initiated in 2010), major early accomplishments have created a foundation and infrastructure for scientific research. These include consensus definitions of terms, an unprecedented global database, development of practical clinical resources and, together with the International Association for the Study of Lung Cancer, development of proposals for the first formal stage classification of these malignant tumors. Many articles have been published or are under way, and a second phase of projects building on the early success is proceeding. The greatest accomplishment of the International Thymic Malignancy Interest Group lies in the establishment of an open culture of collaboration and the engagement of a broad group of individuals united by a common mission. It is a testament to what can be achieved, despite ongoing and inherent challenges, by determination and a collective effort. Copyright © 2014 Elsevier Inc. All rights reserved.

Antitumor activity of nivolumab on hemodialysis after renal allograft rejection.

PubMed

Ong, Michael; Ibrahim, Andrea Marie; Bourassa-Blanchette, Samuel; Canil, Christina; Fairhead, Todd; Knoll, Greg

2016-01-01

Nivolumab (Opdivo™) is a novel IgG4 subclass programmed death-1 (PD-1) inhibiting antibody that has demonstrated breakthrough-designation anti-tumor activity. To date, clinical trials of nivolumab and other checkpoint inhibitors have generally excluded patients with solid organ transplantation and patients with concurrent immunosuppression. However, organ transplant recipients are at high-risk of development of malignancy as a result of suppressed immune surveillance of cancer. We illustrate the outcomes of a 63 year-old type I diabetic female patient who developed pulmonary metastatic, BRAF wild-type cutaneous melanoma 10 years after renal transplantation. After downward titration of the patient's immunosuppressive medications and extensive multidisciplinary review, she was treated with nivolumab in the first-line setting. Within 1 week of administration, the patient experienced acute renal allograft rejection, renal failure and concurrent diabetic ketoacidosis due to steroid therapy. Allograft function did not return, but patient made a full clinical recovery after being placed on hemodialysis. Subsequently, the patient had clinical disease progression off therapy and required re-challenge with nivolumab on hemodialysis, resulting in ongoing clinical and radiographic response. This case illustrates multiple practical challenges and dangers of administering anti-PD1 immune checkpoint inhibitors to patients with solid-organ transplantation including need for titration of immunosuppressive medications, risks of allograft rejection, and treatment during hemodialysis.

A practical approach to the nutritional management of chronic kidney disease patients in Cape Town, South Africa.

PubMed

Ameh, Oluwatoyin I; Cilliers, Lynette; Okpechi, Ikechi G

2016-07-08

The multi-racial and multi-ethnic population of South Africa has significant variation in their nutritional habits with many black South Africans undergoing a nutritional transition to Western type diets. In this review, we describe our practical approaches to the dietary and nutritional management of chronic kidney disease (CKD) patients in Cape Town, South Africa. Due to poverty and socio-economic constraints, significant challenges still exist with regard to achieving the nutritional needs and adequate dietary counselling of many CKD patients (pre-dialysis and dialysis) in South Africa. Inadequate workforce to meet the educational and counselling needs of patients, inability of many patients to effectively come to terms with changing body and metabolic needs due to ongoing kidney disease, issues of adherence to fluid and food restrictions as well as adherence to medications and in some cases the inability to obtain adequate daily food supplies make up some of these challenges. A multi-disciplinary approach (dietitians, nurses and nephrologists) of regularly reminding and educating patients on dietary (especially low protein diets) and nutritional needs is practiced. The South African Renal exchange list consisting of groups of food items with the same nutritional content has been developed as a practical tool to be used by dietitians to convert individualized nutritional prescriptions into meal plan to meet the nutritional needs of patients in South Africa. The list is currently utilized in counselling CKD patients and provides varied options for food items within the same group (exchangeable) as well as offering ease for the description of suitable meal portions (sizes) to our patients. Regular and continuous education of CKD patients by a multi-disciplinary team in South Africa enables our patients to meet their nutritional goals and retard CKD progression. The South African renal exchange list has proved to be a very useful tool in meeting this need.

Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results.

PubMed

Huber, Stephan; Priebe, Janosch A; Baumann, Kaja-Maria; Plidschun, Anne; Schiessl, Christine; Tölle, Thomas R

2017-12-04

Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective RCTs will adjust for potential bias and selection effects. ©Stephan Huber, Janosch A Priebe, Kaja-Maria Baumann, Anne Plidschun, Christine Schiessl, Thomas R Tölle. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 04.12.2017.

Qualitative Analysis of Round-Table Discussions on the Business Case and Procurement Challenges for Hospital Electronic Prescribing Systems

PubMed Central

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

2013-01-01

Objectives There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. Materials and Methods We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. Results We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing “wants” and aspirations from organizational “needs”. Discussion and conclusions Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management. PMID:24260213

A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial.

PubMed

Jiskoot, G; Benneheij, S H; Beerthuizen, A; de Niet, J E; de Klerk, C; Timman, R; Busschbach, J J; Laven, J S E

2017-03-06

Obesity in women with polycystic ovary syndrome (PCOS) negatively affects all clinical features, and a 5 to 10% weight loss has shown promising results on reproductive, metabolic and psychological level. Incorporating a healthy diet, increasing physical activity and changing dysfunctional thought patterns in women with PCOS are key points in losing weight. The biggest challenge in weight management programs is to achieve a reasonable and sustainable weight loss. The aim of this study is to explore whether Cognitive Behavioural Therapy (CBT) by a mental health professional, working in a multidisciplinary team with a dietician and a physical therapist (a three-component intervention), is more effective for weight loss in the long term, within 12 months. We will also explore whether mobile phone applications are effective in supporting behavioural change and sustainable weight loss. The present study is a longitudinal randomized controlled trial (RCT) to study the effectiveness of a three-component 1-year cognitive-behavioural lifestyle intervention in overweight/obese women with PCOS. A total of 210 participants are randomly assigned to three groups: 1) CBT provided by the multidisciplinary team or; 2) CBT provided by the multidisciplinary team and Short Message Service (SMS) or; 3) usual care: encourage weight loss through publicly available services (control group). The primary aim of the 12-month intervention is to explore whether a three-component 1-year cognitive-behavioural lifestyle intervention is effective to decrease weight, when compared to usual care. Secondary outcomes include: the effect of the intervention on the PCOS phenotype, waist circumference, waist to hip ratio, ovulation rates, total testosterone, SHBG, free androgen index (FAI), AMH, hirsutism, acne, fasting glucose, blood pressure and all psychological parameters. Additionally, we assessed time to pregnancy, ongoing pregnancies, clinical pregnancies, miscarriages and birth weight. All outcome variables are measured at the start of the study, and again at 3 months, 6 months, nine months and 12 months. We expect that CBT provided by a multidisciplinary team, especially combined with SMS, is effective in developing a healthy lifestyle and achieving a long-term weight loss in women with PCOS. Losing 5- 10% body weight improves various PCOS characteristics. Consequently, we expect to show that CBT provided by a multidisciplinary team improves reproductive and metabolic outcomes, as well as quality of life, while at the same time being cost-effective. Registered at the Netherlands National Trial Register with number NTR2450 on August 2nd, 2010.

Issues and Strategies for Establishing Work-Integrated Learning for Multidisciplinary Teams: A Focus on Degrees in Sustainability

ERIC Educational Resources Information Center

Wilson, Robyn Fay

2015-01-01

This study was conducted to identify challenges and potential strategies to streamline work-integrated learning placements for multidisciplinary teams of students undertaking degrees in sustainability. Face-to-face interviews using a semi-structured questionnaire were conducted with 15 academics and senior university staff, from four universities…

Alta Scuola Politecnica: An Ongoing Experiment in the Multidisciplinary Education of Top Students towards Innovation in Engineering, Architecture and Design

ERIC Educational Resources Information Center

Benedetto, S.; Bernelli Zazzera, F.; Bertola, P.; Cantamessa, M.; Ceri, S.; Ranci, C.; Spaziante, A.; Zanino, R.

2010-01-01

Politecnico di Milano and Politecnico di Torino, the top technical universities in Italy, united their efforts in 2004 by launching a unique excellence programme called Alta Scuola Politecnica (ASP). The ASP programme is devoted to 150 students, selected each year from among the top 5-10% of those enrolled in the Engineering, Architecture and…

From Systems Understanding to Personalized Medicine: Lessons and Recommendations Based on a Multidisciplinary and Translational Analysis of COPD.

PubMed

Roca, Josep; Cano, Isaac; Gomez-Cabrero, David; Tegnér, Jesper

2016-01-01

Systems medicine, using and adapting methods and approaches as developed within systems biology, promises to be essential in ongoing efforts of realizing and implementing personalized medicine in clinical practice and research. Here we review and critically assess these opportunities and challenges using our work on COPD as a case study. We find that there are significant unresolved biomedical challenges in how to unravel complex multifactorial components in disease initiation and progression producing different clinical phenotypes. Yet, while such a systems understanding of COPD is necessary, there are other auxiliary challenges that need to be addressed in concert with a systems analysis of COPD. These include information and communication technology (ICT)-related issues such as data harmonization, systematic handling of knowledge, computational modeling, and importantly their translation and support of clinical practice. For example, clinical decision-support systems need a seamless integration with new models and knowledge as systems analysis of COPD continues to develop. Our experience with clinical implementation of systems medicine targeting COPD highlights the need for a change of management including design of appropriate business models and adoption of ICT providing and supporting organizational interoperability among professional teams across healthcare tiers, working around the patient. In conclusion, in our hands the scope and efforts of systems medicine need to concurrently consider these aspects of clinical implementation, which inherently drives the selection of the most relevant and urgent issues and methods that need further development in a systems analysis of disease.

Cardiovascular response to thermoregulatory challenges

PubMed Central

Liu, Cuiqing; Yavar, Zubin

2015-01-01

A growing number of extreme climate events are occurring in the setting of ongoing climate change, with an increase in both the intensity and frequency. It has been shown that ambient temperature challenges have a direct and highly varied impact on cardiovascular health. With a rapidly growing amount of literature on this issue, we aim to review the recent publications regarding the impact of cold and heat on human populations with regard to cardiovascular disease (CVD) mortality/morbidity while also examining lag effects, vulnerable subgroups, and relevant mechanisms. Although the relative risk of morbidity/mortality associated with extreme temperature varied greatly across different studies, both cold and hot temperatures were associated with a positive mean excess of cardiovascular deaths or hospital admissions. Cause-specific study of CVD morbidity/mortality indicated that the sensitivity to temperature was disease-specific, with different patterns for acute and chronic ischemic heart disease. Vulnerability to temperature-related mortality was associated with some characteristics of the populations, including sex, age, location, socioeconomic condition, and comorbidities such as cardiac diseases, kidney diseases, diabetes, and hypertension. Temperature-induced damage is thought to be related to enhanced sympathetic reactivity followed by activation of the sympathetic nervous system, renin-angiotensin system, as well as dehydration and a systemic inflammatory response. Future research should focus on multidisciplinary adaptation strategies that incorporate epidemiology, climatology, indoor/building environments, energy usage, labor legislative perfection, and human thermal comfort models. Studies on the underlying mechanism by which temperature challenge induces pathophysiological response and CVD await profound and lasting investigation. PMID:26432837

What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2012-01-01

Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients' ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS. An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes. Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients' reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients' personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs. Decision-making for symptom management and quality of life in ALS care is enhanced when the patient's personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health professionals is how best to engage each patient in decision-making for their future needs, to bridge this gap.

The NASA Langley Multidisciplinary Uncertainty Quantification Challenge

NASA Technical Reports Server (NTRS)

Crespo, Luis G.; Kenny, Sean P.; Giesy, Daniel P.

2014-01-01

This paper presents the formulation of an uncertainty quantification challenge problem consisting of five subproblems. These problems focus on key aspects of uncertainty characterization, sensitivity analysis, uncertainty propagation, extreme-case analysis, and robust design.

Mapping remote and multidisciplinary learning barriers: lessons from challenge-based innovation at CERN

NASA Astrophysics Data System (ADS)

Jensen, Matilde Bisballe; Utriainen, Tuuli Maria; Steinert, Martin

2018-01-01

This paper presents the experienced difficulties of students participating in the multidisciplinary, remote collaborating engineering design course challenge-based innovation at CERN. This is with the aim to identify learning barriers and improve future learning experiences. We statistically analyse the rated differences between distinct design activities, educational background and remote vs. co-located collaboration. The analysis is based on a quantitative and qualitative questionnaire (N = 37). Our analysis found significant ranking differences between remote and co-located activities. This questions whether the remote factor might be a barrier for the originally intended learning goals. Further a correlation between analytical and converging design phases was identified. Hence, future facilitators are suggested to help students in the transition from one design phase to the next rather than only teaching methods in the individual design phases. Finally, we discuss how educators address the identified learning barriers when designing future courses including multidisciplinary or remote collaboration.

A review of the LATEX project: mesoscale to submesoscale processes in a coastal environment

NASA Astrophysics Data System (ADS)

Petrenko, Anne A.; Doglioli, Andrea M.; Nencioli, Francesco; Kersalé, Marion; Hu, Ziyuan; d'Ovidio, Francesco

2017-04-01

The main objective of the LAgrangian Transport EXperiment (LATEX) project was to study the influence of coastal mesoscale and submesoscale physical processes on circulation dynamics, cross-shelf exchanges, and biogeochemistry in the western continental shelf of the Gulf of Lion, Northwestern Mediterranean Sea. LATEX was a five-year multidisciplinary project based on the combined analysis of numerical model simulations and multi-platform field experiments. The model component included a ten-year realistic 3D numerical simulation, with a 1 km horizontal resolution over the gulf, nested in a coarser 3 km resolution model. The in situ component involved four cruises, including a large-scale multidisciplinary campaign with two research vessels in 2010. This review concentrates on the physics results of LATEX, addressing three main subjects: (1) the investigation of the mesoscale to submesoscale processes. The eddies are elliptic, baroclinic, and anticyclonic; the strong thermal and saline front is density compensated. Their generation processes are studied; (2) the development of sampling strategies for their direct observations. LATEX has implemented an adaptive strategy Lagrangian tool, with a reference software available on the web, to perform offshore campaigns in a Lagrangian framework; (3) the quantification of horizontal mixing and cross-shelf exchanges. Lateral diffusivity coefficients, calculated in various ways including a novel technique, are in the range classically encountered for their associated scales. Cross-shelf fluxes have been calculated, after retrieving the near-inertial oscillation contribution. Further perspectives are discussed, especially for the ongoing challenge of studying submesoscale features remotely and from in situ data.

Designing under Constraints: Cell Phone Case Design Challenge

ERIC Educational Resources Information Center

Sutton, Kevin; Grubbs, Michael E.; Ernst, Jeremy

2014-01-01

Engineering design has been suggested as a viable instructional approach for Technology Education (TE) to intentionally provide students the opportunity to apply multidisciplinary concepts to solve ill-defined design challenges (Wells & Ernst, 2012; Sanders & Wells, 2010; Wicklein, 2006). Currently, the context for design challenges in TE…

Developing person-centred practice in hip fracture care for older people.

PubMed

Christie, Jane; Macmillan, Maureen; Currie, Colin; Matthews-Smith, Gerardine

2016-12-14

To facilitate a multidisciplinary collaborative approach to developing person-centred practice in hip fracture care for older people. Collaborative inquiry, a form of action research, was used to collect data for this study. It involved exploration of dilemmas, questions and problems that are part of human experience. Clinical leaders from different disciplines (n=16), who work with older people with hip fractures at different stages of the care pathway, participated in a series of facilitated action meetings. The practice development techniques used in this study included: identifying the strengths and limitations of the current service, values clarification, creating a shared vision, sharing clinical stories, reviewing case records, and reflecting on the experiences of three older people and two caregivers. Hip fracture care was based on meeting service targets, national guidelines and audits. Care was fragmented across different service delivery units, with professional groups working independently. This resulted in suboptimal communication between members of the multidisciplinary group of clinical leaders and care that was process-driven rather than person-centred. Spending time away from clinical practice enabled the multidisciplinary group to collaborate to understand care from the patients' and caregivers' perspectives, and to reflect critically on the care experience as a whole. To develop a person-centred workplace culture, the multidisciplinary team requires facilitated time for reflection. Ongoing facilitative leadership would enable the multidisciplinary team to collaborate effectively to deliver safe, effective person-centred practice in hip fracture care for older people.

NASA's MERBoard: An Interactive Collaborative Workspace Platform. Chapter 4

NASA Technical Reports Server (NTRS)

Trimble, Jay; Wales, Roxana; Gossweiler, Rich

2003-01-01

This chapter describes the ongoing process by which a multidisciplinary group at NASA's Ames Research Center is designing and implementing a large interactive work surface called the MERBoard Collaborative Workspace. A MERBoard system involves several distributed, large, touch-enabled, plasma display systems with custom MERBoard software. A centralized server and database back the system. We are continually tuning MERBoard to support over two hundred scientists and engineers during the surface operations of the Mars Exploration Rover Missions. These scientists and engineers come from various disciplines and are working both in small and large groups over a span of space and time. We describe the multidisciplinary, human-centered process by which this h4ERBoard system is being designed, the usage patterns and social interactions that we have observed, and issues we are currently facing.

Assessment and management of patients with ankle injuries.

PubMed

Walker, Jennie

2014-08-19

Foot and ankle injuries are common and can have a significant effect on an individual's daily activities. Nurses have an important role in the assessment, management, ongoing care and support of patients with ankle injuries. An understanding of the anatomy and physiology of the ankle enables nurses to identify significant injuries, which may result in serious complications, and communicate effectively with the multidisciplinary team to improve patient care and outcomes.

Technology-Rich Learning Environments in Elementary and Secondary Schools: An Interactive Study of Physical Settings and Educational Change.

ERIC Educational Resources Information Center

Stuebing, Susan; And Others

This paper reviews an ongoing study on the physical settings of education with technology at the elementary and high school levels. The study, which is multi-disciplinary in nature, is based in sites in the process of change in teaching strategies, using learning technology as a catalyst for this change to take place. The focus of the study is on…

Getting a Cohesive Answer from a Common Start: Scalable Multidisciplinary Analysis through Transformation of a System Model

NASA Technical Reports Server (NTRS)

Cole, Bjorn; Chung, Seung H.

2012-01-01

One of the challenges of systems engineering is in working multidisciplinary problems in a cohesive manner. When planning analysis of these problems, system engineers must tradeoff time and cost for analysis quality and quantity. The quality is associated with the fidelity of the multidisciplinary models and the quantity is associated with the design space that can be analyzed. The tradeoff is due to the resource intensive process of creating a cohesive multidisciplinary system model and analysis. Furthermore, reuse or extension of the models used in one stage of a product life cycle for another is a major challenge. Recent developments have enabled a much less resource-intensive and more rigorous approach than handwritten translation scripts or codes of multidisciplinary models and their analyses. The key is to work from a core system model defined in a MOF-based language such as SysML and in leveraging the emerging tool ecosystem, such as Query-View- Transform (QVT), from the OMG community. SysML was designed to model multidisciplinary systems and analyses. The QVT standard was designed to transform SysML models. The Europa Hability Mission (EHM) team has begun to exploit these capabilities. In one case, a Matlab/Simulink model is generated on the fly from a system description for power analysis written in SysML. In a more general case, a symbolic mathematical framework (supported by Wolfram Mathematica) is coordinated by data objects transformed from the system model, enabling extremely flexible and powerful tradespace exploration and analytical investigations of expected system performance.

Getting a Cohesive Answer from a Common Start: Scalable Multidisciplinary Analysis through Transformation of a Systems Model

NASA Technical Reports Server (NTRS)

Cole, Bjorn; Chung, Seung

2012-01-01

One of the challenges of systems engineering is in working multidisciplinary problems in a cohesive manner. When planning analysis of these problems, system engineers must trade between time and cost for analysis quality and quantity. The quality often correlates with greater run time in multidisciplinary models and the quantity is associated with the number of alternatives that can be analyzed. The trade-off is due to the resource intensive process of creating a cohesive multidisciplinary systems model and analysis. Furthermore, reuse or extension of the models used in one stage of a product life cycle for another is a major challenge. Recent developments have enabled a much less resource-intensive and more rigorous approach than hand-written translation scripts between multi-disciplinary models and their analyses. The key is to work from a core systems model defined in a MOF-based language such as SysML and in leveraging the emerging tool ecosystem, such as Query/View/Transformation (QVT), from the OMG community. SysML was designed to model multidisciplinary systems. The QVT standard was designed to transform SysML models into other models, including those leveraged by engineering analyses. The Europa Habitability Mission (EHM) team has begun to exploit these capabilities. In one case, a Matlab/Simulink model is generated on the fly from a system description for power analysis written in SysML. In a more general case, symbolic analysis (supported by Wolfram Mathematica) is coordinated by data objects transformed from the systems model, enabling extremely flexible and powerful design exploration and analytical investigations of expected system performance.

76 FR 44588 - Announcement of Requirements and Registration for “Using Public Data for Cancer Prevention and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Announcement of Requirements and Registration for ``Using... Challenge'' is a challenge aimed at encouraging multidisciplinary teams of software developers... Human Services. The statutory authority for this challenge competition is Section 105 of the America...

A multidisciplinary approach to team nursing within a low secure service: the team leader role.

PubMed

Nagi, Claire; Davies, Jason; Williams, Marie; Roberts, Catherine; Lewis, Roger

2012-01-01

This article critically examines the clinical utility of redesigning a nursing practice model within the Intensive Support and Intervention Service, a new low secure mental health facility in the United Kingdom. Specifically, the "team nursing" approach to care delivery has been adapted to consist of multidisciplinary team leaders as opposed to nursing team leaders. The authors describe the role, properties, and functions of the multidisciplinary team leader approach. The authors provide examples of the benefits and challenges posed to date and the ways in which potential barriers have been overcome. Nursing care leadership can be provided by multidisciplinary staff. An adapted model of team nursing can be implemented in a low secure setting. © 2011 Wiley Periodicals, Inc.

Strategies for mHealth research: lessons from 3 mobile intervention studies.

PubMed

Ben-Zeev, Dror; Schueller, Stephen M; Begale, Mark; Duffecy, Jennifer; Kane, John M; Mohr, David C

2015-03-01

The capacity of Mobile Health (mHealth) technologies to propel healthcare forward is directly linked to the quality of mobile interventions developed through careful mHealth research. mHealth research entails several unique characteristics, including collaboration with technologists at all phases of a project, reliance on regional telecommunication infrastructure and commercial mobile service providers, and deployment and evaluation of interventions "in the wild", with participants using mobile tools in uncontrolled environments. In the current paper, we summarize the lessons our multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations. First, we describe three ongoing projects that we draw from to illustrate throughout the paper. We then provide an example for multidisciplinary teamwork and conceptual mHealth intervention development that we found to be particularly useful. Finally, we discuss mHealth research challenges (i.e. evolving technology, mobile phone selection, user characteristics, the deployment environment, and mHealth system "bugs and glitches"), and provide recommendations for identifying and resolving barriers, or preventing their occurrence altogether.

Strategies for mHealth research: lessons from 3 mobile intervention studies

PubMed Central

Ben-Zeev, Dror; Schueller, Stephen M.; Begale, Mark; Duffecy, Jennifer; Kane, John M.; Mohr, David C.

2014-01-01

The capacity of Mobile Health (mHealth) technologies to propel healthcare forward is directly linked to the quality of mobile interventions developed through careful mHealth research. mHealth research entails several unique characteristics, including collaboration with technologists at all phases of a project, reliance on regional telecommunication infrastructure and commercial mobile service providers, and deployment and evaluation of interventions “in the wild”, with participants using mobile tools in uncontrolled environments. In the current paper, we summarize the lessons our multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations. First, we describe three ongoing projects that we draw from to illustrate throughout the paper. We then provide an example for multidisciplinary teamwork and conceptual mHealth intervention development that we found to be particularly useful. Finally, we discuss mHealth research challenges (i.e. evolving technology, mobile phone selection, user characteristics, the deployment environment, and mHealth system “bugs and glitches”), and provide recommendations for identifying and resolving barriers, or preventing their occurrence altogether. PMID:24824311

Surgical treatment of secondary peritonitis : A continuing problem.

PubMed

van Ruler, O; Boermeester, M A

2017-01-01

Secondary peritonitis remains associated with high mortality and morbidity rates. Treatment of secondary peritonitis is challenging even in modern medicine. Surgical intervention for source control remains the cornerstone of treatment, beside adequate antimicrobial therapy and resuscitation. A randomized clinical trial showed that relaparotomy on demand (ROD) after initial emergency surgery is the preferred treatment strategy, irrespective of the severity and extent of peritonitis. The effective and safe use of ROD requires intensive monitoring of the patient in a setting where diagnostic tests and decision making about relaparotomy are guaranteed round the clock. The lack of knowledge on timely and adequate patient selection, together with the lack of use of easy but reliable monitoring tools, seems to hamper full implementation of ROD. The accuracy of the relap decision tool is reasonable for prediction of ongoing peritonitis and selection for computer tomography (CT). The value of CT in an early postoperative phase is unclear. Future research and innovative technologies should focus on the additive value of CT in cases of operated secondary peritonitis and on the further optimization of bedside prediction tools to enhance adequate patient selection for intervention in a multidisciplinary setting.

Multidisciplinary studies of wildlife trade in primates: Challenges and priorities.

PubMed

Blair, Mary E; Le, Minh D; Sterling, Eleanor J

2017-11-01

Wildlife trade is increasingly recognized as an unsustainable threat to primate populations and informing its management is a growing focus and application of primatological research. However, management policies based on ecological research alone cannot address complex socioeconomic or cultural contexts as drivers of wildlife trade. Multidisciplinary research is required to understand trade complexity and identify sustainable management strategies. Here, we define multidisciplinary research as research that combines more than one academic discipline, and highlight how the articles in this issue combine methods and approaches to fill key gaps and offer a more comprehensive understanding of underlying drivers of wildlife trade including consumer demand, enforcement patterns, source population status, and accessibility of targeted species. These articles also focus on how these drivers interact at different scales, how trade patterns relate to ethics, and the potential effectiveness of different policy interventions in reducing wildlife trade. We propose priorities for future research on primate trade including expanding from multidisciplinary to interdisciplinary research questions and approaches co-created by research teams that integrate across different disciplines such as cultural anthropology, ecology, economics, and public policy. We also discuss challenges that limit the integration of information across disciplines to meet these priorities. © 2017 Wiley Periodicals, Inc.

Challenges facing translational research organizations in China: a qualitative multiple case study

PubMed Central

2013-01-01

Background Translational medicine is attracting much attention worldwide and many translational research organizations (TROs) have been established. In China, translational medicine has developed rapidly, but faces many challenges. This study was aimed at exploring these challenges faced by emerging TROs in China. Method A qualitative, multiple case study approach was used to assess the challenges faced by TROs in China. Data were collected between May and August 2012. Results Eight cases were identified. Overall, four themes that characterized TROs in China emerged from analyses: 1. objectives, organizer, and funding resources, 2. participating partners and research teams, 3. management, and 4. achievements. All TROs had objectives related to translating basic discovery to clinic treatment and cultivating translational researchers. In terms of organizer and funding resources, 7 out of 8 TROs were launched only by universities and/or hospitals, and funded mostly through research grants. As for participating partners and multidisciplinary research teams, all but one of the TROs only involved biomedical research institutions who were interested in translational research, and characterized as clinical research centers; 7 out of 8 TROs involved only researchers from biomedicine and clinical disciplines and none involved disciplines related to education, ethnicity, and sociology, or engaged the community. Current management of the TROs were generally nested within the traditional research management paradigms, and failed to adapt to the tenets of translational research. Half of the TROs were at developmental stages defined as infrastructure construction and recruitment of translational researchers. Conclusions TROs in China face the challenge of attracting sustainable funding sources, widening multidisciplinary cooperation, cultivating multi-disciplinary translational researchers and adapting current research management to translational research. Greater emphasis should be placed on increasing multidisciplinary cooperation, and innovating in education programs to cultivate of translational researchers. Efforts should be made to reform research management in TROs, and establish sustainable funding resources. PMID:24119837

Plant genetic resources for food and agriculture: opportunities and challenges emerging from the science and information technology revolution.

PubMed

Halewood, Michael; Chiurugwi, Tinashe; Sackville Hamilton, Ruaraidh; Kurtz, Brad; Marden, Emily; Welch, Eric; Michiels, Frank; Mozafari, Javad; Sabran, Muhamad; Patron, Nicola; Kersey, Paul; Bastow, Ruth; Dorius, Shawn; Dias, Sonia; McCouch, Susan; Powell, Wayne

2018-03-01

Contents Summary 1407 I. Introduction 1408 II. Technological advances and their utility for gene banks and breeding, and longer-term contributions to SDGs 1408 III. The challenges that must be overcome to realise emerging R&D opportunities 1410 IV. Renewed governance structures for PGR (and related big data) 1413 V. Access and benefit sharing and big data 1416 VI. Conclusion 1417 Acknowledgements 1417 ORCID 1417 References 1417 SUMMARY: Over the last decade, there has been an ongoing revolution in the exploration, manipulation and synthesis of biological systems, through the development of new technologies that generate, analyse and exploit big data. Users of Plant Genetic Resources (PGR) can potentially leverage these capacities to significantly increase the efficiency and effectiveness of their efforts to conserve, discover and utilise novel qualities in PGR, and help achieve the Sustainable Development Goals (SDGs). This review advances the discussion on these emerging opportunities and discusses how taking advantage of them will require data integration and synthesis across disciplinary, organisational and international boundaries, and the formation of multi-disciplinary, international partnerships. We explore some of the institutional and policy challenges that these efforts will face, particularly how these new technologies may influence the structure and role of research for sustainable development, ownership of resources, and access and benefit sharing. We discuss potential responses to political and institutional challenges, ranging from options for enhanced structure and governance of research discovery platforms to internationally brokered benefit-sharing agreements, and identify a set of broad principles that could guide the global community as it seeks or considers solutions. © 2018 The Authors. New Phytologist © 2018 New Phytologist Trust.

Hard but Not Too Hard: Challenging Courses and Engineering Students

ERIC Educational Resources Information Center

Martin, Jason H.; Hands, Krista B.; Lancaster, Stephen M.; Trytten, Deborah A.; Murphy, Teri J.

2008-01-01

Some professors claim college students seek the easy way out and prefer classes that lack challenge. In a multidisciplinary and multi-institutional ethnographic research study of the attainment of gender parity in an engineering department, it emerged that student attitudes toward challenge did not support this perception. By far, the majority of…

Troubling the Boundaries: Overcoming Methodological Challenges in a Multi-Sectoral and Multi-Jurisdictional HIV/HCV Policy Scoping Review

ERIC Educational Resources Information Center

Hare, Kathleen A.; Dubé, Anik; Marshall, Zack; Gahagan, Jacqueline; Harris, Gregory E.; Tucker, Maryanne; Dykeman, Margaret; MacDonald, Jo-Ann

2016-01-01

Policy scoping reviews are an effective method for generating evidence-informed policies. However, when applying guiding methodological frameworks to complex policy evidence, numerous, unexpected challenges can emerge. This paper details five challenges experienced and addressed by a policy trainee-led, multi-disciplinary research team, while…

Geologic map of the Rio Rico and Nogales 7.5’ quadrangles, Santa Cruz County, Arizona

USGS Publications Warehouse

Page, William R.; Menges, Christopher M.; Gray, Floyd; Berry, Margaret E.; Bultman, Mark W.; Cosca, Michael A.; VanSistine, D. Paco

2016-04-15

The objectives of our mapping were to define the geologic framework for the Nogales area and the upper Santa Cruz basin to support ongoing multidisciplinary projects. This new work will improve understanding of the Nogales Formation to more fully assess its groundwater resource potential. We significantly revised the Miocene Nogales Formation based on geologic mapping combined with new geochronologic, geophysical, and petrographic studies. 

High Reliability Organization and Applicability to the Battlefield to Reduce Errors Associated with Combat Casualty Care

DTIC Science & Technology

2016-06-10

I placed on the search engine: “English language,” “5 years.” Journal categories included core clinical journals , dental journals , MEDLINE, and...Army) AE Adverse event AHRQ Agency for Healthcare Research and Quality AHS Army Health System AMEDD Army Medical Department CPQ Clinical Practice...harm to a patient (Joint Commission 2015). Clinical Quality Management: A systematic, organized , multidisciplinary approach to the ongoing

Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership.

PubMed

DeCarlo, Linda

2005-09-01

CHANGES IN THE HEALTH CARE environment and reimbursement practices are creating opportunities for nurse entrepreneurs to be partners with other professional nurses and physicians. Advanced practice nurses (APNs) who want to step into an entrepreneurial role must have strong clinical expertise, specific personal characteristics, interpersonal skills, and business acumen. ESTABLISHING A MULTIDISCIPLINARY partnership for providing surgical assisting services has many benefits and presents many challenges.

Evaluation of a multidisciplinary burn care journal club: Lessons learned.

PubMed

Carta, T; Gawaziuk, J P; Cristall, N; Forbes, L; Logsetty, S

2018-05-01

Journal clubs allow discussion of the quality and findings of recent publications. However, journal clubs have not historically been multidisciplinary. Burn care is recognized as a true collaborative care model, including regular multidisciplinary rounds. Since 2011 we have offered a multidisciplinary burn journal club at our institution. We present an evaluation of the factors that have made the sessions successful to facilitate others to commence their own club. At the end of each journal club session participants anonymously completed a structured evaluation. Five-point scales were used to evaluate understanding, meeting objectives, presentation and appropriateness of information. Qualitative questions were asked to identify beneficial factors, suggestions for improvements, ideas for future sessions and feedback for the facilitator. Attendance grew from six to a maximum of 19. Members included physicians, nurses, dieticians, physiotherapists, occupational therapists, social workers, basic scientists and students. Presentations were undertaken by all of these disciplines. Ratings improved steadily over time. Understanding increased from a score of 4.5 to 4.8; meeting objectives from 4 to 4.9; satisfaction with method of presentation from 4.3 to 4.9 and with level of information from 3 to 4.9. Over time, the journal club has evolved to better meet the needs of our team. Successful multidisciplinary journal club implementation requires identification of champions and ongoing evaluation. The success of the journal club has been possible through the engagement of the entire burn team. Champions within each discipline, facilitated discussion and evaluation tools have helped nurture a nonthreatening team based learning environment. Copyright © 2017. Published by Elsevier Ltd.

A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners.

PubMed

Boyle, Eileen; Saunders, Rosemary; Drury, Vicki

2016-07-01

To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.

Multidisciplinary Design, Analysis, and Optimization Tool Development using a Genetic Algorithm

NASA Technical Reports Server (NTRS)

Pak, Chan-gi; Li, Wesley

2008-01-01

Multidisciplinary design, analysis, and optimization using a genetic algorithm is being developed at the National Aeronautics and Space A dministration Dryden Flight Research Center to automate analysis and design process by leveraging existing tools such as NASTRAN, ZAERO a nd CFD codes to enable true multidisciplinary optimization in the pr eliminary design stage of subsonic, transonic, supersonic, and hypers onic aircraft. This is a promising technology, but faces many challe nges in large-scale, real-world application. This paper describes cur rent approaches, recent results, and challenges for MDAO as demonstr ated by our experience with the Ikhana fire pod design.

The psychological complexity of predictive testing for late onset neurogenetic diseases and hereditary cancers: implications for multidisciplinary counselling and for genetic education.

PubMed

Evers-Kiebooms, G; Welkenhuysen, M; Claes, E; Decruyenaere, M; Denayer, L

2000-09-01

Increasing knowledge about the human genome has resulted in the availability of a steadily increasing number of predictive DNA-tests for two major categories of diseases: neurogenetic diseases and hereditary cancers. The psychological complexity of predictive testing for these late onset diseases requires careful consideration. It is the main aim of the present paper to describe this psychological complexity, which necessitates an adequate and systematic multidisciplinary approach, including psychological counselling, as well as ongoing education of professionals and of the general public. Predictive testing for neurogenetic diseases--in an adequate counselling context--so far elicits optimism regarding the short- and mid-term impact of the predictive test result. The psychosocial impact has been most widely studied for Huntington's disease. Longitudinal studies are of the utmost importance in evaluating the long-term impact of predictive testing for neurogenetic diseases on the tested person and his/her family. Given the more recent experience with predictive DNA-testing for hereditary cancers, fewer published scientific data are available. Longitudinal research on the mid- and long-term psychological impact of the predictive test result is essential. Decision making regarding health surveillance or preventive surgery after being detected as a carrier of one of the relevant mutations should receive special attention. Tailoring the professional approach--inside and outside genetic centres--to the families' needs is a continuous challenge. Even if a continuous effort is made, several important questions remain unanswered, last but not least the question regarding the best strategy to guarantee that the availability of predictive genetic testing results in a reduction of suffering caused by genetic disease and in an improvement of the quality of life of families confronted with genetic disease.

Multidisciplinary collaboration in primary care: through the eyes of patients.

PubMed

Cheong, Lynn H; Armour, Carol L; Bosnic-Anticevich, Sinthia Z

2013-01-01

Managing chronic illness is highly complex and the pathways to access health care for the patient are unpredictable and often unknown. While multidisciplinary care (MDC) arrangements are promoted in the Australian primary health care system, there is a paucity of research on multidisciplinary collaboration from patients' perspectives. This exploratory study is the first to gain an understanding of the experiences, perceptions, attitudes and potential role of people with chronic illness (asthma) on the delivery of MDC in the Australian primary health care setting. In-depth semi-structured interviews were conducted with asthma patients from Sydney, Australia. Qualitative analysis of data indicates that patients are significant players in MDC and their perceptions of their chronic condition, perceived roles of health care professionals, and expectations of health care delivery, influence their participation and attitudes towards multidisciplinary services. Our research shows the challenges presented by patients in the delivery and establishment of multidisciplinary health care teams, and highlights the need to consider patients' perspectives in the development of MDC models in primary care.

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.

Multidisciplinary Design Optimization Techniques: Implications and Opportunities for Fluid Dynamics Research

NASA Technical Reports Server (NTRS)

Zang, Thomas A.; Green, Lawrence L.

1999-01-01

A challenge for the fluid dynamics community is to adapt to and exploit the trend towards greater multidisciplinary focus in research and technology. The past decade has witnessed substantial growth in the research field of Multidisciplinary Design Optimization (MDO). MDO is a methodology for the design of complex engineering systems and subsystems that coherently exploits the synergism of mutually interacting phenomena. As evidenced by the papers, which appear in the biannual AIAA/USAF/NASA/ISSMO Symposia on Multidisciplinary Analysis and Optimization, the MDO technical community focuses on vehicle and system design issues. This paper provides an overview of the MDO technology field from a fluid dynamics perspective, giving emphasis to suggestions of specific applications of recent MDO technologies that can enhance fluid dynamics research itself across the spectrum, from basic flow physics to full configuration aerodynamics.

Multidisciplinary care of craniosynostosis

PubMed Central

Buchanan, Edward P; Xue, Yunfeng; Xue, Amy S; Olshinka, Asaf; Lam, Sandi

2017-01-01

The management of craniosynostosis, especially in the setting of craniofacial syndromes, is ideally done in a multidisciplinary clinic with a team focused toward comprehensive care. Craniosynostosis is a congenital disorder of the cranium, caused by the premature fusion of one or more cranial sutures. This fusion results in abnormal cranial growth due to the inability of the involved sutures to accommodate the growing brain. Skull growth occurs only at the patent sutures, resulting in an abnormal head shape. If cranial growth is severely restricted, as seen in multisuture craniosynostosis, elevation in intracranial pressure can occur. Whereas most patients treated in a multidisciplinary craniofacial clinic have non-syndromic or isolated craniosynostosis, the most challenging patients are those with syndromic craniosynostosis. The purpose of this article was to discuss the multidisciplinary team care required to treat both syndromic and non-syndromic craniosynostosis. PMID:28740400

Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management.

PubMed

Ellis, Michael J; Cordingley, Dean; Girardin, Richard; Ritchie, Lesley; Johnston, Janine

The evaluation and management of athletes presenting with clinical features of migraine headache with aura in the setting of sports-related head trauma is challenging. We present a case report of a 15-yr-old boy with a history of migraine with visual aura that developed acute visual disturbance and headache after a head injury during an ice hockey game. The patient underwent comprehensive assessment at a multidisciplinary concussion program, including neuro-ophthalmological examination, neurocognitive testing, and graded aerobic treadmill testing. Clinical history and multidisciplinary assessment was consistent with the diagnosis of coexisting sports-related concussion and migraine with brainstem aura. The authors discuss the pearls and pitfalls of managing patients who develop migraine headache with visual aura after sports-related head injury and the value of a comprehensive multidisciplinary approach to this unique patient population.

Challenges and Experiences of Building Multidisciplinary Datasets across Cultures

NASA Astrophysics Data System (ADS)

Jamiyansharav, K.; Laituri, M.; Fernandez-Gimenez, M.; Fassnacht, S. R.; Venable, N. B. H.; Allegretti, A. M.; Reid, R.; Baival, B.; Jamsranjav, C.; Ulambayar, T.; Linn, S.; Angerer, J.

2017-12-01

Efficient data sharing and management are key challenges to multidisciplinary scientific research. These challenges are further complicated by adding a multicultural component. We address the construction of a complex database for social-ecological analysis in Mongolia. Funded by the National Science Foundation (NSF) Dynamics of Coupled Natural and Human (CNH) Systems, the Mongolian Rangelands and Resilience (MOR2) project focuses on the vulnerability of Mongolian pastoral systems to climate change and adaptive capacity. The MOR2 study spans over three years of fieldwork in 36 paired districts (Soum) from 18 provinces (Aimag) of Mongolia that covers steppe, mountain forest steppe, desert steppe and eastern steppe ecological zones. Our project team is composed of hydrologists, social scientists, geographers, and ecologists. The MOR2 database includes multiple ecological, social, meteorological, geospatial and hydrological datasets, as well as archives of original data and survey in multiple formats. Managing this complex database requires significant organizational skills, attention to detail and ability to communicate within collective team members from diverse disciplines and across multiple institutions in the US and Mongolia. We describe the database's rich content, organization, structure and complexity. We discuss lessons learned, best practices and recommendations for complex database management, sharing, and archiving in creating a cross-cultural and multi-disciplinary database.

Saigas on the brink: Multidisciplinary analysis of the factors influencing mass mortality events

PubMed Central

Kock, Richard A.; Orynbayev, Mukhit; Robinson, Sarah; Zuther, Steffen; Singh, Navinder J.; Beauvais, Wendy; Morgan, Eric R.; Kerimbayev, Aslan; Khomenko, Sergei; Martineau, Henny M.; Rystaeva, Rashida; Omarova, Zamira; Wolfs, Sara; Hawotte, Florent; Radoux, Julien; Milner-Gulland, Eleanor J.

2018-01-01

In 2015, more than 200,000 saiga antelopes died in 3 weeks in central Kazakhstan. The proximate cause of death is confirmed as hemorrhagic septicemia caused by the bacterium Pasteurella multocida type B, based on multiple strands of evidence. Statistical modeling suggests that there was unusually high relative humidity and temperature in the days leading up to the mortality event; temperature and humidity anomalies were also observed in two previous similar events in the same region. The modeled influence of environmental covariates is consistent with known drivers of hemorrhagic septicemia. Given the saiga population’s vulnerability to mass mortality and the likely exacerbation of climate-related and environmental stressors in the future, management of risks to population viability such as poaching and viral livestock disease is urgently needed, as well as robust ongoing veterinary surveillance. A multidisciplinary approach is needed to research mass mortality events under rapid environmental change. PMID:29376120

NASA Multidisciplinary Design and Analysis Fellowship Program

NASA Technical Reports Server (NTRS)

Schrage, D. P.; Craig, J. I.; Mavris, D. N.; Hale, M. A.; DeLaurentis, D.

1999-01-01

This report summarizes the results of a multi-year training grant for the development and implementation of a Multidisciplinary Design and Analysis (MDA) Fellowship Program at Georgia Tech. The Program funded the creation of graduate MS and PhD degree programs in aerospace systems design, analysis and integration. It also provided prestigious Fellowships with associated Industry Internships for outstanding engineering students. The graduate program has become the foundation for a vigorous and productive research effort and has produced: 20 MS degrees, 7 Ph.D. degrees, and has contributed to 9 ongoing Ph.D. students. The results of the research are documented in 32 publications (23 of which are included on a companion CDROM) and 4 annual student design reports (included on a companion CDROM). The legacy of this critical funding is the Center for Aerospace Systems Analysis at Georgia Tech which is continuing the graduate program, the research, and the industry internships established by this grant.

Low-frequency seismic events in a wider volcanological context

NASA Astrophysics Data System (ADS)

Neuberg, J. W.; Collombet, M.

2006-12-01

Low-frequency seismic events have been in the centre of attention for several years, particularly on volcanoes with highly viscous magmas. The ultimate aim is to detect changes in volcanic activity by identifying changes in the seismic behaviour in order to forecast an eruption, or in case of an ongoing eruption, forecast the short and longterm behaviour of the volcanic system. A major boost in recent years arose through several attempts of multi-parameter volcanic monitoring and modelling programs, which allowed multi-disciplinary groups of volcanologists to interpret seismic signals together with, e.g. ground deformation, stress field analysis and petrological information. This talk will give several examples of such multi-disciplinary projects, focussing on the joint modelling of seismic source processes for low-frequency events together with advanced magma flow models, and the signs of magma movement in the deformation and stress field at the surface.

Integrated aerodynamic-structural design of a forward-swept transport wing

NASA Technical Reports Server (NTRS)

Haftka, Raphael T.; Grossman, Bernard; Kao, Pi-Jen; Polen, David M.; Sobieszczanski-Sobieski, Jaroslaw

1989-01-01

The introduction of composite materials is having a profound effect on aircraft design. Since these materials permit the designer to tailor material properties to improve structural, aerodynamic and acoustic performance, they require an integrated multidisciplinary design process. Futhermore, because of the complexity of the design process, numerical optimization methods are required. The utilization of integrated multidisciplinary design procedures for improving aircraft design is not currently feasible because of software coordination problems and the enormous computational burden. Even with the expected rapid growth of supercomputers and parallel architectures, these tasks will not be practical without the development of efficient methods for cross-disciplinary sensitivities and efficient optimization procedures. The present research is part of an on-going effort which is focused on the processes of simultaneous aerodynamic and structural wing design as a prototype for design integration. A sequence of integrated wing design procedures has been developed in order to investigate various aspects of the design process.

Universal Design for Learning: Meeting the Needs of All Students. In the Curriculum--Multidisciplinary

ERIC Educational Resources Information Center

Howard, Kirsten Lee

2004-01-01

For learning to take place, the material must be challenging enough to engage students' interest, but not so challenging that they become frustrated and give up. This article discusses one teacher's challenge to figure out how to make this teaching method a reality in a classroom of 21 diverse first graders with many different learning styles,…

Initial Management of Disorders of Sex Development in Newborns.

PubMed

McNamara, Erin R; Swartz, Jonathan M; Diamond, David A

2017-03-01

Disorders of sex development are challenging to evaluate and diagnose in the newborn. As pediatric urologists, our goals are to (1) identify patients who should be evaluated; (2) rule out life-threatening syndromes; and (3) involve a multidisciplinary team for evaluation, diagnosis, and gender assignment. This review briefly goes over the newborn differential diagnosis in disorders of sex development, highlights the important laboratory and imaging data needed, and discusses the multidisciplinary approach to gender assignment and care of these patients. Early involvement of the family in decision-making with the multidisciplinary team is paramount to a timely evaluation and diagnosis in these patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Proposal of a model for multidisciplinary treatment program of chronic migraine with medication overuse: preliminary study.

PubMed

Grazzi, L; Prunesti, A; Bussone, G

2015-05-01

The treatment of patients with chronic migraine associated with medication overuse is challenging in clinical practice; different strategies of treatment have been recently developed, multidisciplinary treatment approaches have been developed in academic headache centers. Education and support of patients are necessary to improve patients' adherence to pharmacological treatments as well as to non-pharmacological therapies. This study reports a clinical experience conducted at our Headache center with a group of female patients, suffering from chronic migraine complicated by medication overuse, treated by a multidisciplinary approach and followed for a period of 1 year after withdrawal. Results confirm the efficacy of a multifaceted treatment to manage this problematic category of patients.

Plastic Drill Bits

ERIC Educational Resources Information Center

Roman, Harry T.

2013-01-01

This article encourages students to think multidimensionally and in a multidisciplinary fashion with this challenge, and choose a team that can support this kind of thinking. Presented is a challenge in which a major home improvement company makes tools and accessories for use by experienced and new homeowners. This company would like to provide…

Sustainability of groundwater supplies in the Northern Atlantic Coastal Plain aquifer system

USGS Publications Warehouse

Masterson, John P.; Pope, Jason P.

