Using a Semi-Realistic Database to Support a Database Course

ERIC Educational Resources Information Center

Yue, Kwok-Bun

2013-01-01

A common problem for university relational database courses is to construct effective databases for instructions and assignments. Highly simplified "toy" databases are easily available for teaching, learning, and practicing. However, they do not reflect the complexity and practical considerations that students encounter in real-world…

Optical navigation during the Voyager Neptune encounter

NASA Technical Reports Server (NTRS)

Riedel, J. E.; Owen, W. M., Jr.; Stuve, J. A.; Synnott, S. P.; Vaughan, R. M.

1990-01-01

Optical navigation techniques were required to successfully complete the planetary exploration phase of the NASA deep-space Voyager mission. The last of Voyager's planetary encounters, with Neptune, posed unique problems from an optical navigation standpoint. In this paper we briefly review general aspects of the optical navigation process as practiced during the Voyager mission, and discuss in detail particular features of the Neptune encounter which affected optical navigation. New approaches to the centerfinding problem were developed for both stars and extended bodies, and these are described. Results of the optical navigation data analysis are presented, as well as a description of the optical orbit determination system and results of its use during encounter. Partially as a result of the optical navigation processing, results of scientific significance were obtained. These results include the discovery and orbit determination of several new satellites of Neptune and the determination of the size of Triton, Neptune's largest moon.

Structuring group medical practices: tax planning aspects.

PubMed

Gassman, A S; Conetta, T F

1992-01-01

This article is the first in a series addressing the structuring of group medical practice entities, shareholder relationships, and general representation factors. In this article, a general background in federal tax planning is provided, including strategies for minimization of income tax payment and the potential problems that may be encountered when a group practice is not carefully structured.

NASA flight cell and battery issues

NASA Technical Reports Server (NTRS)

Schulze, N. R.

1989-01-01

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

Identifying Fallacies of Reference in Argumentation

ERIC Educational Resources Information Center

Gough, Jim

2009-01-01

The experience of teaching informal logic (sometimes called practical logic) at the introductory level over the last fifteen years has allowed the author the opportunity to identify some interesting problems. These problems have been encountered by students attempting to understand some of the ideas presented in the informal logic course and by…

Impact Assessment of Problem-Based Learning in an Engineering Science Course

ERIC Educational Resources Information Center

Nasr, Karim J.; Ramadan, Bassem H.

2008-01-01

This paper presents the development and implementation of Problem-Based Learning (PBL) in an engineering thermodynamics course at Kettering University. In this project, the thermodynamics course was restructured as modules presenting practical applications first, whereas principles were introduced just-in-time and as encountered. Theoretical…

Interprofessional Legal Practitioners: The Case of the M.D.-LL.B.

ERIC Educational Resources Information Center

Schneller, Eugene Stewart

1975-01-01

Careers and problems encountered by the large majority of M.D.-LL.B's who practice legal medicine are examined. The author argues that the legal profession must strive to create institutionalized career lines so that interprofessional medical-legal practice is a well-founded career choice. (JT)

Dermatologic Practice: Implications for a Primary Care Residency Curriculum.

ERIC Educational Resources Information Center

Branch, William T., Jr.; And Others

1983-01-01

The problems encountered, diagnostic procedures performed, and treatments prescribed in dermatology were studied in a primary care practice and in a dermatology clinic. It is proposed that the findings of this study be the basis for designing a curriculum in dermatology for residents in primary care medicine. (Author/MLW)

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

PubMed

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

2018-01-01

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

Moneymed: a game to develop management skills in general practice

PubMed Central

Essex, B.; Jackson, R. N.

1981-01-01

A game has been developed to train people in the financial and administrative skills needed for effective general practice management. These skills cover a wide range of legal, economic, administrative and personnel problems encountered in general practice. Thirty-four trainees and six trainers showed a highly significant improvement in knowledge and problem-solving skills after playing the game. The format and design of the game allow the problem type, complexity and solution to vary and to be readily updated. So far, this seems to be one of the most effective instruments yet developed for learning these skills. Imagesp736-a PMID:7338867

The Effect of Focus Group Discussions on Pre-Service Teachers' Teaching Experiences and Practices: A Mixed Methods Study

ERIC Educational Resources Information Center

Memduhoglu, Hasan Basri; Kotluk, Nihat; Yayla, Ahmet

2017-01-01

The aim of this study is to investigate the effect of providing feedback to preservice teachers' (PSTs) through focus group discussion on PSTs' self-efficacy perception about teaching experiences and practices, to determine problems encountered during teaching practice by means of focus group discussion and to develop suggestions about solving…

Best Practices In Overset Grid Generation

NASA Technical Reports Server (NTRS)

Chan, William M.; Gomez, Reynaldo J., III; Rogers, Stuart E.; Buning, Pieter G.; Kwak, Dochan (Technical Monitor)

2002-01-01

Grid generation for overset grids on complex geometry can be divided into four main steps: geometry processing, surface grid generation, volume grid generation and domain connectivity. For each of these steps, the procedures currently practiced by experienced users are described. Typical problems encountered are also highlighted and discussed. Most of the guidelines are derived from experience on a variety of problems including space launch and return vehicles, subsonic transports with propulsion and high lift devices, supersonic vehicles, rotorcraft vehicles, and turbomachinery.

Reasons for encounter and disease patterns in Danish primary care: changes over 16 years.

PubMed

Moth, Grete; Olesen, Frede; Vedsted, Peter

2012-06-01

Approximately 98% of Danish citizens are listed with a general practice which they consult for medical advice. Although 85% of the population contact their general practitioner (GP) every year, little is known about these contacts. The aim of the present paper is to gain updated knowledge about patients' reasons for encounter and the GP activities and to make comparisons with a similar study from 1993. All GPs in the Central Denmark Region were invited to register all contacts during one randomly chosen day within a year. The registration included questions about patients' reasons for encounter, the types and contents of the contacts, referrals, and distribution between new episodes and follow-up contacts. Aggregated data were compared with the results from 1993. A total of 404 (46%) GPs participated. The number of contacts per 1000 inhabitants had risen by 19.7%. The reasons for encounter and final diagnoses resembled those in 1993. Musculoskeletal, psychological, and respiratory problems were the most common reasons for encounter, psychological problems being the only type to increase over the period. Interestingly, the proportion of diagnoses within the ICPC 'A' chapter rose from 13.5 to 19.7%. The referral rate rose by 2% (relative: 18.7%) from 10.7% to 12.7% and the share of follow-up contacts rose from 45.9% to 50.4% (relative: 8.7%). Quite small changes were seen in the patterns of reasons for encounter and diagnoses from 1993 to 2009. However, an increase was found in contacts with general practice and referrals and in the proportion of follow-ups.