2016-08-31

The U.S. Geological Survey (USGS) is conducting large-scale multidisciplinary regional studies of groundwater availability as part of its ongoing assessments of the principal aquifers of the Nation. These regional studies are intended to provide citizens, communities, and natural resource managers with knowledge of the status of the Nation’s groundwater resources and how changes in land use, water use, and climate have affected and are likely to affect those resources now and in the future.

Promoting hand hygiene and prudent use of antimicrobials in long-term care facilities.

PubMed

Rummukainen, Maija; Jakobsson, Aino; Karppi, Pertti; Kautiainen, Hannu; Lyytikäinen, Outi

2009-03-01

A multidisciplinary team visited all long-term care facilities (n = 123) for elderly persons in the Central Finland health care district (population, 265,000) during 2004-2005. Use of alcohol-based hand rubs and ongoing systematic antimicrobials were assessed. Thereafter, regional guidelines for prudent use of antimicrobials were published. One year after the visits, a significant increase in the mean amount of alcohol-based hand rubs used was detected while usage of antimicrobials for the prevention of urinary tract reinfections had decreased.

Geochemical survey maps of the wildernesses and roadless areas in the White Mountains National Forest, Coos, Grafton, and Carroll counties, New Hampshire

USGS Publications Warehouse

Canney, F.C.; Howd, F.H.; Domenico, J.A.; Nakagawa, H.M.

1987-01-01

This map is based on joint investigations by the U.S. Geological Survey and the Office of the State Geologists of New Hampshire. The geochemical survey was conducted in the summer of 1980 and was integrated with an on-going multidisciplinary study of mineral resources of the Sherbrooke and Lewiston 1°x2° quadrangles under the Conterminous United States Mineral Assessment Program (CUSMAP).

Endemic zoonoses in the tropics: a public health problem hiding in plain sight.

PubMed

Halliday, Jo E B; Allan, Kathryn J; Ekwem, Divine; Cleaveland, Sarah; Kazwala, Rudovick R; Crump, John A

2015-02-28

Zoonotic diseases are a significant burden on animal and human health, particularly in developing countries. Despite recognition of this fact, endemic zoonoses often remain undiagnosed in people, instead being mistaken for febrile diseases such as malaria. Here, as part of Veterinary Record's ongoing series of articles on One Health, a multidisciplinary team of researchers from Scotland, Tanzania and New Zealand argues that a One Health approach is needed to effectively combat these diseases. British Veterinary Association.

Learning mechanisms in multidisciplinary teamwork with real customers and open-ended problems

NASA Astrophysics Data System (ADS)

Heikkinen, Juho; Isomöttönen, Ville

2015-11-01

Recently, there has been a trend towards adding a multidisciplinary or multicultural element to traditional monodisciplinary project courses in computing and engineering. In this article, we examine the implications of multidisciplinarity for students' learning experiences during a one-semester project course for real customers. We use a qualitative research approach and base our analysis on students' learning reports on three instances of a project course titled Multidisciplinary working life project. The main contribution of this article is the unified theoretical picture of the learning mechanisms stemming from multidisciplinarity. Our main conclusions are that (1) students generally have a positive view of multidisciplinarity; (2) multidisciplinary teams enable students to better identify their own expertise, which leads to increased occupational identity; and (3) learning experiences are not fixed, as team spirit and student attitude play an important role in how students react to challenging situations arising from introduction of the multidisciplinarity.

Towards multi-disciplinary HIV cure research: integrating social science with biomedical research

PubMed Central

Grossman, Cynthia I; Ross, Anna Laura; Auerbach, Judith D.; Ananworanich, Jintanat; Dubé, Karine; Tucker, Joseph D.; Noseda, Veronica; Possas, Cristina; Rausch, Dianne

2015-01-01

The quest for a cure for HIV remains a timely and key challenge for the HIV research community. Despite significant scientific advances, current HIV therapy regimens do not completely eliminate the negative impact of HIV on the immune system; and the economic impact of treating all people infected with HIV globally, for the duration of their lifetimes, presents significant challenges. This article discusses, from a multi-disciplinary approach, critical social, behavioral, ethical, and economic issues permeating the HIV cure research agenda. As part of a search for an HIV cure, both the perspective of patients/participants and clinical researchers should be taken into account. In addition, continued efforts should be made to involve and educate the broader community. PMID:26642901

Solar powered rotorcraft: a multidisciplinary engineering challenge for undergraduate students

NASA Astrophysics Data System (ADS)

Danner, Aaron J.; Henz, Martin; Teo, Brian Shohei

2017-08-01

Controlled, fully solar-powered flight in a rotorcraft is a difficult engineering challenge. Over the past five years, multidiciplinary teams of undergraduate engineering students at the National University of Singapore have built and test-flown a succession of increasingly impressive and larger, more efficient aircraft. While many other multidisciplinary or purely photonics projects are available to students in our programme, this particular project attracts an unusual level of excitement and devotion among students working on it. Why is that the case, and what, in general, makes a good final year undergraduate design project? These questions will be explored. Additionally, videos of solar helicopter test flights and spectacular crashes will be shown in the presentation for which the proceedings below have been prepared.

Towards Multidisciplinary HIV-Cure Research: Integrating Social Science with Biomedical Research.

PubMed

Grossman, Cynthia I; Ross, Anna Laura; Auerbach, Judith D; Ananworanich, Jintanat; Dubé, Karine; Tucker, Joseph D; Noseda, Veronica; Possas, Cristina; Rausch, Dianne M

2016-01-01

The quest for a cure for HIV remains a timely and key challenge for the HIV research community. Despite significant scientific advances, current HIV therapy regimens do not completely eliminate the negative impact of HIV on the immune system; and the economic impact of treating all people infected with HIV globally, for the duration of their lifetimes, presents significant challenges. This article discusses, from a multidisciplinary approach, critical social, behavioral, ethical, and economic issues permeating the HIV-cure research agenda. As part of a search for an HIV cure, both the perspective of patients/participants and clinical researchers should be taken into account. In addition, continued efforts should be made to involve and educate the broader community. Published by Elsevier Ltd.

Starry Cities and Astrolies - Books to communicate with the public

NASA Astrophysics Data System (ADS)

Stanic, N.

2008-06-01

Extragalactic worlds have been presented as star cities in a book of original design - STARRY CITIES - galaxies and time travel, the first book about galaxies written in Serbian for the general public. This book isn't written just for those interested in science, but for all kind of artists, philosophers and thinkers. A second book, ASTROLIES deals with common confusions concerning astronomy and astrology. These two books don't only offer interesting illustrations, data from the latest astronomical observations and currently accepted cosmological theories - they induce, by provoking curiosity in a specific and witty way, a sense of adventure and a challenge to explore. The publisher of both books is the oldest and the biggest publisher of text-books in Serbia, Zavod za udzbenike i nastavna sredstva2, currently celebrating 50 years in publishing (1957-2007). They already publish a dozen books in popular astronomy, but a special astronomical series for the general public was introduced in 2004. STARRY CITIES and ASTROLIES are part of the ongoing multidisciplinary project Astronomy. Inspiration. Art that started at the end of 2004 at the Public Observatory in Belgrade. This project intends to inspire (or perhaps even "infect") artists with cosmic themes and the fantastic scenery of the Universe.

Simulations & Measurements of Airframe Noise: A BANC Workshops Perspective

NASA Technical Reports Server (NTRS)

Choudhari, Meelan; Lockard, David

2016-01-01

Airframe noise corresponds to the acoustic radiation due to turbulent flow in the vicinity of airframe components such as high-lift devices and landing gears. Since 2010, the American Institute of Aeronautics and Astronautics has organized an ongoing series of workshops devoted to Benchmark Problems for Airframe Noise Computations (BANC). The BANC workshops are aimed at enabling a systematic progress in the understanding and high-fidelity predictions of airframe noise via collaborative investigations that integrate computational fluid dynamics, computational aeroacoustics, and in depth measurements targeting a selected set of canonical yet realistic configurations that advance the current state-of-the-art in multiple respects. Unique features of the BANC Workshops include: intrinsically multi-disciplinary focus involving both fluid dynamics and aeroacoustics, holistic rather than predictive emphasis, concurrent, long term evolution of experiments and simulations with a powerful interplay between the two, and strongly integrative nature by virtue of multi-team, multi-facility, multiple-entry measurements. This paper illustrates these features in the context of the BANC problem categories and outlines some of the challenges involved and how they were addressed. A brief summary of the BANC effort, including its technical objectives, strategy, and selective outcomes thus far is also included.

Growing our own: building a native research team.

PubMed

Gray, Jacqueline S; Carter, Paula M

2012-01-01

In 2006, American Indian/Alaska Natives (AI/AN) made up less than 1% of the science, engineering and health doctorates in the U.S. Early introduction of AI/AN students to research and continued opportunities are necessary to develop successful AI/AN researchers who can better serve their communities. This team was developed to form a cohort of American Indian students, staff and faculty interested in research and becoming researchers. Since implementation, the program grew from one student to over 20 AI students ranging from freshmen just entering college to doctoral students working to complete their dissertations. This article highlights the team growth, increasing structure, student needs and the faculty and staff involved. It further addresses the support and educational aspects of growing an ongoing, multidisciplinary research team committed to ethical research in Native communities. The team addresses substance use prevalence, the relationship of substance abuse to other mental health diagnoses, and treatment issues. The team includes weekly team meetings, a Blackboard site on the Internet that is populated with resources and focused on sharing materials and information, a weekly journal club discussion of research articles, and collaborative discussions on each project and the barriers and challenges that need to be addressed to move forward.

Butterfly genomics eclosing.

PubMed

Beldade, P; McMillan, W O; Papanicolaou, A

2008-02-01

Technological and conceptual advances of the last decade have led to an explosion of genomic data and the emergence of new research avenues. Evolutionary and ecological functional genomics, with its focus on the genes that affect ecological success and adaptation in natural populations, benefits immensely from a phylogenetically widespread sampling of biological patterns and processes. Among those organisms outside established model systems, butterflies offer exceptional opportunities for multidisciplinary research on the processes generating and maintaining variation in ecologically relevant traits. Here we highlight research on wing color pattern variation in two groups of Nymphalid butterflies, the African species Bicyclus anynana (subfamily Satyrinae) and species of the South American genus Heliconius (subfamily Heliconiinae), which are emerging as important systems for studying the nature and origins of functional diversity. Growing genomic resources including genomic and cDNA libraries, dense genetic maps, high-density gene arrays, and genetic transformation techniques are extending current gene mapping and expression profiling analysis and enabling the next generation of research questions linking genes, development, form, and fitness. Efforts to develop such resources in Bicyclus and Heliconius underscore the general challenges facing the larger research community and highlight the need for a community-wide effort to extend ongoing functional genomic research on butterflies.

Attrition and erosion: restorative planning and performance.

PubMed

Burrow, Michael F

2012-04-01

The number of patients presenting with severe attrition and associated erosion is increasing in frequency. Treatment of this patient group is very challenging as it is simply not just a case of replacing lost tooth tissue, but also trying to identify and then eliminate the aetiological factors responsible for the loss of tooth structure. In most cases restorative treatment involves extensive rehabilitation of the dentition to restore the aesthetics and function and also to prevent further tooth loss. Such treatment often involves a multidisciplinary approach to eliminate and/or reduce causative factors prior to definitive restoration of teeth. Treatment needs to focus on quick intervention when the problem has been identified and diagnosed. Restorative treatment involves careful if not complex planning culminating in the establishment of a well defined and ongoing maintenance plan. Long-term success of treatment is centred on the maintenance phase. Current restorative options include the use of extensive resin composite build-ups. This is often the best initial starting point as it allows for adjustments, as well as being a reversible and more conservative procedure. The use of indirect restorations is likely to provide a longer lasting outcome after initial stabilization, whether it is metal- or ceramic-based or a combination.

Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases: Current Evidence and Future Perspectives.

PubMed

Lindhardsen, Jesper; Kristensen, Søren Lund; Ahlehoff, Ole

2016-02-01

An increased risk of cardiovascular disease (CVD) has been observed in a range of chronic inflammatory diseases (CID), including rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases (IBD), and systemic lupus erythematosus (SLE). The increased risk of CVDs and reduced life expectancy in these conditions has stimulated considerable research and started an ongoing discussion on the need for a multidisciplinary approach and dedicated guidelines on CVD prevention in these patients. In addition, the possibility of inhibiting inflammation as a means to preventing CVD in these patients has gained considerable interest in recent years. We briefly summarize the current level of evidence of the association between CIDs and CVD and cardiovascular risk management recommendations. Perspectives of ongoing and planned trials are discussed in consideration of potential ways to improve primary and secondary CVD prevention in patients with CID.

The hemodialysis patient: object of diagnosis or part of the treatment team?

PubMed

Burnell, M S

1997-04-01

Through multidisciplinary diagnosis, the end-stage renal disease (ESRD) treatment team defines the patients's problems and sets goals to reach positive outcomes. Each of the team members has a voice in recommending strategies to reach these goals, because each has been trained in appropriate treatment objectives. Patient noncompliance (nonadherence) with team recommendations can be a major, ongoing problem for the team. The untrained, unhealthy, and often unconsulted amateur member of the team is the patient who is asked to carry out the team plan. Where is the patient's place on the team? There is no doubt that the patient can enhance the planning and development of the treatment objectives. But is the patient's presence seen as a hindrance to planning? More consideration needs to be given to this ongoing issue in an effort to achieve successful patient-oriented outcomes.

Geoinformatics: Transforming data to knowledge for geosciences

USGS Publications Warehouse

Sinha, A.K.; Malik, Z.; Rezgui, A.; Barnes, C.G.; Lin, K.; Heiken, G.; Thomas, W.A.; Gundersen, L.C.; Raskin, R.; Jackson, I.; Fox, P.; McGuinness, D.; Seber, D.; Zimmerman, H.

2010-01-01

An integrative view of Earth as a system, based on multidisciplinary data, has become one of the most compelling reasons for research and education in the geosciences. It is now necessary to establish a modern infrastructure that can support the transformation of data to knowledge. Such an information infrastructure for geosciences is contained within the emerging science of geoinformatics, which seeks to promote the utilizetion and integration of complex, multidisciplinary data in seeking solutions to geosciencebased societal challenges.

EPOS: Integrating seismological Research Infrastructures within Europe

NASA Astrophysics Data System (ADS)

Eck Van, Torild; Clinton, John; Haslinger, Florian; Michelini, Alberto

2013-04-01

Seismological data, products and models are currently produced in Europe within individual countries or research organizations, and with the contribution of coordinating organizations like ORFEUS and EMSC. In spite of these partly scattered resources, significant scientific results are obtained, excellent monitoring and information systems are operational and a huge amount of research quality data is being archived and disseminated. The seismological community, however, realizes that an effective European-scale integration of seismological and related geophysical data, products and models, combined with broad and easy access, is needed to facilitate future top level geoscience, for example, to appropriately harness the technological advancements enabling large scale and near-real time data processing. Here we present the technical concepts and developments within European seismology that will build the next generation of integrated services. Within the EPOS initiative and a number of related projects, where seismology infrastructure and IT developments are merging, in depth discussions are on-going on how to realize an effective integration. Concepts and visions addressing the obviously complex challenges resulting from the current highly distributed facilities and resources in Europe are emerging and are already partly being implemented. We will provide an overview of developments within key EU projects (NERA, VERCE, COOPEUS, EUDAT, REAKT, COMMIT, etc) and demonstrate how these are in coherence with EPOS and other on-going global initiatives. Within seismology current focus is on addressing IT related challenges to a) organize distributed data archives, develop metadata attributes for improved data searching, specifically including quality indicators, and define products from data and/or models, and b) define and create(on-line) monitoring, data access and processing tools. While developments to meet those challenges originate partly from within the community itself, it is important to harvest relevant ideas and tools from other scientific communities dealing with similar issues. We will present a short summary of those developments and how they fit within the proposed visions and concepts. These integration developments address a wide framework of seismological services that include: basic seismological data services (waveform data from velocity and acceleration sensors from land and underwater sites); seismological data products (source mechanism and process estimates, earthquake catalogues, structural and tomography model estimations); seismological models (synthetic waveforms, earth and earthquake source models, hazard models).Our aim is to build significantlyimproved seismological services and valuable products for multidisciplinary earth science research.

Scaling up interventions to achieve global tuberculosis control: progress and new developments.

PubMed

Raviglione, Mario; Marais, Ben; Floyd, Katherine; Lönnroth, Knut; Getahun, Haileyesus; Migliori, Giovanni B; Harries, Anthony D; Nunn, Paul; Lienhardt, Christian; Graham, Steve; Chakaya, Jeremiah; Weyer, Karin; Cole, Stewart; Kaufmann, Stefan H E; Zumla, Alimuddin

2012-05-19

Tuberculosis is still one of the most important causes of death worldwide. The 2010 Lancet tuberculosis series provided a comprehensive overview of global control efforts and challenges. In this update we review recent progress. With improved control efforts, the world and most regions are on track to achieve the Millennium Development Goal of decreasing tuberculosis incidence by 2015, and the Stop TB Partnership target of halving 1990 mortality rates by 2015; the exception is Africa. Despite these advances, full scale-up of tuberculosis and HIV collaborative activities remains challenging and emerging drug-resistant tuberculosis is a major threat. Recognition of the effect that non-communicable diseases--such as smoking-related lung disease, diet-related diabetes mellitus, and alcohol and drug misuse--have on individual vulnerability, as well as the contribution of poor living conditions to community vulnerability, shows the need for multidisciplinary approaches. Several new diagnostic tests are being introduced in endemic countries and for the first time in 40 years a coordinated portfolio of promising new tuberculosis drugs exists. However, none of these advances offer easy solutions. Achievement of international tuberculosis control targets and maintenance of these gains needs optimum national health policies and services, with ongoing investment into new approaches and strategies. Despite growing funding in recent years, a serious shortfall persists. International and national financial uncertainty places gains at serious risk. Perseverance and renewed commitment are needed to achieve global control of tuberculosis, and ultimately, its elimination. Copyright © 2012 Elsevier Ltd. All rights reserved.

Global health education: a pilot in trans-disciplinary, digital instruction

PubMed Central

Wipfli, Heather; Press, David J.; Kuhn, Virginia

2013-01-01

Background The development of new global health academic programs provides unique opportunities to create innovative educational approaches within and across universities. Recent evidence suggests that digital media technologies may provide feasible and cost-effective alternatives to traditional classroom instruction; yet, many emerging global health academic programs lag behind in the utilization of modern technologies. Objective We created an inter-departmental University of Southern California (USC) collaboration to develop and implement a course focused on digital media and global health. Design Course curriculum was based on core tenants of modern education: multi-disciplinary, technologically advanced, learner-centered, and professional application of knowledge. Student and university evaluations were reviewed to qualitatively assess course satisfaction and educational outcomes. Results ‘New Media for Global Health’ ran for 18 weeks in the Spring 2012 semester with N=41 students (56.1% global health and 43.9% digital studies students). The course resulted in a number of high quality global health-related digital media products available at http://iml420.wordpress.com/. Challenges confronted at USC included administrative challenges related to co-teaching and frustration from students conditioned to a rigid system of teacher-led learning within a specific discipline. Quantitative and qualitative course evaluations reflected positive feedback for the course instructors and mixed reviews for the organization of the course. Conclusion The development of innovative educational programs in global health requires on-going experimentation and information sharing across departments and universities. Digital media technologies may have implications for future efforts to improve global health education. PMID:23643297

Global health education: a pilot in trans-disciplinary, digital instruction.

PubMed

Wipfli, Heather; Press, David J; Kuhn, Virginia

2013-05-02

The development of new global health academic programs provides unique opportunities to create innovative educational approaches within and across universities. Recent evidence suggests that digital media technologies may provide feasible and cost-effective alternatives to traditional classroom instruction; yet, many emerging global health academic programs lag behind in the utilization of modern technologies. We created an inter-departmental University of Southern California (USC) collaboration to develop and implement a course focused on digital media and global health. Course curriculum was based on core tenants of modern education: multi-disciplinary, technologically advanced, learner-centered, and professional application of knowledge. Student and university evaluations were reviewed to qualitatively assess course satisfaction and educational outcomes. 'New Media for Global Health' ran for 18 weeks in the Spring 2012 semester with N=41 students (56.1% global health and 43.9% digital studies students). The course resulted in a number of high quality global health-related digital media products available at http://iml420.wordpress.com/. Challenges confronted at USC included administrative challenges related to co-teaching and frustration from students conditioned to a rigid system of teacher-led learning within a specific discipline. Quantitative and qualitative course evaluations reflected positive feedback for the course instructors and mixed reviews for the organization of the course. The development of innovative educational programs in global health requires on-going experimentation and information sharing across departments and universities. Digital media technologies may have implications for future efforts to improve global health education.

Engineered nanomaterial risk. Lessons learnt from completed nanotoxicology studies: potential solutions to current and future challenges.

PubMed

Johnston, Helinor; Pojana, Giulio; Zuin, Stefano; Jacobsen, Nicklas Raun; Møller, Peter; Loft, Steffen; Semmler-Behnke, Manuela; McGuiness, Catherine; Balharry, Dominique; Marcomini, Antonio; Wallin, Håkan; Kreyling, Wolfgang; Donaldson, Ken; Tran, Lang; Stone, Vicki

2013-01-01

PARTICLE_RISK was one of the first multidisciplinary projects funded by the European Commission's Framework Programme that was responsible for evaluating the implications of nanomaterial (NM) exposure on human health. This project was the basis for this review which identifies the challenges that exist within the assessment of NM risk. We have retrospectively reflected on the findings of completed nanotoxicology studies to consider what progress and advances have been made within the risk assessment of NMs, as well as discussing the direction that nanotoxicology research is taking and identifying the limitations and failings of existing research. We have reflected on what commonly encountered challenges exist and explored how these issues may be resolved. In particular, the following is discussed (i) NM selection (ii) NM physico-chemical characterisation; (iii) NM dispersion; (iv) selection of relevant doses and concentrations; (v) identification of relevant models, target sites and endpoints; (vi) development of alternatives to animal testing; and (vii) NM risk assessment. These knowledge gaps are relatively well recognised by the scientific community and recommendations as to how they may be overcome in the future are provided. It is hoped that this will help develop better defined hypothesis driven research in the future that will enable comprehensive risk assessments to be conducted for NMs. Importantly, the nanotoxicology community has responded and adapted to advances in knowledge over recent years to improve the approaches used to assess NM hazard, exposure and risk. It is vital to learn from existing information provided by ongoing or completed studies to avoid unnecessary duplication of effort, and to offer guidance on aspects of the experimental design that should be carefully considered prior to the start of a new study.

Research Progress and Accomplishments on ISS

NASA Technical Reports Server (NTRS)

Roe, Lesa B.; Uri, John J.

2002-01-01

The first research payloads reached the International Space Station (ISS) more than two years ago, with research operating continuously since March 2001. Seven research racks are currently on-orbit, with three more arriving soon to expand science capabilities. Through the first five expeditions, 60 unique NASA-managed investigations from 11 nations have been supported, many continuing into later missions. More than 90,000 experiment hours have been completed, and more than 1,000 hours of crew time have been dedicated to research, numbers that grow daily. The multidisciplinary program includes research in life sciences, physical sciences, biotechnology, Earth sciences, technology demonstrations as well as commercial endeavors and educational activities. The Payload Operations and Integration Center monitors the onboard activities around the clock, working with numerous Principal Investigators and Payload Developers at their remote sites. Future years will see expansion of the station with research modules provided by the European Space Agency and Japan, which will be outfitted with additional research racks. The first research payloads arrived at ISS more than two years ago, and continuous science has been ongoing for more than one and a half years. During this time, the research capabilities have been tremendously increased, even as assembly of the overall platform continues. Despite significant challenges along the way, ISS continues to successfully support a large number of investigations in a variety of research disciplines. The results of some of the early investigations are reaching the publication stage. The near future looms with new challenges, but experience to date and dedicated efforts give reason to be optimistic that the challenges will be overcome and that new and greater successes will be added to past ones.

Structural Design Exploration of an Electric Powered Multi-Propulsor Wing Configuration

NASA Technical Reports Server (NTRS)

Moore, James B.; Cutright, Steve

2017-01-01

Advancements in aircraft electric propulsion may enable an expanded operational envelope for electrically powered vehicles compared to their internal combustion engine counterparts. High aspect ratio wings provide additional lift and drag reduction for a proposed multi-propulsor design, however, the challenge is to reduce the weight of wing structures while maintaining adequate structural and aeroelastic margins. Design exploration using a conventional design-and-build philosophy coupled with a finite element method (FEM)-based design of experiments (DOE) strategy are presented to examine high aspect ratio wing structures that have spanwise distributed electric motors. Multiple leading-edge-mounted engine masses presented a challenge to design a wing within acceptable limits for dynamic and aeroelastic stability. Because the first four primary bending eigenmodes of the proposed wing structure are very sensitive to outboard motor placement, safety-of-flight requirements drove the need for multiple spars, rib attachments, and outboard structural reinforcements in the design. Global aeroelasticity became an increasingly important design constraint during the on-going design process, with outboard motor pod flutter ultimately becoming a primary design constraint. Designers successively generated models to examine stress, dynamics, and aeroelasticity concurrently. This research specifically addressed satisfying multi-disciplinary design criteria to generate fluid-structure interaction solution sets, and produced high aspect ratio primary structure designs for the NASA Scalable Convergent Electric Propulsion Technology and Operations Research (SCEPTOR) project in the Aeronautic Research Mission Directorate at NASA. In this paper, a dynamics-driven, quasi-inverse design methodology is presented to address aerodynamic performance goals and structural challenges encountered for the SCEPTOR demonstrator vehicle. These results are compared with a traditional computer aided design based approach.

Challenge Based Learning: The Report from the Implementation Project

ERIC Educational Resources Information Center

Johnson, L.; Adams, S.

2011-01-01

Challenge Based Learning (CBL) is an engaging multidisciplinary approach to teaching and learning that encourages students to leverage the technology they use in their daily lives to solve real-world problems. The approach is collaborative and hands-on, asking students to work with other students, their teachers, and experts in their communities…

Surrogate assisted multidisciplinary design optimization for an all-electric GEO satellite

NASA Astrophysics Data System (ADS)

Shi, Renhe; Liu, Li; Long, Teng; Liu, Jian; Yuan, Bin

2017-09-01

State-of-the-art all-electric geostationary earth orbit (GEO) satellites use electric thrusters to execute all propulsive duties, which significantly differ from the traditional all-chemical ones in orbit-raising, station-keeping, radiation damage protection, and power budget, etc. Design optimization task of an all-electric GEO satellite is therefore a complex multidisciplinary design optimization (MDO) problem involving unique design considerations. However, solving the all-electric GEO satellite MDO problem faces big challenges in disciplinary modeling techniques and efficient optimization strategy. To address these challenges, we presents a surrogate assisted MDO framework consisting of several modules, i.e., MDO problem definition, multidisciplinary modeling, multidisciplinary analysis (MDA), and surrogate assisted optimizer. Based on the proposed framework, the all-electric GEO satellite MDO problem is formulated to minimize the total mass of the satellite system under a number of practical constraints. Then considerable efforts are spent on multidisciplinary modeling involving geosynchronous transfer, GEO station-keeping, power, thermal control, attitude control, and structure disciplines. Since orbit dynamics models and finite element structural model are computationally expensive, an adaptive response surface surrogate based optimizer is incorporated in the proposed framework to solve the satellite MDO problem with moderate computational cost, where a response surface surrogate is gradually refined to represent the computationally expensive MDA process. After optimization, the total mass of the studied GEO satellite is decreased by 185.3 kg (i.e., 7.3% of the total mass). Finally, the optimal design is further discussed to demonstrate the effectiveness of our proposed framework to cope with the all-electric GEO satellite system design optimization problems. This proposed surrogate assisted MDO framework can also provide valuable references for other all-electric spacecraft system design.

Enhanced clarity and holism: the outcome of implementing the ICF with an acute stroke multidisciplinary team in England

PubMed Central

Harries, Priscilla; Kilbride, Cherry; De Souza, Lorraine

2013-01-01

Purpose: Although it is recommended that the ICF (International Classification of Functioning, Disability and Health) should be implemented to aid communication within multidisciplinary stroke services, there is no empirical evidence to demonstrate the outcomes of such implementation. Working with one stroke service, this project aimed to address this gap and sought to evaluate the outcomes of implementing an ICF-based clinical tool into practice. Method: Using an action research framework with mixed methods, data were collected from individual interviews, a focus group, questionnaires, email communications, minutes from relevant meetings and field notes. Thematic analysis was undertaken, using immersion and crystallisation, to define overall themes. Descriptive statistics were used to analyse quantitative data. Data from both sources were combined to create key findings. Results: Three findings were determined from the data analysis. The ICF (1) fosters communication within and beyond the multidisciplinary stroke team; (2) promotes holistic thinking; and (3) helps to clarify team roles. Conclusions: The ICF enhanced clarity of communication and team roles within the acute stroke multidisciplinary team as well as with other clinicians, patients and their relatives. In addition, the ICF challenged stroke clinicians to think holistically, thereby appropriately extending their domain of concern beyond their traditional remit. Implications for Rehabilitation The ICF is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the outcomes of using it in clinical practice have yet to be fully explored. This study found that the ICF enhanced clarity of communication and team roles within an acute stroke multidisciplinary team and to others beyond the team, including clinicians, patients and their relatives. Using the ICF also challenged clinicians to think holistically about patient needs following a stroke. PMID:23530624

Enhanced clarity and holism: the outcome of implementing the ICF with an acute stroke multidisciplinary team in England.

PubMed

Tempest, Stephanie; Harries, Priscilla; Kilbride, Cherry; De Souza, Lorraine

2013-01-01

Although it is recommended that the ICF (International Classification of Functioning, Disability and Health) should be implemented to aid communication within multidisciplinary stroke services, there is no empirical evidence to demonstrate the outcomes of such implementation. Working with one stroke service, this project aimed to address this gap and sought to evaluate the outcomes of implementing an ICF-based clinical tool into practice. Using an action research framework with mixed methods, data were collected from individual interviews, a focus group, questionnaires, email communications, minutes from relevant meetings and field notes. Thematic analysis was undertaken, using immersion and crystallisation, to define overall themes. Descriptive statistics were used to analyse quantitative data. Data from both sources were combined to create key findings. Three findings were determined from the data analysis. The ICF (1) fosters communication within and beyond the multidisciplinary stroke team; (2) promotes holistic thinking; and (3) helps to clarify team roles. The ICF enhanced clarity of communication and team roles within the acute stroke multidisciplinary team as well as with other clinicians, patients and their relatives. In addition, the ICF challenged stroke clinicians to think holistically, thereby appropriately extending their domain of concern beyond their traditional remit. The ICF is a globally accepted framework to describe functioning and is in use in a variety of clinical settings. Yet, the outcomes of using it in clinical practice have yet to be fully explored. This study found that the ICF enhanced clarity of communication and team roles within an acute stroke multidisciplinary team and to others beyond the team, including clinicians, patients and their relatives. Using the ICF also challenged clinicians to think holistically about patient needs following a stroke.

Working to improve the management of sarcoma patients across Europe: a policy checklist.

PubMed

Kasper, Bernd; Lecointe-Artzner, Estelle; Wait, Suzanne; Boldon, Shannon; Wilson, Roger; Gronchi, Alessandro; Valverde, Claudia; Eriksson, Mikael; Dumont, Sarah; Drove, Nora; Kanli, Athanasia; Wartenberg, Markus

2018-04-16

The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients. This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources. Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level.

Anaesthetic management of patients with severe sepsis.

PubMed

Eissa, D; Carton, E G; Buggy, D J

2010-12-01

Severe sepsis, a syndrome characterized by systemic inflammation and acute organ dysfunction in response to infection, is a major healthcare problem affecting all age groups throughout the world. Anaesthetists play a central role in the multidisciplinary management of patients with severe sepsis from their initial deterioration at ward level, transfer to the diagnostic imaging suite, and intraoperative management for emergency surgery. The timely administration of appropriate i.v. antimicrobial therapy is a crucial step in the care of patients with severe sepsis who may require surgery to control the source of sepsis. Preoperative resuscitation, aimed at optimizing major organ perfusion, is based on judicious use of fluids, vasopressors, and inotropes. Intraoperative anaesthesia management requires careful induction and maintenance of anaesthesia, optimizing intravascular volume status, avoidance of lung injury during mechanical ventilation, and ongoing monitoring of arterial blood gases, lactate concentration, haematological and renal indices, and electrolyte levels. Postoperative care overlaps with ongoing management of the severe sepsis syndrome patient in the intensive care unit. These patients are by definition, high risk, already requiring multiple supports, and require experienced and skilful decision-making to optimize their chances of a favourable outcome. Similar to acute myocardial infarction, stroke, or acute trauma, the initial hours (golden hours) of clinical management of severe sepsis represent an important opportunity to reduce morbidity and mortality. Rapid clinical assessment, resuscitation and surgical management by a focused multidisciplinary team, and early effective antimicrobial therapy are the key components to improved patient outcome.

Implementation and Performance Issues in Collaborative Optimization

NASA Technical Reports Server (NTRS)

Braun, Robert; Gage, Peter; Kroo, Ilan; Sobieski, Ian

1996-01-01

Collaborative optimization is a multidisciplinary design architecture that is well-suited to large-scale multidisciplinary optimization problems. This paper compares this approach with other architectures, examines the details of the formulation, and some aspects of its performance. A particular version of the architecture is proposed to better accommodate the occurrence of multiple feasible regions. The use of system level inequality constraints is shown to increase the convergence rate. A series of simple test problems, demonstrated to challenge related optimization architectures, is successfully solved with collaborative optimization.

[Evaluation of an outpatient multidisciplinary Neuro-HIV clinic by the patients and referring doctors].

PubMed

Vallotton, Kevin; Métral, Mélanie; Chocron, Oury; Meuli, Reto; Alves, Deolinda; Du Pasquier, Renaud; Cavassini, Matthias

2017-04-12

The neurocognitive complaints among HIV infected patients remain frequent, and to establish their etiology can be challenging. We created in 2011 an outpatient Neuro-HIV clinical platform that takes advantage of a multidisciplinary approach with 5 specialists (neuropsychologist, neurologist, psychiatrist, infectiologist and neuroradiologist). In order to estimate its utility, we conducted two questionnaire-based interviews by phone calls with the patients and their referring physicians. Three quarters of both the patients and the physicians interviewed consider the platform useful or essential. Even though there is often no immediate treatment for cognitive disorders, the patients receive from this multidisciplinary approach a better understanding of their disease, which may help them to better cope with their anxieties in daily life.

Problem-oriented patient record model as a conceptual foundation for a multi-professional electronic patient record.

PubMed

De Clercq, Etienne

2008-09-01

It is widely accepted that the development of electronic patient records, or even of a common electronic patient record, is one possible way to improve cooperation and data communication between nurses and physicians. Yet, little has been done so far to develop a common conceptual model for both medical and nursing patient records, which is a first challenge that should be met to set up a common electronic patient record. In this paper, we describe a problem-oriented conceptual model and we show how it may suit both nursing and medical perspectives in a hospital setting. We started from existing nursing theory and from an initial model previously set up for primary care. In a hospital pilot site, a multi-disciplinary team refined this model using one large and complex clinical case (retrospective study) and nine ongoing cases (prospective study). An internal validation was performed through hospital-wide multi-professional interviews and through discussions around a graphical user interface prototype. To assess the consistency of the model, a computer engineer specified it. Finally, a Belgian expert working group performed an external assessment of the model. As a basis for a common patient record we propose a simple problem-oriented conceptual model with two levels of meta-information. The model is mapped with current nursing theories and it includes the following concepts: "health care element", "health approach", "health agent", "contact", "subcontact" and "service". These concepts, their interrelationships and some practical rules for using the model are illustrated in this paper. Our results are compatible with ongoing standardization work at the Belgian and European levels. Our conceptual model is potentially a foundation for a multi-professional electronic patient record that is problem-oriented and therefore patient-centred.

Multi-disciplinary scientists as global change adaptation anchors: Filling the gaps in the Boundary Organization paradigm

NASA Astrophysics Data System (ADS)

Terando, A. J.; Collazo, J.

2017-12-01

Boundary organizations, entities that facilitate the co-production and translation of scientific research in decision making processes, have been promoted as a means to assist global change adaptation, particularly in the areas of landscape conservation and natural resource management. However, scientists can and often still must perform a similar role and act as anchoring agents within wicked adaptation problems that involve a myriad of actors, values, scientific uncertainties, governance structures, and multidisciplinary research needs. We illustrate one such case study in Puerto Rico's Bosque Modelo (Model Forest) where we discuss an ongoing scientific effort to undertake a multi-objective landscape conservation design project that intersects with the Bosque Modelo geography and goals. Perspectives are provided from two research ecologists, one with a background in terrestrial ecology who has worked at the intersection of science, conservation, and government for over 30 years, and the other with a multi-disciplinary background in earth sciences, climatology, and terrestrial ecology. We frame our discussion around the learning process that accompanies the development of global change scenarios that are both useful and useable for a wide spectrum of scientists, and the likelihood that scientifically informed adaptive management actions will ultimately be implemented in this complex and changing landscape.

A multidisciplinary three-phase approach to improve the clinical utility of patient safety indicators.

PubMed

Najjar, Peter; Kachalia, Allen; Sutherland, Tori; Beloff, Jennifer; David-Kasdan, Jo Ann; Bates, David W; Urman, Richard D

2015-01-01

The AHRQ Patient Safety Indicators (PSIs) are used for calculation of risk-adjusted postoperative rates for adverse events. The payers and quality consortiums are increasingly requiring public reporting of hospital performance on these metrics. We discuss processes designed to improve the accuracy and clinical utility of PSI reporting in practice. The study was conducted at a 793-bed tertiary care academic medical center where PSI processes have been aggressively implemented to track patient safety events at discharge. A three-phased approach to improving administrative data quality was implemented. The initiative consisted of clinical review of all PSIs, documentation improvement, and provider outreach including active querying for patient safety events. This multidisciplinary effort to develop a streamlined process for PSI calculation reduced the reporting of miscoded PSIs and increased the clinical utility of PSI monitoring. Over 4 quarters, 4 of 41 (10%) PSI-11 and 9 of 138 (7%) PSI-15 errors were identified on review of clinical documentation and appropriate adjustments were made. A multidisciplinary, phased approach leveraging existing billing infrastructure for robust metric coding, ongoing clinical review, and frontline provider outreach is a novel and effective way to reduce the reporting of false-positive outcomes and improve the clinical utility of PSIs.

Challenges of integrating evidence into health policy and planning: linking multiple disciplinary approaches.

PubMed

Huckel Schneider, Carmen; Blyth, Fiona

2017-04-27

To explore the challenges that arise through the multidisciplinary nature of evidence informed policy making (EIPM). Type of program or service: Education and practice for EIPM. This article summarises and compares four disciplinary approaches to EIPM with highly contrasting starting points: behavioural science, policy science, critical theory and intervention research. Key insights and theories are highlighted to provide a gateway into each, and to complement what is already known about the evidence needs of policy makers in terms of high-quality, timely and well-communicated research evidence. The extension of the evidence based medicine approach to EIPM has created interest in the processes of use of evidence in health policy and planning. Research in this field has spanned multiple disciplines; however, the disciplines use very different research methods and begin with different basic assumptions. Thus, despite the multidisciplinary nature of EIPM, true interdisciplinary research and action remain a challenge. We conclude with a set of key questions that can be used as a gateway to interdisciplinary EIPM in the future.

The European Project Semester at ISEP: the challenge of educating global engineers

NASA Astrophysics Data System (ADS)

Malheiro, Benedita; Silva, Manuel; Ribeiro, Maria Cristina; Guedes, Pedro; Ferreira, Paulo

2015-05-01

Current engineering education challenges require approaches that promote scientific, technical, design and complementary skills while fostering autonomy, innovation and responsibility. The European Project Semester (EPS) at Instituto Superior de Engenharia do Porto (ISEP) (EPS@ISEP) is a one semester project-based learning programme (30 European Credit Transfer Units (ECTU)) for engineering students from diverse scientific backgrounds and nationalities that intends to address these goals. The students, organised in multidisciplinary and multicultural teams, are challenged to solve real multidisciplinary problems during one semester. The EPS package, although on project development (20 ECTU), includes a series of complementary seminars aimed at fostering soft, project-related and engineering transversal skills (10 ECTU). Hence, the students enrolled in this programme improve their transversal skills and learn, together and with the team of supervisors, subjects distinct from their core training. This paper presents the structure, implementation and results of the EPS@ISEP that was created in 2011 to apply the best engineering practices and promote internationalisation and engineering education innovation at ISEP.

Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research.

PubMed

Javadi, Dena; Tran, Nhan; Ghaffar, Abdul

2018-05-24

The era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system-oriented fields such as health policy and systems research (HPSR) and health services research must be forward-thinking in optimizing their collective ability to address these global challenges. The objective of this commentary was to share reflections on challenges and strategies in managing the HPSR workforce in order to stimulate dialogue and cross-learning across similar fields. The following strategies are discussed here: definitional clarity of expected competencies and coordination across HPS researchers, national investment in HPSR, institutional capacity for coproduction of knowledge across different types of actors, and participatory leadership. Creative approaches in training, financing, developing, and leading the diverse workforce required to strengthen health systems can pave the way for its full-time and part-time members to work together. © Health Research and Educational Trust.

Putting the Challenge of Achieving International Education Goals into Context: An Examination of the Institutional Determinants of Educational Attainment

ERIC Educational Resources Information Center

Miller, Karyn E.

2016-01-01

This study provides a multidisciplinary approach to understanding the challenge of achieving international educational goals by examining the political, economic, and cultural forces working to expand education globally. I analyze the effect of domestic and global institutions, specifically democracy, global economic integration, and receipt of…

Myositis in the head and neck: challenges in diagnosis and management.

PubMed

Ratansi, R; Fabbroni, G; Kanatas, A

2017-09-01

Myositis in the head and neck may present with non-specific symptoms, and radiographically may mimic malignancy. Multidisciplinary management is often essential, and we describe the challenges in an effort to raise awareness of the condition. Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Climate Change Communication by a Research Institute: Experiences, Successes, and Challenges from a North European Perspective

ERIC Educational Resources Information Center

Lyytimäki, Jari; Nygrén, Nina A.; Ala-Ketola, Ulla; Pellinen, Sirpa; Ruohomäki, Virpi; Inkinen, Aino

2013-01-01

Communicating about climate change is challenging not only because of the multidisciplinary and complex nature of the issue itself and multiple policy options related to mitigation and adaptation, but also because of the plenitude of potential communication methods coupled with limited resources for communication. This article explores climate…

Pragmatic trial of a multidisciplinary lung cancer care model in a community healthcare setting: study design, implementation evaluation, and baseline clinical results

PubMed Central

Smeltzer, Matthew P.; Rugless, Fedoria E.; Jackson, Bianca M.; Berryman, Courtney L.; Faris, Nicholas R.; Ray, Meredith A.; Meadows, Meghan; Patel, Anita A.; Roark, Kristina S.; Kedia, Satish K.; DeBon, Margaret M.; Crossley, Fayre J.; Oliver, Georgia; McHugh, Laura M.; Hastings, Willeen; Osborne, Orion; Osborne, Jackie; Ill, Toni; Ill, Mark; Jones, Wynett; Lee, Hyo K.; Signore, Raymond S.; Fox, Roy C.; Li, Jingshan; Robbins, Edward T.; Ward, Kenneth D.; Klesges, Lisa M.

2018-01-01

Background Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary vs. serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic. Methods We used a mixed-methods approach to conduct a patient-centered, combined implementation and effectiveness study of a multidisciplinary model of lung cancer care. We established a co-located multidisciplinary clinic to study the implementation of this care-delivery model. We identified and engaged key stakeholders from the onset, used their input to develop the program structure, processes, performance benchmarks, and study endpoints (outcome-related process measures, patient- and caregiver-reported outcomes, survival). In this report, we describe the study design, process of implementation, comparative populations, and how they contrast with patients within the local and regional healthcare system. Trial Registration: ClinicalTrials.gov Identifier: NCT02123797. Results Implementation: the multidisciplinary clinic obtained an overall treatment concordance rate of 90% (target >85%). Satisfaction scores were high, with >95% of patients and caregivers rating themselves as being “very satisfied” with all aspects of care from the multidisciplinary team (patient/caregiver response rate >90%). The Reach of the multidisciplinary clinic included a higher proportion of minority patients, more women, and younger patients than the regional population. Comparative effectiveness: The comparative effectiveness trial conducted in the last phase of the study met the planned enrollment per statistical design, with 178 patients in the multidisciplinary arm and 348 in the serial care arm. The multidisciplinary cohort had older age and a higher percentage of racial minorities, with a higher proportion of stage IV patients in the serial care arm. Conclusions This study demonstrates a comprehensive implementation of a multidisciplinary model of lung cancer care, which will advance the science behind implementing this much-advocated clinical care model. PMID:29535915

The importance of multidisciplinary team management of patients with non-small-cell lung cancer

PubMed Central

Ellis, P.M.

2012-01-01

Historically, a simple approach to the treatment of non-small-cell lung cancer (nsclc) was applicable to nearly all patients. Recently, a more complex treatment algorithm has emerged, driven by both pathologic and molecular phenotype. This increasing complexity underscores the importance of a multidisciplinary team approach to the diagnosis, treatment, and supportive care of patients with nsclc. A team approach to management is important at all points: from diagnosis, through treatment, to end-of-life care. It also needs to be patient-centred and must involve the patient in decision-making concerning treatment. Multidisciplinary case conferencing is becoming an integral part of care. Early integration of palliative care into the team approach appears to contribute significantly to quality of life and potentially extends overall survival for these patients. Supportive approaches, including psychosocial and nutrition support, should be routinely incorporated into the team approach. Challenges to the implementation of multidisciplinary care require institutional commitment and support. PMID:22787414

Metabolomics and malaria biology

PubMed Central

Lakshmanan, Viswanathan; Rhee, Kyu Y.; Daily, Johanna P.

2010-01-01

Metabolomics has ushered in a novel and multi-disciplinary realm in biological research. It has provided researchers with a platform to combine powerful biochemical, statistical, computational, and bioinformatics techniques to delve into the mysteries of biology and disease. The application of metabolomics to study malaria parasites represents a major advance in our approach towards gaining a more comprehensive perspective on parasite biology and disease etiology. This review attempts to highlight some of the important aspects of the field of metabolomics, and its ongoing and potential future applications to malaria research. PMID:20970461

Diabetes Education and Support: A Must for Students With Diabetes.

PubMed

Siminerio, Linda M

2015-11-01

Ongoing diabetes self-management education and support is critical to helping youth with diabetes and their families learn about the disease, make and sustain behavioral changes, and cope with the reality of a chronic illness. Diabetes self-management education and support is best provided by a multidisciplinary team. School nurses are an important part of the student's diabetes health care team. This article highlights information and resources that school nurses can use to help support students with diabetes, their families, and other school personnel. © 2015 The Author(s).

Achieving Multidisciplinary Collaboration for the Creation of a Pulmonary Embolism Response Team: Creating a "Team of Rivals".

PubMed

Kabrhel, Christopher

2017-03-01

Pulmonary embolism response teams (PERTs) have recently been developed to streamline care for patients with life-threatening pulmonary embolism (PE). PERTs are unique among rapid response teams, in that they bring together a multidisciplinary team of specialists to care for a single disease for which there are novel treatments but few comparative data to guide treatment. The PERT model describes a process that includes activation of the team; real-time, multidisciplinary consultation; communication of treatment recommendations; mobilization of resources; and collection of research data. Interventional radiologists, along with cardiologists, emergency physicians, hematologists, pulmonary/critical care physicians, and surgeons, are core members of most PERTs. Bringing together such a wide array of experts leverages the expertise and strengths of each specialty. However, it can also lead to challenges that threaten team cohesion and cooperation. The purpose of this article is to discuss ways to integrate multiple specialists, with diverse perspectives and skills, into a cohesive PERT. The authors will discuss the purpose of forming a PERT, strengths of different PERT specialties, strategies to leverage these strengths to optimize participation and cooperation across team members, as well as unresolved challenges.

New Approaches to HSCT Multidisciplinary Design and Optimization

NASA Technical Reports Server (NTRS)

Schrage, D. P.; Craig, J. I.; Fulton, R. E.; Mistree, F.