[Management of asthma in a context of ambulatory pediatrics: relevance and possibility to avoid the problems. Gruppo de lavoro pediatri dell'Abruzzo Basilicata e Puglia].

PubMed

Misticoni, G; Marchetti, F; D'Andrea, N

1994-01-01

41 pediatricians agreed to register on a very simple form, all the cases of children affected by bronchial asthma visited in their clinic during october 1993. The data included basic information related to the therapy prescribed, its duration, a judgement on the efficacy of symptoms control and the main problems encountered with the children and their families. 237 cases were reported (mean age 4.6 year, range 2 months-13 years). 80% of children were monitored by the pediatrician; 47% had allergic reactions. The main drug used for profilaxis is ketotifen, a compound without documented efficacy; the main route for drug administration (especially during acute attacks) is by mouth, instead of by aerosol, evidencing problems in the health education on practical skills. In fact the main problems encountered by doctors are related to the communication with patients and families. This survey represents also a research model for involving health care providers and easily and quickly obtaining a useful, methodologically sound and interesting picture of everyday practice.

Delivery of Clinical Preventive Services in Family Medicine Offices

PubMed Central

Crabtree, Benjamin F.; Miller, William L.; Tallia, Alfred F.; Cohen, Deborah J.; DiCicco-Bloom, Barbara; McIlvain, Helen E.; Aita, Virginia A.; Scott, John G.; Gregory, Patrice B.; Stange, Kurt C.; McDaniel, Reuben R.

2005-01-01

BACKGROUND This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts. METHODS We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observation of outpatient encounters, and patient exit cards were used to calculate practice-level rates of delivery of clinical preventive services. Field notes from direct observation of clinical encounters and prolonged observation of the practice and transcripts from in-depth interviews of practice staff and physicians were systematically examined to identify approaches to delivering clinical preventive services recommended by the US Preventive Services Task Force. RESULTS Practices developed individualized approaches for delivering clinical preventive services, with no one approach being successful across practices. Clinicians acknowledged a 3-fold mission of providing acute care, managing chronic problems, and prevention, but only some made prevention a priority. The clinical encounter was a central focus for preventive service delivery in all practices. Preventive services delivery rates often appeared to be influenced by competing demands within the clinical encounter (including between different preventive services), having a physician champion who prioritized prevention, and economic concerns. CONCLUSIONS Practice quality improvement efforts that assume there is an optimal approach for delivering clinical preventive services fail to account for practices’ propensity to optimize care processes to meet local contexts. Interventions to enhance clinical preventive service delivery should be tailored to meet the local needs of practices and their patient populations. PMID:16189059

Chemorheology of reactive systems: Finite element analysis

NASA Technical Reports Server (NTRS)

Douglas, C.; Roylance, D.

1982-01-01

The equations which govern the nonisothermal flow of reactive fluids are outlined, and the means by which finite element analysis is used to solve these equations for the sort of arbitrary boundary conditions encountered in industrial practice are described. The performance of the computer code is illustrated by several trial problems, selected more for their value in providing insight to polymer processing flows than as practical production problems. Although a good deal remains to be learned as to the performance and proper use of this numerical technique, it is undeniably useful in providing better understanding of today's complicated polymer processing problems.

Perceptions of Turkish Parents with Children Identified as Dyslexic about the Problems that They and Their Children Experience

ERIC Educational Resources Information Center

Yildiz, Mustafa; Yildirim, Kasim; Ates, Seyit; Rasinski, Timothy

2012-01-01

This study identified problems encountered by both dyslexic children and their parents. Seven parents were interviewed. Parents mentioned the negative attitudes of teachers towards them and their children, the use of incorrect practices in the classroom, and educational insufficiency in relation to dyslexia. Similarly, family members were found to…

Problems and Practical Solutions of Web-Based Courses: Lessons Learned from Three Educational Institutions.

ERIC Educational Resources Information Center

Miltiadou, Marios; McIsaac, Marina S.

The purpose of this paper is to review problems encountered in World Wide Web-based courses delivered at three different educational institutions (i.e., two community colleges and a university) in the metropolitan Phoenix (Arizona) area. Implications are discussed based on distance education theories of interaction. Interaction is a vital issue to…

Using video to introduce clinical materials.

PubMed

Kommalage, Mahinda; Senadheera, Chandanie

2012-08-01

The early introduction of clinical material is a recognised strategy in medical education. The University of Ruhana Medical School, where a traditional curriculum is followed, offers students pre-clinical subjects without clinical exposure during their first and second years. Clinical materials in the form of videos were introduced to first-year students. In the videos, patients and their relatives described the diseases and related problems. Students were instructed to identify the problems encountered by patients and relatives. Each video was followed by a discussion of the problems identified by the students. The medical, social and economic problems encountered by patients and relatives were emphasised during post-video discussions. A lecture was conducted linking the contents of the videos to subsequent lectures. The aim of this study is to investigate whether combining teaching preclinical material with a video presentation of relevant clinical cases facilitates the interest and understanding of students. Quantitative data were collected using a questionnaire, whereas qualitative data were collected using focus group discussions. Quantitative data showed that students appreciated the video, had 'better' knowledge acquisition and a 'better' understanding of problems encountered by patients. Qualitative analysis highlighted the following themes: increased interest; enhanced understanding; relevance of basic knowledge to clinical practice; orientation to profession; and personalising theories. The introduction of patients in the form of videos helped students to understand the relevance of subject material for clinical practice, increased their interest and facilitated a better understanding of the subject material. Therefore, it seems video is a feasible medium to introduce clinical materials to first-year students who follow a traditional curriculum in a resource-limited environment. © Blackwell Publishing Ltd 2012.

A CAL-Based Undergraduate Genetics Course.

ERIC Educational Resources Information Center

Garbutt, K.; And Others

1979-01-01

Describes a second-year undergraduate practical course in quantitative genetics and biometrics, based upon computer-assisted learning (CAL); and discusses the educational benefits of the course, some problems encountered, and some implications of the extensive use of CAL. (Author/CMV)

Detection of structural deterioration and associated airline maintenance problems

NASA Technical Reports Server (NTRS)

Henniker, H. D.; Mitchell, R. G.

1972-01-01

Airline operations involving the detection of structural deterioration and associated maintenance problems are discussed. The standard approach to the maintenance and inspection of aircraft components and systems is described. The frequency of inspections and the application of preventive maintenance practices are examined. The types of failure which airline transport aircraft encounter and the steps taken to prevent catastrophic failure are reported.

Doctor-patient communication on the telephone.