1996-01-01

The successful development of a capable and economically viable high speed civil transport (HSCT) is perhaps one of the most challenging tasks in aeronautics for the next two decades. At its heart it is fundamentally the design of a complex engineered system that has significant societal, environmental and political impacts. As such it presents a formidable challenge to all areas of aeronautics, and it is therefore a particularly appropriate subject for research in multidisciplinary design and optimization (MDO). In fact, it is starkly clear that without the availability of powerful and versatile multidisciplinary design, analysis and optimization methods, the design, construction and operation of im HSCT simply cannot be achieved. The present research project is focused on the development and evaluation of MDO methods that, while broader and more general in scope, are particularly appropriate to the HSCT design problem. The research aims to not only develop the basic methods but also to apply them to relevant examples from the NASA HSCT R&D effort. The research involves a three year effort aimed first at the HSCT MDO problem description, next the development of the problem, and finally a solution to a significant portion of the problem.

A multidisciplinary TBI inpatient rehabilitation programme for active duty service members as part of a randomized clinical trial.

PubMed

Braverman, S E; Spector, J; Warden, D L; Wilson, B C; Ellis, T E; Bamdad, M J; Salazar, A M

1999-06-01

To design and describe an effective rehabilitation programme for use in an ongoing trial on the efficacy of multidisciplinary brain injury rehabilitation for moderately head injury military service members. Treatment arm of a randomized control trial. US military tertiary care hospital inpatient rehabilitation programme. Sixty seven active duty military with moderate to severe TBI who were randomized to the treatment arm of the protocol. Eight week rehabilitation programme combining group and individual therapies with an inpatient milieu-oriented neuropsychological focus. Group therapies included fitness, planning and organization, cognitive skills, work skills, medication, and milieu groups, and community re-entry outings. Individual therapy included neuropsychology, work therapy, occupational therapy, and speech and language pathology. Successful return to work and return to duty. At 1 year follow-up, 64 patients returned to work (96%) and 66% (44/67) returned to duty. The described rehabilitation programme demonstrates one successful effort to rehabilitate active duty military service members with TBI who have the potential to return to duty.

Multidisciplinary workshops: learning to work together.

PubMed

Fatchett, Anita; Taylor, Dawn

2013-03-01

Health and social care professional practice needs to move with the times and to respond to the ever-changing combination of health needs, economic realities and health-policy imperatives. A clear understanding of the variety of forces at play and the ability to marshal these to good effect by working in partnership with multidisciplinary colleagues and children/families is a must, not least in this time of economic austerity and ever-rising health inequalities, when vulnerable children's lives and complex family relationships and behaviours so easily become increasingly strained and challenged. This sad reality calls out for relevant joined-up solutions by all participants--an agenda so often called into question by court judgement after court judgement. The multidisciplinary workshops to be discussed have developed and changed over the past decade and provide a safe but realistic learning environment for students from health and social care backgrounds to experience the difficulties and barriers to good multidisciplinary working, to better understand others' perspectives and activities and consider and develop new and better practical strategies for working with multidisciplinary professional colleagues, children and families. All of the workshops are underpinned by specific discipline-focused theoretical work.

Multidisciplinary approaches to climate change questions

USGS Publications Warehouse

Middleton, Beth A.; LePage, Ben A.

2011-01-01

Multidisciplinary approaches are required to address the complex environmental problems of our time. Solutions to climate change problems are good examples of situations requiring complex syntheses of ideas from a vast set of disciplines including science, engineering, social science, and the humanities. Unfortunately, most ecologists have narrow training, and are not equipped to bring their environmental skills to the table with interdisciplinary teams to help solve multidisciplinary problems. To address this problem, new graduate training programs and workshops sponsored by various organizations are providing opportunities for scientists and others to learn to work together in multidisciplinary teams. Two examples of training in multidisciplinary thinking include those organized by the Santa Fe Institute and Dahlem Workshops. In addition, many interdisciplinary programs have had successes in providing insight into climate change problems including the International Panel on Climate Change, the Joint North American Carbon Program, the National Academy of Science Research Grand Challenges Initiatives, and the National Academy of Science. These programs and initiatives have had some notable success in outlining some of the problems and solutions to climate change. Scientists who can offer their specialized expertise to interdisciplinary teams will be more successful in helping to solve the complex problems related to climate change.

System Risk Assessment and Allocation in Conceptual Design

NASA Technical Reports Server (NTRS)

Mahadevan, Sankaran; Smith, Natasha L.; Zang, Thomas A. (Technical Monitor)

2003-01-01

As aerospace systems continue to evolve in addressing newer challenges in air and space transportation, there exists a heightened priority for significant improvement in system performance, cost effectiveness, reliability, and safety. Tools, which synthesize multidisciplinary integration, probabilistic analysis, and optimization, are needed to facilitate design decisions allowing trade-offs between cost and reliability. This study investigates tools for probabilistic analysis and probabilistic optimization in the multidisciplinary design of aerospace systems. A probabilistic optimization methodology is demonstrated for the low-fidelity design of a reusable launch vehicle at two levels, a global geometry design and a local tank design. Probabilistic analysis is performed on a high fidelity analysis of a Navy missile system. Furthermore, decoupling strategies are introduced to reduce the computational effort required for multidisciplinary systems with feedback coupling.

A Way Forward: Cooperative Solutions to Our Climate Challenges

NASA Astrophysics Data System (ADS)

Little, L. J.; Byrne, J. M.

2014-12-01

Solving the global climate crisis is a multidisciplinary challenge. The world is seeking solutions to climate change. The climate research and education community must move beyond the realm of debating the science - we MUST provide the solutions. The research community understands the science and many of the solutions very well. This project will address the specifics of solutions involving social, political and science disciplines. The content is targeted to multidisciplinary education at the senior undergraduate and graduate levels in universities and colleges. Humanity has already changed the climate and current greenhouse gas emission (GHG) projections indicate our world will warm 2-6° C within a young person's lifetime. We must coordinate societal mitigation and adaptation policies, programs and technology transformations. There is now a dramatic need for many, many highly trained multidisciplinary climate change solutions professionals that understand the complexities of the challenges and can work through the social, political and science tribulations needed to sustain communities around the world. This proposed education project: Provides an introduction to the social, political, technical, health and well-being challenges of climate change; Defines and describes the unprecedented changes to personal and community lifestyle, and consumption of energy and other resources; Examines ways and means for rapid transition of energy systems from fossil fuels to clean renewable technologies. Evaluates redevelopment of our infrastructure to withstand increasing weather extremes; Inventories possible abandonment and/or protection of infrastructure that cannot be redeveloped or reworked, particularly with respect to coastal zones where substantial populations currently live. We propose an online living textbook project. Chapter contributions will be invited from outstanding solutions research professionals from around the world. The online presence is the best means to facilitate a multimedia presentation of the core content of the proposed text.

New ideas in asthma and allergy research: creating a multidisciplinary graduate school

PubMed Central

Björkstén, Bengt; Graninger, Göran; Ekman, Gunilla Jacobsson

2003-01-01

The spring term of 2001 saw the start of a new, unique graduate research training program at the Centre for Allergy Research at the Karolinska Institutet in Stockholm, Sweden. The program was created to bridge the gaps between basic, clinical, social, and behavioral sciences and to establish a global approach to the study of asthma and allergy. A reflection, two years on, discusses the strategies that are key to this model’s success and the challenges in introducing a multidisciplinary research program. PMID:12975463

A survey of big data research

PubMed Central

Fang, Hua; Zhang, Zhaoyang; Wang, Chanpaul Jin; Daneshmand, Mahmoud; Wang, Chonggang; Wang, Honggang

2015-01-01

Big data create values for business and research, but pose significant challenges in terms of networking, storage, management, analytics and ethics. Multidisciplinary collaborations from engineers, computer scientists, statisticians and social scientists are needed to tackle, discover and understand big data. This survey presents an overview of big data initiatives, technologies and research in industries and academia, and discusses challenges and potential solutions. PMID:26504265

Review Article: The Role of Molecular Pathological Epidemiology in the Study of Neoplastic and Non-neoplastic Diseases in the Era of Precision Medicine.

PubMed

Ogino, Shuji; Nishihara, Reiko; VanderWeele, Tyler J; Wang, Molin; Nishi, Akihiro; Lochhead, Paul; Qian, Zhi Rong; Zhang, Xuehong; Wu, Kana; Nan, Hongmei; Yoshida, Kazuki; Milner, Danny A; Chan, Andrew T; Field, Alison E; Camargo, Carlos A; Williams, Michelle A; Giovannucci, Edward L

2016-07-01

Molecular pathology diagnostics to subclassify diseases based on pathogenesis are increasingly common in clinical translational medicine. Molecular pathological epidemiology (MPE) is an integrative transdisciplinary science based on the unique disease principle and the disease continuum theory. While it has been most commonly applied to research on breast, lung, and colorectal cancers, MPE can investigate etiologic heterogeneity in non-neoplastic diseases, such as cardiovascular diseases, obesity, diabetes mellitus, drug toxicity, and immunity-related and infectious diseases. This science can enhance causal inference by linking putative etiologic factors to specific molecular biomarkers as outcomes. Technological advances increasingly enable analyses of various -omics, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, metagenomics, microbiome, immunomics, interactomics, etc. Challenges in MPE include sample size limitations (depending on availability of biospecimens or biomedical/radiological imaging), need for rigorous validation of molecular assays and study findings, and paucities of interdisciplinary experts, education programs, international forums, and standardized guidelines. To address these challenges, there are ongoing efforts such as multidisciplinary consortium pooling projects, the International Molecular Pathological Epidemiology Meeting Series, and the Strengthening the Reporting of Observational Studies in Epidemiology-MPE guideline project. Efforts should be made to build biorepository and biobank networks, and worldwide population-based MPE databases. These activities match with the purposes of the Big Data to Knowledge (BD2K), Genetic Associations and Mechanisms in Oncology (GAME-ON), and Precision Medicine Initiatives of the United States National Institute of Health. Given advances in biotechnology, bioinformatics, and computational/systems biology, there are wide open opportunities in MPE to contribute to public health.

Improving the Quality of Care for Patients Diagnosed With Glioma During the Perioperative Period

PubMed Central

Riblet, Natalie B.V.; Schlosser, Evelyn M.; Homa, Karen; Snide, Jennifer A.; Jarvis, Lesley A.; Simmons, Nathan E.; Sargent, David H.; Mason, Linda P.; Cooney, Tobi J.; Kennedy, Nancy L.; Fadul, Camilo E.

2014-01-01

Purpose: Although there is agreement on the oncologic management of patients with glioma, few guidelines exist to standardize other aspects of care, including supportive care. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and identified 10 best-practice measures. Using a plan-do-study-act framework, the team brainstormed and implemented various improvement interventions between June 2011 and October 2012. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing measurement and reporting. Results: The retrospective assessment phase consisted of 43 patients with diagnosis of glioma. A manual medical record review for these patients showed that compliance with 10 best-practice measures ranged from 23% to 100%. Several factors contributed to less-than-ideal process performance, including poor communication among disciplines and lack of familiarity with the larger system of care. After implementing improvement interventions, performance was measured in 96 consecutive patients with glioma. The proportion of patients who met criteria for 10 practice measures significantly improved (pre-QI work, 63%; post-QI work, 85%; P = .003). The largest improvement was observed in the measure assessing for preoperative notification of the neuro-oncology program (pre-QI work, 39%; post-QI work, 97%; P < .001). Conclusion: QI principles were used by a multidisciplinary team to improve the quality of care for patients with glioma during the perioperative period. Leadership involvement, ongoing dialogue across departments, and reporting of system performance were important for sustaining process improvements. PMID:25294392

Switzerland and the Digital Health Revolution.

PubMed

Trono, Didier

2016-12-21

New technologies in life sciences are helping to revolutionize health management with the objective to move towards personalized healthcare. The Swiss Federal government is investing in multidisciplinary, countrywide initiatives such as Health 2030 to meet this challenge.

Multidisciplinary Management of Spondyloarthritis-Related Immune-Mediated Inflammatory Disease.

PubMed

Rizzello, Fernando; Olivieri, Ignazio; Armuzzi, Alessandro; Ayala, Fabio; Bettoli, Vincenzo; Bianchi, Luca; Cimino, Luca; Costanzo, Antonio; Cristaudo, Antonio; D'Angelo, Salvatore; Daperno, Marco; Fostini, Anna Chiara; Galeazzi, Mauro; Gilio, Michele; Gionchetti, Paolo; Gisondi, Paolo; Lubrano, Ennio; Marchesoni, Antonio; Offidani, Annamaria; Orlando, Ambrogio; Pugliese, Daniela; Salvarani, Carlo; Scarpa, Raffaele; Vecchi, Maurizio; Girolomoni, Giampiero

2018-04-01

Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis and uveitis. A Delphi consensus-based approach was used to identify a core set of statements. The process included development of initial questions by a steering committee, an exhaustive search of the literature using complementary approaches to identify potential statements and two Delphi voting rounds for finalization of the statements. Consensus was achieved on the related nature of IMIDs, the existence of a high prevalence of multiple IMIDs in a single patient and the fact that a multidisciplinary approach can result in a more extensive evaluation and comprehensive approach to treatment. The goals of a multidisciplinary team should be to increase diagnosis of concomitant IMIDs, improve the decision-making process, and increase patient satisfaction and adherence. Early referral and diagnosis, early recognition of concomitant IMIDs and optimizing treatment to improve patient quality of life are some of the advantages of using multidisciplinary teams. To be effective, a multidisciplinary team should be equipped with the appropriate tools for diagnosis and follow-up, and at a minimum the multidisciplinary team should include a dermatologist, gastroenterologist and rheumatologist; providing psychologic support via a psychologist and involving an ophthalmologist, general practitioners and nurses in multidisciplinary care is also important. The present Delphi consensus identified a set of overarching principles that may be useful for implementation of a multidisciplinary approach for the management of SpA-related IMIDs. Aristea and Hippocrates.

First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy

PubMed Central

Adams, David; Suhr, Ole B.; Hund, Ernst; Obici, Laura; Tournev, Ivailo; Campistol, Josep M.; Slama, Michel S.; Hazenberg, Bouke P.; Coelho, Teresa

2016-01-01

Purpose of review Early and accurate diagnosis of transthyretin familial amyloid polyneuropathy (TTR-FAP) represents one of the major challenges faced by physicians when caring for patients with idiopathic progressive neuropathy. There is little consensus in diagnostic and management approaches across Europe. Recent findings The low prevalence of TTR-FAP across Europe and the high variation in both genotype and phenotypic expression of the disease means that recognizing symptoms can be difficult outside of a specialized diagnostic environment. The resulting delay in diagnosis and the possibility of misdiagnosis can misguide clinical decision-making and negatively impact subsequent treatment approaches and outcomes. Summary This review summarizes the findings from two meetings of the European Network for TTR-FAP (ATTReuNET). This is an emerging group comprising representatives from 10 European countries with expertise in the diagnosis and management of TTR-FAP, including nine National Reference Centres. The current review presents management strategies and a consensus on the gold standard for diagnosis of TTR-FAP as well as a structured approach to ongoing multidisciplinary care for the patient. Greater communication, not just between members of an individual patient's treatment team, but also between regional and national centres of expertise, is the key to the effective management of TTR-FAP. PMID:26734952

Challenges and successes of a multidisciplinary pediatric obesity treatment program.

PubMed

Walsh, Stephanie M; Palmer, Wendy; Welsh, Jean A; Vos, Miriam B

2014-12-01

Despite the well-documented need for multidisciplinary pediatric obesity treatment programs, few programs exist and best practices are not clearly defined. We describe the design and initial quality-related outcomes of the Strong4Life multidisciplinary pediatric obesity treatment program along with some challenges and solutions implemented over the first 2 years. The purpose of this report is to inform others interested in designing similar programs. The Strong4Life Clinic obesity program was designed to provide children with the medical care, as well as the behavior change guidance and support needed to reverse their obesity and/or minimize the related health risks. This low-intensity program is designed to provide approximately 6 hours of care over 12 months from a medical provider, psychologist, registered dietitian nutritionist, exercise physiologist, and nurse. Between August 2011 and February 2014, the Strong4Life clinic served 781 high-risk (mean sex- and age-adjusted body mass index [BMI] percentile 98.8) and racially/ethnically diverse (45% non-Hispanic black and 24% Hispanic) patients. Of the 781 patients seen, 66% returned for at least 1 visit. Nearly all returning Strong4Life patients stabilized or improved their BMI (90% of those who participated <6 months, 97% of those who participated 6 to <12 months, and 92% of those who participated ≥12 months). This report describes a low-intensity multidisciplinary weight management program that is feasible. Initial assessment of the program suggests benefit in most patients who participate >6 months, but longer follow-up and assessment of comorbidities are needed. © 2014 American Society for Parenteral and Enteral Nutrition.

Multidisciplinary Treatment Approach in a Patient with History of Nasopharyngeal Carcinoma

PubMed Central

Yavuz, Atacan; Ağralı, Ömer Birkan; Çalışkan, Zeynep Lale; Türkaydın, Dilek; Sertgöz, Atilla; Doğan, Başak

2014-01-01

Radiotherapy in NPC patients has side effects on the dentition, which affects quality of life dramatically. This case report presents multidisciplinary dental treatment approach in a 17-year-old male patient with a history of nasopharyngeal carcinoma (NPC), which was treated with chemotherapy and radiotherapy. The adolescent patient applied to dental hospital 4 years after the radiotherapy with aesthetic and functional problems on dentition affecting psychological, social, and physical aspects of his life. The dentition of the patient demonstrated the severe destruction as a devastating side effect of radiotherapy. With a successful multidisciplinary approach, our patient's aesthetics, function, and self-confidence were obtained. Well-established procedures, which include preventative care and maintenance, can reduce the duration and expenses of the treatment and help in challenging the life-long complications of radiotherapy. PMID:24523971

Initial Multidisciplinary Design and Analysis Framework

NASA Technical Reports Server (NTRS)

Ozoroski, L. P.; Geiselhart, K. A.; Padula, S. L.; Li, W.; Olson, E. D.; Campbell, R. L.; Shields, E. W.; Berton, J. J.; Gray, J. S.; Jones, S. M.;

Moving Beyond Motive-based categories of Targeted Violence

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

Weine, Stevan; Cohen, John; Brannegan, David

Today’s categories for responding to targeted violence are motive-based and tend to drive policies, practices, training, media coverage, and research. These categories are based on the assumption that there are significant differences between ideological and non-ideological actors and between domestic and international actors. We question the reliance on these categories and offer an alternative way to frame the response to multiple forms of targeted violence. We propose adopting a community-based multidisciplinary approach to assess risk and provide interventions that are focused on the pre-criminal space. We describe four capabilities that should be implemented locally by establishing and maintaining multidisciplinary responsemore » teams that combine community and law-enforcement components: (1) community members are educated, making them better able to identify and report patterns associated with elevated risk for violence; (2) community-based professionals are trained to assess the risks for violent behavior posed by individuals; (3) community-based professionals learn to implement strategies that directly intervene in causal factors for those individuals who are at elevated risk; and (4) community-based professionals learn to monitor and assess an individual’s risk for violent behaviors on an ongoing basis. Community-based multidisciplinary response teams have the potential to identify and help persons in the pre-criminal space and to reduce barriers that have traditionally impeded community/law-enforcement collaboration.« less

[Long-term experience with multidisciplinary therapy of twenty-six patients with dermatofibrosarcoma protuberans].

PubMed

Mátrai, Zoltán; Liszkay, Gabriella; Plotár, Vanda; Orosz, Zsolt; Székely, Judit; Hitre, Erika; Bartal, Alexandra; Langmár, Zoltán; Bocs, Katalin; Rényi Vámos, Ferenc; Sávolt, Akos; Tóth, László

2009-10-11

Dermatofibrosarcoma protuberans is a low or moderate grade malignant, uncommon soft tissue tumor. The tumor is characterized by slow, but locally aggressive growth, low metastatic potential and high recurrence rate. Initial treatment is the radical surgical excision, using traditional wide excision or Mohs surgery. In case of positive surgical margin or local recurrence, radio-chemotherapy and recently imatinib mesylate is used as adjuvant therapy. Twenty-six patients treated multidisciplinary for dermatofibrosarcoma protuberans were followed up. Mean age of the patients was 44.7 years; mean follow-up time was 60.57 months. In fifteen cases (57.7%) R0 resection was performed, while eleven patients (42,3%) received only R1 resection. An average of 1.87 resections was necessary in order to achieve R0 resection. Six patients (23%) received adjuvant radiotherapy and two patients (7.6%) adjuvant chemotherapy following the removal of the primary tumor. Sixteen patients had no local recurrence. Ongoing treatments were needed in the case of ten patients (38.4%) who developed local recurrence. One patient has deceased due to distant metastases. Using statistical methods we examined the effects indicated as prognostic factors in the literature on local recurrence, precisely, the effect of age above 50 years and surgical radicalism. Dermatofibrosarcoma protuberans can be successfully treated with multidisciplinary therapy. A larger number of cases and randomized multicenter investigations are needed in order to reach more accurate conclusion.

Continued multidisciplinary project-based learning - implementation in health informatics.

PubMed

Wessel, C; Spreckelsen, C

2009-01-01

Problem- and project-based learning are approved methods to train students, graduates and post-graduates in scientific and other professional skills. The students are trained on realistic scenarios in a broader context. For students specializing in health informatics we introduced continued multidisciplinary project-based learning (CM-PBL) at a department of medical informatics. The training approach addresses both students of medicine and students of computer science. The students are full members of an ongoing research project and develop a project-related application or module, or explore or evaluate a sub-project. Two teachers guide and review the students' work. The training on scientific work follows a workflow with defined milestones. The team acts as peer group. By participating in the research team's work the students are trained on professional skills. A research project on a web-based information system on hospitals built the scenario for the realistic context. The research team consisted of up to 14 active members at a time, who were scientists and students of computer science and medicine. The well communicated educational approach and team policy fostered the participation of the students. Formative assessment and evaluation showed a considerable improvement of the students' skills and a high participant satisfaction. Alternative education approaches such as project-based learning empower students to acquire scientific knowledge and professional skills, especially the ability of life-long learning, multidisciplinary team work and social responsibility.

The role of multimodal treatment in patients with advanced lung neuroendocrine tumors

PubMed Central

Ungaro, Antonio; Spada, Francesca; Cella, Chiara Alessandra; Pisa, Eleonora; Barberis, Massimo; Grana, Chiara; Zerini, Dario; Bertani, Emilio; Ribero, Dario; Funicelli, Luigi; Bonomo, Guido; Ravizza, Davide; Guarize, Juliana; De Marinis, Filippo; Petrella, Francesco; Del Signore, Ester; Pelosi, Giuseppe; Spaggiari, Lorenzo

2017-01-01

Lung neuroendocrine tumors (NETs) comprise typical (TC) and atypical carcinoids (AC). They represent the well differentiated (WD) or low/intermediate grade forms of lung neuroendocrine neoplasms (NENs). Unlike the lung poorly differentiated NENs, that are usually treated with chemotherapy, lung NETs can be managed with several different therapies, making a multidisciplinary interaction a key point. We critically discussed the multimodal clinical management of patients with advanced lung NETs. Provided that no therapeutic algorithm has been validate so far, each clinical case should be discussed within a NEN-dedicated multidisciplinary team. Among the systemic therapies available for metastatic lung NETs everolimus is the only approved drug, on the basis of the results of the phase III RADIANT-4 trial. Another phase III trial, the SPINET, is ongoing comparing lanreotide with placebo. Peptide receptor radionuclide therapy and chemotherapy were not studied within phase III trials for lung NETs, and they have been reported to be active within retrospective or phase II prospective studies. Temozolomide and oxaliplatin are two interesting chemotherapeutic agents in lung NETs. While some European Institutions were certificated as Centers of Excellence for gastroenteropancreatic NENs by the European Neuroendocrine Tumor Society (ENETS), an equivalent ENETS certification for lung NENs does not exist yet. Ideally a lung NEN-dedicated multidisciplinary tumor board should include NEN-dedicated medical oncologists, thoracic medical oncologist, thoracic surgeons, pathologists, interventional radiologists, endocrinologists, radiotherapists, interventional pneumologists, nuclear physician. PMID:29201453

Multidisciplinary aerospace design optimization: Survey of recent developments

NASA Technical Reports Server (NTRS)

Sobieszczanski-Sobieski, Jaroslaw; Haftka, Raphael T.

1995-01-01

The increasing complexity of engineering systems has sparked increasing interest in multidisciplinary optimization (MDO). This paper presents a survey of recent publications in the field of aerospace where interest in MDO has been particularly intense. The two main challenges of MDO are computational expense and organizational complexity. Accordingly the survey is focussed on various ways different researchers use to deal with these challenges. The survey is organized by a breakdown of MDO into its conceptual components. Accordingly, the survey includes sections on Mathematical Modeling, Design-oriented Analysis, Approximation Concepts, Optimization Procedures, System Sensitivity, and Human Interface. With the authors' main expertise being in the structures area, the bulk of the references focus on the interaction of the structures discipline with other disciplines. In particular, two sections at the end focus on two such interactions that have recently been pursued with a particular vigor: Simultaneous Optimization of Structures and Aerodynamics, and Simultaneous Optimization of Structures Combined With Active Control.

The challenges of meeting nutritional requirements in children and adults with epidermolysis bullosa: proceedings of a multidisciplinary team study day.

PubMed

Hubbard, L; Haynes, L; Sklar, M; Martinez, A E; Mellerio, J E

2011-08-01

This is a report of a study day held in London on 3 March 2010 to discuss measures with which to meet the nutritional requirements of patients with epidermolysis bullosa (EB). Members of national and international multidisciplinary teams (MDTs) caring for patients with EB attended this event. The study day focused on four challenging aspects of management intimately associated with nutritional status in EB, necessitating close cooperation between MDT members: iron-deficiency anaemia, gastrostomy placement and feeding, muscle mass and mobility, and dental health. The study day provided a unique forum for dietitians, doctors, nurses, physiotherapists, psychologists, psychotherapists, dentists, dental hygienists and occupational therapists to share knowledge and debate problems common to all who strive to promote best practice in this rare and complex group of conditions. © The Author(s). CED © 2011 British Association of Dermatologists.

Leveraging multidisciplinarity in a visual analytics graduate course.

PubMed

Elmqvist, Niklas; Ebert, David S

2012-01-01

Demand is growing in engineering, business, science, research, and industry for students with visual analytics expertise. However, teaching VA is challenging owing to the multidisciplinary nature of the topic, students' diverse backgrounds, and the corresponding requirements for instructors. This article reports best practices from a VA graduate course at Purdue University, where instructors leveraged these challenges to their advantage instead of trying to mitigate them.

Multidisciplinary coordinated care for Type 2 diabetes: A qualitative analysis of patient perspectives.

PubMed

Berkowitz, Seth A; Eisenstat, Stephanie A; Barnard, Lily S; Wexler, Deborah J

2018-06-01

To explore the patient perspective on coordinated multidisciplinary diabetes team care among a socioeconomically diverse group of adults with type 2 diabetes. Qualitative research design using 8 focus groups (n=53). We randomly sampled primary care patients with type 2 diabetes and conducted focus groups at their primary care clinic. Discussion prompts queried current perceptions of team care. Each focus group was audio recorded, transcribed verbatim, and independently coded by three reviewers. Coding used an iterative process. Thematic saturation was achieved. Data were analyzed using content analysis. Most participants believed that coordinated multidisciplinary diabetes team care was a good approach, feeling that diabetes was too complicated for any one care team member to manage. Primary care physicians were seen as too busy to manage diabetes alone, and participants were content to be treated by other care team members, especially if there was a single point of contact and the care was coordinated. Participants suggested that an ideal multidisciplinary approach would additionally include support for exercise and managing socioeconomic challenges, components perceived to be missing from the existing approach to diabetes care. Coordinated, multidisciplinary diabetes team care is understood by and acceptable to patients with type 2 diabetes. Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Making a move in exercise referral: co-development of a physical activity referral scheme.

PubMed

Buckley, B J R; Thijssen, D H J; Murphy, R C; Graves, L E F; Whyte, G; Gillison, F B; Crone, D; Wilson, P M; Watson, P M

2018-04-24

Translational research is required to ensure exercise referral schemes (ERSs) are evidence-based and reflect local needs. This article reports process data from the co-development phase of an ERS, providing an insight into (i) factors that must be considered when translating evidence to practice in an ERS setting, and (ii) challenges and facilitators of conducting participatory research involving multiple stakeholders. An ERS was iteratively co-developed by a multidisciplinary stakeholder group (commissioners, managers, practitioners, patients and academics) via five participatory meetings and an online survey. Audio data (e.g. group discussions) and visual data (e.g. whiteboard notes) were recorded and analysed using NVivo-10 electronic software. Factors to consider when translating evidence to practice in an ERS setting included (i) current ERS culture; (ii) skills, safety and accountability; and (iii) resources and capacity. The co-development process was facilitated by needs-analysis, open questions, multidisciplinary debate and reflective practice. Challenges included contrasting views, irregular attendance and (mis)perceptions of evaluation. The multidisciplinary co-development process highlighted cultural and pragmatic issues related to exercise referral provision, resulting in an evidence-based intervention framework designed to be implemented within existing infrastructures. Further work is required to establish the feasibility and effectiveness of the co-developed intervention in practice.

Early coordinated multidisciplinary intervention to prevent sickness absence and labour market exclusion in patients with low back pain: study protocol of a randomized controlled trial.

PubMed

Fisker, Annette; Langberg, Henning; Petersen, Tom; Mortensen, Ole Steen

2013-03-13

Musculoskeletal disorders account for one third of the long-term absenteeism in Denmark and the number of individuals sick listed for more than four weeks is increasing. Compared to other diagnoses, patients with musculoskeletal diseases, including low back pain, are less likely to return to work after a period of sick leave. It seems that a multidisciplinary intervention, including cooperation between the health sector, the social sector and in the work place, has a positive effect on days off work due to musculoskeletal disorders and particularly low back pain. It is a challenge to coordinate this type of intervention, and the implementation of a return-to-work (RTW)-coordinator is suggested as an effective strategy in this process. The purpose of this paper is to describe the study protocol and present a new type of intervention, where the physiotherapist both has the role as RTW-coordinator and treating the patient. A randomized controlled trial (RCT) is currently on-going. The RCT includes 770 patients with low back pain of minimum four weeks who are referred to an outpatient back centre. The study population consists of patients, who are sick-listed or at risk of sick-leave due to LBP. The control group is treated with usual care in a team of a physiotherapist, a chiropractor, a rheumatologist and a social worker employed at the centre. The Intervention group is treated with usual care and in addition intervention of a psychologist, an occupational physician, an ergonomist, a case manager from the municipal sickness benefit office, who has the authority in the actual case concerning sickness benefit payment and contact to the patients employer/work place. The treating physiotherapist is the RTW-coordinator. Outcome will be reported at the end of treatment as well as 6 and 12 months follow up. The primary outcome is number of days off work. Secondary outcomes are disability, pain, and quality of life. The study will follow the recommendations in CONSORT-statement in designing and reporting RCTs. This large RCT is testing the effectiveness of a preventive intervention targeting patients on short term sick leave or at risk being sick listed because of low back pain. We have developed a novel multidisciplinary team structure using the treating physiotherapist as the return to work coordinator, and having the case manager from the municipal sickness benefit office participating in team meetings. The study has the potential to contribute to the knowledge about how to target the challenges in the treatment of LBP. The aim is to prevent sickness absence and labour market exclusion--both on the individual level and economic costs at community level. Short term results will be available in 2014.This study is approved by the Danish Regional Ethics Committee (J.nr: H-C-2008-112) and is registered at ClinicalTrials.gov: NCT01690234.

The Pursuit of Chronically Reliable Neural Interfaces: A Materials Perspective.

PubMed

Guo, Liang

2016-01-01

Brain-computer interfaces represent one of the most astonishing technologies in our era. However, the grand challenge of chronic instability and limited throughput of the electrode-tissue interface has significantly hindered the further development and ultimate deployment of such exciting technologies. A multidisciplinary research workforce has been called upon to respond to this engineering need. In this paper, I briefly review this multidisciplinary pursuit of chronically reliable neural interfaces from a materials perspective by analyzing the problem, abstracting the engineering principles, and summarizing the corresponding engineering strategies. I further draw my future perspectives by extending the proposed engineering principles.

Multidisciplinary Approach in the Management of a Complex Case: Implant-Prosthetic Rehabilitation of a Periodontal Smoking Patient with Partial Edentulism, Malocclusion, and Aesthetic Diseases

PubMed Central

Di Francesco, Fabrizio; De Marco, Gennaro; Scognamiglio, Fabio; Aruta, Valeria; Itro, Angelo

2017-01-01

Complex periprosthetic cases are considered as challenges by clinicians. Clinical and radiographic parameters should be considered separately to make the right choice between an endodontically or periodontally compromised treated tooth and implant. Therefore, in order to decide whether the tooth is safe or not, data that have to be collected are specific parameters of both the patient and the clinician. In addition, the presence of periodontal, prosthetic, and orthodontic diseases requires patients to be set in multidisciplinary approach. The aim of this case report is to describe how the multidisciplinary approach could be the best way to manage difficult cases of implant-prosthetic rehabilitation. How to rehabilitate with fixed prosthesis on natural teeth and dental implants a smoker patient who presents with active periodontitis, multiple edentulous areas, dental malocclusion, and severe aesthetic problems was also described. PMID:28421148

SEMPATH Ontology: modeling multidisciplinary treatment schemes utilizing semantics.

PubMed

Alexandrou, Dimitrios Al; Pardalis, Konstantinos V; Bouras, Thanassis D; Karakitsos, Petros; Mentzas, Gregoris N

2012-03-01

A dramatic increase of demand for provided treatment quality has occurred during last decades. The main challenge to be confronted, so as to increase treatment quality, is the personalization of treatment, since each patient constitutes a unique case. Healthcare provision encloses a complex environment since healthcare provision organizations are highly multidisciplinary. In this paper, we present the conceptualization of the domain of clinical pathways (CP). The SEMPATH (SEMantic PATHways) Oontology comprises three main parts: 1) the CP part; 2) the business and finance part; and 3) the quality assurance part. Our implementation achieves the conceptualization of the multidisciplinary domain of healthcare provision, in order to be further utilized for the implementation of a Semantic Web Rules (SWRL rules) repository. Finally, SEMPATH Ontology is utilized for the definition of a set of SWRL rules for the human papillomavirus) disease and its treatment scheme. © 2012 IEEE

A social-cognitive framework of multidisciplinary team innovation.

PubMed

Paletz, Susannah B F; Schunn, Christian D

2010-01-01

The psychology of science typically lacks integration between cognitive and social variables. We present a new framework of team innovation in multidisciplinary science and engineering groups that ties factors from both literatures together. We focus on the effects of a particularly challenging social factor, knowledge diversity, which has a history of mixed effects on creativity, most likely because those effects are mediated and moderated by cognitive and additional social variables. In addition, we highlight the distinction between team innovative processes that are primarily divergent versus convergent; we propose that the social and cognitive implications are different for each, providing a possible explanation for knowledge diversity's mixed results on team outcomes. Social variables mapped out include formal roles, communication norms, sufficient participation and information sharing, and task conflict; cognitive variables include analogy, information search, and evaluation. This framework provides a roadmap for research that aims to harness the power of multidisciplinary teams. Copyright © 2009 Cognitive Science Society, Inc.

Multidisciplinary team approach in the oral rehabilitation of patients with cleidocranial dysplasia to achieve a functional aesthetic outcome.

PubMed

Patel, D; Patel, N; Brennan, P A; Kwok, J

2017-11-01

Cleidocranial dysplasia is a hereditary congenital disorder that results in delayed ossification of midline structures, and is caused by mutations in the RunX2 (runt-related transcription factor 2) gene located on the short arm of chromosome 6. Successful treatment depends on multidisciplinary assessment and a comprehensive staged treatment plan. We present a case series of 12 patients who were managed with a specifically tailored combination of surgery, orthodontics, and prosthodontics to provide a functional dentition and restore their smile and facial contour. Successful dental rehabilitation can be challenging in this group because patients often have multiple dental anomalies and a reduced quantity and density of alveolar bone. Rehabilitation with early intervention and a carefully planned multidisciplinary approach has been successful in the long term. Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Assessing Behavioural Manifestations Prior to Clinical Diagnosis of Huntington Disease: "Anger and Irritability" and "Obsessions and Compulsions"

PubMed Central

Vaccarino, Anthony L; Anonymous; Anderson, Karen E.; Borowsky, Beth; Coccaro, Emil; Craufurd, David; Endicott, Jean; Giuliano, Joseph; Groves, Mark; Guttman, Mark; Ho, Aileen K; Kupchak, Peter; Paulsen, Jane S.; Stanford, Matthew S.; van Kammen, Daniel P; Watson, David; Wu, Kevin D; Evans, Ken

2011-01-01

The Functional Rating Scale Taskforce for pre-Huntington Disease (FuRST-pHD) is a multinational, multidisciplinary initiative with the goal of developing a data-driven, comprehensive, psychometrically sound, rating scale for assessing symptoms and functional ability in prodromal and early Huntington disease (HD) gene expansion carriers. The process involves input from numerous sources to identify relevant symptom domains, including HD individuals, caregivers, and experts from a variety of fields, as well as knowledge gained from the analysis of data from ongoing large-scale studies in HD using existing clinical scales. This is an iterative process in which an ongoing series of field tests in prodromal (prHD) and early HD individuals provides the team with data on which to make decisions regarding which questions should undergo further development or testing and which should be excluded. We report here the development and assessment of the first iteration of interview questions aimed to assess "Anger and Irritability" and "Obsessions and Compulsions" in prHD individuals. PMID:21826116

Social organization of self-management support of persons with diabetes: a health systems comparison.

PubMed

Schiøtz, Michaela; Frølich, Anne; Krasnik, Allan; Taylor, Warren; Hsu, John

2012-09-01

Identify important organizational elements for providing self-management support (SMS). Semi-structured qualitative interviews conducted in two healthcare systems. Kaiser Permanente Northern California and the Danish Health Care System. 36 managers and healthcare professionals in the two healthcare systems. Elements important to providing self-management support to persons with diabetes. Healthcare professionals' provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach. Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals.

Earth observations from space: Outlook for the geological sciences

NASA Technical Reports Server (NTRS)

Short, N. M.; Lowman, P. D., Jr.

1973-01-01

Remote sensing from space platforms is discussed as another tool available to geologists. The results of Nimbus observations, the ERTS program, and Skylab EREP are reviewed, and a multidisciplinary approach is recommended for meeting the challenges of remote sensing.

AEROELASTIC SIMULATION TOOL FOR INFLATABLE BALLUTE AEROCAPTURE

NASA Technical Reports Server (NTRS)

Liever, P. A.; Sheta, E. F.; Habchi, S. D.

2006-01-01

A multidisciplinary analysis tool is under development for predicting the impact of aeroelastic effects on the functionality of inflatable ballute aeroassist vehicles in both the continuum and rarefied flow regimes. High-fidelity modules for continuum and rarefied aerodynamics, structural dynamics, heat transfer, and computational grid deformation are coupled in an integrated multi-physics, multi-disciplinary computing environment. This flexible and extensible approach allows the integration of state-of-the-art, stand-alone NASA and industry leading continuum and rarefied flow solvers and structural analysis codes into a computing environment in which the modules can run concurrently with synchronized data transfer. Coupled fluid-structure continuum flow demonstrations were conducted on a clamped ballute configuration. The feasibility of implementing a DSMC flow solver in the simulation framework was demonstrated, and loosely coupled rarefied flow aeroelastic demonstrations were performed. A NASA and industry technology survey identified CFD, DSMC and structural analysis codes capable of modeling non-linear shape and material response of thin-film inflated aeroshells. The simulation technology will find direct and immediate applications with NASA and industry in ongoing aerocapture technology development programs.

Development of a Primary Care-Based Clinic to Support Adults With a History of Childhood Cancer: The Tactic Clinic.

PubMed

Overholser, Linda S; Moss, Kerry M; Kilbourn, Kristin; Risendal, Betsy; Jones, Alison F; Greffe, Brian S; Garrington, Timothy; Leonardi-Warren, Kristin; Yamashita, Traci E; Kutner, Jean S

2015-01-01

Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well. Copyright © 2015 Elsevier Inc. All rights reserved.

An overview of multidisciplinary research resources at the Osaka University Center for Twin Research.

PubMed

Hayakawa, Kazuo; Iwatani, Yoshinori

2013-02-01

Osaka University Center for Twin Research is currently organizing a government-funded, multidisciplinary research project using a large registry of aged twins living in Japan. The purpose of the project is to collect various information as well as biological resources from registered twins, and to establish a biobank and databases for preserving and managing these data and resources. The Center is collecting data from twin pairs, both of whom have agreed to participate in a one-day comprehensive medical examination. The following data are being collected: physical data (e.g., height, body mass, blood pressure, theoretical visceral fat, pulse wave velocity, and bone density), data regarding epidemiology (e.g., medical history, lifestyle, quality of life, mood status, cognitive function, and nutrition), electrocardiogram, ultrasonography (carotid artery and thyroid), dentistry, plastic surgery, positron emission tomography, magnetoencephalogram, and magnetic resonance imaging of brain. These data are then aggregated and systematically stored in specific databases. In addition, peripheral blood is obtained from the participants, and then genomic DNA is purified and sera are stored. A wide variety of studies are ongoing, and more are in the planning stage.

Completion of risk assessment and monitoring within forensic psychiatry.

PubMed

Galappathie, Nuwan; Heeramun, Ragini; Jethwa, Krishma

2009-04-01

There is a clear need for high standards of risk assessment and monitoring within forensic psychiatry. This has been highlighted by a number of high profile homicide enquires which have called for better standards of multidisciplinary risk assessment and monitoring. There are no national standards for risk assessment. We conducted a study to audit electronically the completion rate of a service-designed risk assessment document within Fromside, a medium secure unit in the UK. The completion rates for key sections of 64 risk assessment documents were assessed. Only 48 of the 64 (75%) documents were electronically available. The completion rates ranged from 59/64 (92%) for the retrospective risk review to 46/64 (72%) for relapse indicators. Only 35/64 (55%) risk documents were updated within the last three months. We found that the use of risk profile documents has helped achieve good standards of risk assessment, however greater priority needs to be given to ongoing monitoring. We recommend that consideration is given to the development of national guidelines for multidisciplinary risk assessment and monitoring.

Refugee Health: An Ongoing Commitment and Challenge

PubMed Central

Efird, Jimmy T.; Bith-Melander, Pollie

2018-01-01

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

Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception.

PubMed

DeSisto, Carla L; Estrich, Cameron; Kroelinger, Charlan D; Goodman, David A; Pliska, Ellen; Mackie, Christine N; Waddell, Lisa F; Rankin, Kristin M

2017-11-21

Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC) in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015-2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize clinician implementation team meetings, conduct educational meetings, facilitation, promote network weaving, provide ongoing consultation, and distribute educational materials. Convening a multi-state learning collaborative is a promising approach for facilitating the implementation of new reimbursement policies for evidence-based practices complicated by systems challenges. By integrating several implementation strategies, the Learning Community serves as a meta-strategy for supporting implementation.

Challenges and Strategies for Research in Prisons

PubMed Central

Apa, Zoltán L.; Bai, Ruo Yu; Mukherejee, Dhritiman V.; Herzig, Carolyn T. A.; Koenigsmann, Carl; Lowy, Franklin D.; Larson, Elaine L.

2013-01-01

In this article, we discuss some of the challenges encountered while conducting research in two maximum security prisons and approaches we found helpful to facilitate the research process through the development of collaborative relationships, the establishment of prison contacts, and the implementation of rigorous research methods. As a result of our experiences, we have been successful at maintaining a high rate of inmate participation (>80%) and a well-functioning multidisciplinary team. The approaches described may be useful to other investigators planning to conduct research in a challenging setting such as prisons. PMID:22924569

Advancing research opportunities and promoting pathways in graduate education: a systemic approach to BUILD training at California State University, Long Beach (CSULB).

PubMed

Urizar, Guido G; Henriques, Laura; Chun, Chi-Ah; Buonora, Paul; Vu, Kim-Phuong L; Galvez, Gino; Kingsford, Laura

2017-01-01

First-generation college graduates, racial and ethnic minorities, people with disabilities, and those from disadvantaged backgrounds are gravely underrepresented in the health research workforce representing behavioral health sciences and biomedical sciences and engineering (BHS/BSE). Furthermore, relative to their peers, very few students from these underrepresented groups (URGs) earn scientific bachelor's degrees with even fewer earning doctorate degrees. Therefore, programs that engage and retain URGs in health-related research careers early on in their career path are imperative to promote the diversity of well-trained research scientists who have the ability to address the nation's complex health challenges in an interdisciplinary way. The purpose of this paper is to describe the challenges, lessons learned, and sustainability of implementing a large-scale, multidisciplinary research infrastructure at California State University, Long Beach (CSULB) - a minority-serving institution - through federal funding received by the National Institutes of Health (NIH) Building Infrastructure Leading to Diversity (BUILD) Initiative. The CSULB BUILD initiative consists of developing a research infrastructure designed to engage and retain URGs on the research career path by providing them with the research training and skills needed to make them highly competitive for doctoral programs and entry into the research workforce. This initiative unites many research disciplines using basic, applied, and translational approaches to offer insights and develop technologies addressing prominent community and national health issues from a multidisciplinary perspective. Additionally, this initiative brings together local (e.g., high school, community college, doctoral research institutions) and national (e.g., National Research Mentoring Network) collaborative partners to alter how we identify, develop, and implement resources to enhance student and faculty research. Finally, this initiative establishes a student research training program that engages URGs earlier in their academic development, is larger and multidisciplinary in scope, and is responsive to the life contexts and promotes the cultural capital that URGs bring to their career path. Although there have been many challenges to planning for and developing CSULB BUILD's large-scale, multidisciplinary research infrastructure, there have been many lessons learned in the process that could aid other campuses in the development and sustainability of similar research programs.

Multidisciplinary Management of Breast Cancer During Pregnancy

PubMed Central

Shachar, Shlomit Strulov; Gallagher, Kristalyn; McGuire, Kandace; Zagar, Timothy M.; Faso, Aimee; Muss, Hyman B.; Sweeting, Raeshall

2017-01-01

Abstract Background. Although breast cancer during pregnancy (BCDP) is rare (occurring with only 0.4% of all BC diagnoses in female patients aged 16–49 years), management decisions are challenging to both the patient and the multidisciplinary team. Materials and Methods. Experts in breast cancer at the University of North Carolina conducted a targeted literature search regarding the multidisciplinary treatment approaches to BCDP: medical, surgical, and radiation oncology. Supportive care, including antiemetic agents, and imaging approaches were also reviewed. Results. Review of the literature revealed key points in the management of BCDP. Surgical management is similar to that in nonpregnant patients; pregnant patients may safely undergo breast‐conserving surgery. Recommendations should be tailored to the individual according to the clinical stage, tumor biology, genetic status, gestational age, and personal preferences. Anthracycline‐based chemotherapy can be safely initiated only in the second and third trimesters. The rate of congenital abnormalities in children exposed to chemotherapy is similar to the national average (approximately 3%). Dosing of chemotherapy should be similar to that in the nonpregnant patient (i.e., actual body surface area). Antihuman epidermal growth factor receptor 2 therapy, radiation, and endocrine treatment are contraindicated in pregnancy and lactation. Care should include partnership with obstetricians. The literature regarding prognosis of BCDP is mixed. Conclusion. To maximize benefit and minimize risk to the mother and fetus, an informed discussion with the patient and her medical team should result in an individualized treatment plan, taking into account the timing of the pregnancy and the stage and subtype of the breast cancer. Because BCDP is rare, it is essential to collect patient data in international registries. Implications for Practice. Breast cancer during pregnancy is a major ethical and professional challenge for both the patient and the multidisciplinary treatment team. Although the oncologic care is based on that of the non‐pregnant breast cancer patient, there are many challenges from regarding the medical, surgical and radiation oncology and obstetrical aspects of care that need to be considered to deliver the safest and best treatment plan to both the mother and developing fetus. PMID:28232597

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

PubMed Central

Mok, Quen

2017-01-01

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

The Role of Molecular Pathological Epidemiology in the Study of Neoplastic and Non-Neoplastic Diseases in the Era of Precision Medicine

PubMed Central

Ogino, Shuji; Nishihara, Reiko; VanderWeele, Tyler J.; Wang, Molin; Nishi, Akihiro; Lochhead, Paul; Qian, Zhi Rong; Zhang, Xuehong; Wu, Kana; Nan, Hongmei; Yoshida, Kazuki; Milner, Danny A; Chan, Andrew T.; Field, Alison E.; Camargo, Carlos A; Williams, Michelle A; Giovannucci, Edward L.