PubMed

Curtis, P; Evens, S

1989-01-01

Since its invention, the telephone has been an important tool in medical practice, particularly for primary care physicians. Approximately half the calls made to a physician's office during regular consulting hours are for clinical problems and most are handled effectively over the phone without an immediate office visit. Telephone encounters are generally very brief, and managing such calls requires a pragmatic approach that is often quite different from the approach taken in the office visit. The telephone encounter should be recognized and recorded as a specific medical interaction in the medical chart for both clinical and legal reasons. Effective telephone encounters depend on good communication skills; decision making regarding disposition is a major goal. The physician's perception of a medical problem may be different from the patient's; patients are frequently seeking advice and reassurance rather than diagnosis and treatment, and may call because of anxiety and psychological stress. For physicians and their families who are not prepared for after-hours telephone encounters, calls that interrupt more "legitimate" activities may result in anger or frustration for the physician and dissatisfaction for the patient.

The Possible Application of Socioeconomic Careers and Path Analysis Concepts to the Study of Factors Relevant to Physicians' Choice of Practice Location.

ERIC Educational Resources Information Center

Grimes, Walter F.

In response to the current shortage of rural physicians and the difficulties encountered in studying this problem, this paper attempts to apply a specific multivariate technique (path analysis) and the socioeconomic careers model of Featherman and others to the study of the physician's choice of practice location. The socioeconomic careers model…

Ethical problems and moral sensitivity in physiotherapy: a descriptive study.

PubMed

Kulju, Kati; Suhonen, Riitta; Leino-Kilpi, Helena

2013-08-01

This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists' moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or other professions and patients' self-determination. The dimension of moral strength was emphasised in physiotherapists' self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of the patient. Scarce resources make them feel insufficient but much could still be done to provide quality care in co-operation with other health-care professionals.

Industrial Partners in the Education of an Engineer

ERIC Educational Resources Information Center

Smith, Barnard E.

1973-01-01

Discusses the theory, operation, and practical problems encountered in conducting a professional program which emphasizes close contact with industrial engineers in engineering education. Indicates that the partnership program provides one means for firms to participate in educational activities while serving their own interests. (CC)

Barriers to GPs' use of evidence-based medicine: a systematic review

PubMed Central

Zwolsman, Sandra; te Pas, Ellen; Hooft, Lotty; Waard, Margreet Wieringa-de; van Dijk, Nynke

2012-01-01

Background GPs report various barriers to the use and practice of evidence-based medicine (EBM). A review of research on these barriers may help solve problems regarding the uptake of evidence in clinical outpatient practice. Aim To determine the barriers encountered by GPs in the practice of EBM and to come up with solutions to the barriers identified. Design A systematic review of the literature. Method The following databases were searched: MEDLINE® (PubMed®), Embase, CINAHL®, ERIC, and the Cochrane Library, until February 2011. Primary studies (all methods, all languages) that explore the barriers that GPs encounter in the practice of EBM were included. Results A total of 14 700 articles were identified, of which 22 fulfilled all inclusion criteria. Of the latter, nine concerned qualitative, 12 concerned quantitative, and one concerned both qualitative and quantitative research methods. The barriers described in the articles cover the categories: evidence (including the accompanying EBM steps), the GP’s preferences (experience, expertise, education), and the patient’s preferences. The particular GP setting also has important barriers to the use of EBM. Barriers found in this review, among others, include lack of time, EBM skills, and available evidence; patient-related factors; and the attitude of the GP. Conclusion Various barriers are encountered when using EBM in GP practice. Interventions that help GPs to overcome these barriers are needed, both within EBM education and in clinical practice. PMID:22781999

Perceptions and practices on menstruation amongst Nigerian secondary school girls.

PubMed

Adinma, Echendu Dolly; Adinma, J I B

2008-04-01

This cross-sectional descriptive study was conducted amongst 550 secondary school girls in southeastern Nigeria to determine their perceptions, problems, and practices on menstruation. Majority of the students, (75.6%), were aged 15-17 years. Only 39.3% perceived menstruation to be physiological. Abdominal pain/discomfort, (66.2%), was the commonest medical problem encountered by the respondents, although 45.8% had multiple problems. Medical problems were most commonly discussed with the mother, (47.1%), and least commonly discussed with the teachers, 0.4%. Analgesics, (75.6%), were most commonly used to relieve menstrual pain. Only 10% of respondents used non-pharmacologic remedies. Unsanitary menstrual absorbents were used by 55.7% of the respondents. Menstruation perceptions are poor, and practices often incorrect. A multi-dimensional approach focusing on capacity building of mothers, and teachers on sexuality education skills; using religious organizations as avenues for sexuality education; and effectively using the Mass Media as reproductive health education channels are recommended towards improving adolescents' perceptions and practices on menstruation.

Systems and complexity thinking in general practice: part 1 - clinical application.

PubMed

Sturmberg, Joachim P

2007-03-01

Many problems encountered in general practice cannot be sufficiently explained within the Newtonian reductionist paradigm. Systems and complexity thinking - already widely adopted in most nonmedical disciplines - describes and explores the contextual nature of questions posed in medicine, and in general practice in particular. This article briefly describes the framework underpinning systems and complexity sciences. A case study illustrates how systems and complexity thinking can help to better understand the contextual nature of patient presentations, and how different approaches will lead to different outcomes.

Let's Tell a Story Together

ERIC Educational Resources Information Center

Kelsey, Karishma; Zaliwski, Andrew

2017-01-01

Aim/Purpose: The teaching solution presented in this paper was implemented to overcome the common problems encountered by authors during years of practice of applied business studies teaching. Background: In our school, we have deep multicultural environments where both teachers and students are coming from different countries and cultures. The…

Integrating counselling into general practice.

PubMed

Stone, L; Blashki, G

2000-03-01

General practice counselling has many significant differences to counselling in other settings. General practitioners have long term relationships with their patients involving physical as well as mental health care. General practitioners are often the first point of contact for distressed patients who may not perceive their problem to have a psychological basis. There are barriers to counselling including time management and cultural expectations of the consultation. To outline a practical biopsychosocial model for counselling in the general practice setting using the knowledge and skills unique to each GP. Theoretical and practical barriers to counselling commonly encountered in general practice are discussed. Assessing the problem in a biopsychosocial format highlights strengths and skills the patient already possesses and involves consideration of physical sensations, emotions, behaviours, key relationships, family, social roles and resources. Counselling in general practice requires flexibility and an ability to adapt available resources to address patient needs in an individually appropriate way.

Manufacturing waste disposal practices of the chemical propulsion industry

NASA Technical Reports Server (NTRS)

Goldberg, Benjamin E.; Adams, Daniel E.; Schutzenhofer, Scott A.

1995-01-01

The waste production, mitigation and disposal practices of the United States chemical propulsion industry have been investigated, delineated, and comparatively assessed to the U.S. industrial base. Special emphasis has been placed on examination of ozone depleting chemicals (ODC's). The research examines present and anticipated future practices and problems encountered in the manufacture of solid and liquid propulsion systems. Information collected includes current environmental laws and regulations that guide the industry practices, processes in which ODC's are or have been used, quantities of waste produced, funding required to maintain environmentally compliant practices, and preventive efforts.

Problems Encountered in Teaching/Learning Integrated Photosynthesis: A Case of Ineffective Pedagogical Practice?

ERIC Educational Resources Information Center

Panijpan, Bhinyo; Ruenwongsa, Pintip; Sriwattanarothai, Namkang

2008-01-01

In this article we recount our experiences of teaching photosynthesis in an integrated way to secondary school students and teachers, science undergraduates and postgraduates. Conceptual questions were posed to investigate learners' fundamental understanding of simple light-dependent and light-independent processes taught to most students at…

Mathematics & Economics: Connections for Life, Grades 6-8.

ERIC Educational Resources Information Center

Hoff, Jody; McCorkle, Sarapage; Suiter, Mary; Bettendorf, James; Breidenbach, Lisa; Cornwell, Pamela

This book contains a set of 12 lessons for middle school students that demonstrate how mathematical processes and concepts may be applied to the study of economics and personal finance. Mathematics educators can find lessons connecting mathematics instruction to practical problems and issues that students encounter throughout their life. The…

How to Write Geography Teaching Paper

ERIC Educational Resources Information Center

Liu, Hua; Li, Lu

2011-01-01

Geography teaching paper is the paper especially to describe geography teaching reform and research achievement, its main purpose is to find solution to handle questions encountered in teaching through personal teaching practice, constant trying and exploration, and to scientifically summarize the procedure and methods to deal with the problem,…

The Early Years: Integrating Design

ERIC Educational Resources Information Center

Ashbrook, Peggy; Nellor, Sue

2015-01-01

Engineering is such a common part of children's work in early childhood programs that teachers can simply look around the room to identify examples where students have engaged in engineering practices. This article presents a classroom activity that integrates engineering design by building on the everyday problems that young children encounter in…

Don't Give Up! Practical Strategies for Challenging Collaborations

ERIC Educational Resources Information Center

Cramer, Sharon; Stivers, Jan

2007-01-01

People faced with collaboration challenges are often reluctant to be honest about problems because in many schools collaboration is a norm. But whereas most special educators are intuitively skilled at working with others, "problematic professional encounters are inevitable barriers that will appear occasionally in the life of every special…

Listener Reliability in Assigning Utterance Boundaries in Children's Spontaneous Speech

ERIC Educational Resources Information Center

Stockman, Ida J.

2010-01-01

Research and clinical practices often rely on an utterance unit for spoken language analysis. This paper calls attention to the problems encountered when identifying utterance boundaries in young children's spontaneous conversational speech. The results of a reliability study of utterance boundary assignment are described for 20 females with…

Counseling Older Women: Curriculum Guidelines and Strategies.

ERIC Educational Resources Information Center

Cavallaro, Marion L.

Since the population of older persons is predominantly female, counselor educators need to incorporate into their curriculum topics related to the unique issues faced by older women. Most counselors in their practice will be encountering at some point the problems of older women. Therefore, the preparation of counselors needs to incorporate…

International Survey of the Status of Waldorf Schools.

ERIC Educational Resources Information Center

Ogletree, Earl J.

This international survey study was the first to examine the Waldorf School movement worldwide and focused on the teaching practices, curricula, educational outcomes, and positive program features of Waldorf schools, as well as problems encountered by Waldorf staff. The role of Rudolf Steiner's philosophy, anthroposophy, and its esoteric aspects…

Computer Simulation Utilization in Graduate Behavior Therapy Training.

ERIC Educational Resources Information Center

Lambert, Matthew E.; And Others

Practicum experiences are thought to be a time for honing clinical skills and integrating content course material with clinical practice. Often, however, the range of clinical problems encountered during practica is restricted, limiting the variety of learning experiences available to practicum group members. To provide a wider range of…

Practical Considerations in Evaluating Patient/Consumer Health Education Programs.

ERIC Educational Resources Information Center

Bryant, Nancy H.

This report contains brief descriptions of seven evaluative efforts and outcomes of health education programs, some considerations of problems encountered in evaluating the programs, and detailed descriptions of two case studies: (1) a process evaluation of preoperative teaching and (2) a retrospective study of visiting nurse association use by…

A resident conference for systems-based practice and practice-based learning.

PubMed

Sultana, Carmen J; Baxter, Jason K

2011-02-01

Improving patient safety and quality of care is part of systems-based practice and practice-based learning for residents. We expanded our obstetrics and gynecology department's regularly scheduled morbidity and mortality conferences to teach quality assurance concepts based on patient care on obstetrics and gynecology fourth-year resident rotations. Obstetrics and gynecology fourth-year residents on one of the two rotations each presented and analyzed a systems-based problem they encountered during patient care. They used an online learning module and proposed solutions, many of which were effectively implemented. Over 5 years, case presentations from 33 conferences were available with problems identified in emergency preparedness, coordination of care, scheduling and supervision, communication, medical practice, documentation, and lack of equipment or facilities. Twenty-two of the suggested solutions were partially or totally implemented. Barriers to implementation were identified. In conclusion, a conference presentation by fourth-year residents can identify patient safety problems, aid in their resolution, and suggest changes to patient care while teaching the principles of systems-based practice and practice-based learning.

Beyond Prevention: Promoting Healthy Youth Development in Primary Care

PubMed Central

Borowsky, Iris W.

2012-01-01

Training primary care providers to incorporate a youth development approach during clinical encounters with young people represents an opportunity to integrate public health into primary care practice. We recommend that primary care providers shift their approach with adolescents from focusing on risks and problems to building strengths and assets. Focusing on strengths rather than problems can improve health by fostering resilience and enhancing protective factors among adolescents. A strength-based approach involves intentionally assessing and reinforcing adolescents' competencies, passions, and talents, as well as collaborating with others to strengthen protective networks of support for young people. Training programs should incorporate interactive strategies that allow clinicians to practice skills and provide tools clinicians can implement in their practice settings. PMID:22690965

Pre-registration house officer rotations incorporating general practice: does the order of rotation matter?