2016-01-01

Molecular pathology diagnostics to subclassify diseases based on pathogenesis are increasingly common in clinical translational medicine. Molecular pathological epidemiology (MPE) is an integrative transdisciplinary science based on the unique disease principle and the disease continuum theory. While it has been most commonly applied to research on breast, lung, and colorectal cancers, MPE can investigate etiologic heterogeneity in non-neoplastic diseases such as cardiovascular diseases, obesity, diabetes mellitus, drug toxicity, and immunity-related and infectious diseases. This science can enhance causal inference by linking putative etiologic factors to specific molecular biomarkers as outcomes. Technological advances increasingly enable analyses of various -omics, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, metagenomics, microbiome, immunomics, interactomics, etc. Challenges in MPE include sample size limitations (depending on availability of biospecimens or biomedical / radiological imaging), need for rigorous validation of molecular assays and study findings, and paucities of interdisciplinary experts, education programs, international forums, and standardized guidelines. To address these challenges, there are ongoing efforts such as multidisciplinary consortium pooling projects, the International Molecular Pathological Epidemiology (MPE) Meeting Series, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-MPE guideline project. Efforts should be made to build biorepository and biobank networks, and worldwide population-based MPE databases. These activities match with the purposes of the Big Data to Knowledge (BD2K), Genetic Associations and Mechanisms in Oncology (GAME-ON), and Precision Medicine Initiatives of the United States National Institute of Health. Given advances in biotechnology, bioinformatics, and computational / systems biology, there are wide open opportunities in MPE to contribute to public health. PMID:26928707

Integrated multidisciplinary CAD/CAE environment for micro-electro-mechanical systems (MEMS)

NASA Astrophysics Data System (ADS)

Przekwas, Andrzej J.

1999-03-01

Computational design of MEMS involves several strongly coupled physical disciplines, including fluid mechanics, heat transfer, stress/deformation dynamics, electronics, electro/magneto statics, calorics, biochemistry and others. CFDRC is developing a new generation multi-disciplinary CAD systems for MEMS using high-fidelity field solvers on unstructured, solution-adaptive grids for a full range of disciplines. The software system, ACE + MEMS, includes all essential CAD tools; geometry/grid generation for multi- discipline, multi-equation solvers, GUI, tightly coupled configurable 3D field solvers for FVM, FEM and BEM and a 3D visualization/animation tool. The flow/heat transfer/calorics/chemistry equations are solved with unstructured adaptive FVM solver, stress/deformation are computed with a FEM STRESS solver and a FAST BEM solver is used to solve linear heat transfer, electro/magnetostatics and elastostatics equations on adaptive polygonal surface grids. Tight multidisciplinary coupling and automatic interoperability between the tools was achieved by designing a comprehensive database structure and APIs for complete model definition. The virtual model definition is implemented in data transfer facility, a publicly available tool described in this paper. The paper presents overall description of the software architecture and MEMS design flow in ACE + MEMS. It describes current status, ongoing effort and future plans for the software. The paper also discusses new concepts of mixed-level and mixed- dimensionality capability in which 1D microfluidic networks are simulated concurrently with 3D high-fidelity models of discrete components.

Evaluation of the impact of a clinical pathway on the organization of a multidisciplinary dental sleep clinic.

PubMed

Ten Berge, D M; Braem, M J; Altenburg, A; Dieltjens, M; Van de Heyning, P H; Vanhaecht, K; Vanderveken, O M

2014-05-01

Clinical pathways are used to organize complex care processes by providing structure and standardization. The multidisciplinary approach of oral appliance (OA) therapy for sleep-disordered breathing (SDB) is a complex and dynamic process suitable for such a structured pathway approach. A clinical pathway for patients referred for OA therapy was developed and implemented. The aim of this study was to evaluate the impact of this clinical pathway on the time to delivery of the OA and the organization of the multidisciplinary dental sleep clinic (MDSC). The latter was achieved using the care process self-evaluation tool (CPSET). First, development and implementation of the clinical pathway gave structure and shortened the mean time to delivery by 102 days (240 ± 70 vs. 138 ± 33 days) (Mann-Whitney U: P < 0.001). Second, the CPSET scores were obtained in a cohort of 49 healthcare professionals involved in the pathway. Overall, patient-focused organization received the highest scores (80.5 ± 9.0%), whereas cooperation with primary care received the lowest score (66.7 ± 12.4%). This is the first project on clinical pathways in OA therapy for SDB. The implementation of the pathway in our MDSC has created a significant shortening of the time to delivery. A first evaluation of the clinical pathway using the CPSET scores indicates that all disciplines involved should be thoroughly informed in an ongoing approach.

Prevalence of Malnutrition and Feeding Difficulties in Children With Esophageal Atresia.

PubMed

Menzies, Jessica; Hughes, Jennifer; Leach, Steven; Belessis, Yvonne; Krishnan, Usha

2017-04-01

Growth and feeding problems have been described in children with esophageal atresia (EA). Ongoing gastrointestinal and respiratory complications such as Gastroesophageal reflux disease, esophageal dysmotility, strictures, and respiratory infections may contribute. The aim of the study was to document the prevalence of malnutrition and feeding difficulties and examine predictive factors, which may influence feeding and growth in children attending a multidisciplinary EA clinic in Sydney, Australia. A retrospective review of 75 children, ages 0 to 16 years, who attended a multidisciplinary EA clinic between 2011 and 2014. Data on demographics, comorbidities, nutrition, and mealtime behaviors were collected from their initial clinic appointment. Factors that may affect on growth and mealtime behaviors were identified and analyzed. Nine percent of children were malnourished and 9% were stunted. Infants, children with prior fundoplication, at risk of aspiration, or those who had surgery in the first year of life additional to EA repair were significantly more likely to be malnourished (P < 0.05). Fifty-four percent of children required texture modification at their meals, with parental concern being the most common reason. Younger children were less likely to be eating age-appropriate textures (P = 0.04) which improved after 5 years of age. Poor growth and inability to manage age-appropriate textures are often present in children with EA, particularly in the younger years. This highlights the need for early intervention in a specialist multidisciplinary EA clinic in which dietetics and speech pathology are available.

Integrated care: theory to practice.

PubMed

Stokes, Jonathan; Checkland, Kath; Kristensen, Søren Rud

2016-10-01

'Integrated care' is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team case management is frequently the primary focus of integrated care when implemented internationally. We examine the practical application of integrated care in the NHS in England to exemplify the prevalence of the case management focus. We look at the evidence for effectiveness of multi-disciplinary team case management, for the focus on high-risk groups and for integrated care more generally. We suggest realistic expectations of what integration of care alone can achieve and additional research questions. © The Author(s) 2016.

A Multidisciplinary Investigation of a Polycythemia Vera Cancer Cluster of Unknown Origin

PubMed Central

Seaman, Vincent; Dearwent, Steve M; Gable, Debra; Lewis, Brian; Metcalf, Susan; Orloff, Ken; Tierney, Bruce; Zhu, Jane; Logue, James; Marchetto, David; Ostroff, Stephen; Hoffman, Ronald; Xu, Mingjiang; Carey, David; Erlich, Porat; Gerhard, Glenn; Roda, Paul; Iannuzzo, Joseph; Lewis, Robert; Mellow, John; Mulvihill, Linda; Myles, Zachary; Wu, Manxia; Frank, Arthur; Gross-Davis, Carol Ann; Klotz, Judith; Lynch, Adam; Weissfeld, Joel; Weinberg, Rona; Cole, Henry

2010-01-01

Cancer cluster investigations rarely receive significant public health resource allocations due to numerous inherent challenges and the limited success of past efforts. In 2008, a cluster of polycythemia vera, a rare blood cancer with unknown etiology, was identified in northeast Pennsylvania. A multidisciplinary group of federal and state agencies, academic institutions, and local healthcare providers subsequently developed a multifaceted research portfolio designed to better understand the cause of the cluster. This research agenda represents a unique and important opportunity to demonstrate that cancer cluster investigations can produce desirable public health and scientific outcomes when necessary resources are available. PMID:20617023

Sexual Assault Response Teams (SARTs): mapping a research agenda that incorporates an organizational perspective.

PubMed

Moylan, Carrie A; Lindhorst, Taryn; Tajima, Emiko A

2015-04-01

Multidisciplinary coordinated Sexual Assault Response Teams (SARTs) are a growing model of providing health, legal, and emotional support services to victims of sexual assault. This article conceptualizes SARTs from an organizational perspective and explores three approaches to researching SARTs that have the potential of increasing our understanding of the benefits and challenges of multidisciplinary service delivery. These approaches attend to several levels of organizational behavior, including the organizational response to external legitimacy pressures, the inter-organizational networks of victim services, and the negotiation of power and disciplinary boundaries. Possible applications to organizational research on SARTs are explored. © The Author(s) 2015.

Medical aspects of pediatric rehabilitation after moderate to severe traumatic brain injury.

PubMed

Cantore, Lisa; Norwood, Kenneth; Patrick, Peter

2012-01-01

Recovery from severe traumatic brain injury (TBI) is prolonged, complicated and challenging. Medical rehabilitation is the bridge from acute medical care and stabilization to community reintegration. The process of caring for the recovering brain introduces unknown challenges of neural plasticity with demands to restore and to also move the child and family back to the developmental trajectory they once knew. While the ongoing focus is to maintain and advance medical stability, co- morbid conditions are addressed, and a plan for ongoing health is established. While no one manuscript can cover all of the medical aspects, this article will present in a "systems review" manner the most challenging and demanding medical conditions that children may confront following severe brain injury.

Medicine, madness and murderers: the context of English forensic psychiatric hospitals.

PubMed

McDonald, Ruth; Furtado, Vivek; Völlm, Birgit

2017-08-21

Purpose The purpose of this paper is to add to the understanding of context by shedding light on the relationship between context and organisational actors' abilities to resolve ongoing challenges. Design/methodology/approach The authors used qualitative data collection (interviews and focus groups with staff and site visits to English forensic psychiatry hospitals) and the analysis was informed by Lefebvre's writings on space. Findings Responses to ongoing challenges were both constrained and facilitated by the context, which was negotiated and co-produced by the actors involved. Various (i.e. societal and professional) dimensions of context interacted to create tensions, which resulted in changes in service configuration. These changes were reconciled, to some extent, via discourse. Despite some resolution, the co-production of context preserved contradictions which mean that ongoing challenges were modified, but not resolved entirely. Originality/value The paper highlights the importance of viewing context as co-produced in a continuous manner. This helps us to delineate and understand its dynamic nature and its relationship with the everyday actions and beliefs of the organisational actors concerned.

The Google Online Marketing Challenge and Research Opportunities

ERIC Educational Resources Information Center

Neale, Larry; Treiblmaier, Horst; Henderson, Vani; Hunter, Lee; Hudson, Karen; Murphy, Jamie

2009-01-01

The Google Online Marketing Challenge is an ongoing collaboration between Google and academics, to give students experiential learning. The Challenge gives student teams US$200 in AdWords, Google's flagship advertising product, to develop online marketing campaigns for actual businesses. The end result is an engaging in-class exercise that…

The Challenges and Opportunities of Residence Hall Facilities.

ERIC Educational Resources Information Center

Thaler-Carter, Ruth E.

2001-01-01

Explores the challenges facing college and university residence hall facility managers and how different schools address these issues in diverse ways. Ongoing concerns involving funding needs and maintenance are examined followed by discussions on the new challenges in managing student life, health, and safety. Concluding comments reveal where…

Overview of advances in water management in agricultural production:Sensor based irrigation management

USDA-ARS?s Scientific Manuscript database

Technological advances in irrigated agriculture are crucial to meeting the challenge of increasing demand for agricultural products given limited quality and quantity of water resources for irrigation, impacts of climate variability, and the need to reduce environmental impacts. Multidisciplinary ap...

Social Constructivism and Case-Writing for an Integrated Curriculum

ERIC Educational Resources Information Center

Doubleday, Alison F.; Brown, Blase; Patston, Philip A.; Jurgens-Toepke, Pamela; Strotman, Meaghan Driscoll; Koerber, Anne; Haley, Colin; Briggs, Charlotte; Knight, G. William

2015-01-01

Case-writing within an integrated, systems-based health professions education curriculum presents many unique challenges. Specifically, case-writing in this context must consider integration of multidisciplinary learning objectives and synthesis of biomedical and clinical sciences. Establishing an effective process for content integration and…

Scale Up in Education. Volume 1: Ideas in Principle

ERIC Educational Resources Information Center

Schneider, Barbara Ed.; McDonald, Sarah-Kathryn Ed.

2006-01-01

"Scale Up in Education, Volume 1: Ideas in Principle" examines the challenges of "scaling up" from a multidisciplinary perspective. It brings together contributions from disciplines that routinely take promising innovations to scale, including medicine, business, engineering, computing, and education. Together the contributors explore appropriate…

Hard tissue regeneration using bone substitutes: an update on innovations in materials

PubMed Central

Sarkar, Swapan Kumar

2015-01-01

Bone is a unique organ composed of mineralized hard tissue, unlike any other body part. The unique manner in which bone can constantly undergo self-remodeling has created interesting clinical approaches to the healing of damaged bone. Healing of large bone defects is achieved using implant materials that gradually integrate with the body after healing is completed. Such strategies require a multidisciplinary approach by material scientists, biological scientists, and clinicians. Development of materials for bone healing and exploration of the interactions thereof with the body are active research areas. In this review, we explore ongoing developments in the creation of materials for regenerating hard tissues. PMID:25995658

Hard tissue regeneration using bone substitutes: an update on innovations in materials.

PubMed

Sarkar, Swapan Kumar; Lee, Byong Taek

2015-05-01

Bone is a unique organ composed of mineralized hard tissue, unlike any other body part. The unique manner in which bone can constantly undergo self-remodeling has created interesting clinical approaches to the healing of damaged bone. Healing of large bone defects is achieved using implant materials that gradually integrate with the body after healing is completed. Such strategies require a multidisciplinary approach by material scientists, biological scientists, and clinicians. Development of materials for bone healing and exploration of the interactions thereof with the body are active research areas. In this review, we explore ongoing developments in the creation of materials for regenerating hard tissues.

Idiopathic Pulmonary Fibrosis: Diagnosis and Clinical Manifestations

PubMed Central

Nakamura, Yutaro; Suda, Takafumi

2015-01-01

Idiopathic pulmonary fibrosis (IPF) is a parenchymal lung disease characterized by progressive interstitial fibrosis. The clinical course of IPF can be unpredictable and may be punctuated by acute exacerbations. Although much progress is being made in unraveling the mechanisms underlying IPF, effective therapy for improving survival remains elusive. Longitudinal disease profiling, especially in terms of clinical manifestations in a large cohort of patients, should lead to proper management of the patients and development of new treatments for IPF. Appropriate multidisciplinary assessment in ongoing registries is required to achieve this. This review summarizes the current status of the diagnosis and clinical manifestations of IPF. PMID:27625576

Virtual physiological human: training challenges.

PubMed

Lawford, Patricia V; Narracott, Andrew V; McCormack, Keith; Bisbal, Jesus; Martin, Carlos; Bijnens, Bart; Brook, Bindi; Zachariou, Margarita; Freixa, Jordi Villà I; Kohl, Peter; Fletcher, Katherine; Diaz-Zuccarini, Vanessa

2010-06-28

The virtual physiological human (VPH) initiative encompasses a wide range of activities, including structural and functional imaging, data mining, knowledge discovery tool and database development, biomedical modelling, simulation and visualization. The VPH community is developing from a multitude of relatively focused, but disparate, research endeavours into an integrated effort to bring together, develop and translate emerging technologies for application, from academia to industry and medicine. This process initially builds on the evolution of multi-disciplinary interactions and abilities, but addressing the challenges associated with the implementation of the VPH will require, in the very near future, a translation of quantitative changes into a new quality of highly trained multi-disciplinary personnel. Current strategies for undergraduate and on-the-job training may soon prove insufficient for this. The European Commission seventh framework VPH network of excellence is exploring this emerging need, and is developing a framework of novel training initiatives to address the predicted shortfall in suitably skilled VPH-aware professionals. This paper reports first steps in the implementation of a coherent VPH training portfolio.

Expanding multi-disciplinary approaches to healthcare information technologies: what does information systems offer medical informatics?

PubMed

Chiasson, Mike; Reddy, Madhu; Kaplan, Bonnie; Davidson, Elizabeth

2007-06-01

The effective use of information technology (IT) is a crucial component for the delivery of effective services in health care. Current approaches to medical informatics (MI) research have significantly contributed to the success of IT use in health care but important challenges remain to be addressed. We believe that expanding the multi-disciplinary basis for MI research is important to meeting these research challenges. In this paper, we outline theories and methods used in information systems (IS) research that we believe can inform our understanding of health care IT applications and outcomes. To do so, we discuss some general differences in the focus and methods of MI and IS research to identify broad opportunities. We then review conceptual and methodological approaches in IS that have been applied in health care IT research. These include: technology-use mediation, collaborative work, genre theory, interpretive research, action research, and modeling. Examples of these theories and methods in healthcare IS research are illustrated.

Climatology and archaeoastronomy - Environmental anthropology, a multidisciplinary exact science

NASA Astrophysics Data System (ADS)

Gregori, G. P.; Gregori, L. G.

2003-04-01

During the last few tens thousand years, a dominating unprecedented "virus" - the human kind - controlled climate. It widespread over the Earth's surface and implied both short- and long-range effects in space and time. Phenomena can be expressively investigated like cycles of climate and civilisation, by which the entire human history has to be reinterpreted in terms of environmental anthropology. This is just much like every classical and conventional exact science, based on experimental quantitative observations. Archaeoastronomy is the "instrumental" tool for exploiting such measurements (much like a particle accelerator is the instrument for high-energy subnuclear physics, or a telescope for astrophysics). Its comparative wealth of information is even much larger. The anthropic factor is one leader in climate control, and such understanding helps in facing present disquieting challenges of society. Deontologically, such multidisciplinary studies are a "must" for every savant in order to avoid (i) misunderstanding that can lead to false or non-sense concerns, and (ii) correct underestimating of the real severe challenges and hazards.

Changing therapeutic paradigms in CMV retinitis in AIDS.

PubMed

Piper, H; Ciulla, T A; Danis, R P; Pratt, L M

2000-12-01

Cytomegalovirus (CMV) retinitis is a common ocular complication of immunosuppression. The management of CMV retinitis has been continuously evolving over the last decade. The mainstay of therapy remains ganciclovir and foscarnet. However, increasing resistance and ongoing toxicities to these agents remain a challenge. Additional frequently utilised agents include cidofovir and fomivirsen. The advent of highly active antiretroviral therapy (HAART) has allowed the restoration of immunocompetency to many patients previously challenged by CMV infection. In some circumstances, HAART has even eliminated the need for ongoing antiviral therapy. This paper reviews the current treatment modalities, including their toxicities and dosing recommendations.

The need for a prescribing competency framework to address the burden of complex polypharmacy among multiple long-term conditions.

PubMed

Picton, Catherine; Loughrey, Claire; Webb, Andrew

2016-10-01

The original requirement for a competency framework for prescribers was to identify the essential skills for non-medical prescribers. However, core prescribing competencies are relevant to any prescriber. The new, revised version is especially relevant for doctors/physicians. Doctors are the most frequent prescribers - prescribing is the most common therapeutic intervention. The quantity and complexity of medicine use is increasing through multiple treatment strategies/pathways for multiple comorbidities, resulting in polypharmacy - especially with long-term conditions. This is against a background of the ongoing introduction of new drugs with novel mechanisms of action with increased risks of adverse effects, compounded by drug-drug and disease-drug interactions. This has increased the need for monitoring and follow-up, including identification and management of poor adherence. It is challenging for doctors to maintain safe and effective prescribing and train other doctors and non-medical prescribers within the multidisciplinary team. The prescribing competency framework provides a systematic approach to support doctors to prescribe safely and effectively. It can be used by medical schools to teach prescribing, including preparation for the prescribing safety assessment; by F1/F2 doctors to support prescribing in early years; as part of prescribing quality improvement initiatives and as a continuing professional development framework in general practice or acute care settings. © Royal College of Physicians 2016. All rights reserved.

Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer

PubMed Central

Sadick, Maliha; Schoenberg, Stefan O.; Hoermann, Karl; Sadick, Haneen

2012-01-01

The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic options, HNSCC still represents a multidisciplinary challenge. One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome predicition in patients with HNSCC. This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRI are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning. PMID:23320060

Fertility preservation for medical reasons in girls and women: British fertility society policy and practice guideline.

PubMed

Yasmin, Ephia; Balachandren, Neerujah; Davies, Melanie C; Jones, Georgina L; Lane, Sheila; Mathur, Raj; Webber, Lisa; Anderson, Richard A

2018-04-01

Fertility preservation in the female poses several challenges due to the invasive nature of the techniques available to achieve it. The guideline aims to bring together the evidence available for the measures for fertility preservation and their outcome. The guideline addresses fertility preservation for medical reasons and includes both oncological and non-oncological causes. The techniques that the guideline considers are: (i) embryo and oocyte cryopreservation; (ii) ovarian tissue cryopreservation; (iii) GnRH agonist suppression and (iv) ovarian transposition. Although ovarian tissue cryopreservation is still considered experimental, the availability of this technique is gaining momentum as more live births from auto-transplanted tissue are reported. The guideline also highlights use of current treatment modalities for benign and malignant conditions that have a better fertility sparing profile. The guideline recommends a multidisciplinary approach in counselling women and girls about the risk to their fertility and available techniques. The role of psychological support in assisting women and girls with decision-making is highlighted. The guideline also highlights the risks associated with these techniques. Women need to be medically fit to undergo invasive procedures. Fertility preservation techniques are appropriate when treatment has curative intent. Fertility preservation is a subject of on-going research on outcomes of different techniques and at the time of publication, studies are still likely to emerge adding to the available literature.

Identification and Prediction of Fish Assemblages in Streams of the Albemarle-Pamlico Basin, USA

EPA Science Inventory

Set within the Ecological Services Research Program (ESRP) of USEPA’s Office of Research and Development, a multi-disciplinary research collaborative (MEERT –Multimedia Ecological Exposure Research Team) has taken on a challenge to develop a regional assessment of several ecosyst...

Handbook of Father Involvement: Multidisciplinary Perspectives.

ERIC Educational Resources Information Center

Tamis-LeMonda, Catherine S., Ed.; Cabrera, Natasha, Ed.

Despite an unprecedented surge of research on fathers, progress in the study of father involvement generally occurs within rather than across disciplines. This handbook highlights the challenges facing researchers of father involvement across disciplines. Following an introduction, the chapters of the book are as follows: 1) "Methodological,…

An Investigation of the Development and Management of University Research Institutes

ERIC Educational Resources Information Center

Philbin, Simon P.

2011-01-01

Multidisciplinary research institutes provide universities with an important vehicle to conduct research across traditional disciplines, and this can be an attractive capability for external funding bodies. However, there can be particular challenges, including managing different reporting lines, the need for effective research coordination, and…

STEM Studio: Where Innovation Generates Innovation

ERIC Educational Resources Information Center

Plonczak, Irene; Brooks, Jacqueline Grennon; Wilson, Gloria Lodato; Elijah, Rosebud; Caliendo, Julia

2014-01-01

STEM Studio at Hofstra University is a clinical practice site that brings together public school pupils and preservice teachers in settings with three features that lead to enhanced learning of all participants: classroom structures using multidisciplinary STEM tasks as platforms for learning; design challenge templates for diverse student…

Multidisciplinary management of chronic heart failure: principles and future trends.

PubMed

Davidson, Patricia M; Newton, Phillip J; Tankumpuan, Thitipong; Paull, G; Dennison-Himmelfarb, Cheryl

2015-10-01

Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF. Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management. Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention. Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

Improving outcomes following reconstruction of pressure sores in spinal injury patients: A multidisciplinary approach.

PubMed

Tadiparthi, S; Hartley, A; Alzweri, L; Mecci, M; Siddiqui, H

2016-07-01

Pressure sore treatment in spinal injury patients is challenging. A multidisciplinary approach with joint management by the plastic surgery and spinal injury teams was initiated at our institution in 2005 to improve patient care and surgical outcomes following reconstruction. This study assessed the surgical outcomes following reconstruction using the team approach and to compare inpatient stay and readmissions for complications before and after the multidisciplinary protocol was introduced. A retrospective review of consecutive patients in the multidisciplinary pressure sore clinic was performed. Data were collected on patient demographics, reconstructive techniques, surgical outcomes and readmission for any complications. In total, 45 patients with 60 pressure sores (grade 3 or 4) were reviewed in the joint clinic between 2005 and 2011. The majority of patients were paraplegic (78%), while the remaining 22% were tetraplegic. Ischial sores were the most common (45%) followed by trochanteric (23%) and sacral (20%) sores. Multiple sores were noted in 44% of patients. Flap reconstruction was required in 32 patients (71%); after a mean follow-up time of 33 months (range 25-72 months), there were three (9%) major complications (two recurrences of pressure sores and one sinus) and seven (22%) minor complications. After introduction of patient care pathways through the multidisciplinary approach, the rate of readmission for complications decreased from 14% to 5.5% and inpatient stay upon readmission reduced from 65 to 45 days. Implementation of a multidisciplinary approach was key to optimising surgical outcomes, achieving a low recurrence rate (6%) and reducing readmissions. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

New Approaches to HSCT Multidisciplinary Design and Optimization

NASA Technical Reports Server (NTRS)

Schrage, Daniel P.; Craig, James I.; Fulton, Robert E.; Mistree, Farrokh

1999-01-01

New approaches to MDO have been developed and demonstrated during this project on a particularly challenging aeronautics problem- HSCT Aeroelastic Wing Design. To tackle this problem required the integration of resources and collaboration from three Georgia Tech laboratories: ASDL, SDL, and PPRL, along with close coordination and participation from industry. Its success can also be contributed to the close interaction and involvement of fellows from the NASA Multidisciplinary Analysis and Optimization (MAO) program, which was going on in parallel, and provided additional resources to work the very complex, multidisciplinary problem, along with the methods being developed. The development of the Integrated Design Engineering Simulator (IDES) and its initial demonstration is a necessary first step in transitioning the methods and tools developed to larger industrial sized problems of interest. It also provides a framework for the implementation and demonstration of the methodology. Attachment: Appendix A - List of publications. Appendix B - Year 1 report. Appendix C - Year 2 report. Appendix D - Year 3 report. Appendix E - accompanying CDROM.

A Multidisciplinary Approach to Mixer-Ejector Analysis and Design

NASA Technical Reports Server (NTRS)

Hendricks, Eric, S.; Seidel, Jonathan, A.

2012-01-01

The design of an engine for a civil supersonic aircraft presents a difficult multidisciplinary problem to propulsion system engineers. There are numerous competing requirements for the engine, such as to be efficient during cruise while yet quiet enough at takeoff to meet airport noise regulations. The use of mixer-ejector nozzles presents one possible solution to this challenge. However, designing a mixer-ejector which will successfully address both of these concerns is a difficult proposition. Presented in this paper is an integrated multidisciplinary approach to the analysis and design of these systems. A process that uses several low-fidelity tools to evaluate both the performance and acoustics of mixer-ejectors nozzles is described. This process is further expanded to include system-level modeling of engines and aircraft to determine the effects on mission performance and noise near airports. The overall process is developed in the OpenMDAO framework currently being developed by NASA. From the developed process, sample results are given for a notional mixer-ejector design, thereby demonstrating the capabilities of the method.

Robotic System for Condition Assessment of Concrete Bridge Decks : Data Driven Decisions [Tech Brief

DOT National Transportation Integrated Search

2012-12-11

In the United States, the stewardship and management of approximately 599,000 bridges present ongoing planning, operational, maintenance, and economic challenges for Federal, State, and local transportation agencies. To help overcome these challenges...

Patient-physician interaction in general practice and health inequalities in a multidisciplinary study: design, methods and feasibility in the French INTERMEDE study.

PubMed

Kelly-Irving, Michelle; Rolland, Christine; Afrite, Anissa; Cases, Chantal; Dourgnon, Paul; Lombrail, Pierre; Pascal, Jean; Lang, Thierry

2009-04-22

The way in which patients and their doctors interact is a potentially important factor in optimal communication during consultations as well as treatment, compliance and follow-up care. The aim of this multidisciplinary study is to use both qualitative and quantitative methods to explore the 'black box' that is the interaction between the two parties during a general practice consultation, and to identify factors therein that may contribute to producing health inequalities. This paper outlines the original multidisciplinary methodology used, and the feasibility of this type of study. The study design combines methodologies on two separate samples in two phases. Firstly, a qualitative phase collected ethnographical and sociological data during consultation, followed by in-depth interviews with both patients and doctors independently. Secondly, a quantitative phase on a different sample of patients and physicians collected data via several questionnaires given to patients and doctors consisting of specific 'mirrored' questions asked post-consultation, as well as collecting information on patient and physician characteristics. The design and methodology used in this study were both successfully implemented, and readily accepted by doctors and patients alike. This type of multidisciplinary study shows great potential in providing further knowledge into the role of patient/physician interaction and its influence on maintaining or producing health inequalities. The next challenge in this study will be implementing the multidisciplinary approach during the data analysis.

[INTESTINAL FAILURE IN PEDIATRIC PATIENTS: EXPERIENCE AND MANAGEMENT BY A MULTIDISCIPLINARY GROUP].

PubMed

Giraldo Villa, Adriana; Martínez Volkmar, María Isabel; Valencia Quintero, Andrés Felipe; Montoya Delgado, Diana Catalina; Henao Roldan, Catherine; Ruiz Navas, Patricia; García Loboguerrero, Fanny; Contreras Ramírez, Mónica María

2015-12-01

institutions with multidisciplinary teams have shown improvements in patient outcomes with intestinal failure. Multidisciplinary approach allows an integral management and effective communication between families and care teams. describe the multidisciplinary management and outcome in pediatric patients with intestinal failure. retrospective study in patients 18 years old or less, with intestinal failure and Total Parenteral Nutrition (TPN) required. Simple frequencies and percentages were used for qualitative variables, and central tendency and dispersion measures were used for quantitative variables. 33 patients with a median follow up of 281 days were evaluated. The median duration of the TPN was 68 days and the mean of catheter-related infections was 2.26 per patient. In 31 patients oral or enteral nutrition was provided, starting in 61.3% of cases through tube and continuous infusion. As concomitant treatment 72.7% of children received ursodeoxycholic acid, 67.7%, cholestyramine 57.6% loperamide, 48.5% antibiotics and 36.4% probiotic. The families of 24 patients were evaluated by social work professionals. Intestinal autonomy was achieved in 69.7% of cases, 72.7% of them showed an improvement in the score z of weight and showed an end albumin significantly higher than the initial (p value: 0.012). the management of patients with intestinal failure is a challenge for health institutions and require care based on a standardized protocol and a multidisciplinary group. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

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.

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

Using computerised decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance

PubMed Central

Patkar, Vivek; Acosta, Dionisio; Davidson, Tim; Jones, Alison; Fox, John

2012-01-01

Objectives The cancer multidisciplinary team (MDT) meeting (MDM) is regarded as the best platform to reduce unwarranted variation in cancer care through evidence-compliant management. However, MDMs are often overburdened with many different agendas and hence struggle to achieve their full potential. The authors developed an interactive clinical decision support system called MATE (Multidisciplinary meeting Assistant and Treatment sElector) to facilitate explicit evidence-based decision making in the breast MDMs. Design Audit study and a questionnaire survey. Setting Breast multidisciplinary unit in a large secondary care teaching hospital. Participants All members of the breast MDT at the Royal Free Hospital, London, were consulted during the process of MATE development and implementation. The emphasis was on acknowledging the clinical needs and practical constraints of the MDT and fitting the system around the team's workflow rather than the other way around. Delegates, who attended MATE workshop at the England Cancer Networks' Development Programme conference in March 2010, participated in the questionnaire survey. Outcome measures The measures included evidence-compliant care, measured by adherence to clinical practice guidelines, and promoting research, measured by the patient identification rate for ongoing clinical trials. Results MATE identified 61% more patients who were potentially eligible for recruitment into clinical trials than the MDT, and MATE recommendations demonstrated better concordance with clinical practice guideline than MDT recommendations (97% of MATE vs 93.2% of MDT; N=984). MATE is in routine use in breast MDMs at the Royal Free Hospital, London, and wider evaluations are being considered. Conclusions Sophisticated decision support systems can enhance the conduct of MDMs in a way that is acceptable to and valued by the clinical team. Further rigorous evaluations are required to examine cost-effectiveness and measure the impact on patient outcomes. The decision support technology used in MATE is generic and if found useful can be applied across medicine. PMID:22734113

Managing MDO Software Development Projects

NASA Technical Reports Server (NTRS)

Townsend, J. C.; Salas, A. O.

2002-01-01

Over the past decade, the NASA Langley Research Center developed a series of 'grand challenge' applications demonstrating the use of parallel and distributed computation and multidisciplinary design optimization. All but the last of these applications were focused on the high-speed civil transport vehicle; the final application focused on reusable launch vehicles. Teams of discipline experts developed these multidisciplinary applications by integrating legacy engineering analysis codes. As teams became larger and the application development became more complex with increasing levels of fidelity and numbers of disciplines, the need for applying software engineering practices became evident. This paper briefly introduces the application projects and then describes the approaches taken in project management and software engineering for each project; lessons learned are highlighted.

Supporting the Thesis Writing Process of International Research Students through an Ongoing Writing Group

ERIC Educational Resources Information Center

Li, Linda Y.; Vandermensbrugghe, Joelle

2011-01-01

Evidence from research suggests writing support is particularly needed for international research students who have to tackle the challenges of thesis writing in English as their second language in Western academic settings. This article reports the development of an ongoing writing group to support the thesis writing process of international…

Grand Challenges: Nanotechnology and the Social Studies

ERIC Educational Resources Information Center

Manfra, Meghan McGlinn

2013-01-01

This article explores a multidisciplinary lesson on nanotechnology that can provide an effective means for teaching about both STEM and social studies topics. This approach encourages students to consider the "role that science and technology play in our lives and in our cultures." The extraordinary promise of nanotechnology, however, is…

Geriatric Education across 94 Million Acres: Adapting Conference Programming in a Rural State

ERIC Educational Resources Information Center

Murphy-Southwick, Colleen; McBride, Melen

2006-01-01

Montana, a predominantly rural state, with a unique blend of geography and history, low population density, and cultural diversity represents the challenges for program development and implementation across remote areas. The paper discusses two statewide multidisciplinary geriatric education programs for health professionals offered by the…

The Diploma in Science

ERIC Educational Resources Information Center

Lawlor, Hugh

2010-01-01

At the heart of the vision for the Diploma in Science is a multidisciplinary approach to learning by tackling scientific challenges and questions in applied work-related contexts. This, together with the innovative delivery model offered by a consortia approach, will bridge a significant gap in the provision of science and mathematics education.…

Knowledge Building by Full Integration with Virtual Reality Environments and Its Effects on Personal and Social Life.

ERIC Educational Resources Information Center

Fialho, Francisco Antonio Pereira; Catapan, Araci Hack

1999-01-01

Argues that the creation of distributed environments for constructivist learning is a challenge which requires a multidisciplinary development and support team. Outlines recommended strategies for the collective creation of virtual worlds which can improve learning. Contains 11 references. (Author/WRM)

Using Generalizability Analysis to Estimate Parameters for Anatomy Assessments: A Multi-institutional Study

ERIC Educational Resources Information Center

Byram, Jessica N.; Seifert, Mark F.; Brooks, William S.; Fraser-Cotlin, Laura; Thorp, Laura E.; Williams, James M.; Wilson, Adam B.

2017-01-01

With integrated curricula and multidisciplinary assessments becoming more prevalent in medical education, there is a continued need for educational research to explore the advantages, consequences, and challenges of integration practices. This retrospective analysis investigated the number of items needed to reliably assess anatomical knowledge in…

Examining Construct Validity of the Quantitative Literacy VALUE Rubric in College-Level STEM Assignments

ERIC Educational Resources Information Center

Gray, Julie S.; Brown, Melissa A.; Connolly, John P.

2017-01-01

Data-driven decision making is increasingly viewed as essential in a globally competitive society. Initiatives to augment standardized testing with performance-based assessment have increased as educators progressively respond to mandates for authentic measurement of student attainment. To meet this challenge, multidisciplinary rubrics were…

Characterizing land use change in multidisciplinary landscape-level analyses.

Treesearch

Jeffrey D. Kline

2003-01-01

Economists increasingly face opportunities to collaborate with ecologists on landscape-level analyses of socioeconomic and ecological processes. This often calls for developing empirical models to project land use change as input into ecological models. Providing ecologists with the land use information they desire can present many challenges regarding data, modeling,...

Abstract for 1999 Rational Software User Conference

NASA Technical Reports Server (NTRS)

Dunphy, Julia; Rouquette, Nicolas; Feather, Martin; Tung, Yu-Wen

1999-01-01

We develop spacecraft fault-protection software at NASA/JPL. Challenges exemplified by our task: 1) high-quality systems - need for extensive validation & verification; 2) multi-disciplinary context - involves experts from diverse areas; 3) embedded systems - must adapt to external practices, notations, etc.; and 4) development pressures - NASA's mandate of "better, faster, cheaper".

Collection Development in Public Health: A Guide to Selection Tools

ERIC Educational Resources Information Center

Wallis, Lisa C.

2004-01-01

Public health librarians face many challenges in collection development because the field is multidisciplinary, the collection's users have varied needs, and many of the essential resources are grey literature materials. Further, little has been published about public health selection tools. However, librarians responsible for these areas have a…

Juvenile Obesity, Physical Activity, and Lifestyle Changes.

ERIC Educational Resources Information Center

Bar-Or, Oded

2000-01-01

Because many obese children become obese adults, the recent rapid increase in juvenile obesity poses a major public health challenge. Enhanced physical activity is a cornerstone in a multidisciplinary approach to preventing and treating juvenile obesity. Giving exercise recommendations focused for obese youth is critical. Cutting down on sedentary…

Lesbian Presentations and Representations of Leadership, and the Implications for HRD

ERIC Educational Resources Information Center

Gedro, Julie

2010-01-01

Purpose: This paper seeks to identify, examine, and discuss the unique challenges for lesbians who serve in leadership positions in corporate America. Design/methodology/approach: Drawing upon a multi-disciplinary framework of management, diversity, feminist, and leadership literature, the paper critically examines the myriad of pressures exerted…

A Multidisciplinary Team-Teaching Approach to Sustainable Business Education

ERIC Educational Resources Information Center

Izberk-Bilgin, Elif; Klein, Barbara D.; Chandra, Charu; Lee, Hei-Wai; Susko, David; Lee, Moses; Zikanov, Oleg

2012-01-01

Sustainability has been identified as one of the most pressing challenges for business and society. However, research shows that sustainability topics are still not given sufficient attention in higher education, particularly in the undergraduate business curriculum. This paper offers a template for an interdisciplinary, team-taught undergraduate…

Implementing a Diversity-Orientated Online Graduate-Level Health Professions Education Program

ERIC Educational Resources Information Center

Savard, Isabelle

2015-01-01

This case describes the strategies implemented in the development of an online Master's degree program in Health Professions Education (HPE) and an online short, Master's level diploma program. The strategies presented pertain to three of the main challenges identified: program cohesiveness, a multidisciplinary approach, and information technology…

Enhanced Podcasts for Teaching Biochemistry to Veterinary Students

ERIC Educational Resources Information Center

Gough, Kevin C.

2011-01-01

The teaching of biochemistry within medical disciplines presents certain challenges; firstly to relay a large body of complex facts and abstract concepts, and secondly to motivate students that this relatively difficult topic is worth their time to study. Here, nutrient biochemistry was taught within a multidisciplinary module as part of an…

Solutions to Challenges Facing a University Digital Library and Press

PubMed Central

D'Alessandro, Michael P.; Galvin, Jeffrey R.; Colbert, Stephana I.; D'Alessandro, Donna M.; Choi, Teresa A.; Aker, Brian D.; Carlson, William S.; Pelzer, Gay D.

2000-01-01

During the creation of a university digital library and press intended to serve as a medical reference and education tool for health care providers and their patients, six distinct and complex digital publishing challenges were encountered. Over nine years, through a multidisciplinary approach, solutions were devised to the challenges of digital content ownership, management, mirroring, translation, interactions with users, and archiving. The result is a unique, author-owned, internationally mirrored, university digital library and press that serves as an authoritative medical reference and education tool for users around the world. The purpose of this paper is to share the valuable digital publishing lessons learned and outline the challenges facing university digital libraries and presses. PMID:10833161

Multidisciplinary Analysis and Control of High Performance Air Vehicles

DTIC Science & Technology

2005-05-06

G (s)u(s) + Gf (s)f(s) (4) where {GP(s) = C(sl - A)-’B + D G1(s) =C(sl - A)-’R, + R2 From a practical point of view, it is reasonable to make no...between various dynamics that makes control of this class of vehicles very challenging. 5. Human Resource Development: The grant was used to attract...characteristics of AHF make modeling and control of AHFVs especially challenging. Due to the strong coupling between the aerodynamics, the airframe, and

Probabilistic methods for sensitivity analysis and calibration in the NASA challenge problem

DOE PAGES

Safta, Cosmin; Sargsyan, Khachik; Najm, Habib N.; ...

2015-01-01

In this study, a series of algorithms are proposed to address the problems in the NASA Langley Research Center Multidisciplinary Uncertainty Quantification Challenge. A Bayesian approach is employed to characterize and calibrate the epistemic parameters based on the available data, whereas a variance-based global sensitivity analysis is used to rank the epistemic and aleatory model parameters. A nested sampling of the aleatory–epistemic space is proposed to propagate uncertainties from model parameters to output quantities of interest.

Probabilistic methods for sensitivity analysis and calibration in the NASA challenge problem

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

Safta, Cosmin; Sargsyan, Khachik; Najm, Habib N.

In this study, a series of algorithms are proposed to address the problems in the NASA Langley Research Center Multidisciplinary Uncertainty Quantification Challenge. A Bayesian approach is employed to characterize and calibrate the epistemic parameters based on the available data, whereas a variance-based global sensitivity analysis is used to rank the epistemic and aleatory model parameters. A nested sampling of the aleatory–epistemic space is proposed to propagate uncertainties from model parameters to output quantities of interest.

Supporting Children with Developmental Challenges.

ERIC Educational Resources Information Center

Brand, Marie

1998-01-01

Examines strategies for developing challenging but appropriate programs for children with disabilities. Discusses the importance of identifying and understanding the particular needs of individual children; developing appropriate routines; maintaining ongoing communication with, and the involvement of, family members; and playing an active support…

Mono-disciplinary or multidisciplinary back pain guidelines? How can we achieve a common message in primary care?

PubMed

Breen, Alan C; van Tulder, Maurits W; Koes, Bart W; Jensen, Irene; Reardon, Rhoda; Bronfort, Gert

2006-05-01

Description of a workshop entitled "Sharing Guidelines for Low Back Pain Between Primary Health Care Providers: Toward a Common Message in Primary Care" that was held at the Fifth International Forum on Low Back Pain in Primary Care in Canada in May 2002. Despite a considerable degree of acceptance of current evidence-based guidelines, in practice, primary health care providers still do not share a common message. The objective of the workshop was to describe the outcomes of a workshop on the sharing of guidelines in primary care. The Fifth International Forum on Low Back Pain Research in Primary Care focused on relations between stakeholders in the primary care management of back pain. Participants in this workshop contributed to an open discussion on "how and why" evidence-based guidelines about back pain do or do not work in practice. Ways to minimise the factors that inhibit implementation were discussed in the light of whether guidelines are mono-disciplinary or multidisciplinary. Examples of potential issues for debate were contained in introductory presentations. The prospects for improving implementation and reducing barriers, and the priorities for future research, were then considered by an international group of researchers. This paper summarises the conclusions of three researcher subgroups that focused on the sharing of guidelines under the headings of: (1) the content, (2) the development process, and (3) implementation. How to share the evidence and make it meaningful to practice stakeholders is the main challenge of guideline implementation. There is a need to consider the balance between the strength of evidence in multidisciplinary guidelines and the utility/feasibility of mono-disciplinary guidelines. The usefulness of both mono-disciplinary and multidisciplinary guidelines was agreed on. However, in order to achieve consistent messages, mono-disciplinary guidelines should have a multidisciplinary parent. In other words, guidelines should be developed and monitored by a multidisciplinary team, but may be transferred to practice by mono-disciplinary messengers. Despite general agreement that multi-faceted interventions are most effective for implementing guidelines, the feasibility of doing this in busy clinical settings is questioned. Research is needed from local implementation pilots and quality monitoring studies to understand how to develop and deliver the contextual understanding required. This relates to processes of care as well as outcomes, and to social factors and policymaking as well as health care interventions. We commend these considerations to all who are interested in the challenges of achieving better-integrated, evidence-based care for people with back pain.

The integration of chiropractors into healthcare teams: a case study from sport medicine.

PubMed

Theberge, Nancy

2008-01-01

This article examines the integration of chiropractors into multi-disciplinary healthcare teams in the specialisation of sport medicine. Sport medicine is practised in a number of contexts in professional and amateur sport. The current analysis focuses on the highest levels of amateur sport, as exemplified by the Olympics. Data are taken from interviews with 35 health professionals, including physicians, physiotherapists, athletic therapists and chiropractors. A defining feature of sport medicine is an emphasis on performance, which is the basis for a client-centred model of practice. These two elements have provided the main grounds for the inclusion of chiropractic in sport medicine. While the common understanding that 'athletes wanted them' has helped to secure a position for chiropractic within the system of sport medicine professions, this position is marked by ongoing tensions with other professions over the scope and content of practice, and the nature of the patient-practitioner relationship. In the context of these tensions, chiropractors' success in achieving acceptance on sport medicine teams is contingent on two factors: (a) reduced scope of practice in which they work primarily as manual therapists; and (b) the exemplary performance of individual practitioners who 'fit' into multi-disciplinary sport medicine teams.

'My kidneys, my choice, decision aid': supporting shared decision making.

PubMed

Fortnum, Debbie; Smolonogov, Tatiana; Walker, Rachael; Kairaitis, Luke; Pugh, Debbie

2015-06-01

For patients with chronic kidney disease (CKD) who are progressing to end-stage kidney disease (ESKD) a decision of whether to undertake dialysis or conservative care is a critical component of the patient journey. Shared decision making for complex decisions such as this could be enhanced by a decision aid, a practice which is well utilised in other disciplines but limited for nephrology. A multidisciplinary team in Australia and New Zealand (ANZ) utilised current decision-making theory and best practice to develop the 'My Kidneys, My Choice', a decision aid for the treatment of kidney disease. A patient-centred, five-sectioned tool is now complete and freely available to all ANZ units to support the ESKD education and shared decision-making process. Distribution and education have occurred across ANZ and evaluation of the decision aid in practice is in the first phase. Development of a new tool such as an ESKD decision aid requires vision, multidisciplinary input and ongoing implementation resources. This tool is being integrated into ANZ, ESKD education practice and is promoting the philosophy of shared decision making. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Formalising multidisciplinary peer review: developing a haematological malignancy-specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence-based clinical practice.

PubMed

Trotman, Judith; Trinh, Jimmy; Kwan, Yiu Lam; Estell, Jane A; Fletcher, Julie; Archer, Kate; Lee, Kenneth; Foo, Kerwin; Curnow, Jennifer; Bianchi, Alessandra; Wignall, Lynda; Verner, Emma; Gasiorowski, Robin; Siedlecka, Elizabeth; Cunningham, Ilona

2017-05-01

Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care. © 2016 Royal Australasian College of Physicians.

Integrated, Multidisciplinary and Technology-Enhanced Science Education: The Next Frontier

PubMed Central

Dinov, Ivo D.

2011-01-01

Contemporary science education at all levels presents several critical pedagogical and social challenges to educators and learners alike. Among these challenges are the widening Intergenerational Information Technology (IIT) divide and the need for a comprehensive and balanced multidisciplinary training. In the past few years, it has become clear that one significant hurdle impedes the efforts to integrate information technology in the classroom – the Intergenerational IT divide. The IIT gap reflects a different growing misalignment between providers and recipients of the science and technology educational content in terms of the expected vs. supplied, needed vs. perceived and contextual vs. abstract specialized learning. The common K-12 teacher or college instructor is much less familiar with, and slower to adapt to, the new ether of communication and novel IT resources. The transfer and blending of data, research challenges and methodologies between diverse areas of science is also critical in motivating wider spectra of students, demonstrating cross-disciplinary methodological concepts and synergies, as well as for engaging students in research projects. This article discusses the problems faced by modern science educators and suggests some methods and vision for coping with the increasing IIT divide and the social need to train “complete” and broadly educated citizens. PMID:21552453

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.

Thinking, feeling and moving: drama and movement therapy as an adjunct to a multidisciplinary rehabilitation approach for chronic pain in two adolescent girls.

PubMed

Christie, Deborah; Hood, Deborah; Griffin, Angela

2006-10-01

Chronic Pain without an identifiable organic basis represents a substantial element of referrals to both medical and mental health professionals. Chronic pain can compromise independence, school attendance, physical and social activities. The tendency to label 'nonorganic' pain as having a psychological origin is usually strongly resisted by parents and young people with treatment creating a significant challenge for health care professionals. Collaborative, multidisciplinary treatment programmes encourage families to find ways of getting on with their lives by taking a proactive approach to challenging pain. The family is invited to join with the team in the task of challenging the pain through the use of physiotherapy to increase strength, stamina and suppleness alongside a range of individual and group activities that can include relaxation training, hypnotherapy, systemic and cognitive-behavioural approaches. This article describes how drama and movement therapy was introduced as an additional component of the treatment programme of two adolescents who had been long-term inpatients on a medical adolescent ward. The experiences of adding a complementary therapy to the programme are described to illustrate a creative way of contributing to established treatment programmes through the use of sound, movement and gesture in order to provide a space to explore new ways of being and expanding abilities.

The Impact of Evidence-Based Practice Implementation and Fidelity Monitoring on Staff Turnover: Evidence for a Protective Effect

ERIC Educational Resources Information Center

Aarons, Gregory A.; Sommerfeld, David H.; Hecht, Debra B.; Silovsky, Jane F.; Chaffin, Mark J.

2009-01-01

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff…

The MOOC and Learning Analytics Innovation Cycle (MOLAC): A Reflective Summary of Ongoing Research and Its Challenges

ERIC Educational Resources Information Center

Drachsler, H.; Kalz, M.

2016-01-01

The article deals with the interplay between learning analytics and massive open online courses (MOOCs) and provides a conceptual framework to situate ongoing research in the MOOC and learning analytics innovation cycle (MOLAC framework). The MOLAC framework is organized on three levels: On the micro-level, the data collection and analytics…

Current research in aging: a report from the 2015 Ageing Summit.

PubMed

Moyse, Emmanuel; Lahousse, Lies; Krantic, Slavica

2015-01-01

Ageing Summit, London, UK, 10-12 February 2015 The Ageing Summit 2015 held on 10-12 February 2015 in London (UK) provided an extensive update to our knowledge of the 'Biology of Ageing' and a forum to discuss the participants' latest research progress. The meeting was subdivided into four thematic sessions: cellular level research including the aging brain; slowing down progression, rejuvenation and self-repair; genetic and epigenetic regulation; and expression and pathology of age-related diseases. Each session included multiple key presentations, three to five short research communications and ongoing poster presentations. The meeting provided an exciting multidisciplinary overview of the aging process from cellular and molecular mechanisms to medico-social aspects of human aging.

Is It PANS, CANS, or PANDAS? Neuropsychiatric Pediatric Disorders That Are Not Black and White--Implications for the School Nurse.

PubMed

Bagian, Kathy; Hartung, Sheila Q

2015-03-01

The terms pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), pediatric acute-onset neuropsychiatric syndrome (PANS), and childhood acute neuropsychiatric symptoms (CANS) have all been used to describe certain acute onset neuropsychiatric pediatric disorders. Additionally, controversy is ongoing concerning the diagnosis and etiology of the disorders. The school nurse, as a member of a multidisciplinary team, benefits from an awareness of these disorders, the resulting impact on school performance, and the recommended treatment. The school nurse assists the team through the development of an Individualized Healthcare Plan to help the student to achieve success in school. © 2014 The Author(s).

Staying Connected: Sustaining Collaborative Care Models with Limited Funding.

PubMed

Johnston, Brenda J; Peppard, Lora; Newton, Marian

2015-08-01

Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed. Copyright 2015, SLACK Incorporated.

Technical challenges involved in supporting the Lambda Point Experiment

NASA Technical Reports Server (NTRS)

Petrac, D.; Israelsson, U.; Otth, D.; Simmons, L.; Staats, J.; Thompson, A.

1990-01-01

The Lambda Point Experiment (LPE) is one of the instruments included in the U.S. Microgravity Payload Mission 1 planned for one of the Space Shuttle flights in 1992. The objective of the experiment is to measure the heat capacity of liquid helium within a narrow interval around the transition between superfluid and normal helium (the lambda point) with an unprecedented temperature resolution of about 10 to the -10th. Multiple technical challenges are presented in the areas of structural support, safety analysis, and modal frequency tests. This paper describes the technical challenges of JPL's multidisciplinary involvement in support of these experiments in microgravity.

Challenges in Teaching "Colloid and Surface Chemistry"--A Danish Experience

ERIC Educational Resources Information Center

Kontogeorgis, Georgios M.; Vigild, Martin E.

2009-01-01

Seven years ago we were asked, as one of our first teaching duties at the Technical University of Denmark (DTU), to teach a 5 ECTS point course on "Colloid and Surface Chemistry". The topic is itself at the same time exciting and demanding, largely due to its multidisciplinary nature. Several "local" requirements posed…

ICT Tools in Environmental Education: Reviewing Two Newcomers to Schools

ERIC Educational Resources Information Center

Fauville, G.; Lantz-Andersson, A.; Säljö, R.

2014-01-01

United Nations of Education Scientific and Cultural Organisation's (UNESCO's) founding statements about environmental education (EE) in the 1970s positioned it as a multidisciplinary field of inquiry. When enacted as such, it challenges traditional ways of organising secondary school education by academic subject areas. Equally,…

A Service-Learning Project: Linking an Art Museum, Honors Students, and the Visual Arts

ERIC Educational Resources Information Center

Cempellin, Leda

2012-01-01

This article focuses on the structure, challenges, and outcomes of a service-learning project experimented by an art historian in an innovative special topics course Museum Experience, cross-listed with an Honors art appreciation course. The discussion includes: creating a new course content planned according to a multidisciplinary perspective…

Between "Homo Sociologicus" and "Homo Biologicus": The Reflexive Self in the Age of Social Neuroscience

ERIC Educational Resources Information Center

Pickel, Andreas

2012-01-01

The social sciences rely on assumptions of a unified self for their explanatory logics. Recent work in the new multidisciplinary field of social neuroscience challenges precisely this unproblematic character of the subjective self as basic, well-defined entity. If disciplinary self-insulation is deemed unacceptable, the philosophical challenge…

The Carbon Cycle and the Earth Systems--Studying the Carbon Cycle in Multidisciplinary Environmental Context.

ERIC Educational Resources Information Center

Gudovitch, Yossi; Orion, Nir

This paper describes a method that attempts to confront the challenges of developing an environmentally-based earth sciences program. The research scheme includes five stages: (1) predevelopment study; (2) curriculum development; (3) implementation; (4) formative evaluation; and (5) curriculum modification. The research results indicate that the…

Challenge Based Innovation: Translating Fundamental Research into Societal Applications

ERIC Educational Resources Information Center

Kurikka, Joona; Utriainen, Tuuli; Repokari, Lauri

2016-01-01

This paper is based on work done at IdeaSquare, a new innovation experiment at CERN, the European Organization for Nuclear Research. The paper explores the translation of fundamental research into societal applications with the help of multidisciplinary student teams, project- and problem-based learning and design thinking methods. The theme is…

Number Sense and Number Nonsense: Understanding the Challenges of Learning Math

ERIC Educational Resources Information Center

Krasa, Nancy; Shunkwiler, Sara

2009-01-01

How do children learn math--and why do some children struggle with it? The answers are in "Number Sense and Number Nonsense," a straightforward, reader-friendly book for education professionals and an invaluable multidisciplinary resource for researchers. More than a first-ever research synthesis, this highly accessible book brings math…

In the Wake of China's Quickening Economy, Universities Struggle to Keep Pace

ERIC Educational Resources Information Center

Hennock, Mary

2012-01-01

In China the global challenges of fast-evolving technology and multidisciplinary studies are complicated by the newness of the market. Only 40 years ago, professors were condemned to manual labor if suspected of capitalist sympathies, and most universities were shut down during the decade-long Cultural Revolution. The government is preoccupied…

The Northeast Regional Center for Rural Development: 1999 Annual Report. NERCRD Publication #75.

ERIC Educational Resources Information Center

Northeast Regional Center for Rural Development, University Park, PA.

The Northeast Regional Center for Rural Development is funded by the U.S. Department of Agriculture and private foundations, and invests in research and education to help rural communities meet the challenges of today's global society through a multidisciplinary network of university research and extension faculty, policy makers, and rural…

Vertical Integration of System-on-Chip Concepts in the Digital Design Curriculum

ERIC Educational Resources Information Center

Tang, Ying; Head, L. M.; Ramachandran, R. P.; Chatman, L. M.

2011-01-01

The rapid evolution of System-on-Chip (SoC) challenges academic curricula to keep pace with multidisciplinary/interdisciplinary system thinking. This paper presents a curricular prototype that cuts across artificial course boundaries and provides a meaningful exploration of diverse facets of SoC design. Specifically, experimental contents of a…

Crop improvement in the era of climate change: an integrated, multi-disciplinary approach for common bean (Phaseolus vulgaris L.)

USDA-ARS?s Scientific Manuscript database

Two forces are converging that will jointly challenge researchers to design programs that ensure our crop production systems meet the world’s food demand. Climate change will potentially reduce productivity while a global population increase will require more food. If productivity is not increased...

Reforming the Higher Education Curriculum. Internationalizing the Campus. American Council on Education/Oryx Press Series on Higher Education.

ERIC Educational Resources Information Center

Mestenhauser, Josef A., Ed.; Ellingboe, Brenda J.

The 13 chapters of this book attempt to challenge assumptions about international education and urge comprehensive curricular changes involving integration of international and global education into all disciplines. Chapters are organized into three parts that address internationalization for the 21st century, multidisciplinary perspectives on…

Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care.

PubMed

Kolarczyk, Lavinia M; Arora, Harendra; Manning, Michael W; Zvara, David A; Isaak, Robert S

2018-02-01

Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. All rights reserved.

A new concept of a multidisciplinary lymphoedema centre: established in connection to a department of dermatology and the Copenhagen Wound Healing Center.

PubMed

Birkballe, S; Karlsmark, T; Noerregaard, S; Gottrup, F

2012-07-01

Lymphoedema is increasingly recognized as a significant problem in healthcare. The number of patients is growing, posing a future challenge to healthcare systems and economics. Over the past decade, specialized lymphoedema management has been established around the world to accommodate the growing demands. However, information on organization, experiences and outcome are scarce. To conduct a clinical perspective analysis describing the establishment, organization, function and results of a new, multidisciplinary lymphoedema centre functioning as a university hospital unit in connection to a department of dermatology and the Copenhagen Wound Healing Center and integrated as a national expert function in the public healthcare organization of Denmark. Data were collected following the establishment of a lymphoedema centre based on the structured, multidisciplinary organization of lymphoedema management. During the first 4·5 years a total of 8058 patient consultations were performed. The mean duration of symptoms at the first visit was 19 years (range 1-67) and 31% of patients had never received any diagnosis or treatment prior to referral. Complications were found in 48% of referred patients. All patients received appropriate diagnostic investigations and treatment according to best practice. Multidisciplinary assessment involving four or more different healthcare professions was needed in 86% of cases. Research opportunities and expert education of staff were enhanced. A multidisciplinary lymphoedema centre improves management, knowledge and awareness of lymphoedema. This model, with minor adjustments, may be applicable for other regions and countries. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

Bio-Nanotechnology: Challenges for Trainees in a Multidisciplinary Research Program

NASA Technical Reports Server (NTRS)

Koehne, Jessica Erin

2009-01-01

The recent developments in the field of nanotechnology have provided scientists with a new set of nanoscale materials, tools and devices in which to investigate the biological science thus creating the mulitdisciplinary field of bio-nanotechnology. Bio-nanotechnology merges the biological sciences with other scientific disciplines ranging from chemistry to engineering. Todays students must have a working knowledge of a variety of scientific disciplines in order to be successful in this new field of study. This talk will provide insight into the issue of multidisciplinary education from the perspective of a graduate student working in the field of bio-nanotechnology. From the classes we take to the research we perform, how does the modern graduate student attain the training required to succeed in this field?

Structural Model Tuning Capability in an Object-Oriented Multidisciplinary Design, Analysis, and Optimization Tool

NASA Technical Reports Server (NTRS)

Lung, Shun-fat; Pak, Chan-gi

2008-01-01

Updating the finite element model using measured data is a challenging problem in the area of structural dynamics. The model updating process requires not only satisfactory correlations between analytical and experimental results, but also the retention of dynamic properties of structures. Accurate rigid body dynamics are important for flight control system design and aeroelastic trim analysis. Minimizing the difference between analytical and experimental results is a type of optimization problem. In this research, a multidisciplinary design, analysis, and optimization (MDAO) tool is introduced to optimize the objective function and constraints such that the mass properties, the natural frequencies, and the mode shapes are matched to the target data as well as the mass matrix being orthogonalized.

Structural Model Tuning Capability in an Object-Oriented Multidisciplinary Design, Analysis, and Optimization Tool

NASA Technical Reports Server (NTRS)

Lung, Shun-fat; Pak, Chan-gi

2008-01-01

Updating the finite element model using measured data is a challenging problem in the area of structural dynamics. The model updating process requires not only satisfactory correlations between analytical and experimental results, but also the retention of dynamic properties of structures. Accurate rigid body dynamics are important for flight control system design and aeroelastic trim analysis. Minimizing the difference between analytical and experimental results is a type of optimization problem. In this research, a multidisciplinary design, analysis, and optimization [MDAO] tool is introduced to optimize the objective function and constraints such that the mass properties, the natural frequencies, and the mode shapes are matched to the target data as well as the mass matrix being orthogonalized.

Novel Multidisciplinary Models Assess the Capabilities of Smart Structures to Manage Vibration, Sound, and Thermal Distortion in Aeropropulsion Components

NASA Technical Reports Server (NTRS)

Saravanos, Dimitris A.

1997-01-01

The development of aeropropulsion components that incorporate "smart" composite laminates with embedded piezoelectric actuators and sensors is expected to ameliorate critical problems in advanced aircraft engines related to vibration, noise emission, and thermal stability. To facilitate the analytical needs of this effort, the NASA Lewis Research Center has developed mechanics and multidisciplinary computational models to analyze the complicated electromechanical behavior of realistic smart-structure configurations operating in combined mechanical, thermal, and acoustic environments. The models have been developed to accommodate the particular geometries, environments, and technical challenges encountered in advanced aircraft engines, yet their unique analytical features are expected to facilitate application of this new technology in a variety of commercial applications.

Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: Study protocol

PubMed Central

2012-01-01

Background Care of children and young people (children) with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. Methods/Design This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using: i) A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statistics ii) Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s) for subsequent in-depth study Phase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the professionals involved in each case-study. Participants will provide signed consent; data gathering will involve a combination of: minimally-obtrusive observations in the clinical setting and families' homes; de-briefing interviews with participants to obtain views on selected interactions; focussed 'verbatim' field-notes, and case-note reviews. Data gathering will focus on communication between parents and professionals as parents learn care-giving skills and knowledge. Interviews will be digitally recorded and transcribed anonymously. Discussion This study involves an iterative-inductive approach and will provide a unique, detailed insight into the social context in which professionals teach and parents learn; it will inform professionals' parent-educative roles, educational curricula, and health care policy PMID:22333296

Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: study protocol.

PubMed

Swallow, Veronica M; Allen, Davina; Williams, Julian; Smith, Trish; Crosier, Jean; Lambert, Heather; Qizalbash, Leila; Wirz, Lucy; Webb, Nicholas J A

2012-02-14

Care of children and young people (children) with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using:i) A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statisticsii) Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s) for subsequent in-depth studyPhase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the professionals involved in each case-study. Participants will provide signed consent; data gathering will involve a combination of: minimally-obtrusive observations in the clinical setting and families' homes; de-briefing interviews with participants to obtain views on selected interactions; focussed 'verbatim' field-notes, and case-note reviews. Data gathering will focus on communication between parents and professionals as parents learn care-giving skills and knowledge. Interviews will be digitally recorded and transcribed anonymously. This study involves an iterative-inductive approach and will provide a unique, detailed insight into the social context in which professionals teach and parents learn; it will inform professionals' parent-educative roles, educational curricula, and health care policy.

A Multidisciplinary Breast Cancer Brain Metastases Clinic: The University of North Carolina Experience.

PubMed

McKee, Megan J; Keith, Kevin; Deal, Allison M; Garrett, Amy L; Wheless, Amy A; Green, Rebecca L; Benbow, Julie M; Dees, E Claire; Carey, Lisa A; Ewend, Matthew G; Anders, Carey K; Zagar, Timothy M

2016-01-01

Breast cancer brain metastasis (BCBM) confers a poor prognosis and is unusual in requiring multidisciplinary care in the metastatic setting. The University of North Carolina at Chapel Hill (UNC-CH) has created a BCBM clinic to provide medical and radiation oncology, neurosurgical, and supportive services to this complex patient population. We describe organization and design of the clinic as well as characteristics, treatments, and outcomes of the patients seen in its first 3 years. Clinical and demographic data were collected from patients in a prospectively maintained database. Descriptive statistics are reported as percentages and means. The Kaplan-Meier method was used to estimate time-to-event outcomes. Sixty-five patients were seen between January 2012 and January 2015. At the time of presentation to the BCBM clinic, most patients (74%) had multiple (≥2) brain metastases and had received prior systemic (77%) and whole-brain radiation therapy and/or central nervous system stereotactic radiosurgery (65%) in the metastatic setting. Seventy-eight percent returned for a follow-up visit; 32% were enrolled in a clinical trial. Median time from diagnosis of brain metastasis to death was 2.11 years (95% confidence interval [CI] 1.31-2.47) for all patients, 1.15 years (95% CI 0.4-2.43) for triple-negative breast cancer, 1.31 years (95% CI 0.51-2.52) for hormone receptor-positive/HER2- breast cancer, and 3.03 years (95% CI lower limit 1.94, upper limit not estimable) for HER2+ breast cancer (p = .0037). Patients with BCBM have unique and complex needs that require input from several oncologic disciplines. The development of the UNC-CH multidisciplinary BCBM clinic is a model that can be adapted at other centers to provide coordinated care for patients with a challenging and complex disease. Patients with breast cancer brain metastases often require unique multidisciplinary care to meet the numerous and uncommon challenges associated with their conditions. Here, the development and characteristics of a clinic designed specifically to provide for the multidisciplinary needs of patients with breast cancer brain metastases are described. This clinic may serve as a model for other institutions interested in creating specialty clinics with similar objectives. ©AlphaMed Press.

DEVELOPMENT OF CFD SIMULATION APPLICATIONS FOR LOCAL-SCALE AREAS AND POTENTIAL INTERFACE WITH MESOSCALE MODELS

EPA Science Inventory

The presentation summarizes developments of ongoing applications of fine-scale (geometry specific) CFD simulations to urban areas within atmospheric boundary layers. Enabling technology today and challenges for the future are discussed. There is a challenging need to develop a ...

Community-Based Research Assessments: Some Principles and Practices.

ERIC Educational Resources Information Center

Marullo, Sam; Cooke, Deanna; Willis, Jason; Rollins, Alexandra; Burke, Jacqueline; Bonilla, Paul; Waldref, Vanessa

2003-01-01

Examines benefits and challenges of undertaking assessments in community-based research (CBR). Such assessments are compared and contrasted to more traditional research processes. Further, the challenges of integrating CBR assessments into an ongoing social change initiative are analyzed. Five principles to guide CBR assessments are articulated. A…

People with Learning Disabilities and "Active Ageing"

ERIC Educational Resources Information Center

Foster, Liam; Boxall, Kathy

2015-01-01

Background: People (with and without learning disabilities) are living longer. Demographic ageing creates challenges and the leading policy response to these challenges is "active ageing". "Active" does not just refer to the ability to be physically and economically active, but also includes ongoing social and civic engagement…

Identifying pathways for improving household food self-sufficiency outcomes in the hills of Nepal

USDA-ARS?s Scientific Manuscript database

Maintaining and improving food security in mountain regions is an ongoing challenge. There are many facets to the problem, including comparatively high levels of system diversity and crop-livestock integration, challenging terrain and transportation bottlenecks, declining labor availability due to o...

Active and Healthy Ageing as a Wicked Problem: The Contribution of a Multidisciplinary Research University.

PubMed

Riva, Giuseppe; Graffigna, Guendalina; Baitieri, Maddalena; Amato, Alessandra; Bonanomi, Maria Grazia; Valentini, Paolo; Castelli, Guido

2014-01-01

The quest for an active and healthy ageing can be considered a "wicked problem." It is a social and cultural problem, which is difficult to solve because of incomplete, changing, and contradictory requirements. These problems are tough to manage because of their social complexity. They are a group of linked problems embedded in the structure of the communities in which they occur. First, they require the knowledge of the social and cultural context in which they occur. They can be solved only by understanding of what people do and why they do it. Second, they require a multidisciplinary approach. Wicked problems can have different solutions, so it is critical to capture the full range of possibilities and interpretations. Thus, we suggest that Università Cattolica del Sacro Cuore (UCSC) is well suited for accepting and managing this challenge because of its applied research orientation, multidisciplinary approach, and integrated vision. After presenting the research activity of UCSC, we describe a possible "systems thinking" strategy to consider the complexity and interdependence of active ageing and healthy living.

Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective

PubMed Central

Johnson, Robert W.; Alvarez-Pasquin, Marie-José; Bijl, Marc; Franco, Elisabetta; Gaillat, Jacques; Clara, João G.; Labetoulle, Marc; Michel, Jean-Pierre; Naldi, Luigi; Sanmarti, Luis S.; Weinke, Thomas

2015-01-01

Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed. PMID:26478818

The Need for Screening, Assessment, and Treatment for Cognitive Dysfunction in Multiple Sclerosis

PubMed Central

Benedict, Ralph H.B.; Gromisch, Elizabeth S.; DeLuca, John

2012-01-01

Cognitive dysfunction is observed in about half of people with multiple sclerosis (MS), and MS health-care professionals face the challenge of screening, assessing, and treating patients for cognitive problems. Considering the inconsistent or limited empirical evidence to assist in this task, a multidisciplinary consensus conference of MS experts, sponsored by the Consortium of Multiple Sclerosis Centers (CMSC), was held on September 24, 2010, to address these issues. Key articles from the literature on these topics were distributed prior to the meeting, and CMSC member professionals were surveyed on clinical practices related to screening, assessment, and treatment for cognitive problems. The purpose of the meeting was threefold: 1) to achieve a multidisciplinary perspective on practices for screening, monitoring, evaluating, and treating MS patients for cognitive problems; 2) to propose consensus candidate measures for screening and/or monitoring for cognitive problems in MS that neurologists or nurses might administer on a regular basis; and 3) to propose consensus treatment approaches from a multidisciplinary perspective. This article summarizes the conclusions of the conference participants and provides preliminary suggestions for screening and brief assessment. PMID:24453735

Game playbooks: tools to guide multidisciplinary teams in developing videogame-based behavior change interventions.

PubMed

Duncan, Lindsay R; Hieftje, Kimberly D; Culyba, Sabrina; Fiellin, Lynn E

2014-03-01

As mobile technologies and videogaming platforms are becoming increasingly prevalent in the realm of health and healthcare, so are the opportunities to use these resources to conduct behavioral interventions. The creation and empirical testing of game style interventions, however, is challenged by the requisite collaboration of multidisciplinary teams, including researchers and game developers who have different cultures, terminologies, and standards of evidence. Thus, traditional intervention development tools such as logic models and intervention manuals may need to be augmented by creating what we have termed "Game Playbooks" which are intervention guidebooks that are created by, understood by, and acceptable to all members of the multidisciplinary game development team. The purpose of this paper is to describe the importance and content of a Game Playbook created to aide in the development of a videogame intervention designed specifically for health behavior change in young teens as well as the process for creating such a tool. We draw on the experience of our research and game design team to describe the critical components of the Game Playbook and the necessity of creating such a tool.

Primary care and cancer: Facing the challenge of early diagnosis and survivorship.

PubMed

Round, Thomas

2017-05-01

With ageing populations and an increasing lifetime risk of cancer, primary care will continue to play an increasingly important role in early diagnosis and cancer survivorship, especially with the lowering of risk thresholds for referral and diagnostic investigations. However, primary care in many countries is in crisis with increasing workloads for primary care physicians. Potential solutions to these challenges will be outlined including development of multidisciplinary teams, diagnostic decision support, increasing access to diagnostics and cost-effective referral pathways. © 2017 John Wiley & Sons Ltd.

The role of the general practitioner in multidisciplinary teams: a qualitative study in elderly care.

PubMed

Grol, Sietske M; Molleman, Gerard R M; Kuijpers, Anne; van der Sande, Rob; Fransen, Gerdine A J; Assendelft, Willem J J; Schers, Henk J

2018-03-10

In the western world, a growing number of the older people live at home. In the Netherlands, GPs are expected to play a pivotal role in the organization of integrated care for this patient group. However, little is known about how GPs can play this role best. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. A mixed qualitative research model in four multidisciplinary teams for elderly care in the Netherlands was used. With these four teams, consisting of 46 health care and social service professionals, we carried out two rounds of focus-group interviews. Moreover, we performed semi-structured interviews with four GPs. We analysed data using a hybrid inductive/deductive thematic analysis. According to the health care and social service professionals in our study, the role of GPs in multidisciplinary teams for elderly care was characterized by the ability to 'see the bigger picture'. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. Practice setting and phase of multidisciplinary team development influenced the way in which GPs fulfilled their roles. According to team members, GPs were the central professionals in care services for older people. The opinions of GPs about their own roles were diverse. GPs took an important role in successful care settings for older people. Five key concepts seemed to be important for best practices in care for frail older people: networking (community), facilitating (organization), team building (professional), integrating care elements (patient), and leadership (personal). Team members from primary care and social services indicated that GPs had an indispensable role in such teams. It would be advantageous for GPs to be aware of this attributed role. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people.

Creating a multidisciplinary low back pain guideline: anatomy of a guideline adaptation process.

PubMed

Harstall, Christa; Taenzer, Paul; Angus, Donna K; Moga, Carmen; Schuller, Tara; Scott, N Ann

2011-08-01

A collaborative, multidisciplinary guideline adaptation process was developed to construct a single overarching, evidence-based clinical practice guideline (CPG) for all primary care practitioners responsible for the management of low back pain (LBP) to curb the use of ineffective treatments and improve patient outcomes. The adaptation strategy, which involved multiple committees and partnerships, leveraged existing knowledge transfer connections to recruit guideline development group (GDG) members and ensure that all stakeholders had a voice in the guideline development process. Videoconferencing was used to coordinate the large, geographically dispersed GDG. Information services and health technology assessment experts were used throughout the process to lighten the GDG's workload. The GDG reviewed seven seed guidelines and drafted an Alberta-specific guideline during 10 half-day meetings over a 12-month period. The use of ad hoc subcommittees to resolve uncertainties or disagreements regarding evidence interpretation expedited the process. Challenges were encountered in dealing with subjectivity, guideline appraisal tools, evidence source limitations and inconsistencies, and the lack of sophisticated evidence analysis inherent in guideline adaptation. Strategies for overcoming these difficulties are discussed. Guideline adaptation is useful when resources are limited and good-quality seed CPGs exist. The Ambassador Program successfully utilized existing stakeholder interest to create an overarching guideline that aligned guidance for LBP management across multiple primary care disciplines. Unforeseen challenges in guideline adaptation can be overcome with credible seed guidelines, a consistently applied and transparent methodology, and clear documentation of the subjective contextualization process. Multidisciplinary stakeholder input and an open, trusting relationship among all contributors will ensure that the end product is clinically meaningful. © 2010 Blackwell Publishing Ltd.

Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team.

PubMed

Ryan, Tony; Harrison, Madeleine; Gardiner, Clare; Jones, Amanda

2017-10-01

To explore the organized stroke unit experience from the multiple perspectives of stroke survivor, family carer and the multi-disciplinary team. Organized stroke unit care reduces morbidity, mortality and institutionalization and is promoted globally as the most effective form of acute and postacute provision. Little research has focused on how care is experienced in this setting from the perspectives of those who receive and provide care. This study used a qualitative approach, employing Framework Analysis. This methodology allows for a flexible approach to data collection and a comprehensive and systematic method of analysis. Semi-structured interviews were undertaken during 2011 and 2012 with former stroke unit stroke survivors, family carers and senior stroke physicians. In addition, eight focus groups were conducted with members of the multi-disciplinary team. One hundred and twenty-five participants were recruited. Three key themes were identified across all data sets. First, two important processes are described: responses to the impact of stroke and seeking information and stroke-specific knowledge. These are underpinned by a third theme: the challenge in building relationships in organized stroke unit care. Stroke unit care provides satisfaction for stroke survivors, particularly in relation to highly specialized medical and nursing care and therapy. It is proposed that moves towards organized stroke unit care, particularly with the emphasis on reduction of length of stay and a focus on hyper-acute models, have implications for interpersonal care practices and the sharing of stroke-specific knowledge. © 2017 John Wiley & Sons Ltd.

Digitizing Patterns of Power - Cartographic Communication for Digital Humanities

NASA Astrophysics Data System (ADS)

Kriz, Karel; Pucher, Alexander; Breier, Markus

2018-05-01

The representation of space in medieval texts, the appropriation of land and the subsequent installation of new structures of power are central research topics of the project "Digitizing Patterns of Power" (DPP). The project focuses on three regional case studies: the Eastern Alps and the Morava-Thaya region, the historical region of Macedonia, and historical Southern Armenia. DPP is a multidisciplinary project, conducted by the Austrian Academy of Sciences the Institute for Medieval Research (IMAFO) in cooperation with the University of Vienna, Department of Geography and Regional Research. It is part of an initiative to promote digital humanities research in Austria. DPP brings together expertise from historical and archaeological research as well as cartography and geocommunication to explore medieval geographies. The communication of space, time and spatial interconnectivity is an essential aspect of DPP. By incorporating digital cartographic expertise, relevant facts can be depicted in a more effective visual form. Optimal cartographic visualization of base data as well as the historical and archaeological information in an interactive map-based online platform are important features. However, the multidisciplinary of the project presents the participants with various challenges. The different involved disciplines, among them cartography, archaeology and history each have their own approaches to relevant aspects of geography and geocommunication. This paper treats geocommunication characteristics and approaches to interactive mapping in a historical and archaeological context within a multidisciplinary project environment. The fundamental challenges of cartographic communication within DPP will be presented. Furthermore, recent results on the communication of historical topographic, as well as uncertain thematic content will be demonstrated.

Multidisciplinary surgical management of cherubism complicated by neurofibromatosis type 1.

PubMed

Hachach-Haram, Nadine; Gerarchi, Paul; Benyon, Sarah L; Saggar, Anand; McLellan, Guy; Kirkpatrick, W Niall A

2011-11-01

Cherubism is a rare, autosomal dominant, mostly self-limiting disease of the jaw. It is characterized by bilateral fibrous tissue hyperplasia, giant cell proliferation, and bony degeneration in the lower facial skeleton, which can result in a massive and severely deforming prominence of the maxillomandibular structure. This case study examines the multidisciplinary management of a severe case of cherubism complicated by neurofibromatosis type 1, 2 codominant nonsegregating conditions that were clinically and genetically diagnosed, an extremely rare combination. Adequate mandibular reduction, reconstruction, and dental implantation afforded good restoration of oral function as well as a marked aesthetic improvement. A 14-year-old Fijian girl was referred to our unit for management of severe overgrowth of her mandible that compromised her speech and deglutition. In addition, she displayed clinical features consistent with neurofibromatosis type 1. Radiologic, histologic, and genetic analyses confirmed the diagnosis of both conditions. Our craniofacial multidisciplinary team undertook mandibular reconstruction followed by placement of osseointegrated dental implants. Mandibular reduction, reconstruction, and dental implantation resulted in a significantly improved functional and aesthetic outcome with no further regrowth at 3-year follow-up when she returned to the United Kingdom for osseointegrated dental implant insertion. The successful outcome of this surgically challenging, grossly disfiguring, and rare condition was largely a result of the combined input from our multidisciplinary team, adequate preoperative planning, and the use of a novel surgical technique in debulking and reconstructing her mandible.

Searching for Grey Literature for Systematic Reviews: Challenges and Benefits

ERIC Educational Resources Information Center

Mahood, Quenby; Van Eerd, Dwayne; Irvin, Emma

2014-01-01

There is ongoing interest in including grey literature in systematic reviews. Including grey literature can broaden the scope to more relevant studies, thereby providing a more complete view of available evidence. Searching for grey literature can be challenging despite greater access through the Internet, search engines and online bibliographic…

Applied Linguistics: The Challenge of Theory

ERIC Educational Resources Information Center

McNamara, Tim

2015-01-01

Language has featured prominently in contemporary social theory, but the relevance of this fact to the concerns of Applied Linguistics, with its necessary orientation to practical issues of language in context, represents an ongoing challenge. This article supports the need for a greater engagement with theory in Applied Linguistics. It considers…

Committed to Conservation

ERIC Educational Resources Information Center

Boulard, Garry

2009-01-01

Addressing ongoing and costly deferred-maintenance needs is a challenge for any two- or four-year school. During an economically challenging time, many HBCUs have put energy efficiency and other green projects on the back burner. However, some are finding that deferred maintenance does not have to be a barrier to becoming green. Despite budget…

Playing on Reality: Do Geomodels Improve the Perception of Geographical Terms?

ERIC Educational Resources Information Center

Czigány, Szabolcs; Császár, Zsuzsa; Kiss, Kinga; Halmai, Ákos; Lóczy, Dénes; Nagyváradi, László; Pirkhoffer, Ervin

2018-01-01

Remodeling of geography education has been an ongoing challenge recently. Constructivist pedagogy, employing tools of problem and model-based learning, offers new opportunities to meet these challenges. Geomodels, flumes and stream tables may ease the understanding of geographic processes through hand-on-experience for students. With a…

Researching across Boundaries and Borders: The Challenges for Research

ERIC Educational Resources Information Center

Bowl, Marion; Cooke, Sandra; Hockings, Christine

2008-01-01

This article explores some of the challenges of conducting action research in higher education. It arises from an ongoing research project funded by the Economic and Social Research Council's Teaching and Learning Research Programme (ESRC/TLRP), "Learning and Teaching for Social Diversity and Difference", which examines the dynamics of…

Inclusive Education for Students with Hearing Impairment in the Regular Secondary Schools in the North-West Region of Cameroon: Initiatives and Challenges

ERIC Educational Resources Information Center

Bamu, Beryl Ndongwa; De Schauwer, Elisabeth; Verstraete, Sara; Van Hove, Geert

2017-01-01

Although some initiatives are implemented in the education of students with hearing impairments in the regular school, challenges are still encountered in their education. This article which is part of the results from an ongoing qualitative study in the North-West region of Cameroon addresses the different initiatives and challenges involved with…

Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care.

PubMed

Shore, Neal D; Jacoby, Dana

2016-01-01

Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.

Pain and pain management in haemophilia

PubMed Central

Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić

2016-01-01

Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients. PMID:27439216

From social liminality to cultural negotiation: Transformative processes in immigrant mental wellbeing.

PubMed

Simich, Laura; Maiter, Sarah; Ochocka, Joanna

2009-12-01

The underlying psychosocial processes that produce immigrant mental wellbeing are understudied in anthropology and medicine. This paper provides insights into these processes by describing culturally diverse immigrants' perceptions of mental health and adaptation strategies. Qualitative data were collected from 21 focus groups as part of a large, multidisciplinary, participatory action research project about mental health with five ethnolinguistic groups (Mandarin-speaking Chinese, Polish, Punjabi Sikh, Somali and Spanish-speaking Latin American) in Ontario, Canada. In framing the analysis, transformative concepts are applied to address dimensions of power and culture - social liminality and cultural negotiation - to the ongoing psychosocial processes of coping with mental distress. 'Social liminality' describes how immigrants perceive themselves to be in a psychologically stressful, transitional state, whereas 'cultural negotiation' describes how they actively cope with cultural tensions and respond to mental health challenges. Study findings show that while social liminality and cultural negotiation are stressful, they also have the potential to help individuals adapt by producing a positive synthesis of ideas about mental health in new social and cultural contexts. The study contributes to the shift from problem identification using a biomedical model of mental illness to a more psychosocial and ecological approach that reveals the potential for resolving some mental health problems experienced in immigrant communities. Describing active psychosocial process of adaptation also reinforces the therapeutic and educational value of partnerships between practitioners and clients and immigrant communities and mental health systems.

Examining the teaching roles and experiences of non-physician health care providers in family medicine education: a qualitative study.

PubMed

Beber, Serena; Antao, Viola; Telner, Deanna; Krueger, Paul; Peranson, Judith; Meaney, Christopher; Meindl, Maria; Webster, Fiona

2015-02-13

Primary Care reform in Canada and globally has encouraged the development of interprofessional primary care initiatives. This has led to significant involvement of non-physician Health Care Providers (NPHCPs) in the teaching of medical trainees. The objective of this study was to understand the experiences, supports and challenges facing non-physician health care providers in Family Medicine education. Four focus groups were conducted using a semi-structured interview guide with twenty one NPHCPs involved in teaching at the University of Toronto, Department of Family & Community Medicine. The focus groups were transcribed and analyzed for recurrent themes. The multi-disciplinary research team held several meetings to discuss themes. NPHCPs were highly involved in Family Medicine education, formally and informally. NPHCPs felt valued as teachers, but this often did not occur until after learners understood their educator role through increased time and exposure. NPHCPs expressed a lack of advance information of learner knowledge level and expectations, and missed opportunities to give feedback or receive teaching evaluations. Adequate preparation time, teaching space and financial compensation were important to NPHCPs, yet were often lacking. There was low awareness but high interest in faculty status and professional development opportunities. Sharing learner goals and objectives and offering NPHCPs feedback and evaluation would help to formalize NPHCP roles and optimize their capacity for cross-professional teaching. Preparation time and dedicated space for teaching are also necessary. NPHCPs should be encouraged to pursue faculty appointments and to access ongoing Professional Development opportunities.

Health care professionals' experience, understanding and perception of need of advanced cancer patients with cachexia and their families: The benefits of a dedicated clinic.

PubMed

Scott, David; Reid, Joanne; Hudson, Peter; Martin, Peter; Porter, Sam

2016-12-30

Cachexia is defined as the on-going loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support. It is found in up to 80% of patients with advanced cancer and has profound psycho-social consequences for patients and their families. Previous studies demonstrate that many healthcare professionals receive little formal education in cachexia management leading them to feel that they have limited understanding of the syndrome and cannot intervene effectively. This study aims to examine the value of a dedicated cachexia clinic and its influence on staff understanding and practice. An exploratory qualitative study was conducted. The study employed semi-structured interviews with a range of healthcare professionals responsible for designing and delivering cancer care in a large teaching hospital in Australia. This hospital had a dedicated cachexia clinic. In-depth interviews were conducted with 8 healthcare professionals and senior managers. Four themes were identified: formal and informal education; knowledge and understanding; truth telling in cachexia and palliative care; and, a multi-disciplinary approach. Findings show that improved knowledge and understanding across a staff body can lead to enhanced staff confidence and a willingness to address cancer cachexia and its consequences with patients and their families. Comparisons with similar previous research demonstrate the advantages of providing a structure for staff to gain knowledge about cachexia and how this can contribute to feelings of improved understanding and confidence necessary to respond to the challenge of cachexia.

Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System.

PubMed

Psek, Wayne; Davis, F Daniel; Gerrity, Gloria; Stametz, Rebecca; Bailey-Davis, Lisa; Henninger, Debra; Sellers, Dorothy; Darer, Jonathan

2016-01-01

Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders' perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders' perspectives on the LHS and learning activities in an integrated delivery system. A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders' responses were categorized into themes. Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals. Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed. Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery.

Incorporating Sustainability and 21st-Century Problem Solving into Physics Courses

ERIC Educational Resources Information Center

Rogers, Michael; Pfaff, Tom; Hamilton, Jason; Erkan, Ali

2013-01-01

As educators we are facing an unprecedented challenge to prepare our students not only for traditional careers but also for future careers that don't exist today. Many of these careers will require a firm grounding in disciplines such as physics, along with multidisciplinary, Global, and systems thinking skill sets. Our Multidisciplinary…

Identifying Obstacles to a Multidisciplinary Understanding of "Disruptive" Behaviour

ERIC Educational Resources Information Center

Macleod, Gale

2010-01-01

This paper examines the possibilities and challenges presented by an interdisciplinary approach to the study of disruptive behaviour. It is argued that whilst such an approach is to be welcomed, work needs to be done in order to ensure that educational research joins the discussion as an equal partner. The paper begins with a demonstration of how…

Developing a Pedagogy for Globalization: A Marketing and Political Science Multi-Disciplinary and Transnational Approach

ERIC Educational Resources Information Center

Arsenault, Paul M.; Stevenson, Linda S.

2013-01-01

One of the greatest challenges facing social science and marketing programs in the start of the 21st century is how to "globalize" our curriculums, so that our tech-savvy, but often internationally and cross-culturally inexperienced students have, understand, and are prepared to embrace the diverse opportunities that will be an…

Experimental Physical Sciences Vitae 2017

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

Kippen, Karen Elizabeth; Del Mauro, Diana; Patterson, Eileen Frances

Frequently our most basic research experiments stimulate solutions for some of the most intractable national security problems, such as nuclear weapons stewardship, homeland security, intelligence and information analysis, and nuclear and alternative energy. This publication highlights our talented and creative staff who deliver solutions to these complex scientific and technological challenges by conducting cutting-edge multidisciplinary physical science research.

Academy-Community Partnerships: Challenges and Changes in Israeli Urban Regeneration Projects

ERIC Educational Resources Information Center

Tal, Rinat Botbol; Fenster, Tovi; Kulka, Tal

2015-01-01

Students worked with low-income Jaffa residents on a 3-year building renewal project as part of a multidisciplinary clinic operated through the collaboration of the Faculty of Law, the Department of Geography at the Faculty of Humanities, and the Faculty of Management at Tel-Aviv University. Alternative models in the legal and planning literature…

Issues and Challenges Identified in the Development of a Broad Multidisciplinary Work Integrated Learning Package

ERIC Educational Resources Information Center

Sutherland, Karen; Symmons, Mark

2013-01-01

Work integrated learning (WIL) units can be discipline specific and constructed for majors or degrees with a strong vocational orientation. This paper describes an undergraduate unit with its genesis in a public relations internship. The original unit enjoyed strong support from industry partners and was instrumental in many graduates securing…

Selective Guide to Literature on Mining Engineering. Engineering Literature Guides, Number 6.

ERIC Educational Resources Information Center

Erdmann, Charlotte A., Comp.

The multidisciplinary field of mining engineering offers many challenges. Often, many sources must be used to solve a problem. This document is a survey of information sources in mining engineering and is intended to identify those core resources which can help engineers and librarians to find information about the discipline. Sections include:…

Perceived Status and Value: The Student-Customer Relationship Inflected by the Inherent Challenges of University-Industry Collaboration

ERIC Educational Resources Information Center

Heikkinen, Juho; Isomöttönen, Ville

2017-01-01

This article examines how students in a multidisciplinary project-based learning course involving real customers perceive their interactions with their customers. The authors conducted a qualitative study and analysed students' learning reports by means of a thematic network analysis. The analysis shows how students perceive their status in…

The Structure of Legal Education and the Legal Profession, Multidisciplinary Practice, Competition, and Globalization.

ERIC Educational Resources Information Center

Daly, Mary C.

2002-01-01

Discusses challenges facing the legal profession: the increasing importance of a law school's identity as national, regional, or local to graduates' career trajectories; disjunction between the legal academy and the profession; the threat to local and regional law schools' economic viability from online education; and emergence of new types of…

Authorship in Multi-Disciplinary, Multi-National North-South Research Projects: Issues of Equity, Capacity and Accountability

ERIC Educational Resources Information Center

Jeffery, Roger

2014-01-01

The challenges of ensuring equity among partners of very different academic power and status, across continents, within complex research projects involving differing disciplines with their own norms, and balancing needs for capacity development of individuals and for institutions can be major sources of conflicts. While each of these concerns has…

Challenging the First Year of College: Old Models and New Imperatives

ERIC Educational Resources Information Center

Mills, Shala A.; Mehaffy, George L.

2016-01-01

This chapter argues that the first year of college needs to be reconsidered. The authors offer, as an alternative, a new kind of course, one created by groups of faculty members from different campuses, multidisciplinary in focus, delivered in a blended format, focused on civic outcomes, and intended primarily for first-year students.

Western Australian High School Students' Understandings about the Socioscientific Issue of Climate Change

ERIC Educational Resources Information Center

Dawson, Vaille

2015-01-01

Climate change is one of the most significant science issues facing humanity; yet, teaching students about climate change is challenging: not only is it multidisciplinary, but also it is contentious and debated in political, social and media forums. Students need to be equipped with an understanding of climate change science to be able to…

Using Evaluation Research as a Means for Policy Analysis in a "New" Mission-Oriented Policy Context

ERIC Educational Resources Information Center

Amanatidou, Effie; Cunningham, Paul; Gök, Abdullah; Garefi, Ioanna

2014-01-01

Grand challenges stress the importance of multi-disciplinary research, a multi-actor approach in examining the current state of affairs and exploring possible solutions, multi-level governance and policy coordination across geographical boundaries and policy areas, and a policy environment for enabling change both in science and technology and in…

Solid Oxide Fuel Cell Seal Development at NASA Glenn Research Center

NASA Technical Reports Server (NTRS)

Steinetz, Bruce M.; Bansal, Narottam P.; Dynys, Fred W.; Lang, Jerry; Daniels, Christopher C.; Palko, Joeseph L.; Choi, S. R.

2004-01-01

Researchers at NASA GRC are confronting the seal durability challenges of Solid Oxide Fuel Cells by pursuing an integrated and multidisciplinary development effort incorporating thermo-structural analyses, advanced materials, experimentation, and novel seal design concepts. The successful development of durable hermetic SOFC seals is essential to reliably producing the high power densities required for aerospace applications.

Cameras in the Curriculum. A Challenge to Teacher Creativity. An NEA/KODAK Program. Volume 2/1983-84.

ERIC Educational Resources Information Center

McMillan, Samuel, Ed.; Quinto, Frances, Ed.

Designed as a teacher's guide to stimulate student interest, creativity, and achievement, this teaching guide includes 132 projects which involve the use of photography as an instructional tool. The volume is divided into subject areas with grade levels ranging from kindergarten through higher education. Most projects are multidisciplinary, and…

Surgery, virtual reality, and the future.

PubMed

Vosburgh, Kirby G; Golby, Alexandra; Pieper, Steven D

2013-01-01

MMVR has provided the leading forum for the multidisciplinary interaction and development of the use of Virtual Reality (VR) techniques in medicine, particularly in surgical practice. Here we look back at the foundations of our field, focusing on the use of VR in Surgery and similar interventional procedures, sum up the current status, and describe the challenges and opportunities going forward.

Complex lower genitourinary reconstruction following combat-related injury.

PubMed

Uppal, L; Anderson, P; Evriviades, Demetrius

2013-03-01

There is little data in the literature on the reconstruction of combat related lower genitourinary trauma. Published reports document patterns of injury, which is useful for epidemiological analysis of military trauma, but very few describe the reconstructive management. We aim to describe a systematic multidisciplinary approach to planning the challenging reconstruction of the severely injured male perineum.

Determination of the Heat of Combustion of Biodiesel Using Bomb Calorimetry: A Multidisciplinary Undergraduate Chemistry Experiment

ERIC Educational Resources Information Center

Akers, Stephen M.; Conkle, Jeremy L.; Thomas, Stephanie N.; Rider, Keith B.

2006-01-01

Biodiesel was synthesized by transesterification of waste vegetable oil using common glassware and reagents, and characterized by measuring heat of combustion, cloud point, density and measuring the heat of combustion and density together allows the student the energy density of the fuel. Analyzing the biodiesel can serve as a challenging and…

Pediatric Psychosocial Oncology: Textbook for Multidisciplinary Care | Center for Cancer Research

Cancer.gov

This textbook walks clinicians through the psychosocial issues and challenges faced by children and adolescents with cancer and their families. Through a developmental lens, the text provides guidance and resources that will enable clinicians to understand the physical and emotional impact of the disease from diagnosis onwards, to work with families in distress, and to

Delivering Advanced Methods in Mathematical Programming to Students of All Disciplines Using Abstraction, Modularity and Open-Ended Assignments

ERIC Educational Resources Information Center

Ezra, Elishai; Nahmias, Yaakov

2015-01-01

The advent of integrated multidisciplinary research has given rise to some of the most important breakthroughs of our time, but has also set significant challenges to the current educational paradigm. Current academic education often limits cross-discipline discussion, depends on close-ended problems, and restricts utilization of interdisciplinary…

Constraints on the Multidisciplinary Approach: Uses and Misuses of the Kuhnian Paradigm.