PubMed

Williams, C; Cantillon, P; Cochrane, M

2001-06-01

In relation to pre-registration house officer (PRHO) rotations incorporating general practice, previous research has recommended that where possible, no PRHO should undertake general practice as the first placement, because of the difficulties encountered. It was recognized that logistically, this could make such schemes almost unworkable. Within the context of a larger qualitative evaluation comparing how 24 PRHOs learned in hospital and general practice settings, the issue of rotation order was explored. In-depth semistructured interviews were conducted with the 12 PRHOs who were involved in general practice rotations. They were interviewed at the beginning and end of the PRHO year, and following their return to hospital work after the general practice placement. Each rotation order had both advantages and disadvantages, with no particular rotation order being obviously better or worse for the PRHOs involved. This small qualitative evaluation has highlighted a number of advantages and disadvantages specific to each rotation order, and makes some practical recommendations to help alleviate the problems encountered. It is important that future evaluations of similar schemes consider this issue, as there are conflicting reports about the significance of the rotation order.

Retention and application of Skylab experiences to future programs. [a postflight review of technical programs.

NASA Technical Reports Server (NTRS)

Gillespie, V. G.; Kelly, R. O.

1974-01-01

The problems encountered and special techniques and procedures developed on the Skylab program are described along with the experiences and practical benefits obtained for dissemination and use on future programs. Three major topics are discussed: electrical problems, mechanical problems, and special techniques. Special techniques and procedures are identified that were either developed or refined during the Skylab program. These techniques and procedures came from all manufacturing and test phases of the Skylab program and include both flight and GSE items from component level to sophisticated spaceflight systems.

Reality-Based Decision Cases in ESP Teacher Education: Windows on Practice.

ERIC Educational Resources Information Center

Jackson, Jane

1998-01-01

A rationale and framework for the use of case studies in English for Specific Purposes (ESP) teacher education. It explores why and how reality-based cases can revitalize teacher education programs that are specifically designed to prepare teachers for the problems they could encounter as ESP practitioners. (Author/JL)

Methodological Issues and Practical Strategies in Research on Child Maltreatment Victims' Abilities and Experiences as Witnesses

ERIC Educational Resources Information Center

Chae, Yoojin; Goodman, Gail S.; Bederian-Gardner, Daniel; Lindsay, Adam

2011-01-01

Scientific studies of child maltreatment victims' memory abilities and court experiences have important legal, psychological, and clinical implications. However, state-of-the-art research on child witnesses is often hindered by methodological challenges. In this paper, we address specific problems investigators may encounter when attempting such…

Finding Our Own Way: Teachers Exploring Their Assumptions.

ERIC Educational Resources Information Center

Newman, Judith M., Ed.

Intended for teachers, the articles in this book examine some of the uncertainties and problems that practicing teachers encountered when moving from a traditional to a holistic perspective in their teaching. The book shares the questions, the conflicts the teachers have undergone, and the change in beliefs that are part of becoming a…

Writing-to-Learn in the Inquiry-Science Classroom: Effective Strategies from Middle School Science and Writing Teachers

ERIC Educational Resources Information Center

Baker, William P.; Barstack, Renee; Clark, Diane; Hull, Elizabeth; Goodman, Ben; Kook, Judy; Kraft, Kaatje; Ramakrishna, Pushpa; Roberts, Elisabeth; Shaw, Jerome; Weaver, David; Lang, Michael

2008-01-01

Student writing skills are an important concern for every teacher. This is especially true when using inquiry-based approaches in the science classroom. Writing promotes critical-thinking skills and construction of vital scientific concepts and challenges ingrained misconceptions. Yet, many teachers encounter practical problems when incorporating…

Practical Supervision: The First Line of Management.

ERIC Educational Resources Information Center

Erkkila, John; MacKay, Pamela

1990-01-01

Discusses the problems encountered by first time library supervisors who have to learn not only their new professional jobs but also how to supervise others. A supervisory approach based on work checking is described, and the role that managers should play in assisting their supervisors to acquire necessary skills is outlined. (14 references) (CLB)

Taking Your Show on the Road: A Guide for New Student Recruiters.

ERIC Educational Resources Information Center

Linstrum, Helen

Intended for faculty, staff, and volunteers who represent an institution of higher education in student recruiting efforts, the handbook offers guidelines for counseling college-bound young people as well as practical suggestions for everyday problems encountered when "on the road." Individual chapters are as follows: "Your Role as an Outreach…

Child Neurology Education for Pediatric Residents.

PubMed

Albert, Dara V F; Patel, Anup D; Behnam-Terneus, Maria; Sautu, Beatriz Cunill-De; Verbeck, Nicole; McQueen, Alisa; Fromme, H Barrett; Mahan, John D

2017-03-01

The aim of this study was to evaluate whether the current state of child neurology education during pediatric residency provides adequate preparation for pediatric practice. A survey was sent to recent graduates from 3 pediatric residency programs to assess graduate experience, perceived level of competence, and desire for further education in child neurology. Responses from generalists versus subspecialists were compared. The response rate was 32%, half in general pediatric practice. Only 22% feel very confident in approaching patients with neurologic problems. This may represent the best-case scenario as graduates from these programs had required neurology experiences, whereas review of Accreditation Council of Graduate Medical Education-accredited residency curricula revealed that the majority of residencies do not. Pediatric neurologic problems are common, and pediatric residency graduates do encounter such problems in practice. The majority of pediatricians report some degree of confidence; however, some clear areas for improvement are apparent.

Challenges in conducting qualitative research in health: A conceptual paper.

PubMed

Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva

2015-01-01

Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

Fix and forget or fix and report: a qualitative study of tensions at the front line of incident reporting.

PubMed

Hewitt, Tanya Anne; Chreim, Samia

2015-05-01

Practitioners frequently encounter safety problems that they themselves can resolve on the spot. We ask: when faced with such a problem, do practitioners fix it in the moment and forget about it, or do they fix it in the moment and report it? We consider factors underlying these two approaches. We used a qualitative case study design employing in-depth interviews with 40 healthcare practitioners in a tertiary care hospital in Ontario, Canada. We conducted a thematic analysis, and compared the findings with the literature. 'Fixing and forgetting' was the main choice that most practitioners made in situations where they faced problems that they themselves could resolve. These situations included (A) handling near misses, which were seen as unworthy of reporting since they did not result in actual harm to the patient, (B) prioritising solving individual patients' safety problems, which were viewed as unique or one-time events and (C) encountering re-occurring safety problems, which were framed as inevitable, routine events. In only a few instances was 'fixing and reporting' mentioned as a way that the providers dealt with problems that they could resolve. We found that generally healthcare providers do not prioritise reporting if a safety problem is fixed. We argue that fixing and forgetting patient safety problems encountered may not serve patient safety as well as fixing and reporting. The latter approach aligns with recent calls for patient safety to be more preventive. We consider implications for practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

From problem solving to problem definition: scrutinizing the complex nature of clinical practice.