ERIC Educational Resources Information Center

Parsons, Gerald Michael

The general enthusiasm that governs composition studies is the result of more than 20 years of collective efforts to define central issues in theory and research, and to help refocus national attention on composition literacy. The optimistic vision of future challenge and direction in discourse studies is largely premised on Thomas Kuhn's…

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.

Policy recommendations for addressing privacy challenges associated with cell-based research and interventions.

PubMed

Ogbogu, Ubaka; Burningham, Sarah; Ollenberger, Adam; Calder, Kathryn; Du, Li; El Emam, Khaled; Hyde-Lay, Robyn; Isasi, Rosario; Joly, Yann; Kerr, Ian; Malin, Bradley; McDonald, Michael; Penney, Steven; Piat, Gayle; Roy, Denis-Claude; Sugarman, Jeremy; Vercauteren, Suzanne; Verhenneman, Griet; West, Lori; Caulfield, Timothy

2014-02-03

The increased use of human biological material for cell-based research and clinical interventions poses risks to the privacy of patients and donors, including the possibility of re-identification of individuals from anonymized cell lines and associated genetic data. These risks will increase as technologies and databases used for re-identification become affordable and more sophisticated. Policies that require ongoing linkage of cell lines to donors' clinical information for research and regulatory purposes, and existing practices that limit research participants' ability to control what is done with their genetic data, amplify the privacy concerns. To date, the privacy issues associated with cell-based research and interventions have not received much attention in the academic and policymaking contexts. This paper, arising out of a multi-disciplinary workshop, aims to rectify this by outlining the issues, proposing novel governance strategies and policy recommendations, and identifying areas where further evidence is required to make sound policy decisions. The authors of this paper take the position that existing rules and norms can be reasonably extended to address privacy risks in this context without compromising emerging developments in the research environment, and that exceptions from such rules should be justified using a case-by-case approach. In developing new policies, the broader framework of regulations governing cell-based research and related areas must be taken into account, as well as the views of impacted groups, including scientists, research participants and the general public. This paper outlines deliberations at a policy development workshop focusing on privacy challenges associated with cell-based research and interventions. The paper provides an overview of these challenges, followed by a discussion of key themes and recommendations that emerged from discussions at the workshop. The paper concludes that privacy risks associated with cell-based research and interventions should be addressed through evidence-based policy reforms that account for both well-established legal and ethical norms and current knowledge about actual or anticipated harms. The authors also call for research studies that identify and address gaps in understanding of privacy risks.

Policy recommendations for addressing privacy challenges associated with cell-based research and interventions

PubMed Central

2014-01-01

Background The increased use of human biological material for cell-based research and clinical interventions poses risks to the privacy of patients and donors, including the possibility of re-identification of individuals from anonymized cell lines and associated genetic data. These risks will increase as technologies and databases used for re-identification become affordable and more sophisticated. Policies that require ongoing linkage of cell lines to donors’ clinical information for research and regulatory purposes, and existing practices that limit research participants’ ability to control what is done with their genetic data, amplify the privacy concerns. Discussion To date, the privacy issues associated with cell-based research and interventions have not received much attention in the academic and policymaking contexts. This paper, arising out of a multi-disciplinary workshop, aims to rectify this by outlining the issues, proposing novel governance strategies and policy recommendations, and identifying areas where further evidence is required to make sound policy decisions. The authors of this paper take the position that existing rules and norms can be reasonably extended to address privacy risks in this context without compromising emerging developments in the research environment, and that exceptions from such rules should be justified using a case-by-case approach. In developing new policies, the broader framework of regulations governing cell-based research and related areas must be taken into account, as well as the views of impacted groups, including scientists, research participants and the general public. Summary This paper outlines deliberations at a policy development workshop focusing on privacy challenges associated with cell-based research and interventions. The paper provides an overview of these challenges, followed by a discussion of key themes and recommendations that emerged from discussions at the workshop. The paper concludes that privacy risks associated with cell-based research and interventions should be addressed through evidence-based policy reforms that account for both well-established legal and ethical norms and current knowledge about actual or anticipated harms. The authors also call for research studies that identify and address gaps in understanding of privacy risks. PMID:24485220

A multi-disciplinary consensus statement concerning surgical approaches to low-grade, high-grade astrocytomas and diffuse intrinsic pontine gliomas in childhood (CPN Paris 2011) using the Delphi method.

PubMed

Walker, David A; Liu, JoFen; Kieran, Mark; Jabado, Nada; Picton, Susan; Packer, Roger; St Rose, Christian

2013-04-01

Astrocytic tumors account for 42% of childhood brain tumors, arising in all anatomical regions and associated with neurofibromatosis type 1 (NF1) in 15%. Anatomical site determines the degree and risk of resectability; the more complete resection, the better the survival rates. New biological markers and modern radiotherapy techniques are altering the risk assessments of clinical decisions for tumor resection and biopsy. The increasingly distinct pediatric neuro-oncology multidisciplinary team (PNMDT) is developing a distinct evidence base. A multidisciplinary consensus conference on pediatric neurosurgery was held in February 2011, where 92 invited participants reviewed evidence for clinical management of hypothalamic chiasmatic glioma (HCLGG), diffuse intrinsic pontine glioma (DIPG), and high-grade glioma (HGG). Twenty-seven statements were drafted and subjected to online Delphi consensus voting by participants, seeking >70% agreement from >60% of respondents; where <70% consensus occurred, the statement was modified and resubmitted for voting. Twenty-seven statements meeting consensus criteria are reported. For HCLGG, statements describing overall therapeutic purpose and indications for biopsy, observation, or treatment aimed at limiting the risk of visual damage and the need for on-going clinical trials were made. Primary surgical resection was not recommended. For DIPG, biopsy was recommended to ascertain biological characteristics to enhance understanding and targeting of treatments, especially in clinical trials. For HGG, biopsy is essential, the World Health Organization classification was recommended; selection of surgical strategy to achieve gross total resection in a single or multistep process should be discussed with the PNMDT and integrated with trials based drug strategies for adjuvant therapies.

Liposuction for Advanced Lymphedema: A Multidisciplinary Approach for Complete Reduction of Arm and Leg Swelling.

PubMed

Boyages, John; Kastanias, Katrina; Koelmeyer, Louise A; Winch, Caleb J; Lam, Thomas C; Sherman, Kerry A; Munnoch, David Alex; Brorson, Håkan; Ngo, Quan D; Heydon-White, Asha; Magnussen, John S; Mackie, Helen

2015-12-01

This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology. Liposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.

Regional Multiteam Systems in Cancer Care Delivery

PubMed Central

Monson, John R.T.; Rizvi, Irfan; Savastano, Ann; Green, James S.A.; Sevdalis, Nick

2016-01-01

Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions. PMID:27650833

Cryptosporidium Priming Is More Effective than Vaccine for Protection against Cryptosporidiosis in a Murine Protein Malnutrition Model

PubMed Central

Bartelt, Luther A.; Bolick, David T.; Kolling, Glynis L.; Zaenker, Edna I.; Lara, Ana M.; Noronha, Francisco Jose; Cowardin, Carrie A.; Moore, John H.; Turner, Jerrold R.; Warren, Cirle A.; Buck, Gregory A.; Guerrant, Richard L.

2016-01-01

Cryptosporidium is a major cause of severe diarrhea, especially in malnourished children. Using a murine model of C. parvum oocyst challenge that recapitulates clinical features of severe cryptosporidiosis during malnutrition, we interrogated the effect of protein malnutrition (PM) on primary and secondary responses to C. parvum challenge, and tested the differential ability of mucosal priming strategies to overcome the PM-induced susceptibility. We determined that while PM fundamentally alters systemic and mucosal primary immune responses to Cryptosporidium, priming with C. parvum (106 oocysts) provides robust protective immunity against re-challenge despite ongoing PM. C. parvum priming restores mucosal Th1-type effectors (CD3+CD8+CD103+ T-cells) and cytokines (IFNγ, and IL12p40) that otherwise decrease with ongoing PM. Vaccination strategies with Cryptosporidium antigens expressed in the S. Typhi vector 908htr, however, do not enhance Th1-type responses to C. parvum challenge during PM, even though vaccination strongly boosts immunity in challenged fully nourished hosts. Remote non-specific exposures to the attenuated S. Typhi vector alone or the TLR9 agonist CpG ODN-1668 can partially attenuate C. parvum severity during PM, but neither as effectively as viable C. parvum priming. We conclude that although PM interferes with basal and vaccine-boosted immune responses to C. parvum, sustained reductions in disease severity are possible through mucosal activators of host defenses, and specifically C. parvum priming can elicit impressively robust Th1-type protective immunity despite ongoing protein malnutrition. These findings add insight into potential correlates of Cryptosporidium immunity and future vaccine strategies in malnourished children. PMID:27467505

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.

Social work in the Veterans Health Administration (VA) System: rewards, challenges, roles and interventions.

PubMed

Beder, Joan; Postiglione, Paul

2013-01-01

For the social worker in the Veterans Health Administration (VA) System, numerous challenges are faced and met while serving the nation's Veterans. As part of the multidisciplinary team, social workers perform a variety of tasks and function in diverse roles. The qualitative survey research reported in this article sought to detail what social workers identified about the impact and rewards of their work and what they saw as the challenges and frustrations. In addition the social workers were asked to clarify their role with the patient and the family. Intervention strategies used in the course of the social workers interaction with the Veterans was also ascertained.

Development of knowledge tests for multi-disciplinary emergency training: a review and an example.

PubMed

Sørensen, J L; Thellesen, L; Strandbygaard, J; Svendsen, K D; Christensen, K B; Johansen, M; Langhoff-Roos, P; Ekelund, K; Ottesen, B; Van Der Vleuten, C

2015-01-01

The literature is sparse on written test development in a post-graduate multi-disciplinary setting. Developing and evaluating knowledge tests for use in multi-disciplinary post-graduate training is challenging. The objective of this study was to describe the process of developing and evaluating a multiple-choice question (MCQ) test for use in a multi-disciplinary training program in obstetric-anesthesia emergencies. A multi-disciplinary working committee with 12 members representing six professional healthcare groups and another 28 participants were involved. Recurrent revisions of the MCQ items were undertaken followed by a statistical analysis. The MCQ items were developed stepwise, including decisions on aims and content, followed by testing for face and content validity, construct validity, item-total correlation, and reliability. To obtain acceptable content validity, 40 out of originally 50 items were included in the final MCQ test. The MCQ test was able to distinguish between levels of competence, and good construct validity was indicated by a significant difference in the mean score between consultants and first-year trainees, as well as between first-year trainees and medical and midwifery students. Evaluation of the item-total correlation analysis in the 40 items set revealed that 11 items needed re-evaluation, four of which addressed content issues in local clinical guidelines. A Cronbach's alpha of 0.83 for reliability was found, which is acceptable. Content and construct validity and reliability were acceptable. The presented template for the development of this MCQ test could be useful to others when developing knowledge tests and may enhance the overall quality of test development. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

GEOWOW: a drought scenario for multidisciplinary data access and use

NASA Astrophysics Data System (ADS)

Santoro, Mattia; Sorichetta, Alessandro; Roglia, Elena; Craglia, Massimo; Nativi, Stefano

2013-04-01

Recent enhancements of the GEOSS Common Infrastructure (GCI; http://www.earthobservations.org/gci_gci.shtml), and in particular the introduction of a middleware in the GCI that brokers across heterogeneous information systems, have increased significantly the number of information resources discoverable worldwide. Now the challenge moves to the next level of ensuring access and use of the resources discovered, which have many different and domain-specific data models, communication protocols, encoding formats, etc. The GEOWOW Project - GEOSS interoperability for Weather, Ocean and Water, http://www.geowow.eu - developed a set of multidisciplinary use scenarios to advance the present GCI. This work describes the "Easy discovery and use of GEOSS resources for addressing multidisciplinary challenges related to drought scenarios" showcase demonstrated at the last GEO Plenary in Foz de Iguazu (Brazil). The scientific objectives of this showcase include: prevention and mitigation of water scarcity and drought situations, assessment of the population and geographical area potentially affected, evaluation of the possible distribution of mortality and economic loss risk, and support in building greater capacity to cope with drought. The need to address these challenges calls for producing scientifically robust and consistent information about the extent of land affected by drought and degradation. Similarly, in this context it is important: (i) to address uncertainties about the way in which various biological, physical, social, and economic factors interact each other and influence the occurrence of drought events, and (ii) to develop and test adequate indices and/or combination of them for monitoring and forecasting drought in different geographic locations and at various spatial scales (Brown et al., 2002). The scientific objectives above can be met with an increased interoperability across the multidisciplinary domains relevant to this drought scenario. In particular, we demonstrate in this instance (i) an improved search capability through semantically related resources, (ii) a harmonized access to the heterogeneous resources discovered, and (iii) a flexible transformation framework to access, download and use the resources discovered, and implement scientifically-sound scenarios that respond to environmental global challenges. This showcase demonstrates how the middleware services provided by the GEO Discovery and Access Broker - DAB (Nativi et al., 2013) - component can be used to address the multidisciplinary interoperability challenges. With respect to discovery, the GEO DAB allows to expand the traditional discovery functionalities using a set of semantically connected concepts delivered through vocabulary services. This makes it possible to obtain an extended result set, where the user can find new unexpected datasets of interest for her/his analysis. Moreover, the use of semantics-enabled queries makes it possible to search and retrieve data resources in multiple languages, which is a crucial issue in global research. With respect to access and use, the GEO DAB makes it possible for users to preview, access, and use the resources discovered according to a common grid environment. Users can define a common grid environment - Coordinate Reference System (CRS), spatial resolution, spatial extent (e.g., a subset of a discovered dataset), and data encoding format - to download all the datasets of interest. This is crucial for advancing an effective integrated exploitation of multidisciplinary data coming from heterogeneous sources. In normal practice, the manipulation of the data discovered (pre-processing) that is necessary ahead of the analysis has to be done by the user. The GEO DAB takes this burden away from the user providing a true added value service. The showcase presented here goes of course beyond the specifics of drought applications, and is of interest because it demonstrates real advancements in the use of complex system of systems, form simple discovery, to more semantically aware multilingual discovery, and above all access and use of the information resources which is the critical goal. The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under Grant Agreement n. 282915. References Jesslyn F. Brown, Bradley C. Reed, Michael J. Hayes, Donald A. Wilhite, and Kenneth Hubbard. A Prototype Drought Monitoring System Integrating Climate and Satellite Data. Pecora 15/Land Satellite Information IV/ISPRS Commission I/FIEOS 2002 Conference Proceedings S. Nativi, M. Craglia, J. Pearlman, 2013, "Earth Science Infrastructures Interoperability: the Brokering Approach", in press on IEEE JSTARS

Role expectations in dementia care among family physicians and specialists.

PubMed

Hum, Susan; Cohen, Carole; Persaud, Malini; Lee, Joyce; Drummond, Neil; Dalziel, William; Pimlott, Nicholas

2014-09-01

The assessment and ongoing management of dementia falls largely on family physicians. This pilot study explored perceived roles and attitudes towards the provision of dementia care from the perspectives of family physicians and specialists. Semi-structured, one-to-one interviews were conducted with six family physicians and six specialists (three geriatric psychiatrists, two geriatricians, and one neurologist) from University of Toronto-affiliated hospitals. Transcripts were subjected to thematic content analysis. Physicians' clinical experience averaged 16 years. Both physician groups acknowledged that family physicians are more confident in diagnosing/treating uncomplicated dementia than a decade ago. They agreed on care management issues that warranted specialist involvement. Driving competency was contentious, and specialists willingly played the "bad cop" to resolve disputes and preserve long-standing therapeutic relationships. While patient/caregiver education and support were deemed essential, most physicians commented that community resources were fragmented and difficult to access. Improving collaboration and communication between physician groups, and clarifying the roles of other multi-disciplinary team members in dementia care were also discussed. Future research could further explore physicians' and other multi-disciplinary members' perceived roles and responsibilities in dementia care, given that different health-care system-wide dementia care strategies and initiatives are being developed and implemented across Ontario.

Role Expectations in Dementia Care Among Family Physicians and Specialists

PubMed Central

Hum, Susan; Cohen, Carole; Persaud, Malini; Lee, Joyce; Drummond, Neil; Dalziel, William; Pimlott, Nicholas

2014-01-01

Background The assessment and ongoing management of dementia falls largely on family physicians. This pilot study explored perceived roles and attitudes towards the provision of dementia care from the perspectives of family physicians and specialists. Methods Semi-structured, one-to-one interviews were conducted with six family physicians and six specialists (three geriatric psychiatrists, two geriatricians, and one neurologist) from University of Toronto-affiliated hospitals. Transcripts were subjected to thematic content analysis. Results Physicians’ clinical experience averaged 16 years. Both physician groups acknowledged that family physicians are more confident in diagnosing/treating uncomplicated dementia than a decade ago. They agreed on care management issues that warranted specialist involvement. Driving competency was contentious, and specialists willingly played the “bad cop” to resolve disputes and preserve long-standing therapeutic relationships. While patient/caregiver education and support were deemed essential, most physicians commented that community resources were fragmented and difficult to access. Improving collaboration and communication between physician groups, and clarifying the roles of other multi-disciplinary team members in dementia care were also discussed. Conclusions Future research could further explore physicians’ and other multi-disciplinary members’ perceived roles and responsibilities in dementia care, given that different health-care system-wide dementia care strategies and initiatives are being developed and implemented across Ontario. PMID:25232368

Scientific Process Flowchart Assessment (SPFA): A Method for Evaluating Changes in Understanding and Visualization of the Scientific Process in a Multidisciplinary Student Population

PubMed Central

Wilson, Kristy J.; Rigakos, Bessie

2016-01-01

The scientific process is nonlinear, unpredictable, and ongoing. Assessing the nature of science is difficult with methods that rely on Likert-scale or multiple-choice questions. This study evaluated conceptions about the scientific process using student-created visual representations that we term “flowcharts.” The methodology, Scientific Process Flowchart Assessment (SPFA), consisted of a prompt and rubric that was designed to assess students’ understanding of the scientific process. Forty flowcharts representing a multidisciplinary group without intervention and 26 flowcharts representing pre- and postinstruction were evaluated over five dimensions: connections, experimental design, reasons for doing science, nature of science, and interconnectivity. Pre to post flowcharts showed a statistically significant improvement in the number of items and ratings for the dimensions. Comparison of the terms used and connections between terms on student flowcharts revealed an enhanced and more nuanced understanding of the scientific process, especially in the areas of application to society and communication within the scientific community. We propose that SPFA can be used in a variety of circumstances, including in the determination of what curricula or interventions would be useful in a course or program, in the assessment of curriculum, or in the evaluation of students performing research projects. PMID:27856551

Recent advances in multidisciplinary management of hepatocellular carcinoma

PubMed Central

Gomaa, Asmaa I; Waked, Imam

2015-01-01

The incidence of hepatocellular carcinoma (HCC) is increasing, and it is currently the second leading cause of cancer-related death worldwide. Potentially curative treatment options for HCC include resection, transplantation, and percutaneous ablation, whereas palliative treatments include trans-arterial chemoembolization (TACE), radioembolization, and systemic treatments. Due to the diversity of available treatment options and patients’ presentations, a multidisciplinary team should decide clinical management of HCC, according to tumor characteristics and stage of liver disease. Potentially curative treatments are suitable for very-early- and early-stage HCC. However, the vast majority of HCC patients are diagnosed in later stages, where the tumor characteristics or progress of liver disease prevent curative interventions. For patients with intermediate-stage HCC, TACE and radioembolization improve survival and are being evaluated in addition to potentially curative therapies or with systemic targeted therapy. There is currently no effective systemic chemotherapy, immunologic, or hormonal therapy for HCC, and sorafenib is the only approved molecular-targeted treatment for advanced HCC. Other targeted agents are under investigation; trials comparing new agents in combination with sorafenib are ongoing. Combinations of systemic targeted therapies with local treatments are being evaluated for further improvements in HCC patient outcomes. This article provides an updated and comprehensive overview of the current standards and trends in the treatment of HCC. PMID:25866604

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

PubMed Central

Chehade, Samer; Palma, David A.

2015-01-01

Aim To review key studies evaluating stereotactic radiotherapy in the setting of early-stage non-small cell lung cancer (NSCLC) for inoperable or high-risk patients, and discuss areas of ongoing research and clinical trials. Background The use of stereotactic radiotherapy for the treatment of early stage non-small cell lung cancer (NSCLC) has increased rapidly over the past decade. Numerous studies have reported outcomes for patients treated with SBRT who are unfit for surgical resection, or at high risk of surgical complications. Materials and methods A narrative review. Results The preponderance of evidence suggests that SBRT is associated with excellent local control (∼90% at 3 years) and a favorable toxicity profile. In patients with higher operative risks, such as the elderly and patients with severe COPD, SBRT may provide a less-toxic treatment than surgery with similar oncologic outcomes. Ongoing studies are evaluating the use of SBRT for locally advanced or oligometastatic NSCLC. Conclusions A large body of evidence now exists to support the use of SBRT for early-stage NSCLC. Decisions regarding the optimal choice of treatment should be individualized, and made in the context of a multidisciplinary team. PMID:26696779

The helical ventricular myocardial band: global, three-dimensional, functional architecture of the ventricular myocardium.

PubMed

Kocica, Mladen J; Corno, Antonio F; Carreras-Costa, Francesc; Ballester-Rodes, Manel; Moghbel, Mark C; Cueva, Clotario N C; Lackovic, Vesna; Kanjuh, Vladimir I; Torrent-Guasp, Francisco

2006-04-01

We are currently witnessing the advent of new diagnostic tools and therapies for heart diseases, but, without serious scientific consensus on fundamental questions about normal and diseased heart structure and function. During the last decade, three successive, international, multidisciplinary symposia were organized in order to setup fundamental research principles, which would allow us to make a significant step forward in understanding heart structure and function. Helical ventricular myocardial band of Torrent-Guasp is the revolutionary new concept in understanding global, three-dimensional, functional architecture of the ventricular myocardium. This concept defines the principal, cumulative vectors, integrating the tissue architecture (i.e. form) and net forces developed (i.e. function) within the ventricular mass. Here we expose the compendium of Torrent-Guasp's half-century long functional anatomical investigations in the light of ongoing efforts to define the integrative approach, which would lead to new understanding of the ventricular form and function by linking across multiple scales of biological organization, as defined in ongoing Physiome project. Helical ventricular myocardial band of Torrent-Guasp may also, hopefully, allow overcoming some difficulties encountered in contemporary efforts to create a comprehensive mathematical model of the heart.

Using Public Posting as a Motivation Strategy in Physical Education, Sport, and Adult Exercise Settings

ERIC Educational Resources Information Center

Martin, Matt; Sharpe, Tom

2009-01-01

One of the ongoing challenges that physical educators, coaches, and fitness professionals face is discovering and implementing motivational strategies that encourage long-term participation and effort. This challenge exists in public school physical education classes, on the playing field, and in structured adult physical activity settings. In…

Revisiting the Media Generation: Youth Media Use and Computational Literacy Instruction

ERIC Educational Resources Information Center

Jenson, Jennifer; Droumeva, Milena

2017-01-01

An ongoing challenge of 21st century learning is ensuring everyone has the requisite skills to participate in a digital, knowledge-based economy. Once an anathema to parents and teachers, digital games are increasingly at the forefront of conversations about ways to address student engagement and provoke challenges to media pedagogies. While…

Challenges for an Interdisciplinary Consideration of Cognitive Training

ERIC Educational Resources Information Center

Birney, Damian Patrick

2015-01-01

Whether fluid cognitive functions are malleable has been a topic of ongoing debate for at least the past 100 years. Ever-evolving technology has led to new and diverse fields of investigation entering this debate. There are significant advantages to be gained by integrating different scientific paradigms, but there are also significant challenges.…

Creative Tension: Turn The Challenges of Learning Together Into Opportunities

ERIC Educational Resources Information Center

Dobbs, Christina L.; Ippolito, Jacy; Charner-Laird, Megin

2016-01-01

Effective and authentic communities of practice in schools have the potential to support teachers in improving their instructional practices around perennial challenges, such as improving the literacy skills of all students. But before they can achieve such goals, communities of practice take time to build, effort to sustain, and ongoing support…

Xtranormal Learning for Millennials: An Innovative Tool for Group Projects

ERIC Educational Resources Information Center

Stratton, Micheal T.; Julien, Mark

2014-01-01

Encouraging students to actively engage with course material is an ongoing challenge for many management educators. One common tactic is to use various technologies that allow tech-savvy Millennial Generation students to take a more active role in their learning. In this article, we describe an innovative group project that challenges students to…

Financial Management: Education Faces Challenges in Achieving Financial Management Reform. Testimony before the Subcommittee on Oversight and Investigations, Committee on Education and the Workforce, House of Representatives.

ERIC Educational Resources Information Center

Jarmon, Gloria L.

This report provides a fiscal analysis of the Department of Education's 1999 financial audit results. It focuses on the relationship between the audit findings and the potential for waste, fraud, and abuse, and examines the status of an ongoing study of the Department's grantback account. It describes the ongoing accounting problems that have…

Development of a Three Dimensional Wireless Sensor Network for Terrain-Climate Research in Remote Mountainous Environments

NASA Astrophysics Data System (ADS)

Kavanagh, K.; Davis, A.; Gessler, P.; Hess, H.; Holden, Z.; Link, T. E.; Newingham, B. A.; Smith, A. M.; Robinson, P.

2011-12-01

Developing sensor networks that are robust enough to perform in the world's remote regions is critical since these regions serve as important benchmarks compared to human-dominated areas. Paradoxically, the factors that make these remote, natural sites challenging for sensor networking are often what make them indispensable for climate change research. We aim to overcome these challenges by developing a three-dimensional sensor network arrayed across a topoclimatic gradient (1100-1800 meters) in a wilderness area in central Idaho. Development of this sensor array builds upon advances in sensing, networking, and power supply technologies coupled with experiences of the multidisciplinary investigators in conducting research in remote mountainous locations. The proposed gradient monitoring network will provide near real-time data from a three-dimensional (3-D) array of sensors measuring biophysical parameters used in ecosystem process models. The network will monitor atmospheric carbon dioxide concentration, humidity, air and soil temperature, soil water content, precipitation, incoming and outgoing shortwave and longwave radiation, snow depth, wind speed and direction, tree stem growth and leaf wetness at time intervals ranging from seconds to days. The long-term goal of this project is to realize a transformative integration of smart sensor networks adaptively communicating data in real-time to ultimately achieve a 3-D visualization of ecosystem processes within remote mountainous regions. Process models will be the interface between the visualization platforms and the sensor network. This will allow us to better predict how non-human dominated terrestrial and aquatic ecosystems function and respond to climate dynamics. Access to the data will be ensured as part of the Northwest Knowledge Network being developed at the University of Idaho, through ongoing Idaho NSF-funded cyber infrastructure initiatives, and existing data management systems funded by NSF, such as the CUAHSI Hydrologic Information System (HIS). These efforts will enhance cross-disciplinary understanding of natural and anthropogenic influences on ecosystem function and ultimately inform decision-making.

Bridging the Gap between Health and Social Care for Rare Diseases: Key Issues and Innovative Solutions.

PubMed

Castro, Raquel; Senecat, Juliette; de Chalendar, Myriam; Vajda, Ildikó; Dan, Dorica; Boncz, Béata

2017-01-01

Bridging the gaps between health and social care for rare diseases is not only necessary but crucial to increase the life expectancy, quality of life and autonomy of people living with a rare disease, supporting them in the full realisation of their fundamental human rights.The complexity of rare diseases, their strong relation to disability and the current unmet social and daily life needs of people living with a rare disease must not be underestimated and require urgent attention from all stakeholders involved in care provision, from healthcare to social and community services.The Commission Expert Group Recommendations to Support the Incorporation of Rare Diseases into Social Services and Policies, adopted unanimously in April 2016, by the representatives of European Member States and the other rare disease stakeholders, clearly set the tone for the need to promote measures that facilitate multidisciplinary, holistic, continuous, person-centred and participative care provision to people living with rare diseases.These recommendations, sided by other recent policy developments at European and national levels, represent an important policy step into approaching rare diseases' complex challenges in regards to holistic care provision.Innovative approaches aiming at bridging the gap between health, social and community service and support providers are currently being developed and tested in different European countries: standards of care, networks of expertise, case management services, one-stop-shop services, amongst others.These ongoing pilot approaches, presented in this chapter, have the power to inspire future policies and the effective and efficient implementation of holistic care pathways for people living with a rare disease, bringing about significant changes for patients, carers, care providers, competent authorities and the society at large.Nonetheless, the challenges to fully address this issue remain numerous and other key issues will also need to be taken into account when moving forward with the implementation of measures that aim at bridging the gaps between care providers and providing holistic care to people living with a rare disease.

Magic Mountains and multi-disciplines in international medical mobilities Comment on "Patient mobility in the global marketplace: a multidisciplinary perspective".

PubMed

Mainil, Tomas; Meulemans, Herman

2014-06-01

Medical mobilities offer both opportunities and challenges. This tension follows the same ratio as many other historic fora, but offers at the same time a sustainable equilibrium. Multi-disciplines are, therefore, the key to the medical lifeworld for the global health and well-being of transnational health users around the globe.

Reflections on the Role of the "Users": Challenges in a Multi-Disciplinary Context of Learner-Centred Design for Children on the Autism Spectrum

ERIC Educational Resources Information Center

Parsons, Sarah; Cobb, Sue

2014-01-01

Technology design in the field of human-computer interaction has developed a continuum of participatory research methods, closely mirroring methodological approaches and epistemological discussions in other fields. This paper positions such approaches as examples of inclusive research (to varying degrees) within education, and illustrates the…

From air to land: understanding water resources through plant-based multidisciplinary research.

PubMed

Silva, Lucas C R

2015-07-01

Current global challenges require solutions that cannot be delivered by any one field alone. New developments in the analysis and interpretation of plant-derived climatic records bridge traditional disciplines, advancing understanding of phenomena of great ecological and societal significance, specifically, those related to changes in the terrestrial water cycle. Copyright © 2015 Elsevier Ltd. All rights reserved.

"My Daughter Does Not Know How to Make the Chappati": Understanding Food Access among African Immigrants in Lewiston, Maine

ERIC Educational Resources Information Center

Jacobus, Michelle Vazquez; Ahmed, Hussein; Jalali, Reza

2013-01-01

Food access for Maine's growing African refugee population reflects multiple levels of general access to society. To better understand the challenges and opportunities unique to this community, a multidisciplinary team of students, faculty, and community partners integrated the expertise of local residents with the results of a food assessment of…

How to Achieve Synergy between Medical Education and Cognitive Neuroscience? An Exercise on Prior Knowledge in Understanding

ERIC Educational Resources Information Center

Ruiter, Dirk J.; van Kesteren, Marlieke T. R.; Fernandez, Guillen

2012-01-01

A major challenge in contemporary research is how to connect medical education and cognitive neuroscience and achieve synergy between these domains. Based on this starting point we discuss how this may result in a common language about learning, more educationally focused scientific inquiry, and multidisciplinary research projects. As the topic of…

A New Model for a Multi-Disciplinary Engineering Summer Research Program for High School Seniors: Program Overview, Effectiveness, and Outcomes

ERIC Educational Resources Information Center

Kittur, H.; Shaw, L.; Herrera, W.

2017-01-01

The High School Summer Research Program (HSSRP) is a rigorous eight-week research experience that challenges high school students to a novel scientific question in an engineering laboratory at the Henry Samueli School of Engineering and Applied Science (HSSEAS) at the University of California, Los Angeles (UCLA). The program collates highly…

How big is too big or how many partners are needed to build a large project which still can be managed successfully?

NASA Astrophysics Data System (ADS)

Henkel, Daniela; Eisenhauer, Anton

2017-04-01

During the last decades, the number of large research projects has increased and therewith the requirement for multidisciplinary, multisectoral collaboration. Such complex and large-scale projects pose new competencies to form, manage, and use large, diverse teams as a competitive advantage. For complex projects the effort is magnified because multiple large international research consortia involving academic and non-academic partners, including big industries, NGOs, private and public bodies, all with cultural differences, individually discrepant expectations on teamwork and differences in the collaboration between national and multi-national administrations and research organisations, challenge the organisation and management of such multi-partner research consortia. How many partners are needed to establish and conduct collaboration with a multidisciplinary and multisectoral approach? How much personnel effort and what kinds of management techniques are required for such projects. This presentation identifies advantages and challenges of large research projects based on the experiences made in the context of an Innovative Training Network (ITN) project within Marie Skłodowska-Curie Actions of the European HORIZON 2020 program. Possible strategies are discussed to circumvent and avoid conflicts already at the beginning of the project.

The first Team Haemophilia Education meeting, 2015, Amsterdam, The Netherlands.

PubMed

Berntorp, Erik; Hart, Daniel; Mancuso, Maria Elisa; d'Oiron, Roseline; Perry, David; O'Mahony, Brian; Kaczmarek, Radoslaw; Crato, Miguel; Pasi, John; Miners, Alec; Carlsson, Katarina Steen; Kitchen, Steve; Boehlen, Françoise; Giangrande, Paul; Cebura, Elizabete; Uitslager, Nanda; Osooli, Mehdi; Janeckova, Daniela; Haldon, Rosie; Rivolta, Gianna Franca

2016-07-01

Haemophilia remains a complex disorder to diagnose and manage, requiring close cooperation between multidisciplinary healthcare professionals. There are still many unmet challenges in haemophilia care. The first Team Haemophilia Education (THE) meeting, held on 7-8 May 2015 in Amsterdam, The Netherlands, aimed to promote the optimal care of haemophilia patients through education of the multidisciplinary treatment team. This was achieved by reviewing the latest developments in haemophilia management, considering how these can be implemented in the clinic to improve patient care and providing a platform for networking and debate for all haemophilia treatment team members. Haemophilia treatment centres from several countries were asked to complete a premeeting online questionnaire to establish the biggest challenges that they face when managing patients. The concerns expressed were used to develop the agenda, which comprised a combination of formal presentations, case studies and informal workshops covering such topics as pharmacokinetics, laboratory assays and tailoring of treatment to individual patients. This report is a summary of the key developments in haemophilia care presented by various investigators and healthcare professionals at THE meeting 2015. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

GEOSS: Addressing Big Data Challenges

NASA Astrophysics Data System (ADS)

Nativi, S.; Craglia, M.; Ochiai, O.

2014-12-01

In the sector of Earth Observation, the explosion of data is due to many factors including: new satellite constellations, the increased capabilities of sensor technologies, social media, crowdsourcing, and the need for multidisciplinary and collaborative research to face Global Changes. In this area, there are many expectations and concerns about Big Data. Vendors have attempted to use this term for their commercial purposes. It is necessary to understand whether Big Data is a radical shift or an incremental change for the existing digital infrastructures. This presentation tries to explore and discuss the impact of Big Data challenges and new capabilities on the Global Earth Observation System of Systems (GEOSS) and particularly on its common digital infrastructure called GCI. GEOSS is a global and flexible network of content providers allowing decision makers to access an extraordinary range of data and information at their desk. The impact of the Big Data dimensionalities (commonly known as 'V' axes: volume, variety, velocity, veracity, visualization) on GEOSS is discussed. The main solutions and experimentation developed by GEOSS along these axes are introduced and analyzed. GEOSS is a pioneering framework for global and multidisciplinary data sharing in the Earth Observation realm; its experience on Big Data is valuable for the many lessons learned.

Towards multidisciplinary assessment of older people: exploring the change process.

PubMed

Ross, Fiona; O'Tuathail, Claire; Stubberfield, Debbie

2005-04-01

This paper discusses the process of change that took place in an intervention study of standardized multidisciplinary assessment guidelines implemented in a female ward for older people in a District General Hospital in South London. This study was one of nine implementation projects in the South Thames Evidence-Based Practice Project. The relationship between the worlds of research and healthcare practice is uneasy and contested and, as such, is a breeding ground for challenging questions about how evidence can be used to foment change in clinical practice. Recent literature on change highlights the importance of understanding complexity, which informed our approach and analysis. A multifaceted approach to change that comprised evidence-based guidelines, leadership (project leader) and change management was evaluated before and after the implementation by telephone interviews with patients, a postal survey of community staff and interviews with ward staff. A diagnostic analysis of current assessment practice informed the change process. The project leader collected data on adherence. This paper draws on descriptive and qualitative data and addresses the links between contextual issues and the processes and pathways of change, informed by theoretical ideas from the change literature. Key themes emerged: working through others and across boundaries, managing uncertainty and unanticipated challenges. Adherence of ward staff to using the multidisciplinary assessment guidelines was high, with evidence of some dissemination to community staff at follow-up. Three years after the project finished the multidisciplinary assessment is still part of routine clinical practice. The analysis contributes to understanding about the nursing leadership of change within an interprofessional arena of practice. It highlights the importance of understanding the context in relation to the impact and sustainability of change and thus the utility of conducting a diagnostic analysis in the early stages of implementation. This has implications for developing approaches to change in nursing and interprofessional practice in other settings. Using research to change practice needs clinical leaders who are supported by the organization and have the skills to implement research evidence, manage uncertainty and build trust with a range of other professionals.

Svalbard Integrated Arctic Earth Observing System (sios): Facilitating Easy Access to Multidisciplinary Arctic Data Through the Brokering Approach.

NASA Astrophysics Data System (ADS)

Bye, B. L.; Godøy, Ø.

2014-12-01

Environmental and climate changes are important elements of our global challenges. They are observed at a global scale and in particular in the Arctic. In order to give better estimates of the future changes, the Arctic has to be monitored and analyzed by a multi-disciplinary observation system that will improve Earth System Models. The best chance to achieve significant results within a relatively short time frame is found in regions with a large natural climate gradient, and where processes sensitive to the expected changes are particularly important. Svalbard and the surrounding ocean areas fulfil all these criteria. The vision for SIOS is to be a regional observational system for long term acquisition and proliferation of fundamental knowledge on global environmental change within an Earth System Science perspective in and around Svalbard. SIOS will systematically develop and implement methods for how observational networks are to be construed. The distributed SIOS data management system (SDMS) will be implemented through a combination of technologies tailored to the multi-disciplinary nature of the Arctic data. One of these technologies is The Brokering approach or "Framework". The Brokering approach provides a series of services such as discovery, access, transformation and semantics support to enable translation from one discipline/culture to another. This is exactly the challenges the SDMS will have to handle and thus the Brokering approach is integrated in the design of the system. A description of the design strategy for the SDMS that includes The Brokering approach will be presented. The design and implementation plans for the SDMS are based on research done in the EU funded ESFRI project SIOS and examples of solutions for interoperable systems producing Arctic datasets and products coordinated through SIOS will be showcased. The reported experience from SIOS brokering approach will feed into the process of developing a sustainable brokering governance in the framework of Research Data Alliance. It will also support the Global Earth Observation System of Systems (GEOSS). This is a contribution to increase our global capacity to create interoperable systems that provide multi-disciplinary dataset and products.

Patient experience in a coordinated care model featuring diabetes self-management education integrated into the patient-centered medical home.

PubMed

Janiszewski, Debra; O'Brian, Catherine A; Lipman, Ruth D

2015-08-01

The purpose of this study is to gain insight about patient experience of diabetes self-management education in a patient-centered medical home. Six focus groups consisting of 37 people with diabetes, diverse in race and ethnicity, were conducted at 3 sites. Participants described their experience in the program and their challenges in diabetes self-management; they also suggested services to meet their diabetes care needs. The most common theme was ongoing concerns about care and support. There was much discussion about the value of the support provided by health navigators integrated in the diabetes health care team. Frequent concerns expressed by participants centered on personal challenges in engaging in healthy lifestyle behaviors. Ongoing programmatic support of self-management goals was widely valued. Individuals who received health care in a patient-centered medical home and could participate in diabetes self-management education with integrated support valued both activities. The qualitative results from this study suggest need for more formalized exploration of effective means to meet the ongoing support needs of people with diabetes. © 2015 The Author(s).

Recent Advances and Challenges towards Sustainable Polyhydroxyalkanoate (PHA) Production.

PubMed

Kourmentza, Constantina; Plácido, Jersson; Venetsaneas, Nikolaos; Burniol-Figols, Anna; Varrone, Cristiano; Gavala, Hariklia N; Reis, Maria A M

2017-06-11

Sustainable biofuels, biomaterials, and fine chemicals production is a critical matter that research teams around the globe are focusing on nowadays. Polyhydroxyalkanoates represent one of the biomaterials of the future due to their physicochemical properties, biodegradability, and biocompatibility. Designing efficient and economic bioprocesses, combined with the respective social and environmental benefits, has brought together scientists from different backgrounds highlighting the multidisciplinary character of such a venture. In the current review, challenges and opportunities regarding polyhydroxyalkanoate production are presented and discussed, covering key steps of their overall production process by applying pure and mixed culture biotechnology, from raw bioprocess development to downstream processing.

Isolation and analysis of ginseng: advances and challenges

PubMed Central

Wang, Chong-Zhi

2011-01-01

Ginseng occupies a prominent position in the list of best-selling natural products in the world. Because of its complex constituents, multidisciplinary techniques are needed to validate the analytical methods that support ginseng’s use worldwide. In the past decade, rapid development of technology has advanced many aspects of ginseng research. The aim of this review is to illustrate the recent advances in the isolation and analysis of ginseng, and to highlight their new applications and challenges. Emphasis is placed on recent trends and emerging techniques. The current article reviews the literature between January 2000 and September 2010. PMID:21258738

Tuberculosis remains a challenge despite economic growth in Panama.

PubMed

Tarajia, M; Goodridge, A

2014-03-01

Tuberculosis (TB) is a disease associated with inequality, and wise investment of economic resources is considered critical to its control. Panama has recently secured its status as an upper-middle-income country with robust economic growth. However, the prioritisation of resources for TB control remains a major challenge. In this article, we highlight areas that urgently require action to effectively reduce TB burden to minimal levels. Our conclusions suggest the need for fund allocation and a multidisciplinary approach to ensure prompt laboratory diagnosis, treatment assurance and workforce reinforcement, complemented by applied and operational research, development and innovation.

Multilayered Functional Insulation System (MFIS) for AC Power Transmission in High Voltage Hybrid Electrical Propulsion

NASA Technical Reports Server (NTRS)

Lizcano, Maricela

2017-01-01

High voltage hybrid electric propulsion systems are now pushing new technology development efforts for air transportation. A key challenge in hybrid electric aircraft is safe high voltage distribution and transmission of megawatts of power (>20 MW). For the past two years, a multidisciplinary materials research team at NASA Glenn Research Center has investigated the feasibility of distributing high voltage power on future hybrid electric aircraft. This presentation describes the team's approach to addressing this challenge, significant technical findings, and next steps in GRC's materials research effort for MW power distribution on aircraft.

Mapping a Path to Autonomous Flight in the National Airspace

NASA Technical Reports Server (NTRS)

Lodding, Kenneth N.

2011-01-01

The introduction of autonomous flight, whether military, commercial, or civilian, into the National Airspace System (NAS) will present significant challenges. Minimizing the impact and preventing the changes from becoming disruptive, rather than an enhancing technology will not be without difficulty. From obstacle detection and avoidance to real-time verification and validation of system behavior, there are significant problems which must be solved prior to the general acceptance of autonomous systems. This paper examines some of the key challenges and the multi-disciplinary collaboration which must occur for autonomous systems to be accepted as equal partners in the NAS.

Development of a virtual multidisciplinary lung cancer tumor board in a community setting.

PubMed

Stevenson, Marvaretta M; Irwin, Tonia; Lowry, Terry; Ahmed, Maleka Z; Walden, Thomas L; Watson, Melanie; Sutton, Linda

2013-05-01

Creating an effective platform for multidisciplinary tumor conferences can be challenging in the rural community setting. The Duke Cancer Network created an Internet-based platform for a multidisciplinary conference to enhance the care of patients with lung cancer. This conference incorporates providers from different physical locations within a rural community and affiliated providers from a university-based cancer center 2 hours away. An electronic Web conferencing tool connects providers aurally and visually. Conferences were set up using a commercially available Web conferencing platform. The video platform provides a secure Web site coupled with a secure teleconference platform to ensure patient confidentiality. Multiple disciplines are invited to participate, including radiology, radiation oncology, thoracic surgery, pathology, and medical oncology. Participants only need telephone access and Internet connection to participate. Patient histories and physicals are presented, and the Web conferencing platform allows radiologic and histologic images to be reviewed. Treatment plans for patients are discussed, allowing providers to coordinate care among the different subspecialties. Patients who need referral to the affiliated university-based cancer center for specialized services are identified. Pertinent treatment guidelines and journal articles are reviewed. On average, there are 10 participants with one to two cases presented per session. The use of a Web conferencing platform allows subspecialty providers throughout the community and hours away to discuss lung cancer patient cases. This platform increases convenience for providers, eliminating travel to a central location. Coordination of care for patients requiring multidisciplinary care is facilitated, shortening evaluation time before definitive treatment plan.

Whey protein stories - An experiment in writing a multidisciplinary biography.

PubMed

Jensen, Tenna; Bechshoeft, Rasmus L; Giacalone, Davide; Otto, Marie Haulund; Castro-Mejía, Josue; Bin Ahmad, Hajar Fauzan; Reitelseder, Søren; Jespersen, Astrid Pernille

2016-12-01

This is an experimental, dual-purpose article about whey protein and how to conduct interdisciplinary analyses and writings. On the one hand, this article is a multidisciplinary commodity biography, which consists of five descriptions of whey protein written by the five different research groups involved in the interdisciplinary research project CALM(Counteracting Age-related loss of Skeletal Muscle Mass). On the other hand, it is a meta-analysis, which aims to uncover and highlight examples of how the five descriptions contribute to each other with insights into the contextualisation of knowledge, contrasts between the descriptions and the new dimensions they bring to established fields of interest. The meta-analysis also contains a discussion of interdisciplinary study objects and the usefulness of the multidisciplinary commodity biography as a format for interdisciplinary publications. The article contributes to the field of food studies with a multidisciplinary biography of whey protein - including its sensory qualities and challenges, insights into its cultural history, its nutritional value and effects on the human body and an analysis of how it is perceived by people who consume it. The biography thereby expands upon existing understandings of whey protein while discussing the usefulness of employing the commodity biography format in interdisciplinary writing. Moreover, the article contributes to the field of interdisciplinary research by providing a practical example of a joint publication and reflections upon the existence, interaction and possibilities of monodisciplinary knowledge structures within interdisciplinary studies and publications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Thoracic Vertebral Hemangioma with Spinal Cord Compression: Multidisciplinary Surgical Treatment and Follow-up of Six Patients.

PubMed

Zhang, Hui-Lin; Hu, Yong-Cheng; Aryal, Rajendra; He, Xin; Lun, Deng-Xing; Zhao, Li-Ming

2016-11-01

To provide useful insights of multidisciplinary surgical treatment for vertebral hemangioma with spinal cord compression. From 2009 to 2014, data on six patients who were diagnosed with cord compression vertebral hemangioma were reviewed and analyzed retrospectively. There were five women and one man with a mean age of 48.6 years (range, 26-68 years). All the patients were treated by multidisciplinary approach, including use of gelfoam, pedicle screw instrumentation, vertebroplasty, and decompression laminectomy. Neurological status and Frankel grades were documented, CT scan and MRI were performed after surgery. The follow-up period ranged from 8 to 54 months. Mean blood loss was around 367 mL, and the mean surgical time was 2.30 h. All patients had uneventful intraoperative and postoperative courses and reported symptomatic and neurological relief to varying degrees, at an average follow-up period of 23 months. Bone cement distribution was disseminated homogeneously over the affected vertebra and no leakage was observed. All the patients had a complete restoration to Frankel grade E. The postoperative and follow-up imaging showed that the implant was in perfect position, and no recurrence occurred in all patients. The vertebral hemangioma with cord compression is a challenge to surgeons for therapeutic improvement, and an active involvement of several disciplines as well as performance of multidisciplinary surgical treatment can be crucial in achieving favorable results. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

A methodology towards virtualisation-based high performance simulation platform supporting multidisciplinary design of complex products

NASA Astrophysics Data System (ADS)

Ren, Lei; Zhang, Lin; Tao, Fei; (Luke) Zhang, Xiaolong; Luo, Yongliang; Zhang, Yabin

2012-08-01

Multidisciplinary design of complex products leads to an increasing demand for high performance simulation (HPS) platforms. One great challenge is how to achieve high efficient utilisation of large-scale simulation resources in distributed and heterogeneous environments. This article reports a virtualisation-based methodology to realise a HPS platform. This research is driven by the issues concerning large-scale simulation resources deployment and complex simulation environment construction, efficient and transparent utilisation of fine-grained simulation resources and high reliable simulation with fault tolerance. A framework of virtualisation-based simulation platform (VSIM) is first proposed. Then the article investigates and discusses key approaches in VSIM, including simulation resources modelling, a method to automatically deploying simulation resources for dynamic construction of system environment, and a live migration mechanism in case of faults in run-time simulation. Furthermore, the proposed methodology is applied to a multidisciplinary design system for aircraft virtual prototyping and some experiments are conducted. The experimental results show that the proposed methodology can (1) significantly improve the utilisation of fine-grained simulation resources, (2) result in a great reduction in deployment time and an increased flexibility for simulation environment construction and (3)achieve fault tolerant simulation.

Cognitive rehabilitation in multiple sclerosis: a randomized controlled trial.

PubMed

Hanssen, K T; Beiske, A G; Landrø, N I; Hofoss, D; Hessen, E

2016-01-01

The evidence base in cognitive rehabilitation in multiple sclerosis (MS) is still sparse. The aim of the study was to investigate the effects of cognitive rehabilitation on cognitive and executive coping, psychological well-being and psychological aspects of health-related quality of life (HRQoL) in patients with MS. One hundred and twenty patients with cognitive complaints, taking part in a 4-week multidisciplinary rehabilitation, were randomized to an intervention group (n = 60) and a control group (n = 60). Both groups underwent neuropsychological assessment with subsequent feedback and took part in general multidisciplinary MS rehabilitation. Additionally, the intervention group participated in cognitive group sessions as well as individual sessions. The main focus was to formulate Goal Attainment Scaling goals for coping with cognitive challenges. For 3 months past rehabilitation, the intervention group received biweekly telephone follow-up, focusing on goal attainment. Executive functioning improved significantly from baseline to four and 7 months in both groups. Improvements in psychological well-being and psychological aspects of HRQoL occurred only in the intervention group. Multicomponent cognitive rehabilitation administered within the context of multidisciplinary rehabilitation can improve psychological well-being and psychological aspects of HRQoL. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Collaborative simulation method with spatiotemporal synchronization process control

NASA Astrophysics Data System (ADS)

Zou, Yisheng; Ding, Guofu; Zhang, Weihua; Zhang, Jian; Qin, Shengfeng; Tan, John Kian

2016-10-01

When designing a complex mechatronics system, such as high speed trains, it is relatively difficult to effectively simulate the entire system's dynamic behaviors because it involves multi-disciplinary subsystems. Currently,a most practical approach for multi-disciplinary simulation is interface based coupling simulation method, but it faces a twofold challenge: spatial and time unsynchronizations among multi-directional coupling simulation of subsystems. A new collaborative simulation method with spatiotemporal synchronization process control is proposed for coupling simulating a given complex mechatronics system across multiple subsystems on different platforms. The method consists of 1) a coupler-based coupling mechanisms to define the interfacing and interaction mechanisms among subsystems, and 2) a simulation process control algorithm to realize the coupling simulation in a spatiotemporal synchronized manner. The test results from a case study show that the proposed method 1) can certainly be used to simulate the sub-systems interactions under different simulation conditions in an engineering system, and 2) effectively supports multi-directional coupling simulation among multi-disciplinary subsystems. This method has been successfully applied in China high speed train design and development processes, demonstrating that it can be applied in a wide range of engineering systems design and simulation with improved efficiency and effectiveness.

Stimulating high impact HIV-related cardiovascular research: recommendations from a multidisciplinary NHLBI Working Group on HIV-related heart, lung, and blood disease.

PubMed

Shah, Monica R; Cook, Nakela; Wong, Renee; Hsue, Priscilla; Ridker, Paul; Currier, Judith; Shurin, Susan

2015-02-24

The clinical challenges confronting patients with human immunodeficiency virus (HIV) have shifted from acquired immunodeficiency syndrome (AIDS)-related illnesses to chronic diseases, such as coronary artery disease, chronic lung disease, and chronic anemia. With the growing burden of HIV-related heart, lung, and blood (HLB) disease, the National Heart, Lung, and Blood Institute (NHLBI) recognizes it must stimulate and support HIV-related HLB research. Because HIV offers a natural, accelerated model of common pathological processes, such as inflammation, HIV-related HLB research may yield important breakthroughs for all patients with HLB disease. This paper summarizes the cardiovascular recommendations of an NHLBI Working Group, Advancing HIV/AIDS Research in Heart, Lung, and Blood Diseases, charged with identifying scientific priorities in HIV-related HLB disease and developing recommendations to promote multidisciplinary collaboration among HIV and HLB investigators. The working group included multidisciplinary sessions, as well as HLB breakout sessions for discussion of disease-specific issues, with common themes about scientific priorities and strategies to stimulate HLB research emerging in all 3 groups. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach.

PubMed

Jonely, Holly; Brismée, Jean-Michel; Desai, Mehul J; Reoli, Rachel

2015-02-01

Sacroiliac joint pain and dysfunction affect 15-25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient's Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient's rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up.

CCTC and the Process for Reauthorization of Bilingual Teacher Preparation Standards: A Critical-Historical Perspective

ERIC Educational Resources Information Center

Cadiero-Kaplan, Karen; Berta-Avila, Margarita; Flores, Juan

2007-01-01

California and the rest of the United Sates are undergoing significant challenges in providing educational opportunities for an increasingly diverse population. These challenges include inadequate literacy and numeracy skills among large segments of the student and adult populations; an ongoing shift in the demographic profile of the population,…

Student Retention: A Description of First-Generation Minority Male Students' Interaction with Faculty

ERIC Educational Resources Information Center

Alford, Keyimani L.

2017-01-01

Challenges in retaining minority male students is an on-going issue in higher education in America. In addition, research suggests that the challenge is greater at Predominantly White Institutions. For many years, institutions have adopted principles and strategies suggested by researchers to counterattack this concern. Although a vast wealth of…

Radiation Testing on State-of-the-Art CMOS: Challenges, Plans, and Preliminary Results

NASA Technical Reports Server (NTRS)

LaBel, Kenneth A.; Cohn, Lewis M.

2009-01-01

At GOMAC 2007 and 2008, we discussed a variety of challenges for radiation testing of modern semiconductor devices and technologies [1, 2]. In this presentation, we provide more specific details in this on-going investigation focusing on out-of-the-box lessons observed for providing radiation effects assurances as well as preliminary test results.

In Pursuit of Being Canadian: Examining the Challenges of Culturally Relevant Education in Teacher Education Programs

ERIC Educational Resources Information Center

Dlamini, S. Nombuso; Martinovic, Dragana

2007-01-01

This article is about an ongoing initiative that addresses the challenges confronted by teacher candidates to whom English is an additional language and whose cultures are considered different from those of the Canadian mainstream. The initiative is a seminar, Language and Cultural Engagement, in which teacher candidates are prepared for practice…

The Handbook of High-Risk Challenging Behaviors in People with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Luiselli, James K., Ed.

2012-01-01

Aggressive and destructive behaviors are an ongoing challenge for many children, adolescents, and adults with intellectual and developmental disabilities (I/DD). What's behind these high-risk behaviors, and how can professionals help manage them? Discover the answers in this comprehensive text, the most up-to-date compendium of knowledge on…

Enhancing Large-Class Teaching: A Systematic Comparison of Rich-Media Materials

ERIC Educational Resources Information Center

Saunders, F. C.; Hutt, I.

2015-01-01

Large cohorts (>200 students) are an ever-increasing presence in the UK higher education (HE) sector. Providing excellent teaching and learning to these large classes is an ongoing challenge for teaching faculty, a challenge intensified when the cohort comprises 85% non-native English speakers. This paper presents the findings of a project to…

One Goal, Two Institutions: How a Community College and 4-Year University Partner to Bridge Student College Readiness Gaps

ERIC Educational Resources Information Center

Wilson, Dawna; Lowry, Kimberly M.

2017-01-01

Recent national attention on college completion poses unique challenges and opportunities for community colleges. Moving underprepared students through basic skills educational courses to degree attainment represents an ongoing challenge. With more than 60% of community college students enrolled in remedial education, 2-year institutions must…

The Future Role of the United States in Global Health: Emphasis on Cardiovascular Disease.

PubMed

Fuster, Valentin; Frazer, Jendayi; Snair, Megan; Vedanthan, Rajesh; Dzau, Victor

2017-12-26

U.S. global health investment has focused on detection, treatment, and eradication of infectious diseases such as tuberculosis, malaria, and human immunodeficiency virus/acquired immunodeficiency syndrome, with significant results. Although efforts should be maintained and expanded to provide ongoing therapy for chronic infectious disease, there is a pressing need to meet the challenge of noncommunicable diseases, which constitute the highest burden of diseases globally. A Committee of the National Academies of Sciences, Engineering, and Medicine has made 14 recommendations that require ongoing commitments to eradication of infectious disease and increase the emphasis on chronic diseases such as cardiovascular disease. These include improving early detection and treatment, mitigating disease risk factors, shifting global health infrastructure to include management of cardiovascular disease, developing global partners and private-public ventures to meet infrastructure and funding challenges, streamlining medical product development and supply, increasing research and development capacity, and addressing gaps in global political and institutional leadership to meet the shifting challenge. Copyright © 2017. Published by Elsevier Inc.

Climate, environmental and socio-economic change: weighing up the balance in vector-borne disease transmission

PubMed Central

Parham, Paul E.; Waldock, Joanna; Christophides, George K.; Hemming, Deborah; Agusto, Folashade; Evans, Katherine J.; Fefferman, Nina; Gaff, Holly; Gumel, Abba; LaDeau, Shannon; Lenhart, Suzanne; Mickens, Ronald E.; Naumova, Elena N.; Ostfeld, Richard S.; Ready, Paul D.; Thomas, Matthew B.; Velasco-Hernandez, Jorge; Michael, Edwin

2015-01-01

Arguably one of the most important effects of climate change is the potential impact on human health. While this is likely to take many forms, the implications for future transmission of vector-borne diseases (VBDs), given their ongoing contribution to global disease burden, are both extremely important and highly uncertain. In part, this is owing not only to data limitations and methodological challenges when integrating climate-driven VBD models and climate change projections, but also, perhaps most crucially, to the multitude of epidemiological, ecological and socio-economic factors that drive VBD transmission, and this complexity has generated considerable debate over the past 10–15 years. In this review, we seek to elucidate current knowledge around this topic, identify key themes and uncertainties, evaluate ongoing challenges and open research questions and, crucially, offer some solutions for the field. Although many of these challenges are ubiquitous across multiple VBDs, more specific issues also arise in different vector–pathogen systems. PMID:25688012

An Integrated Tool for System Analysis of Sample Return Vehicles

NASA Technical Reports Server (NTRS)

Samareh, Jamshid A.; Maddock, Robert W.; Winski, Richard G.

2012-01-01

The next important step in space exploration is the return of sample materials from extraterrestrial locations to Earth for analysis. Most mission concepts that return sample material to Earth share one common element: an Earth entry vehicle. The analysis and design of entry vehicles is multidisciplinary in nature, requiring the application of mass sizing, flight mechanics, aerodynamics, aerothermodynamics, thermal analysis, structural analysis, and impact analysis tools. Integration of a multidisciplinary problem is a challenging task; the execution process and data transfer among disciplines should be automated and consistent. This paper describes an integrated analysis tool for the design and sizing of an Earth entry vehicle. The current tool includes the following disciplines: mass sizing, flight mechanics, aerodynamics, aerothermodynamics, and impact analysis tools. Python and Java languages are used for integration. Results are presented and compared with the results from previous studies.

Multidisciplinary collaboration as a sustainable research model for device development.

PubMed

Chandra, Ankur

2013-02-01

The concurrent problems of research sustainability and decreased clinician involvement with medical device development can be jointly addressed through a novel, multidisciplinary solution. The University of Rochester Cardiovascular Device Design Program is a sustainable program in medical device design supported through a collaboration between the Schools of Medicine and Engineering. This article provides a detailed description of the motivation for starting the program, the current structure of the program, the methods of financial sustainability, and the direct impact it intends to have on the national vascular surgery community. The further expansion of this program and encouragement for development of similar programs throughout the country aims to address many of our current challenges in both research funding and device development education. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Psycho-oncology: a brief history and case study.

PubMed

Kurkjian, Natalie; Kurkjian, Carla; Pant, Shubham; Tucker, Phebe

2013-12-01

Ms. W. is a 55-year-old retired Caucasian woman who was diagnosed with esophageal cancer in October 2011. She underwent neoadjuvant chemotherapy with subsequent esophagectomy. She sought psychiatric help after receiving her cancer diagnosis. The field of psycho-oncology was developed to assist cancer patients and caregivers through their "cancer journey" from the time of diagnosis, throughout treatment and beyond. Criteria-defined psychiatric disorder, with adjustment disorder being the most common, is reported in approximately 33% to 50% of cancer patients. These realities have given psychiatry a role in the multi-disciplinary care approach in major cancer centers around the country. In this article, we describe the challenges faced by Ms. W. during her cancer diagnosis and provide a review of the literature in the emerging field of psycho-oncology and its role in the multidisciplinary care of cancer patients.

A systematic model to compare nurses' optimal and actual competencies in the clinical setting.

PubMed

Meretoja, Riitta; Koponen, Leena

2012-02-01

This paper is a report of a study to develop a model to compare nurses' optimal and actual competencies in the clinical setting.   Although future challenge is to focus the developmental and educational targets in health care, limited information is available on methods for how to predict optimal competencies. A multidisciplinary group of 24 experts on perioperative care were recruited to this study. They anticipated the effects of future challenges on perioperative care and specified the level of optimal competencies by using the Nurse Competence Scale before and after group discussions. The expert group consensus discussions were held to achieve the highest possible agreement on the overall level of optimal competencies. Registered Nurses (n = 87) and their nurse managers from five different units conducted assessments of the actual level of nurse competence with the Nurse Competence Scale instrument. Data were collected in 2006-2007. Group consensus discussions solidified experts' anticipations about the optimal competence level. This optimal competence level was significantly higher than the nurses' self-reported actual or nurse managers' assessed level of actual competence. The study revealed some competence items that were seen as key challenges for future education of professional nursing practice. It is important that the multidisciplinary experts in a particular care context develop a share understanding of the future competency requirements of patient care. Combining optimal competence profiles to systematic competence assessments contribute to targeted continual learning and educational interventions. © 2011 Blackwell Publishing Ltd.

Dynamic Undergraduate Climate Change Affinity Program: University of Delaware Climate Program for Undergraduates (CPUG)

NASA Astrophysics Data System (ADS)

Merrill, J.

2017-12-01

Multidisciplinary undergraduate climate change education is critical for students entering any sector of the workforce. The University of Delaware has developed a new interdisciplinary affinity program—UD Climate Program for Undergraduates (CPUG)—open to undergraduate students of all majors to provide a comprehensive educational experience designed to educate skilled climate change problem-solvers for a wide range of professional careers. The program is designed to fulfill all General Education requirements, and includes a residential community commitment and experiential learning in community outreach and problem solving. Seminars will introduce current popular press and research materials and provide practice in confirming source credibility, communications training, and psychological support, as well as team building. As undergraduates, members of the UD CPUG team will define, describe, and develop a solution or solutions for a pressing local climate challenge that has the potential for global impact. The choice of a challenge and approach to addressing it will be guided by the student's advisor. Students are expected to develop a practical, multidisciplinary solution to address the challenge as defined, using their educational and experiential training. Solutions will be presented to the UD community during the spring semester of their senior year, as a collaborative team solution, with enhancement through individual portfolios from each team member. The logic model, structure, curricular and co-curricular supports for the CPUG will be provided. Mechanisms of support available through University administration will also be discussed.

Planning for the Future of Geo-Cybereducation: Outcomes of the Workshop, Challenges, and Future Directions

NASA Astrophysics Data System (ADS)

Ryan, J. G.; Eriksson, S. C.

2010-12-01

Inspired by the recommendations of the NSF report “Fostering Learning in the Networked World: The Cyberlearning Opportunity and Challenge” (NSF08204), the NSF National STEM Digital Learning program funded “Planning for the Future of Geocybereducation” Workshop sought to bring together leaders from the geoscience education community, from major geoscience research initiatives, and from the growing public- and private-sector geoscience information community. The objectives of the workshop were to begin conversations aimed at identifying best practices and tools for geoscience cyber-education, in the context of both the changing nature of learners and of rapidly evolving geo-information platforms, and to provide guidance to the NSF as to necessary future directions and needs for funding. 65 participants met and interacted live for the two-day workshop, with ongoing post-meeting virtual interactions via a collaborative workspace (www.geocybered.ning.com). Topics addressed included the rapidly changing character of learners, the growing capabilities of geoscience information systems and their affiliated tools, and effective models for collaboration among educators, researchers and geoinformation specialists. Discussions at the meeting focused on the implications of changing learners on the educational process, the challenges for teachers and administrators in keeping pace, and on the challenges of communication among these divergent professional communities. Ongoing virtual discussions and collaborations have produced a draft workshop document, and the workshop conveners are maintaining the workshop site as a venue for ongoing discussion and interaction. Several key challenges were evident from the workshop discussions and subsequent interactions: a) the development of most of the large geoinformatics and geoscience research efforts were not pursued with education as a significant objective, resulting in limited financial support for such activities after the fact; b) the “playing field” of cybertechnologies relevant to geoscience education, research and informatics changes so rapidly that even committed “players” find that staying current is challenging; c) the scholarly languages of geoscience education, geoscience research, and geoinformatics are different, making easy communication about respective needs and constraints surprisingly difficult; and d) the impact of “everyday” cybertechnologies on learner audiences is profound and (so far) not well addressed by educators. Discussions on these issues are ongoing in a number of other venues.

Microvascular complications and the diabetic pregnancy.

PubMed

Bond, Melton J; Umans, Jason G

2006-08-01

Without strict glycemic control, diabetic pregnancies are frequently complicated by spontaneous abortion, stillbirth, or congenital malformation. Retrospective studies have been largely reassuring that pregnancy does not accelerate morbid outcomes in women with diabetic vascular disease. Improved outcomes of high-risk pregnancy in women with pregestational, type 1, or type 2 diabetes mellitus remain challenging, depending on a comprehensive and multidisciplinary team approach and extensive preconception counseling.

SolEn for a Sustainable Future: Developing and Teaching a Multidisciplinary Course on Solar Energy to Further Sustainable Education in Chemistry

ERIC Educational Resources Information Center

Pullen, Sonja; Brinkert, Katharina

2014-01-01

The high demand for the integration of sustainable topics into university curricula presents new challenges for the way chemistry is traditionally taught. New teaching concepts are required that consider and connect different disciplines to achieve a higher student awareness of the importance of these topics for humanity, the environment, and the…

Magic Mountains and multi-disciplines in international medical mobilities Comment on "Patient mobility in the global marketplace: a multidisciplinary perspective"

PubMed Central

Mainil, Tomas; Meulemans, Herman

2014-01-01

Medical mobilities offer both opportunities and challenges. This tension follows the same ratio as many other historic fora, but offers at the same time a sustainable equilibrium. Multi-disciplines are, therefore, the key to the medical lifeworld for the global health and well-being of transnational health users around the globe. PMID:24987724

Science-policy challenges for biodiversity, public health and urbanization: examples from Belgium

NASA Astrophysics Data System (ADS)

Keune, H.; Kretsch, C.; De Blust, G.; Gilbert, M.; Flandroy, L.; Van den Berge, K.; Versteirt, V.; Hartig, T.; De Keersmaecker, L.; Eggermont, H.; Brosens, D.; Dessein, J.; Vanwambeke, S.; Prieur-Richard, A. H.; Wittmer, H.; Van Herzele, A.; Linard, C.; Martens, P.; Mathijs, E.; Simoens, I.; Van Damme, P.; Volckaert, F.; Heyman, P.; Bauler, T.

2013-06-01

Internationally, the importance of a coordinated effort to protect both biodiversity and public health is more and more recognized. These issues are often concentrated or particularly challenging in urban areas, and therefore on-going urbanization worldwide raises particular issues both for the conservation of living natural resources and for population health strategies. These challenges include significant difficulties associated with sustainable management of urban ecosystems, urban development planning, social cohesion and public health. An important element of the challenge is the need to interface between different forms of knowledge and different actors from science and policy. We illustrate this with examples from Belgium, showcasing concrete cases of human-nature interaction. To better tackle these challenges, since 2011, actors in science, policy and the broader Belgian society have launched a number of initiatives to deal in a more integrated manner with combined biodiversity and public health challenges in the face of ongoing urbanization. This emerging community of practice in Belgium exemplifies the importance of interfacing at different levels. (1) Bridges must be built between science and the complex biodiversity/ecosystem-human/public health-urbanization phenomena. (2) Bridges between different professional communities and disciplines are urgently needed. (3) Closer collaboration between science and policy, and between science and societal practice is needed. Moreover, within each of these communities closer collaboration between specialized sections is needed.

Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study.

PubMed

Smekal, Michelle D; Tam-Tham, Helen; Finlay, Juli; Donald, Maoliosa; Benterud, Eleanor; Thomas, Chandra; Quinn, Robert R; Tam, Kin; Manns, Braden J; Tonelli, Marcello; Bello, Aminu; Tangri, Navdeep; Hemmelgarn, Brenda R

2018-01-01

The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care. We aimed to describe patient, family, and health care provider's perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input. We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey. Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants' feedback. We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.

Factors that impact access to ongoing health care for First Nation children with a chronic condition.

PubMed

Coombes, Julieann; Hunter, Kate; Mackean, Tamara; Holland, Andrew J A; Sullivan, Elizabeth; Ivers, Rebecca

2018-06-14

Access to multidisciplinary health care services for First Nation children with a chronic condition is critical for the child's health and well-being, but disparities and inequality in health care systems have been almost impossible to eradicate for First Nation people globally. The objective of this review is to identify the factors that impact access and ongoing care for First Nation children globally with a chronic condition. An extensive systematic search was conducted of nine electronic databases to identify primary studies that explored factors affecting access to ongoing services for First Nation children with a chronic disease or injury. Due to the heterogeneity of included studies the Mixed Method Appraisal Tool (MMAT) was used to assess study quality. A total of six studies from Australia, New Zealand and Canada were identified and included in this review. Four studies applied qualitative approaches using in-depth semi structured interviews, focus groups and community fora. Two of the six studies used quantitative approaches. Facilitators included the utilisation of First Nation liaison workers or First Nation Health workers. Key barriers that emerged included lack of culturally appropriate health care, distance, language and cultural barriers, racism, the lack of incorporation of First Nation workers in services, financial difficulties and transport issues. There are few studies that have identified positive factors that facilitate access to health care for First Nation children. There is an urgent need to develop programs and processes to facilitate access to appropriate health care that are inclusive of the cultural needs of First Nation children.

Joint federal research and development process to meet state and local needs. Part 1. Science and technology and political decision making

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

Wise, H F; Smith, L K; Einsweiler, R C

This part of the handbook addresses the basic how to do it - how states and local governments can identify complex and cross-cutting issues and develop and manage scientific and technical resources in seeking policy solutions to such issues. The following subjects are discussed: background statement of the issue; the research/decision-making process; defining problems and identifying research components; research and decision-making strategies; how to identify existing knowledge or ongoing research in the area of policy concern; and managing multi-disciplinary research. The fourteen agencies involved in this effort include: US Departments of Energy, Agriculture, Transportation, Housing and Urban Development, Environmental Protectionmore » Agency, and National Science Foundation. (PSB)« less

Concussions in American Football.

PubMed

Womble, Melissa N; Collins, Michael W

Major advancements in sport-related concussion (SRC) management have been made across time to improve the safety of contact sports, including football. Nevertheless, these advances are often overlooked due to concerns regarding the potential long-term effects of SRC. Although further research is needed, it is critical that current efforts are focused on better understanding SRC in order to recognize and change ongoing factors leading to prolonged recoveries, increased risk for injury, and potentially long-term effects. To reduce risk for these outcomes, future focus must be placed on increased education efforts, immediate reporting of injury, prevention techniques, targeted treatment, and the development of multidisciplinary treatment teams nationwide. Finally, with the progress in understanding concussion, it is important to remain vigilant of additional advances that will help to further improve the safety of contact sports, including football.

The NASA-sponsored Maryland center for hypersonic education and research

NASA Technical Reports Server (NTRS)

Lewis, Mark J.; Gupta, Ashwani K.

1995-01-01

The Office of Aeronautics of the National Aeronautics and Space Administration has established a program to support university programs in the field of hypersonic flight. Beginning in the fall of 1993, three universities, including the University of Maryland at College Park, were selected to participate in this activity. The program at the University of Maryland includes faculty in the Department of Aerospace Engineering and Department of Mechanical Engineering, and provides a multidisciplinary environment for graduate and undergraduate students to study and conduct research in the field of hypersonic flight. Ongoing projects cover the range of applications from cruisers through transatmospheric and reentry vehicles. Research activities, focused on propulsion, fluid dynamics, inverse design, and vehicle optimization and integration, are conducted in conjuntion with industrial partners and government laboratories.

An update on MS Nurse PROfessional, an ongoing project of the European Multiple Sclerosis Platform.

PubMed

Winslow, Anne

2016-12-01

Within the multidisciplinary team required to manage people with multiple sclerosis (MS) effectively, the nurse is the central component of coordinated care and support. A 2009 survey led by the European Multiple Sclerosis Platform, an umbrella organization of national MS associations, identified variance and disparity across Europe in the nursing care of MS patients. This led to development of MS Nurse PROfessional, a continuing medical education-accredited modular online learning program endorsed and approved by leading international nursing and professional groups, and people with MS, as a tool to support the evolving role of the European MS nurse. Analysis of participant experience and nurse practice to date has been overwhelmingly positive. Expansion of MS Nurse PRO is underway or planned for future.

Violent Extremism, Community-Based Violence Prevention, and Mental Health Professionals.

PubMed

Weine, Stevan M; Stone, Andrew; Saeed, Aliya; Shanfield, Stephen; Beahrs, John; Gutman, Alisa; Mihajlovic, Aida

2017-01-01

New community-based initiatives being developed to address violent extremism in the United States are utilizing mental health services and leadership. This article reviews current approaches to preventing violent extremism, the contribution that mental illness and psychosocial problems can make to violent extremism, and the rationale for integrating mental health strategies into preventing violent extremism. The authors describe a community-based targeted violence prevention model and the potential roles of mental health professionals. This model consists of a multidisciplinary team that assesses at-risk individuals with comprehensive threat and behavioral evaluations, arranges for ongoing support and treatment, conducts follow-up evaluations, and offers outreach, education, and resources for communities. This model would enable mental health professionals in local communities to play key roles in preventing violent extremism through their practice and leadership.

Locations and descriptions of gravity, box, and push cores collected in San Francisco Bay between January and February, 1990 and 1991

USGS Publications Warehouse

Anima, Roberto J.; Clifton, H. Edward; Reiss, Carol; Wong, Florence L.

2005-01-01

A project to study San Francisco Bay sediments collected over 300 sediment gravity cores; six push cores, and three box cores in San Francisco Bay during the years 1990-91. The purpose of the sampling effort is to establish a database on the Holocene sediment history of the bay. The samples described and mapped are the first effort to catalog and present the data collected. Thus far the cores have been utilized in various cooperative studies with state colleges and universities, and other USGS divisions. These cores serve as a base for ongoing multidisciplinary studies. The sediment studies project has initiated subsequent coring efforts within the bay using refined coring techniques to attain deeper cores.

Retinitis pigmentosa in Spain. The Spanish Multicentric and Multidisciplinary Group for Research into Retinitis Pigmentosa.

PubMed

Ayuso, C; Garcia-Sandoval, B; Najera, C; Valverde, D; Carballo, M; Antiñolo, G

1995-09-01

Retinitis pigmentosa is a term commonly given to a group of inherited and progressive disorders which affect the photoreceptors of the retina. As part of an ongoing research programme throughout Spain, clinical, epidemiological, and genetic studies have been carried out on these diseases. Here, we report the relative frequencies of the different genetic types in 503 non-syndromic and 89 syndromic RP families of Spanish origin. The most frequent syndromic RP forms were Usher syndrome type 1 (20/89 families = 30%) and Usher syndrome type 2 (44 families = 49%). Among non-syndromic RP forms, 12% were autosomal dominant, 39% autosomal recessive and 4% X-linked. Forty-one percent were isolated or simplex cases and in 4% the genetic type could not be established.

Implementation of secondary fracture prevention services after hip fracture: a qualitative study using extended Normalization Process Theory.

PubMed

Drew, Sarah; Judge, Andrew; May, Carl; Farmer, Andrew; Cooper, Cyrus; Javaid, M Kassim; Gooberman-Hill, Rachael

2015-04-23

National and international guidance emphasizes the need for hospitals to have effective secondary fracture prevention services, to reduce the risk of future fractures in hip fracture patients. Variation exists in how hospitals organize these services, and there remain significant gaps in care. No research has systematically explored reasons for this to understand how to successfully implement these services. The objective of this study was to use extended Normalization Process Theory to understand how secondary fracture prevention services can be successfully implemented. Forty-three semi-structured interviews were conducted with healthcare professionals involved in delivering secondary fracture prevention within 11 hospitals that receive patients with acute hip fracture in one region in England. These included orthogeriatricians, fracture prevention nurses and service managers. Extended Normalization Process Theory was used to inform study design and analysis. Extended Normalization Process Theory specifies four constructs relating to collective action in service implementation: capacity, potential, capability and contribution. The capacity of healthcare professionals to co-operate and co-ordinate their actions was achieved using dedicated fracture prevention co-ordinators to organize important processes of care. However, participants described effective communication with GPs as challenging. Individual potential and commitment to operationalize services was generally high. Shared commitments were promoted through multi-disciplinary team working, facilitated by fracture prevention co-ordinators. Healthcare professionals had capacity to deliver multiple components of services when co-ordinators 'freed up' time. As key agents in its intervention, fracture prevention coordinators were therefore indispensable to effective implementation. Aside from difficulty of co-ordination with primary care, the intervention was highly workable and easily integrated into practice. Nevertheless, implementation was threatened by under-staffed and under-resourced services, lack of capacity to administer scans and poor patient access. To ensure ongoing service delivery, the contributions of healthcare professionals were shaped by planning, in multi-disciplinary team meetings, the use of clinical databases to identify patients and define the composition of clinical work and monitoring to improve clinical practice. Findings identify and describe elements needed to implement secondary fracture prevention services successfully. The study highlights the value of Normalization Process Theory to achieve comprehensive understanding of healthcare professionals' experiences in enacting a complex intervention.

The northwest Arkansas transit assessment study

DOT National Transportation Integrated Search

2000-03-01

Providing adequate public transportation, including transportation services for the disadvantaged in Northwest Arkansas is an ongoing challenge. Unmet transit needs for the four-county area (Washington, Benton, Carroll and Madison Counties) included ...

Ongoing measles outbreak in Wallonia, Belgium, December 2016 to March 2017: characteristics and challenges

PubMed Central

Grammens, Tine; Schirvel, Carole; Leenen, Sylvie; Shodu, Nathalie; Hutse, Veronik; Mendes da Costa, Elise; Sabbe, Martine

2017-01-01

We describe characteristics of an ongoing measles outbreak in Wallonia, Belgium, and difficulties in control measures implementation. As at 12 March 2017, 177 measles cases were notified, of which 50% were 15 years and older, 49% female. Atypical clinical presentation and severe complications, mainly among adults, in combination with late notification, low or unknown vaccination coverage of contacts, infected healthcare workers and increased workload due to contact tracing, are the main concerns for outbreak management. PMID:28488998

LeaderBeing: Critical Reflections on Context, Character and Challenge in the Culture of Research and Its Administration

ERIC Educational Resources Information Center

Gabriele, Edward F.; Caines, Vaughan V.

2014-01-01

Servant leadership is a critical concept for understanding the ongoing importance of research administration as a central profession of service within the culture of research itself. The leadership of research administrators is both a unique gift and a challenge to the research culture. To ensure the continued productivity of the research…

Overcoming the Challenges of Retaining Novice Teachers in a County Public School

ERIC Educational Resources Information Center

Albert, Ernst

2017-01-01

Retaining novice teachers in a Northeast Florida county public school is an ongoing challenge. Research indicates that 14% of new teachers will leave the field within 5 years. The purpose of this case study was to investigate the major factors that contributed to this unique group of novice teachers' decisions to continue to teach at the school…

Developing a Rural and Regional Science Challenge to Utilise Community and Industry-Based Partnerships

ERIC Educational Resources Information Center

Blake, Damian; Campbell, Coral

2009-01-01

Interest and participation in science in schools has been declining for many years and there is a genuine need to rejuvenate interest in science at the high school level. One possible solution is the completion of challenging science projects which fulfill an authentic purpose in the community. This paper discusses the results of ongoing research…

Threats to cross-border wildlife linkages in the Sky Islands Wildlands Network

Treesearch

Kim Vacariu

2005-01-01

One of the greatest challenges facing conservationists in the Sky Islands region is finding a realistic means to maintain historic travel routes for wide-ranging species crossing the United States-Mexico border. This challenge is made difficult due to the ongoing efforts by the Federal government to install additional security infrastructure to stem the flood of...

If the Shoe Doesn't Fit: A Case and a Place for Collaborative Learning for Music Practice in Higher Education

ERIC Educational Resources Information Center

Forbes, Melissa

2016-01-01

This article reviews relevant literature to provide a rationale for the use of collaborative learning for first year music practice courses at an Australian regional university. Higher music education is still grappling with the challenges posed by the Dawkins Review and ongoing reforms in the sector. These challenges include increased public…

Feminist Perceptions and the Challenges for Women's Education in Jeddah, Saudi Arabia in the 21st Century

ERIC Educational Resources Information Center

Bawazeer, Khadijah

2015-01-01

This article aims to contribute to the ongoing discussion about women's education. Conflicting discourses, regarding the positions of women as student learners, create an educational challenge that faces the GCC countries in the 21st century. This study explores the prevalent feminist positions in Jeddah in Saudi Arabia and presents the findings…

Challenges of NDE simulation tool validation, optimization, and utilization for composites

NASA Astrophysics Data System (ADS)

Leckey, Cara A. C.; Seebo, Jeffrey P.; Juarez, Peter

2016-02-01

Rapid, realistic nondestructive evaluation (NDE) simulation tools can aid in inspection optimization and prediction of inspectability for advanced aerospace materials and designs. NDE simulation tools may someday aid in the design and certification of aerospace components; potentially shortening the time from material development to implementation by industry and government. Furthermore, ultrasound modeling and simulation are expected to play a significant future role in validating the capabilities and limitations of guided wave based structural health monitoring (SHM) systems. The current state-of-the-art in ultrasonic NDE/SHM simulation is still far from the goal of rapidly simulating damage detection techniques for large scale, complex geometry composite components/vehicles containing realistic damage types. Ongoing work at NASA Langley Research Center is focused on advanced ultrasonic simulation tool development. This paper discusses challenges of simulation tool validation, optimization, and utilization for composites. Ongoing simulation tool development work is described along with examples of simulation validation and optimization challenges that are more broadly applicable to all NDE simulation tools. The paper will also discuss examples of simulation tool utilization at NASA to develop new damage characterization methods for composites, and associated challenges in experimentally validating those methods.

The transition to dementia--individual and family experiences of receiving a diagnosis: a review.

PubMed

Robinson, Louise; Gemski, Alan; Abley, Clare; Bond, John; Keady, John; Campbell, Sarah; Samsi, Kritika; Manthorpe, Jill

2011-09-01

Consensus recommends early recognition of memory problems through multi-disciplinary assessment in memory clinics; however, little is known about the experiences of people accessing such services. The aim of this review was to synthesis empirical evidence on patient and carer experiences in the transition to dementia. This review updates an earlier review (Bamford et al., 2004) on the topic of disclosure of the diagnosis of dementia. Key electronic databases were searched including OVID Medline, CINAHL, Web of Science, EMBASE, and Sociological Abstracts; this was supplemented by hand searching of reference lists and contact with experts in the field. Only papers published after 2003 were included. Of the 35 papers included in the review, only one study observed the process of disclosure and only two papers explored the effects on the person with dementia's health. The vast majority of people with dementia wished to know their diagnosis. The key challenges for the person with dementia were coming to terms with losses on multiple levels. Although there may be short-term distress, the majority of people with dementia do not appear to experience long-term negative effects on their psychological health. For family carers, becoming the main decision-maker and adjusting to increased responsibility were common concerns. There is still little empirical research observing the process of diagnostic disclosure in dementia. Studies exploring the views of patients and their families suggest this should be an ongoing process with the provision of support and information tailored to individual needs. The term "Alzheimer's disease" appears to have more negative connotations than the word "dementia".

Lead poisoning and the deceptive recovery of the critically endangered California condor

PubMed Central

Finkelstein, Myra E.; Doak, Daniel F.; George, Daniel; Burnett, Joe; Brandt, Joseph; Church, Molly; Grantham, Jesse; Smith, Donald R.

2012-01-01

Endangered species recovery programs seek to restore populations to self-sustaining levels. Nonetheless, many recovering species require continuing management to compensate for persistent threats in their environment. Judging true recovery in the face of this management is often difficult, impeding thorough analysis of the success of conservation programs. We illustrate these challenges with a multidisciplinary study of one of the world’s rarest birds—the California condor (Gymnogyps californianus). California condors were brought to the brink of extinction, in part, because of lead poisoning, and lead poisoning remains a significant threat today. We evaluated individual lead-related health effects, the efficacy of current efforts to prevent lead-caused deaths, and the consequences of any reduction in currently intensive management actions. Our results show that condors in California remain chronically exposed to harmful levels of lead; 30% of the annual blood samples collected from condors indicate lead exposure (blood lead ≥ 200 ng/mL) that causes significant subclinical health effects, measured as >60% inhibition of the heme biosynthetic enzyme δ-aminolevulinic acid dehydratase. Furthermore, each year, ∼20% of free-flying birds have blood lead levels (≥450 ng/mL) that indicate the need for clinical intervention to avert morbidity and mortality. Lead isotopic analysis shows that lead-based ammunition is the principle source of lead poisoning in condors. Finally, population models based on condor demographic data show that the condor’s apparent recovery is solely because of intensive ongoing management, with the only hope of achieving true recovery dependent on the elimination or substantial reduction of lead poisoning rates. PMID:22733770

Building Trust: The History and Ongoing Relationships Amongst DSD Clinicians, Researchers, and Patient Advocacy Groups.

PubMed

Lossie, A C; Green, J

2015-05-01

Individuals born with differences or disorders of sex development (DSD) have been marginalized by society and the health care system. Standards of care in the mid-20(th) century were based on fixing the child with a DSD, using hormonal and surgical interventions; these treatments and the diagnoses were almost never disclosed to the child, and sometimes they were not disclosed to the parents. This led to secrecy, shame, and stigma. When these children became adults and demanded access to their medical records, the realization of the depth of secrecy led to the formation of activism groups that shook the medical community. Despite precarious beginnings, advocates, health care professionals, and researchers were able to elicit changes in the standard of care. The 2006 Consensus Statement on Management of Intersex Disorders called for a multidisciplinary approach to care and questioned the evidence for many of the standard procedures. Standard of care moved from a concealment model to a patient-centered paradigm, and funding agencies put resources into determining the future paths of research on DSD. Recognition of the need to address patient priorities led to changing international standards for including patients in research design. Some challenges that remain include: the findings from the Institute of Medicine that sexual and gender minorities experience poor health outcomes; establishing trust across all parties; developing a common language and creating venues where individuals can participate in dialogue that addresses personal experiences, research design, clinical practices and intervention strategies. © Georg Thieme Verlag KG Stuttgart · New York.

Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System

PubMed Central

Psek, Wayne; Davis, F. Daniel; Gerrity, Gloria; Stametz, Rebecca; Bailey-Davis, Lisa; Henninger, Debra; Sellers, Dorothy; Darer, Jonathan

2016-01-01

Introduction: Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders’ perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders’ perspectives on the LHS and learning activities in an integrated delivery system. Methods: A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders’ responses were categorized into themes. Findings: Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals. Discussion: Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed. Conclusion: Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery. PMID:27683668

Lead poisoning and the deceptive recovery of the critically endangered California condor.

PubMed

Finkelstein, Myra E; Doak, Daniel F; George, Daniel; Burnett, Joe; Brandt, Joseph; Church, Molly; Grantham, Jesse; Smith, Donald R

2012-07-10

Endangered species recovery programs seek to restore populations to self-sustaining levels. Nonetheless, many recovering species require continuing management to compensate for persistent threats in their environment. Judging true recovery in the face of this management is often difficult, impeding thorough analysis of the success of conservation programs. We illustrate these challenges with a multidisciplinary study of one of the world's rarest birds-the California condor (Gymnogyps californianus). California condors were brought to the brink of extinction, in part, because of lead poisoning, and lead poisoning remains a significant threat today. We evaluated individual lead-related health effects, the efficacy of current efforts to prevent lead-caused deaths, and the consequences of any reduction in currently intensive management actions. Our results show that condors in California remain chronically exposed to harmful levels of lead; 30% of the annual blood samples collected from condors indicate lead exposure (blood lead ≥ 200 ng/mL) that causes significant subclinical health effects, measured as >60% inhibition of the heme biosynthetic enzyme δ-aminolevulinic acid dehydratase. Furthermore, each year, ∼20% of free-flying birds have blood lead levels (≥450 ng/mL) that indicate the need for clinical intervention to avert morbidity and mortality. Lead isotopic analysis shows that lead-based ammunition is the principle source of lead poisoning in condors. Finally, population models based on condor demographic data show that the condor's apparent recovery is solely because of intensive ongoing management, with the only hope of achieving true recovery dependent on the elimination or substantial reduction of lead poisoning rates.

Dysphonia, Perceived Control, and Psychosocial Distress: A Qualitative Study.

PubMed

Misono, Stephanie; Haut, Caroline; Meredith, Liza; Frazier, Patricia A; Stockness, Ali; Michael, Deirdre D; Butcher, Lisa; Harwood, Eileen M

2018-05-11

The purpose of this qualitative study was to examine relationships between psychological factors, particularly perceived control, and voice symptoms in adults seeking treatment for a voice problem. Semistructured interviews of adult patients with a clinical diagnosis of muscle tension dysphonia were conducted and transcribed. Follow-up interviews were conducted as needed for further information or clarification. A multidisciplinary team analyzed interview content using inductive techniques. Common themes and subthemes were identified. A conceptual model was developed describing the association between voice symptoms, psychological factors, precipitants of ongoing voice symptoms, and perceived control. Thematic saturation was reached after 23 interviews. No participants reported a direct psychological cause for their voice problem, although half described significant life events preceding voice problem onset (eg, miscarriage and other health events, interpersonal conflicts, and family members' illnesses, injuries, and deaths). Participants described psychological influences on voice symptoms that led to rapid exacerbation of their voice symptoms. Participants described the helpfulness of speech therapy and sometimes also challenges of applying techniques in daily life. They also discussed personal coping strategies that included behavioral (eg, avoiding triggers and seeking social support) and psychological (eg, mind-body awareness and emotion regulation) components. Voice-related perceived control was associated with adaptive emotional and behavioral responses, which appeared to facilitate symptom improvement. In this qualitative pilot study, participant narratives suggested that psychological factors and emotions influence voice symptoms, facilitating development of a preliminary conceptual model of how adaptive and maladaptive responses develop and how they influence vocal function. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Harnessing Cerebrospinal Fluid Biomarkers in Clinical Trials for Treating Alzheimer's and Parkinson's Diseases: Potential and Challenges

PubMed Central

Kim, Dana; Kim, Young-Sam; Shin, Dong Wun; Park, Chang-Shin

2016-01-01

No disease-modifying therapies (DMT) for neurodegenerative diseases (NDs) have been established, particularly for Alzheimer's disease (AD) and Parkinson's disease (PD). It is unclear why candidate drugs that successfully demonstrate therapeutic effects in animal models fail to show disease-modifying effects in clinical trials. To overcome this hurdle, patients with homogeneous pathologies should be detected as early as possible. The early detection of AD patients using sufficiently tested biomarkers could demonstrate the potential usefulness of combining biomarkers with clinical measures as a diagnostic tool. Cerebrospinal fluid (CSF) biomarkers for NDs are being incorporated in clinical trials designed with the aim of detecting patients earlier, evaluating target engagement, collecting homogeneous patients, facilitating prevention trials, and testing the potential of surrogate markers relative to clinical measures. In this review we summarize the latest information on CSF biomarkers in NDs, particularly AD and PD, and their use in clinical trials. The large number of issues related to CSF biomarker measurements and applications has resulted in relatively few clinical trials on CSF biomarkers being conducted. However, the available CSF biomarker data obtained in clinical trials support the advantages of incorporating CSF biomarkers in clinical trials, even though the data have mostly been obtained in AD trials. We describe the current issues with and ongoing efforts for the use of CSF biomarkers in clinical trials and the plans to harness CSF biomarkers for the development of DMT and clinical routines. This effort requires nationwide, global, and multidisciplinary efforts in academia, industry, and regulatory agencies to facilitate a new era. PMID:27819412

Harnessing Cerebrospinal Fluid Biomarkers in Clinical Trials for Treating Alzheimer's and Parkinson's Diseases: Potential and Challenges.

PubMed

Kim, Dana; Kim, Young Sam; Shin, Dong Wun; Park, Chang Shin; Kang, Ju Hee

2016-10-01

No disease-modifying therapies (DMT) for neurodegenerative diseases (NDs) have been established, particularly for Alzheimer's disease (AD) and Parkinson's disease (PD). It is unclear why candidate drugs that successfully demonstrate therapeutic effects in animal models fail to show disease-modifying effects in clinical trials. To overcome this hurdle, patients with homogeneous pathologies should be detected as early as possible. The early detection of AD patients using sufficiently tested biomarkers could demonstrate the potential usefulness of combining biomarkers with clinical measures as a diagnostic tool. Cerebrospinal fluid (CSF) biomarkers for NDs are being incorporated in clinical trials designed with the aim of detecting patients earlier, evaluating target engagement, collecting homogeneous patients, facilitating prevention trials, and testing the potential of surrogate markers relative to clinical measures. In this review we summarize the latest information on CSF biomarkers in NDs, particularly AD and PD, and their use in clinical trials. The large number of issues related to CSF biomarker measurements and applications has resulted in relatively few clinical trials on CSF biomarkers being conducted. However, the available CSF biomarker data obtained in clinical trials support the advantages of incorporating CSF biomarkers in clinical trials, even though the data have mostly been obtained in AD trials. We describe the current issues with and ongoing efforts for the use of CSF biomarkers in clinical trials and the plans to harness CSF biomarkers for the development of DMT and clinical routines. This effort requires nationwide, global, and multidisciplinary efforts in academia, industry, and regulatory agencies to facilitate a new era.

Ongoing ostomy self-care challenges of long-term rectal cancer survivors.

PubMed

Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C; Krouse, Robert S

2018-05-29

Surgical treatment for rectal cancer (RC) can result in an intestinal ostomy that requires lifelong adaptation and investment of physical, cognitive, and financial resources. However, little is known about the extent of ongoing challenges related to ostomy self-care among long-term RC survivors. We analyzed the prevalence of self-reported ostomy self-care challenges and the physical and environmental factors that can support or undermine ostomy self-care. We mailed surveys to long-term (≥ 5 years post-diagnosis) RC survivors, including 177 adults with ostomies who were members of integrated health systems in northern California, Oregon, and Washington State. Potential participants were identified through tumor registries. Data were also extracted from electronic health records. The response rate was 65%. The majority of respondents were male (67%), and the mean age was 75 years. Sixty-three percent of respondents reported at least one ostomy self-care challenge. The most common challenges were leakage or skin problems around the ostomy and needing to change the pouching system too frequently. Twenty-two percent reported difficulty caring for their ostomy. Younger age and higher BMI were consistently related to ostomy self-care challenges. The majority of RC survivors reported ostomy-related self-care challenges, and 31% experienced problems across multiple domains of ostomy self-care. In addition, most survivors reported significant physical challenges that could lead to ostomy-related disability. Although the participants surveyed had access to ostomy care nurses, the care gaps we found suggest that additional work is needed to understand barriers to ostomy care, reduce unmet needs, and improve well-being among this group.

Recent Advances and Challenges towards Sustainable Polyhydroxyalkanoate (PHA) Production

PubMed Central

Kourmentza, Constantina; Plácido, Jersson; Venetsaneas, Nikolaos; Burniol-Figols, Anna; Varrone, Cristiano; Gavala, Hariklia N.; Reis, Maria A. M.