PubMed

Cristancho, Sayra; Lingard, Lorelei; Regehr, Glenn

2017-02-01

In medical education, we have tended to present problems as being singular, stable, and solvable. Problem solving has, therefore, drawn much of medical education researchers' attention. This focus has been important but it is limited in terms of preparing clinicians to deal with the complexity of the 21st century healthcare system in which they will provide team-based care for patients with complex medical illness. In this paper, we use the Soft Systems Engineering principles to introduce the idea that in complex, team-based situations, problems usually involve divergent views and evolve with multiple solution iterations. As such we need to shift the conversation from (1) problem solving to problem definition, and (2) from a problem definition derived exclusively at the level of the individual to a definition derived at the level of the situation in which the problem is manifested. Embracing such a focus on problem definition will enable us to advocate for novel educational practices that will equip trainees to effectively manage the problems they will encounter in complex, team-based healthcare.

Everyday Ethics: Ethical Issues and Stress in Nursing Practice

PubMed Central

Ulrich, Connie M.; Taylor, Carol; Soeken, Karen; O'Donnell, Patricia; Farrar, Adrienne; Danis, Marion; Grady, Christine

2010-01-01

Aim This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Background Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. Methods A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analyzed using descriptive statistics, cross-tabulations and Pearson correlations. Results A total of 422 questionnaires were used in the analysis. The five most frequently-occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Conclusion Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. PMID:20735502

Everyday ethics: ethical issues and stress in nursing practice.

PubMed

Ulrich, Connie M; Taylor, Carol; Soeken, Karen; O'Donnell, Patricia; Farrar, Adrienne; Danis, Marion; Grady, Christine

2010-11-01

This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analysed using descriptive statistics, cross-tabulations and Pearson correlations. A total of 422 questionnaires were used in the analysis. The five most frequently occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. © 2010 Blackwell Publishing Ltd.

Describing the content of primary care: limitations of Canadian billing data.

PubMed

Katz, Alan; Halas, Gayle; Dillon, Michael; Sloshower, Jordan

2012-02-15

Primary health care systems are designed to provide comprehensive patient care. However, the ICD 9 coding system used for billing purposes in Canada neither characterizes nor captures the scope of clinical practice or complexity of physician-patient interactions. This study aims to describe the content of primary care clinical encounters and examine the limitations of using administrative data to capture the content of these visits. Although a number of U.S studies have described the content of primary care encounters, this is the first Canadian study to do so. Study-specific data collection forms were completed by 16 primary care physicians in community health and family practice clinics in Winnipeg, Manitoba, Canada. The data collection forms were completed immediately following the patient encounter and included patient and visit characteristics, such as primary reason for visit, topics discussed, actions taken, degree of complexity as well as diagnosis and ICD-9 codes. Data was collected for 760 patient encounters. The diagnostic codes often did not reflect the dominant topic of the visit or the topic requiring the most amount of time. Physicians often address multiple problems and provide numerous services thus increasing the complexity of care. This is one of the first Canadian studies to critically analyze the content of primary care clinical encounters. The data allowed a greater understanding of primary care clinical encounters and attests to the deficiencies of singular ICD-9 coding which fails to capture the comprehensiveness and complexity of the primary care encounter. As primary care reform initiatives in the U.S and Canada attempt to transform the way family physicians deliver care, it becomes increasingly important that other tools for structuring primary care data are considered in order to help physicians, researchers and policy makers understand the breadth and complexity of primary care.

Challenges Inherent in the Design and Implementation of After-School Intervention Programs for Middle Grade Underachieving Readers

ERIC Educational Resources Information Center

Velten, Justin; Mokhtari, Kouider

2016-01-01

In this brief report, we share three challenges we encountered when designing and implementing an after school intervention program for an ethnically diverse group of middle grade underachieving readers. We also offer practical solutions to help guide middle school teams in anticipating and addressing potential problems when putting in place…

My Voice Heard: The Journey of a Young Man with a Cerebral Visual Impairment

ERIC Educational Resources Information Center

Macintyre-Beon, Catriona; Mitchell, Kate; Gallagher, Ian; Cockburn, Debbie; Dutton, Gordon N.; Bowman, Richard

2012-01-01

This longitudinal case study presents John's journey through childhood and adolescence, living with visual difficulties associated with a cerebral visual impairment. It highlights the day-to-day problems that John encountered, giving practical solutions and strategies that have enabled his dream of going to a university to be realized. John and…

Practical Functional Approach to Quality Assessment in Subtitling: "Pocahontas II--Case Study"

ERIC Educational Resources Information Center

Hussain, Alaa Eddin; Khuddro, Ahmad

2016-01-01

The present research work deals with subtitling errors encountered by simulators and proof-readers. The resultant work is of significant contribution to problem decision makings in the field of quality assessment of audiovisual translation (AVT). The outcome of this paper is the result of accumulated working experience in this domain. The relevant…

Spontaneous Dancemaking with Beginning Improvisers: Foundational Practices in Presence, Stillness, and Problem Solving

ERIC Educational Resources Information Center

Martin, Nina

2017-01-01

Many dance artists in their first encounters with improvisational dance making begin not only to learn how to compose spontaneously, but also to gain skills for coping with the uncertainties inherent in the form. This article suggests helpful dance scores for beginning students of physical improvisation and those who teach improvisational…

Building Enrollment Through Curriculum Change: The Implementation of a Comprehension-Based Program in Spanish.

ERIC Educational Resources Information Center

Long, Donna R.

1985-01-01

Describes the implementation of a first-year comprehension-based Spanish language program at New Mexico State University. Includes a discussion of the history of the program and of the problems encountered in changing a traditional curriculum. Also describes the materials, classroom practice, and testing and evaluation techniques used in the…

Teaching Creative Thinking and Transitioning Students to the Workplace in an Academic Setting

ERIC Educational Resources Information Center

Senra, Michael; Fogler, H. Scott

2014-01-01

In their collegiate studies, students are given a wide range of concepts, theories, and equations to assist them in their future endeavors. However, students have not been sufficiently exposed to practical critical thinking methodologies that will benefit them as they encounter open-ended problems. A course developed at the University of Michigan…

Ethical Aspects of the Hippocratic Corpus text De arte.

PubMed

Konstantinidou, Meropi K

2016-12-01

The practice of medicine is a complex situation from an ethical point of view in the modern Western societies. But some very simple principles could help the immediate and effective response, at least to a percentage of the problems encountered. Such assistance can be derived from the writings of the Hippocratic Corpus, not only from the so-called ethical or theoretical texts. In this direction, the book titled De arte contains remarks about the right way of practicing medicine and the skills needed by the doctor.

[Software for illustrating a cost-quality balance carried out by clinical laboratory practice].