2017-01-01

Sustainable biofuels, biomaterials, and fine chemicals production is a critical matter that research teams around the globe are focusing on nowadays. Polyhydroxyalkanoates represent one of the biomaterials of the future due to their physicochemical properties, biodegradability, and biocompatibility. Designing efficient and economic bioprocesses, combined with the respective social and environmental benefits, has brought together scientists from different backgrounds highlighting the multidisciplinary character of such a venture. In the current review, challenges and opportunities regarding polyhydroxyalkanoate production are presented and discussed, covering key steps of their overall production process by applying pure and mixed culture biotechnology, from raw bioprocess development to downstream processing. PMID:28952534

"In the storminess": multi-disciplinary approaches to scriptural images representing ethical challenges in the pastor-congregant relationship.

PubMed

O'Connor, Thomas St James; Walsh-Bowers, Richard; Psychology, Community; Ross, Christopher; Sawchuk, Dana; Hatzipantelis, Maria

2006-01-01

In this qualitative study the authors examine the Scriptural images that 10 Lutheran pastors employed in describing the ethical challenges in the pastor-congregant relationship. The analysis of Scriptural images is part of a larger study on pastors' experiences of a mandatory workshop, "Crossing the Boundaries (CTB),"which is required of Evangelical Lutheran Church in Canada (ELCIC) seminarians. The pastors' images were analyzed from the four perspectives of depth psychology, theology, social ethics, and sociology. In commenting on tensions in the pastors' Scriptural images the authors note commonalities among the four theoretical perspectives and discuss implications for practice and future research.

The Primary Care Pediatrician and the Care of Children With Cleft Lip and/or Cleft Palate.

PubMed

Lewis, Charlotte W; Jacob, Lisa S; Lehmann, Christoph U

2017-05-01

Orofacial clefts, specifically cleft lip and/or cleft palate (CL/P), are among the most common congenital anomalies. CL/P vary in their location and severity and comprise 3 overarching groups: cleft lip (CL), cleft lip with cleft palate (CLP), and cleft palate alone (CP). CL/P may be associated with one of many syndromes that could further complicate a child's needs. Care of patients with CL/P spans prenatal diagnosis into adulthood. The appropriate timing and order of specific cleft-related care are important factors for optimizing outcomes; however, care should be individualized to meet the specific needs of each patient and family. Children with CL/P should receive their specialty cleft-related care from a multidisciplinary cleft or craniofacial team with sufficient patient and surgical volume to promote successful outcomes. The primary care pediatrician at the child's medical home has an essential role in making a timely diagnosis and referral; providing ongoing health care maintenance, anticipatory guidance, and acute care; and functioning as an advocate for the patient and a liaison between the family and the craniofacial/cleft team. This document provides background on CL/P and multidisciplinary team care, information about typical timing and order of cleft-related care, and recommendations for cleft/craniofacial teams and primary care pediatricians in the care of children with CL/P. Copyright © 2017 by the American Academy of Pediatrics.

The use of music therapy within the SCERTS model for children with Autism Spectrum Disorder.

PubMed

Walworth, Darcy DeLoach

2007-01-01

The SCERTS model is a new, comprehensive curriculum designed to assess and identify treatment goals and objectives within a multidisciplinary team of clinicians and educators for children with Autism Spectrum Disorders (ASD). This model is an ongoing assessment tool with resulting goals and objectives derived there from. Because music therapy offers a unique interaction setting for children with ASD to elicit communication skills, music therapists will need to be an integral part of the multidisciplinary assessment team using the SCERTS model which is projected to become the primary nation wide curriculum for children with ASD. The purpose of this paper is to assist music therapists in transitioning to this model by providing an overview and explanation of the SCERTS model and by identifying how music therapists are currently providing clinical services incorporated in the SCERTS Model for children with ASD. In order to formulate comprehensive transitional suggestions, a national survey of music therapists working with clients at risk or diagnosed with ASD was conducted to: (a) identify the areas of SCERTS assessment model that music therapists are currently addressing within their written goals for clients with ASD, (b) identify current music therapy activities that address various SCERTS goals and objectives, and (c) provide demographic information about settings, length, and tools used in music therapy interventions for clients with ASD.

Cancer cachexia, mechanism and treatment

PubMed Central

Aoyagi, Tomoyoshi; Terracina, Krista P; Raza, Ali; Matsubara, Hisahiro; Takabe, Kazuaki

2015-01-01

It is estimated that half of all patients with cancer eventually develop a syndrome of cachexia, with anorexia and a progressive loss of adipose tissue and skeletal muscle mass. Cancer cachexia is characterized by systemic inflammation, negative protein and energy balance, and an involuntary loss of lean body mass. It is an insidious syndrome that not only has a dramatic impact on patient quality of life, but also is associated with poor responses to chemotherapy and decreased survival. Cachexia is still largely an underestimated and untreated condition, despite the fact that multiple mechanisms are reported to be involved in its development, with a number of cytokines postulated to play a role in the etiology of the persistent catabolic state. Existing therapies for cachexia, including orexigenic appetite stimulants, focus on palliation of symptoms and reduction of the distress of patients and families rather than prolongation of life. Recent therapies for the cachectic syndrome involve a multidisciplinary approach. Combination therapy with diet modification and/or exercise has been added to novel pharmaceutical agents, such as Megestrol acetate, medroxyprogesterone, ghrelin, omega-3-fatty acid among others. These agents are reported to have improved survival rates as well as quality of life. In this review, we will discuss the emerging understanding of the mechanisms of cancer cachexia, the current treatment options including multidisciplinary combination therapies, as well an update on new and ongoing clinical trials. PMID:25897346

EMSO: European multidisciplinary seafloor observatory

NASA Astrophysics Data System (ADS)

Favali, Paolo; Beranzoli, Laura

2009-04-01

EMSO has been identified by the ESFRI Report 2006 as one of the Research Infrastructures that European members and associated states are asked to develop in the next decades. It will be based on a European-scale network of multidisciplinary seafloor observatories from the Arctic to the Black Sea with the aim of long-term real-time monitoring of processes related to geosphere/biosphere/hydrosphere interactions. EMSO will enhance our understanding of processes, providing long time series data for the different phenomenon scales which constitute the new frontier for study of Earth interior, deep-sea biology and chemistry, and ocean processes. The development of an underwater network is based on past EU projects and is supported by several EU initiatives, such as the on-going ESONET-NoE, aimed at strengthening the ocean observatories' scientific and technological community. The EMSO development relies on the synergy between the scientific community and industry to improve European competitiveness with respect to countries such as USA, Canada and Japan. Within the FP7 Programme launched in 2006, a call for Preparatory Phase (PP) was issued in order to support the foundation of the legal and organisational entity in charge of building up and managing the infrastructure, and coordinating the financial effort among the countries. The EMSO-PP project, coordinated by the Italian INGV with participation by 11 institutions from as many European countries, started in April 2008 and will last four years.

Multi-wavelength Searches for Massive Black Holes in Dwarf Galaxies

NASA Astrophysics Data System (ADS)

Reines, Amy E.

2018-01-01

Contrary to conventional wisdom, low-mass, physically small dwarf galaxies can indeed host massive black holes (BHs). Moreover, the population and properties of BHs in nearby dwarf galaxies hold clues to the formation of the first seed BHs in the earlier Universe. Identifying BHs in dwarf galaxies, however, is challenging. AGNs powered by smaller BHs are less luminous and more difficult to detect than typical AGNs in more massive systems, and low-mass galaxies generally have ongoing star formation, gas and dust that can mimic or mask signatures of BH accretion. With these challenges in mind, I will present ongoing multi-wavelength searches for AGNs in dwarf galaxies, as well as follow-up studies of existing samples. I will also discuss how this work has implications for directly detecting BH activity in the first galaxies at high redshift.

Perspectives of HER2-targeting in gastric and esophageal cancer.

PubMed

Gerson, James N; Skariah, Sam; Denlinger, Crystal S; Astsaturov, Igor

2017-05-01

The blockade of HER2 signaling has significantly improved the outlook for esophagogastric cancer patients. However, targeting HER2 still remains challenging due to complex biology of this receptor in gastric and esophageal cancers. Areas covered: Here, we review complex HER2 biology, current methods of HER2 testing and tumor heterogeneity of gastroesophageal cancer. Ongoing and completed clinical research data are discussed. Expert opinion: HER2 overexpression is a validated target in gastroesophageal cancer, with therapeutic implications resulting in prolonged survival when inhibited in the front-line setting. With standardized HER2 testing in gastro-esophageal cancer, the ongoing trials are testing newer agents and combinations including combination of anti-HER2 antibodies with immunotherapy. Clonal heterogeneity and emergence of resistance will challenge our approach to treating these patients beyond the frontline settings.

'Nobody knows what's around the corner': the challenges of caring for people with long-term conditions in care homes.

PubMed

Martin, Susan; Martin, Joy

2018-06-02

People living with long-term conditions are increasingly being cared for in care homes. Prognostication in this population is particularly challenging, and outcomes are often uncertain. This case history highlights some of the difficulties encountered when clinicians give a time-bound prognosis. It also illustrates how education programmes with high facilitation and ongoing support for care home staff can sustain practice development and enable staff to become highly skilled in working with uncertainty. Practice development programmes such as those based on the Six Steps to Success Programme for care homes give care home staff a framework within which to regularly review a resident's clinical status and the confidence to have the ongoing conversations that empower residents to contribute to decision making and focus on their own goals for care.

Limited genetic divergence among Australian alpine Poa tussock grasses coupled with regional structuring points to ongoing gene flow and taxonomic challenges

PubMed Central

Griffin, Philippa C.; Hoffmann, Ary A.

2014-01-01

Background and Aims While molecular approaches can often accurately reconstruct species relationships, taxa that are incompletely differentiated pose a challenge even with extensive data. Such taxa are functionally differentiated, but may be genetically differentiated only at small and/or patchy regions of the genome. This issue is considered here in Poa tussock grass species that dominate grassland and herbfields in the Australian alpine zone. Methods Previously reported tetraploidy was confirmed in all species by sequencing seven nuclear regions and five microsatellite markers. A Bayesian approach was used to co-estimate nuclear and chloroplast gene trees with an overall dated species tree. The resulting species tree was used to examine species structure and recent hybridization, and intertaxon fertility was tested by experimental crosses. Key Results Species tree estimation revealed Poa gunnii, a Tasmanian endemic species, as sister to the rest of the Australian alpine Poa. The taxa have radiated in the last 0·5–1·2 million years and the non-gunnii taxa are not supported as genetically distinct. Recent hybridization following past species divergence was also not supported. Ongoing gene flow is suggested, with some broad-scale geographic structure within the group. Conclusions The Australian alpine Poa species are not genetically distinct despite being distinguishable phenotypically, suggesting recent adaptive divergence with ongoing intertaxon gene flow. This highlights challenges in using conventional molecular taxonomy to infer species relationships in recent, rapid radiations. PMID:24607721

Development of a Virtual Multidisciplinary Lung Cancer Tumor Board in a Community Setting

PubMed Central

Stevenson, Marvaretta M.; Irwin, Tonia; Lowry, Terry; Ahmed, Maleka Z.; Walden, Thomas L.; Watson, Melanie; Sutton, Linda

2013-01-01

Purpose: Creating an effective platform for multidisciplinary tumor conferences can be challenging in the rural community setting. The Duke Cancer Network created an Internet-based platform for a multidisciplinary conference to enhance the care of patients with lung cancer. This conference incorporates providers from different physical locations within a rural community and affiliated providers from a university-based cancer center 2 hours away. An electronic Web conferencing tool connects providers aurally and visually. Methods: Conferences were set up using a commercially available Web conferencing platform. The video platform provides a secure Web site coupled with a secure teleconference platform to ensure patient confidentiality. Multiple disciplines are invited to participate, including radiology, radiation oncology, thoracic surgery, pathology, and medical oncology. Participants only need telephone access and Internet connection to participate. Results: Patient histories and physicals are presented, and the Web conferencing platform allows radiologic and histologic images to be reviewed. Treatment plans for patients are discussed, allowing providers to coordinate care among the different subspecialties. Patients who need referral to the affiliated university-based cancer center for specialized services are identified. Pertinent treatment guidelines and journal articles are reviewed. On average, there are 10 participants with one to two cases presented per session. Conclusion: The use of a Web conferencing platform allows subspecialty providers throughout the community and hours away to discuss lung cancer patient cases. This platform increases convenience for providers, eliminating travel to a central location. Coordination of care for patients requiring multidisciplinary care is facilitated, shortening evaluation time before definitive treatment plan. PMID:23942505

Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2015-10-01

Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. © 2013 John Wiley & Sons Ltd.

The NASA/NSERC Student Airborne Research Program Land Focus Group - a Paid Training Program in Multi-Disciplinary STEM Research for Terrestrial Remote Sensing

NASA Astrophysics Data System (ADS)

Kefauver, S. C.; Ustin, S.; Davey, S. W.; Furey, B. J.; Gartner, A.; Kurzweil, D.; Siebach, K. L.; Slawsky, L.; Snyder, E.; Trammell, J.; Young, J.; Schaller, E.; Shetter, R. E.

2011-12-01

The Student Airborne Research Program (SARP) of the National Aeronautics and Space Administration (NASA) and the National Suborbital Education and Research Center (NSERC) is a unique six week multidisciplinary paid training program which directly integrates students into the forefront of airborne remote sensing science. Students were briefly trained with one week of lectures and laboratory exercises and then immediately incorporated into ongoing research projects which benefit from access to the DC-8 airborne platform and the MODIS-ASTER Airborne Simulator (MASTER) sensor. Students were split into three major topical categories of Land, Ocean, and Air for the data collection and project portions of the program. This poster details the techniques and structure used for the student integration into ongoing research, professional development, hypothesis building and results as developed by the professor and mentor of the Land focus group. Upon assignment to the Land group, students were issued official research field protocols and split into four field specialty groups with additional specialty reading assignments. In the field each group spent more time in their respective specialty, but also participated in all field techniques through pairings with UC Davis research team members using midday rotations. After the field campaign, each specialty group then gave summary presentations on the techniques, preliminary results, and significance to overall group objectives of their specialty. Then students were required to submit project proposals within the bounds of Land airborne remote sensing science and encouraging, but not requiring the use of the field campaign data. These proposals are then reviewed by the professor and mentor and students are met with one by one to discuss the skills of each student and objectives of the proposed research project. The students then work under the supervision of the mentor and benefit again from professor feedback in a formal practice presentation session. At the end of the six week program, students present to all SARP program focus groups, mentors, professors, and, in addition, NSERC and NASA airborne science and education program directors and personnel.

Resection of a large carotid paraganglioma in Carney-Stratakis syndrome: a multidisciplinary feat.

PubMed

Nicholas, Rebecca Spenser; Quddus, Ayyaz; Topham, Charlotte; Baker, Daryll

2015-04-16

A 39-year-old man was referred to the vascular surgeons with a right-sided cervical mass, palpitations, headaches and sweating. He had presented with abdominal discomfort 12 months earlier. Investigations had revealed a gastrointestinal stromal tumour (GIST) and left adrenalectomy. CT of the neck with contrast demonstrated a large right carotid paraganglioma, extending superiorly from below the carotid bifurcation to encase the internal carotid artery. Genetic screening confirmed the diagnosis of Carney-Stratakis syndrome, an SDH-D germline mutation leading to GIST and multifocal paragangliomas. Successful surgical excision required considerable multidisciplinary teamwork between neuroendocrinologists, anaesthetists and surgeons. The tumour was highly vascular and involved the right carotid body, hypoglossal and vagus nerves. Access was challenging and maxillofacial surgical expertise were required for division of the mandible. The patient made a good recovery following speech and swallowing rehabilitation. 2015 BMJ Publishing Group Ltd.

Roadmap to the multidisciplinary design analysis and optimisation of wind energy systems

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

Perez-Moreno, S. Sanchez; Zaaijer, M. B.; Bottasso, C. L.

Here, a research agenda is described to further encourage the application of Multidisciplinary Design Analysis and Optimisation (MDAO) methodologies to wind energy systems. As a group of researchers closely collaborating within the International Energy Agency (IEA) Wind Task 37 for Wind Energy Systems Engineering: Integrated Research, Design and Development, we have identified challenges that will be encountered by users building an MDAO framework. This roadmap comprises 17 research questions and activities recognised to belong to three research directions: model fidelity, system scope and workflow architecture. It is foreseen that sensible answers to all these questions will enable to more easilymore » apply MDAO in the wind energy domain. Beyond the agenda, this work also promotes the use of systems engineering to design, analyse and optimise wind turbines and wind farms, to complement existing compartmentalised research and design paradigms.« less

Culture, Health, and Science: A Multidisciplinary Liberal Arts Alternative to the Public Health Major.

PubMed

Morgan, Lynn M; Knight, Sabina; Gubrium, Aline C

2016-01-01

Since the 2003 call by the Institute of Medicine to educate undergraduates in public health, various models have emerged for incorporating public health into the liberal arts and sciences. One model is a professionalized public health major that uses core public health competencies to prepare a workforce of health professionals. A second model offers a broad-based public health major rooted in liberal arts principles, resisting the utilitarian trend toward human capital formation. A third model resists even the label of "public health," preferring instead to introduce undergraduates to many ways of analyzing human health and healing. The multidisciplinary Culture, Health, and Science Program, based on six key commitments for preparing liberal arts students to analyze health and respond to global health challenges, is offered as an alternative to the public health major. © The Author(s) 2016.

Methodologies for sustaining barcode medication administration compliance. A multi-disciplinary approach.

PubMed

McNulty, Judy; Donnelly, Eileen; Iorio, Kris

2009-01-01

Numerous recent studies have looked at how nursing workarounds and technology failures can undermine the patient safety benefits of barcode medication administration (BCMA) systems. This article will discuss how Solaris Health System in Edison, NJ, methodically addressed these challenges to achieve and sustain 95 percent compliance with BCMA, one of two major initiatives of the non-profit Solaris Patient Safety Institute, which was established to research best practices that could be shared with other organizations. Through meetings and interviews with frontline nurses and their managers, a multidisciplinary team (pharmacy, IT, nursing) identified 12 educational, technological and process-oriented issues, then developed concrete action plans to address each one (e.g., one-on-one software and device training, additional wireless access points, a "hard stop" to require scanning the patient's wristband). Key success factors included demonstrating executive dedication, creating a culture of ownership by engaging frontline nurses in solution design and providing a strong support system.

Multidisciplinary team of intensive therapy: humanization and fragmentation of the work process.

PubMed

Evangelista, Viviane Canhizares; Domingos, Thiago da Silva; Siqueira, Fernanda Paula Cerântola; Braga, Eliana Mara

2016-01-01

to understand the meaning of humanized care in intensive care units considering the experience of the multidisciplinary team. descriptive and exploratory qualitative research. For this purpose, we conducted semi-structured interviews with 24 professionals of the heath-care team, and, after transcription, we organized the qualitative data according to content analysis. from two main categories, we were able to understand that humanized care is characterized in the actions of health-care: effective communication, team work, empathy, singularity, and integrality; and mischaracterized in the management processes, specifically in the fragmentation of the work process and health-care, in the precarious work conditions, and in differing conceptual aspects of the political proposal of humanization. care activities in intensive therapy are guided by the humanization of care and corroborate the hospital management as a challenge to be overcome to boost advances in the operationalization of this Brazilian policy.

Roadmap to the multidisciplinary design analysis and optimisation of wind energy systems

DOE PAGES

Perez-Moreno, S. Sanchez; Zaaijer, M. B.; Bottasso, C. L.; ...

2016-10-03

Here, a research agenda is described to further encourage the application of Multidisciplinary Design Analysis and Optimisation (MDAO) methodologies to wind energy systems. As a group of researchers closely collaborating within the International Energy Agency (IEA) Wind Task 37 for Wind Energy Systems Engineering: Integrated Research, Design and Development, we have identified challenges that will be encountered by users building an MDAO framework. This roadmap comprises 17 research questions and activities recognised to belong to three research directions: model fidelity, system scope and workflow architecture. It is foreseen that sensible answers to all these questions will enable to more easilymore » apply MDAO in the wind energy domain. Beyond the agenda, this work also promotes the use of systems engineering to design, analyse and optimise wind turbines and wind farms, to complement existing compartmentalised research and design paradigms.« less

Critical Zone Science as a Multidisciplinary Framework for Teaching Earth Science and Sustainability

NASA Astrophysics Data System (ADS)

Wymore, A.; White, T. S.; Dere, A. L. D.; Hoffman, A.; Washburne, J. C.; Conklin, M. H.

2016-12-01

The Earth's Critical Zone (CZ) is the terrestrial portion of the continents ranging from the top of the vegetative canopy down through soil and bedrock to the lowest extent of freely circulating groundwater. The primary objective of CZ science is to characterize and understand how the reciprocal interactions among rock, soil, water, air and terrestrial organisms influence the Earth as a habitable environment. Thus it is a highly multidisciplinary science that incorporates the biological, hydrological, geological and atmospheric sciences and provides a holistic approach to teaching Earth system science. Here we share highlights from a full-semester university curriculum that introduces upper-division Environmental Science, Geology, Hydrology and Earth Science students to CZ science. We emphasize how a CZ framework is appropriate to teach concepts across the scientific disciplines, concepts of sustainability, and how CZ science serves as a useful approach to solving humanities' grand challenges.

Interconnecting Multidiscilinary Data Infrastructures: From Federation to Brokering Framework

NASA Astrophysics Data System (ADS)

Nativi, S.

2014-12-01

Standardization and federation activities have been played an essential role to push interoperability at the disciplinary and cross-disciplinary level. However, they demonstrated not to be sufficient to resolve important interoperability challenges, including: disciplinary heterogeneity, cross-organizations diversities, cultural differences. Significant international initiatives like GEOSS, IODE, and CEOS demonstrated that a federation system dealing with global and multi-disciplinary domain turns out to be rater complex, raising more the already high entry level barriers for both Providers and Users. In particular, GEOSS demonstrated that standardization and federation actions must be accompanied and complemented by a brokering approach. Brokering architecture and its implementing technologies are able to implement an effective interoperability level among multi-disciplinary systems, lowering the entry level barriers for both data providers and users. This presentation will discuss the brokering philosophy as a complementary approach for standardization and federation to interconnect existing and heterogeneous infrastructures and systems. The GEOSS experience will be analyzed, specially.

Multidisciplinary treatment approach in Treacher Collins syndrome.

PubMed

Hylton, Joseph B; Leon-Salazar, Vladimir; Anderson, Gary C; De Felippe, Nanci L O

2012-01-01

Treacher Collins syndrome (TCS) is a common genetic disorder with high penetrance and phenotypic variability. First and second branchial arches are affected in TCS, resulting in craniofacial and intraoral anomalies such as: severe convex facial profile; mid-face hypoplasia; microtia; eyelid colobomas; mandibular retrognathism; cleft palate; dental hypoplasia; heterotopic teeth; maxillary transverse hypoplasia; anterior open bite; and Angle Class II molar relationship. A high incidence of caries is also a typical finding in TCS patients. Nonetheless, even simple dental restorative procedures can be challenging in this patient population due to other associated medical conditions, such as: congenital heart defects; decreased oropharyngeal airways; hearing loss; and anxiety toward treatment. These patients often require a multidisciplinary treatment approach, including: audiology; speech and language pathology; otorhinolaryngology; general dentistry; orthodontics; oral and maxillofacial surgery; and plastic and reconstructive surgeries to improve facial appearance. This paper's purpose was to present a current understanding of Treacher Collins syndrome etiology, phenotype, and current treatment approaches.

Resection of a large carotid paraganglioma in Carney-Stratakis syndrome: a multidisciplinary feat

PubMed Central

Nicholas, Rebecca Spenser; Quddus, Ayyaz; Topham, Charlotte; Baker, Daryll

2015-01-01

A 39-year-old man was referred to the vascular surgeons with a right-sided cervical mass, palpitations, headaches and sweating. He had presented with abdominal discomfort 12 months earlier. Investigations had revealed a gastrointestinal stromal tumour (GIST) and left adrenalectomy. CT of the neck with contrast demonstrated a large right carotid paraganglioma, extending superiorly from below the carotid bifurcation to encase the internal carotid artery. Genetic screening confirmed the diagnosis of Carney-Stratakis syndrome, an SDH-D germline mutation leading to GIST and multifocal paragangliomas. Successful surgical excision required considerable multidisciplinary teamwork between neuroendocrinologists, anaesthetists and surgeons. The tumour was highly vascular and involved the right carotid body, hypoglossal and vagus nerves. Access was challenging and maxillofacial surgical expertise were required for division of the mandible. The patient made a good recovery following speech and swallowing rehabilitation. PMID:25883251

Coordinating an interdisciplinary disease management conference on a military installation: collaboration between military and civilian communities, lessons learned.

PubMed

Lewis-Fleming, Glenda; Knapp, Casey A

2009-08-01

The needs of individuals with chronic diseases or disabilities are similar whether within military or civilian communities. With finite resources and the continuing global war on terrorism, military treatment facilities (MTFs) may find collaborative, multidisciplinary, continuing education efforts with community agencies invaluable. Collaborative efforts that bring military and civilian communities together can result in innovative programs that offer cost-effective high-quality information to enhance the knowledge and skill level of military families, providers, and other professionals who provide services and care for military eligible beneficiaries. This article addresses the development and implementation of two major multidisciplinary disease management conferences at Naval Medical Center Portsmouth (NMCP), Virginia. It provides an overview of lessons learned in the areas of preplanning, team building, program development, implementation, and evaluation. Despite challenges, tremendous benefits may be reaped from efforts to include diverse target populations from military and civilian communities.

Domestic Violence Offender Treatment and Multidisciplinary Treatment Teams: The Role of "Treatment" Victim Advocates.

PubMed

Richards, Tara N; Gover, Angela R

2018-03-01

In Colorado, "treatment victim advocates" (TVAs) serve alongside providers and probation/parole officers on "multidisciplinary treatment teams" (MTTs) to oversee domestic violence offender's treatment. Although this model provides an opportunity for victim safety concerns to be heard, the utility of using victim advocates as advisors regarding interventions for domestic violence offenders has yet to be studied. Using survey data and narrative responses from TVAs ( N = 37), the current study examines the challenges and opportunities TVAs face while serving on MTTs. Results suggest that, overall, TVAs are successful in communicating with other members of the MTT, are confident that their perspectives are valued in the offender decision-making process, and are able to provide a wide variety of services and referrals to the victims with whom they are engaged. Implications and recommendations for the Colorado model as well as correctional professionals managing domestic violence offenders internationally are presented and discussed.

Nutrition in medical education: reflections from an initiative at the University of Cambridge

PubMed Central

Ball, Lauren; Crowley, Jennifer; Laur, Celia; Rajput-Ray, Minha; Gillam, Stephen; Ray, Sumantra

2014-01-01

Landmark reports have confirmed that it is within the core responsibilities of doctors to address nutrition in patient care. There are ongoing concerns that doctors receive insufficient nutrition education during medical training. This paper provides an overview of a medical nutrition education initiative at the University of Cambridge, School of Clinical Medicine, including 1) the approach to medical nutrition education, 2) evaluation of the medical nutrition education initiative, and 3) areas identified for future improvement. The initiative utilizes a vertical, spiral approach during the clinically focused years of the Cambridge undergraduate and graduate medical degrees. It is facilitated by the Nutrition Education Review Group, a group associated with the UK Need for Nutrition Education/Innovation Programme, and informed by the experiences of their previous nutrition education interventions. Three factors were identified as contributing to the success of the nutrition education initiative including the leadership and advocacy skills of the nutrition academic team, the variety of teaching modes, and the multidisciplinary approach to teaching. Opportunities for continuing improvement to the medical nutrition education initiative included a review of evaluation tools, inclusion of nutrition in assessment items, and further alignment of the Cambridge curriculum with the recommended UK medical nutrition education curriculum. This paper is intended to inform other institutions in ongoing efforts in medical nutrition education. PMID:24899813

Relevance of chemistry to white biotechnology

PubMed Central

Gupta, Munishwar N; Raghava, Smita

2007-01-01

White biotechnology is a fast emerging area that concerns itself with the use of biotechnological approaches in the production of bulk and fine chemicals, biofuels, and agricultural products. It is a truly multidisciplinary area and further progress depends critically on the role of chemists. This article outlines the emerging contours of white biotechnology and encourages chemists to take up some of the challenges that this area has thrown up. PMID:17880746

Skin Microbiota Workshop: Multidisciplinary Perspectives, Challenges and Opportunities

DTIC Science & Technology

2014-12-08

by changing host responses? How does changing the community in one body site (e.g. the gut ) trigger changes in the microbiome at another body site (e.g...computational techniques for interrogating the microbiome to define research frontiers at the intersection of these important areas. The workshop outlined...U.S. Army Research Office P.O. Box 12211 Research Triangle Park, NC 27709-2211 skin microbiome , army, bioinformatics REPORT DOCUMENTATION PAGE 11

Future Directions for the Early Detection of Recurrent Breast Cancer

PubMed Central

Schneble, Erika J.; Graham, Lindsey J.; Shupe, Matthew P.; Flynt, Frederick L.; Banks, Kevin P.; Kirkpatrick, Aaron D.; Nissan, Aviram; Henry, Leonard; Stojadinovic, Alexander; Shumway, Nathan M.; Avital, Itzhak; Peoples, George E.; Setlik, Robert F.

2014-01-01

The main goal of follow-up care after breast cancer treatment is the early detection of disease recurrence. In this review, we emphasize the multidisciplinary approach to this continuity of care from surgery, medical oncology, and radiology. Challenges within each setting are briefly addressed as a means of discussion for the future directions of an effective and efficient surveillance plan of post-treatment breast cancer care. PMID:24790657

Experiences of a Multidisciplinary Course on Geo-Signal Processing from a DSP Perspective Offered in Electrical Engineering at King Fahd University of Petroleum and Minerals

ERIC Educational Resources Information Center

Mousa, W. A.

2012-01-01

The purpose of this paper is to share the experience gained in, and the efforts made toward, introducing and implementing a new course in the challenging and important area of geophysical signal processing at the Electrical Engineering (EE) Department, King Fahd University of Petroleum and Minerals (KFUPM), Dhahran, Saudi Arabia. The new course,…

Effect of climate change and resource scarcity on health care.

PubMed

Richardson, Janet; Grose, Jane; Jackson, Bethany; Gill, Jamie-Lee; Sadeghian, Hannah Becky; Hertel, Johannes; Kelsey, Janet

2014-07-15

Climate change and resource scarcity pose significant threats to healthcare delivery. Nurses should develop the skills to cope with these challenges in the future. Skills sessions using sustainability scenarios can help nursing students to understand the effect climate change and resource scarcity will have on health care. Involving design students in clinical skills sessions can encourage multidisciplinary working and help to find solutions to promote healthcare sustainability.

[The psychosocial challenges of epilepsy and the role of the clinical nurse specialist].

PubMed

Chartrand, Dominic

2015-01-01

Epilepsy in children is a complex disease with significant psychosocial consequences for the child and their family. The intervention of a multidisciplinary team enables the care to be adapted and provides support for the families. At Sainte-Justine Hospital in Montreal, Canada, the nurse clinician specialised in epilepsy plays a key role in this team. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The Experiences of Specialist Nurses Working Within the Uro-oncology Multidisciplinary Team in the United Kingdom

PubMed Central

Punshon, Geoffrey; Endacott, Ruth; Aslett, Phillippa; Brocksom, Jane; Fleure, Louisa; Howdle, Felicity; Masterton, Morven; O’Connor, Anita; Swift, Adrian; Trevatt, Paul; Leary, Alison

2017-01-01

Purpose: United Kingdom prostate cancer nursing care is provided by a variety of urology and uro-oncology nurses. The experience of working in multidisciplinary teams (MDT) was investigated in a national study. Design: The study consisted of a national survey with descriptive statistics and thematic analysis. Methods: A secondary analysis of a data subset from a UK whole population survey was undertaken (n = 285) of the specialist nursing workforce and the services they provide. Data were collected on the experience of working in the MDT. Results: Forty-five percent of the respondents felt that they worked in a functional MDT, 12% felt that they worked in a dysfunctional MDT, and 3.5% found the MDT meeting intimidating. Furthermore, 34% of the nurses felt that they could constructively challenge all members of the MDT in meetings. Themes emerging from open-ended questions were lack of interest in nonmedical concerns by other team members, ability to constructively challenge decisions or views within the meeting, and little opportunity for patients’ wishes to be expressed. Conclusions: Despite expertise and experience, nurses had a variable, often negative, experience of the MDT. It is necessary to ensure that all participants can contribute and are heard and valued. More emphasis should be given to patients’ nonmedical needs. PMID:28594672

Research Priorities in Mental Health, Justice, and Safety: A Multidisciplinary Stakeholder Report

PubMed Central

Crocker, Anne G.; Nicholls, Tonia L.; Seto, Michael C.; Roy, Laurence; Leclair, Marichelle C.; Brink, Johann; Simpson, Alexander I. F.; Côté, Gilles

2015-01-01

This paper is based on the report following the National Research Agenda Meeting on Mental Health, Justice, and Safety held in Montreal on November 19, 2014, which convened academics; health, social, and legal professionals; and people with lived experience of mental illness from across Canada. The goal was to identify research priorities addressing relevant knowledge gaps and research strategies that can translate into public policy action and improvements in evidence-based services. Participants identified key challenges: (1) inadequate identification and response to needs by civil mental health services and frontline law enforcement, (2) limited specialized resources in forensic and correctional settings, (3) fragmented care and gaps between systems, (4) limited resources for adequate community reintegration, and (5) poor knowledge transfer strategies as obstacles to evidence-based policies. Knowledge gaps were identified in epidemiology and risk reduction, frontline training and programs, forensic and correctional practices, organizations and institutions, knowledge transfer, and rehabilitation. Finally, participants identified potential sources of support to conduct real time research with regard to data collection and sharing. The findings represent a roadmap for how forensic mental health systems can best proceed to address current challenges through research and practice initiatives, drawing from lived, clinical and research experiences of a multidisciplinary group of experts. PMID:26681928

A novel combined interventional radiologic and hepatobiliary surgical approach to a complex traumatic hilar biliary stricture.

PubMed

NeMoyer, Rachel E; Shah, Mihir M; Hasan, Omar; Nosher, John L; Carpizo, Darren R

2018-01-01

Benign strictures of the biliary system are challenging and uncommon conditions requiring a multidisciplinary team for appropriate management. The patient is a 32-year-old male that developed a hilar stricture as sequelae of a gunshot wound. Due to the complex nature of the stricture and scarring at the porta hepatis a combined interventional radiologic and surgical approach was carried out to approach the hilum of the right and left hepatic ducts. The location of this stricture was found by ultrasound guidance intraoperatively using a balloon tipped catheter placed under fluoroscopy in the interventional radiology suite prior to surgery. This allowed the surgeons to select the line of parenchymal transection for best visualization of the stricture. A left hepatectomy was performed, the internal stent located and the right hepatic duct opened tangentially to allow a side-to-side Roux-en-Y hepaticojejunostomy (a Puestow-like anastomosis). Injury to the intrahepatic biliary ductal confluence is rarely fatal, however, the associated injuries lead to severe morbidity as seen in this example. Management of these injuries poses a considerable challenge to the surgeon and treating physicians. Here we describe an innovative multi-disciplinary approach to the repair of this rare injury. Copyright © 2018. Published by Elsevier Ltd.

The Experiences of Specialist Nurses Working Within the Uro-oncology Multidisciplinary Team in the United Kingdom.

PubMed

Punshon, Geoffrey; Endacott, Ruth; Aslett, Phillippa; Brocksom, Jane; Fleure, Louisa; Howdle, Felicity; Masterton, Morven; O'Connor, Anita; Swift, Adrian; Trevatt, Paul; Leary, Alison

United Kingdom prostate cancer nursing care is provided by a variety of urology and uro-oncology nurses. The experience of working in multidisciplinary teams (MDT) was investigated in a national study. The study consisted of a national survey with descriptive statistics and thematic analysis. A secondary analysis of a data subset from a UK whole population survey was undertaken (n = 285) of the specialist nursing workforce and the services they provide. Data were collected on the experience of working in the MDT. Forty-five percent of the respondents felt that they worked in a functional MDT, 12% felt that they worked in a dysfunctional MDT, and 3.5% found the MDT meeting intimidating. Furthermore, 34% of the nurses felt that they could constructively challenge all members of the MDT in meetings. Themes emerging from open-ended questions were lack of interest in nonmedical concerns by other team members, ability to constructively challenge decisions or views within the meeting, and little opportunity for patients' wishes to be expressed. Despite expertise and experience, nurses had a variable, often negative, experience of the MDT. It is necessary to ensure that all participants can contribute and are heard and valued. More emphasis should be given to patients' nonmedical needs.

Monitoring of IgE-mediated food allergy in childhood.

PubMed

Thong, B Y H; Hourihane, J O' B

2004-06-01

The prevalence of IgE-mediated food allergy (FA) in childhood varies from 6% to 8% in the first year of life compared to 1% to 2% in adults. In contrast to adults, FA in childhood, often part of the "allergic march", resolves in more than 85% of children, especially those with hypersensitivity to cow's milk and egg. This paper explains the rationale for continuing care for childhood FA and describes how children should be monitored for resolution/persistence of FA. A clinical, multidisciplinary approach and management algorithm based on relevant, peer-reviewed original research articles and reviews using the keywords anaphylaxis, atopic eczema, children, milk allergy, double-blind placebo-controlled food challenge, egg allergy, epinephrine, failure to thrive, food allergy, food challenge, food hypersensitivity, immunoglobulin E, nutrition, natural history, paediatrics, peanut allergy, prevalence, psychosocial factors, quality of life, radioallergosorbent test, and tolerance from years 1966 to 2003 in MEDLINE. Additional studies were identified from article reference lists. A combination of outcome measures, a multidisciplinary approach involving a dietitian and allergy nurse specialist, and a management algorithm are useful tools in clinical management. Prospective studies of non-selected children, optimally from birth cohorts, are needed to evaluate the effects of such management programmes regarding FA in childhood.

Psychopathological aspects of kidney transplantation: Efficacy of a multidisciplinary team

PubMed Central

De Pasquale, Concetta; Veroux, Massimiliano; Indelicato, Luisa; Sinagra, Nunzia; Giaquinta, Alessia; Fornaro, Michele; Veroux, Pierfrancesco; Pistorio, Maria L

2014-01-01

Renal transplantation is a well established treatment for end-stage renal disease, allowing most patients to return to a satisfactory quality of life. Studies have identified many problems that may affect adaptation to the transplanted condition and post-operative compliance. The psychological implications of transplantation have important consequences even on strictly physical aspects. Organ transplantation is very challenging for the patient and acts as an intense stressor stimulus to which the patient reacts with neurotransmitter and endocrine-metabolic changes. Transplantation can result in a psychosomatic crisis that requires the patient to mobilize all bio-psycho-social resources during the process of adaptation to the new foreign organ which may result in an alteration in self-representation and identity, with possible psychopathologic repercussions. These reactions are feasible in mental disorders, e.g., post-traumatic stress disorder, adjustment disorder, and psychosomatic disorders. In organ transplantation, the fruitful collaboration between professionals with diverse scientific expertise, calls for both a guarantee for mental health and greater effectiveness in challenging treatments for a viable association between patients, family members and doctors. Integrated and multidisciplinary care should include uniform criteria and procedures for standard assessments, for patient autonomy, adherence to therapy, new coping strategies and the adoption of more appropriate lifestyles. PMID:25540735

Malignant Bowel Obstruction in Advanced Gynecologic Cancers: An Updated Review from a Multidisciplinary Perspective

PubMed Central

Lee, Yeh Chen; Jivraj, Nazlin; O'Brien, Catherine; Chawla, Tanya; Shlomovitz, Eran; Buchanan, Sarah; Lau, Jenny; Croke, Jennifer; Allard, Johane P.; Dhar, Preeti; Laframboise, Stephane; Ferguson, Sarah E.; Dhani, Neesha; Butler, Marcus; Ng, Pamela; Stuart-McEwan, Terri; Savage, Pamela; Tinker, Lisa; Oza, Amit M.

2018-01-01

Malignant bowel obstruction (MBO) is a major complication in women with advanced gynecologic cancers which imposes a significant burden on patients, caregivers, and healthcare systems. Symptoms of MBO are challenging to palliate and result in progressive decompensation of already vulnerable patients with limited therapeutic options and a short prognosis. However, there is a paucity of guidelines or innovative approaches to improve the care of women who develop MBO. MBO is a complex clinical situation that requires a multidisciplinary approach to ensure the appropriate treatment modality and interprofessional care to optimally manage these patients. This review summarizes the current literature on the different approaches targeting MBO management including surgical intervention, chemotherapy, total parenteral nutrition, and pharmacological treatment. In addition, the impact of MBO management on patients' quality of life (QOL) is examined. This article focuses on the challenges in developing evidence-based treatment guidelines for MBO and barriers in clinical trial design for MBO and proposes strategies to advance the MBO management. Collaboration is essential to design studies that may improve the overall care and quality of life for these patients. Prospective data are needed to inform clinical practice, establish a new benchmark for evidence-based MBO management, and better understand the biology of MBO. PMID:29887891

Support for global science: Remote sensing's challenge

NASA Technical Reports Server (NTRS)

Estes, J. E.; Star, J. L.

1986-01-01

Remote sensing uses a wide variety of techniques and methods. Resulting data are analyzed by man and machine, using both analog and digital technology. The newest and most important initiatives in the U. S. civilian space program currently revolve around the space station complex, which includes the core station as well as co-orbiting and polar satellite platforms. This proposed suite of platforms and support systems offers a unique potential for facilitating long term, multidisciplinary scientific investigations on a truly global scale. Unlike previous generations of satellites, designed for relatively limited constituencies, the space station offers the potential to provide an integrated source of information which recognizes the scientific interest in investigating the dynamic coupling between the oceans, land surface, and atmosphere. Earth scientist already face problems that are truly global in extent. Problems such as the global carbon balance, regional deforestation, and desertification require new approaches, which combine multidisciplinary, multinational research teams, employing advanced technologies to produce a type, quantity, and quality of data not previously available. The challenge before the international scientific community is to continue to develop both the infrastructure and expertise to, on the one hand, develop the science and technology of remote sensing, while on the other hand, develop an integrated understanding of global life support systems, and work toward a quantiative science of the biosphere.

Critical care considerations in the management of the trauma patient following initial resuscitation

PubMed Central

2012-01-01

Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients. PMID:22989116

Digital Savings: A Study of Academic Libraries Finds that Going from Print to Electronic Journals Can Save Money, if It's Done Right, but Challenges Remain

ERIC Educational Resources Information Center

Schonfeld, Roger C.; Fenton, Eileen Gifford

2005-01-01

Without question, the ongoing transition from print to electronic periodicals has challenged librarians to rethink their strategies. While some effects of this change have been immediately apparent--greater breadth of material, easier access, exposure to new sources, publisher package deals, and open access--the broader outcomes on library…

From the National Academies: Ongoing Challenges to Evolution Education--Resources and Activities of the National Academies

ERIC Educational Resources Information Center

Labov, Jay B.

2005-01-01

The problem of misconceptions about science is not unique to evolution, of course. In the case of evolution, the problem is compounded because many students have been told that their personal belief systems will be challenged or undermined by engaging in learning about this subject. This concern underlies the angst and anger that some parents,…

Making the Transition: Interim Results of the National Guard Youth ChalleNGe Evaluation

ERIC Educational Resources Information Center

Millenky, Megan; Bloom, Dan; Dillon, Colleen

2010-01-01

Young people who drop out of high school face long odds of success in a labor market that increasingly values education and skills. This report presents interim results from a rigorous, ongoing evaluation of the National Guard Youth ChalleNGe Program, which aims to "reclaim the lives of at-risk youth" who have dropped out of high school.…

Making the Transition: Interim Results of the National Guard Youth ChalleNGe Evaluation. [Executive Summary

ERIC Educational Resources Information Center

Millenky, Megan; Bloom, Dan; Dillon, Colleen

2010-01-01

Young people who drop out of high school face long odds of success in a labor market that increasingly values education and skills. This report presents interim results from a rigorous, ongoing evaluation of the National Guard Youth ChalleNGe Program, which aims to "reclaim the lives of at-risk youth" who have dropped out of high school. ChalleNGe…

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

PubMed Central

Liparulo, Valeria; Pica, Alessandra; Guarro, Giuseppe; Alfano, Carmine; Puma, Francesco

2017-01-01

Background Chest wall resection and reconstruction (CWRR) is quite challenging in surgery, due to evolution in techniques. Neoplasms of the chest wall, primary or secondary, have been considered inoperable for a long time. Thanks to evolving surgical techniques, reconstruction after extensive chest wall resection is possible with good functional and aesthetic results. Methods In our single-center experience, seven cases of extensive CWRR for tumors were performed with a multidisciplinary approach by both thoracic and plastic surgeons. Patients have been retrospective analyzed. Results Acceptable clinical and aesthetical results have been recorded, with a smooth post-operative course and a low rate of post-surgical complications. Two early complications and one late complication (asymptomatic bone allograft fracture on the site of the bar implant) were recorded. Neither postoperative deaths nor local recurrences were registered after a median follow-up period of 13 months. Conclusions Surgical planning is most effective when it is tailored to the patient. Specifically, in the treatment of selected chest wall tumors, the multidisciplinary approach is considered mandatory when an extensive demolition is required. Indeed, here, the radical wide en-bloc resection can lead to good results provided that the extent of resection is not influenced by any anticipated problem in reconstruction. PMID:29312715

Time of Flight based diagnostics for high energy laser driven ion beams

NASA Astrophysics Data System (ADS)

Scuderi, V.; Milluzzo, G.; Alejo, A.; Amico, A. G.; Booth, N.; Cirrone, G. A. P.; Doria, D.; Green, J.; Kar, S.; Larosa, G.; Leanza, R.; Margarone, D.; McKenna, P.; Padda, H.; Petringa, G.; Pipek, J.; Romagnani, L.; Romano, F.; Schillaci, F.; Borghesi, M.; Cuttone, G.; Korn, G.

2017-03-01

Nowadays the innovative high power laser-based ion acceleration technique is one of the most interesting challenges in particle acceleration field, showing attractive characteristics for future multidisciplinary applications, including medical ones. Nevertheless, peculiarities of optically accelerated ion beams make mandatory the development of proper transport, selection and diagnostics devices in order to deliver stable and controlled ion beams for multidisciplinary applications. This is the main purpose of the ELIMAIA (ELI Multidisciplinary Applications of laser-Ion Acceleration) beamline that will be realized and installed within 2018 at the ELI-Beamlines research center in the Czech Republic, where laser driven high energy ions, up to 60 MeV/n, will be available for users. In particular, a crucial role will be played by the on-line diagnostics system, recently developed in collaboration with INFN-LNS (Italy), consisting of TOF detectors, placed along the beamline (at different detection distances) to provide online monitoring of key characteristics of delivered beams, such as energy, fluence and ion species. In this contribution an overview on the ELIMAIA available ion diagnostics will be briefly given along with the preliminary results obtained during a test performed with high energy laser-driven proton beams accelerated at the VULCAN PW-laser available at RAL facility (U.K.).

The CTSA as an Exemplar Framework for Developing Multidisciplinary Translational Teams

PubMed Central

Calhoun, William J.; Wooten, Kevin; Bhavnani, Suresh; Anderson, Karl E.; Freeman, Jean

2012-01-01

Abstract Translational science requires that scientists from multiple disciplines work together to improve the prevention, diagnosis, and treatment of human disease. Although a literature exists on the design and management of multidisciplinary teams, little has been written on multidisciplinary translational teams (MTTs). MTTs are distinct hybrid entities, with goals taken from both industry and academic models. We identified 30 design factors in 10 domains from a literature survey relevant to our MTT model: specific goals, structures, and processes. These dimensions were adapted to our own institutional environment in the selection and management of 11 MTTs that exploited resources of University of Texas Medical Branch (UTMB) Clinical and Translational Sciences Awards (CTSA). Case illustrations of two specific MTTs illustrate some of the challenges encountered and opportunities realized in terms of education and scientific advances. Network depiction of disciplinarity indicated that CTSA KRs and CTSA leadership contributed to discipline diversity especially in small (or nascent) MTTs. A separate depiction of MTT‐KR utilization indicated that data analysis, translational technologies, and novel methods were heavily utilized by MTTs, whereas other KRs contributed significant effort to infrastructure development. We conclude that the CTSA can provide a rich 
infrastructural framework and scientific environment for the development of successful MTTs. Clin Trans Sci 2013; Volume 6: 60–71 PMID:23399092