PubMed

Nishibori, Masahiro; Asayama, Hitoshi; Kimura, Satoshi; Takagi, Yasushi; Hagihara, Michio; Fujiwara, Mutsunori; Yoneyama, Akiko; Watanabe, Takashi

2010-09-01

We have no proper reference indicating the quality of clinical laboratory practice, which should clearly illustrates that better medical tests require more expenses. Japanese Society of Laboratory Medicine was concerned about recent difficult medical economy and issued a committee report proposing a guideline to evaluate the good laboratory practice. According to the guideline, we developed software that illustrate a cost-quality balance carried out by clinical laboratory practice. We encountered a number of controversial problems, for example, how to measure and weight each quality-related factor, how to calculate costs of a laboratory test and how to consider characteristics of a clinical laboratory. Consequently we finished only prototype software within the given period and the budget. In this paper, software implementation of the guideline and the above-mentioned problems are summarized. Aiming to stimulate these discussions, the operative software will be put on the Society's homepage for trial

Aggressive behaviour - prevention and management in the general practice environment.

PubMed

Sim, Moira G; Wain, Toni; Khong, Eric

2011-11-01

Aggressive behaviour is commonly encountered in the general practice setting and can often be de-escalated using good communication skills. This article provides strategies to reduce and manage early aggression in the general practice environment. Aggressive behaviour usually occurs when a person feels unfairly treated. Having a systematic approach to the problem can improve safety for both staff and patients. This includes patient centred practice, identifying and managing the early signs of aggression to prevent escalation, having a plan to seek assistance if required, setting limits using a calm respectful manner and reinforcing limits using behaviour contracts when required. The physical layout of the practice and restraint of aggressive people are beyond the scope of this article.

Problems Encountered by Religious Vocational Secondary School and Other Secondary School Students in Physical Education and Sports Activities

ERIC Educational Resources Information Center

Bar, Mustafa; Yaman, Menzure Sibel; Hergüner, Gülten

2016-01-01

The study aimed to determine problems encountered by Religious Vocational Secondary School and other Secondary School students in physical education and sports activities and to compare these problems according to school type and gender. A questionnaire named "Problems encountered in attending to physical education and sports activities"…

Linking guidelines to Electronic Health Record design for improved chronic disease management.

PubMed

Barretto, Sistine A; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and workflow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR.

Linking Guidelines to Electronic Health Record Design for Improved Chronic Disease Management

PubMed Central

Barretto, Sistine A.; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and work-flow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR. PMID:14728135

[Professional debate on shortage of physicians].

PubMed

Gérvas, Juan; Bonis, Julio

2008-01-01

We do not know the best answer to problems due to shortage of physicians (absolute number and by specialities) but perhaps what is important is the lack of a professional debate about what means 'to be' a physician. In this paper we address four key professional questions: 1/ the over-training of physicians when health demand now includes minor problems, 2/ predominance of physician-patient direct encounters in a world of telecommunications and indirect encounters, 3/ the need to delegate power and responsibilities to other health professionals as a consequence of new technology developments and changes in role-design, and 4/ too much emphasis in diagnosis with the danger to initiate cascades with its side-effects. Practical answers to these questions require changes in pre and postgraduate education, improvement in health services organization to profit the use of telecommunications and analysis and re-design of the limits in between professions, levels of care, institutions and health and social sectors.

Isolation of bioactive allelochemicals from sunflower (variety Suncross-42) through fractionation-guided bioassays.

PubMed

Anjum, Tehmina; Bajwa, Rukhsana

2010-11-01

Plants are rich source of biologically active allelochemicals. However, natural product discovery is not an easy task. Many problems encountered during this laborious practice can be overcome through the modification of preliminary trials. Bioassay-directed isolation of active plant compounds can increase efficiency by eliminating many of the problems encountered. This strategy avoids unnecessary compounds, concentrating on potential components and thus reducing the cost and time required. In this study, a crude aqueous extract of sunflower leaves was fractionated through high performance liquid chromatography. The isolated fractions were checked against Chenopodium album and Rumex dentatus. The fraction found active against two selected weeds was re-fractionated, and the active components were checked for their composition. Thin layer chromatography isolated a range of phenolics, whereas the presence of bioactive terpenoids was confirmed through mass spectroscopy and nuclear magnetic resonance spectroscopy.

The Quest for a Culture of Learning: A South African Schools Perspective

ERIC Educational Resources Information Center

Weeks, F. H.

2012-01-01

Within the media and the literature the need is often expressed for the establishment of a culture of learning within South African schools. The contrasting view tends to be one of dysfunctional schools that have come into being, giving rise to significant learner behaviour problems and poor pass rates being encountered in practice. This paper is…

Probability and Statistics in Aerospace Engineering

NASA Technical Reports Server (NTRS)

Rheinfurth, M. H.; Howell, L. W.

1998-01-01

This monograph was prepared to give the practicing engineer a clear understanding of probability and statistics with special consideration to problems frequently encountered in aerospace engineering. It is conceived to be both a desktop reference and a refresher for aerospace engineers in government and industry. It could also be used as a supplement to standard texts for in-house training courses on the subject.

Too Many Problems and Not Enough Help: Exploring the Need for School Social Workers in the Hashemite Kingdom of Jordan

ERIC Educational Resources Information Center

Alhajjaj, Huda A.

2017-01-01

Social work encompasses many different fields of practice. School social workers provide services to students encountering a wide spectrum of psychosocial and behavioral challenges at school, home, and society. While school social workers exist in many countries across the globe, many countries such as Jordan remain without school social workers.…

A Primer on Responsibility Centre Budgeting and Responsibility Centre Management. Professional File, Winter 1999, Number 17.

ERIC Educational Resources Information Center

Lang, Daniel W.

This monograph is a "how-to" manual on responsibility center budgeting (RCB) and responsibility center management (RCM) in the context of Canadian and U.S. institutions. It explains how RCB/RCM works in practice and discusses some of the problems encountered in implementing this strategy at a number of Canadian and U.S. universities. The…

Nurse-midwifery in rural Pakistan.

PubMed

Woods, A B

1991-01-01

Pakistan is a relatively new nation of predominantly Islamic influence. Like many developing countries, it is plagued by extensive communicable diseases, malnutrition, inadequate sewage systems, and illiteracy. Religious beliefs and cultural influences impact heavily on access to health care and on maternal-child health outcomes. This paper examines the major maternal-child health problems encountered, as well as implications for midwifery practice in an Islamic country.

AMDIS Case Conference

PubMed Central

Graham, J.; Levick, D.; Schreiber, R.

2010-01-01

Clinical decision support that provides enhanced patient safety at the point of care frequently encounters significant pushback from clinicians who find the process intrusive or time-consuming. We present a hypothetical medical center’s dilemma about its allergy alerting system and discuss similar problems faced by real hospitals. We then share some lessons learned and best practices for institutions who wish to implement these tools themselves. PMID:23616828

Goodbye, Podium: An Engineering Course Puts Theory into Practice

ERIC Educational Resources Information Center

Connor, Kenneth A.

2012-01-01

When students complete a lab experiment at home or in a staffed lab on campus, they come to class better able to explain what they have done and why they think the approach is correct, and to provide explanations or questions about any problems they encountered. What is so cool is that the learning experience has all the key aspects of the…

[Problem-posing as a nutritional education strategy with obese teenagers].

PubMed

Rodrigues, Erika Marafon; Boog, Maria Cristina Faber

2006-05-01

Obesity is a public health issue with relevant social determinants in its etiology and where interventions with teenagers encounter complex biopsychological conditions. This study evaluated intervention in nutritional education through a problem-posing approach with 22 obese teenagers, treated collectively and individually for eight months. Speech acts were collected through the use of word cards, observer recording, and tape-recording. The study adopted a qualitative methodology, and the approach involved content analysis. Problem-posing facilitated changes in eating behavior, triggering reflections on nutritional practices, family circumstances, social stigma, interaction with health professionals, and religion. Teenagers under individual care posed problems more effectively in relation to eating, while those under collective care posed problems in relation to family and psychological issues, with effective qualitative eating changes in both groups. The intervention helped teenagers understand their life history and determinants of eating behaviors, spontaneously implementing eating changes and making them aware of possibilities for maintaining the new practices and autonomously exercising their role as protagonists in their own health care.

Lessons learned from the reimbursement profile of a mature private medical toxicology practice: office-based practice pays.

PubMed

Thompson, Trevonne M; Leikin, Jerrold B

2015-03-01

We previously reported the financial data for the first 5 years of one of the author's medical toxicology practice. The practice has matured; changes have been made. The practice is increasing its focus on office-based encounters and reducing hospital-based acute care encounters. We report the reimbursement rates and other financial metrics of the current practice. Financial records from October 2009 through September 2013 were reviewed. This is a period of 4 fiscal years and represents the currently available financial data. Charges, payments, and reimbursement rates were recorded according to the type and setting of the medical toxicology encounter: forensic consultations, outpatient clinic encounters, nonpsychiatric inpatient consultations, emergency department (ED) consultations, and inpatient psychiatric consultations. All patients were seen regardless of ability to pay or insurance status. The number of billed Current Procedural Terminology (CPT) codes for office-based encounters increased over the study period; the number of billed CPT codes for inpatient and ED consultations reduced. Office-based encounters demonstrate a higher reimbursement rate and higher payments. In the fiscal year (FY) of 2012, office-based revenue exceeded hospital-based acute care revenue by over $140,000 despite a higher number of billed CPT encounters in acute care settings, and outpatient payments were 2.39 times higher than inpatient, inpatient psychiatry, observation unit, and ED payments combined. The average payment per CPT code was higher for outpatient clinic encounters than inpatient encounters for each fiscal year studied. There was an overall reduction in CPT billing volume between FY 2010 and FY 2013. Despite this, there was an increase in total practice revenue. There was no change in payor mix, practice logistics, or billing/collection service company. In this medical toxicology practice, office-based encounters demonstrate higher reimbursement rates and overall payments compared to inpatient and ED consultations. While consistent with our previous studies, these differences have been accentuated. This study demonstrates the results of changes to the practice--reduced inpatient/ED consultations and increased outpatient encounters. These practice changes resulted in higher overall revenue despite a lower patient volume. In this analysis, the office-based practice of medical toxicology has higher reimbursement rates, nearly 2.5 times higher, when compared to hospital-based acute care consultations.

Challenges in conducting qualitative research in health: A conceptual paper

PubMed Central

Khankeh, Hamidreza; Ranjbar, Maryam; Khorasani-Zavareh, Davoud; Zargham-Boroujeni, Ali; Johansson, Eva

2015-01-01

Background: Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. Materials and Methods: This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. Results: One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues. Conclusions: The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others. PMID:26793245

Observed intra-cluster correlation coefficients in a cluster survey sample of patient encounters in general practice in Australia

PubMed Central

Knox, Stephanie A; Chondros, Patty

2004-01-01

Background Cluster sample study designs are cost effective, however cluster samples violate the simple random sample assumption of independence of observations. Failure to account for the intra-cluster correlation of observations when sampling through clusters may lead to an under-powered study. Researchers therefore need estimates of intra-cluster correlation for a range of outcomes to calculate sample size. We report intra-cluster correlation coefficients observed within a large-scale cross-sectional study of general practice in Australia, where the general practitioner (GP) was the primary sampling unit and the patient encounter was the unit of inference. Methods Each year the Bettering the Evaluation and Care of Health (BEACH) study recruits a random sample of approximately 1,000 GPs across Australia. Each GP completes details of 100 consecutive patient encounters. Intra-cluster correlation coefficients were estimated for patient demographics, morbidity managed and treatments received. Intra-cluster correlation coefficients were estimated for descriptive outcomes and for associations between outcomes and predictors and were compared across two independent samples of GPs drawn three years apart. Results Between April 1999 and March 2000, a random sample of 1,047 Australian general practitioners recorded details of 104,700 patient encounters. Intra-cluster correlation coefficients for patient demographics ranged from 0.055 for patient sex to 0.451 for language spoken at home. Intra-cluster correlations for morbidity variables ranged from 0.005 for the management of eye problems to 0.059 for management of psychological problems. Intra-cluster correlation for the association between two variables was smaller than the descriptive intra-cluster correlation of each variable. When compared with the April 2002 to March 2003 sample (1,008 GPs) the estimated intra-cluster correlation coefficients were found to be consistent across samples. Conclusions The demonstrated precision and reliability of the estimated intra-cluster correlations indicate that these coefficients will be useful for calculating sample sizes in future general practice surveys that use the GP as the primary sampling unit. PMID:15613248

Problems and Processes in Medical Encounters: The CASES method of dialogue analysis

PubMed Central

Laws, M. Barton; Taubin, Tatiana; Bezreh, Tanya; Lee, Yoojin; Beach, Mary Catherine; Wilson, Ira B.

2013-01-01

Objective To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. Methods Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The Comprehensive Analysis of the Structure of Encounters System (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads – the problems or issues addressed; and processes within threads –basic tasks of clinical care labeled Presentation, Information, Resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. Results 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. Conclusions In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. Practice Implications Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective. PMID:23391684

Avoiding (or fixing) problems with lawyers and courts.

PubMed

Reid, William H

2013-03-01

Clinicians who do work for attorneys and courts sometimes encounter problems in defining their roles, with access to records or litigants, with unexpected changes or additions to their tasks, or with being compensated for their work. Understanding the context of the forensic consultation and the processes commonly employed by lawyers and the judiciary can prevent many problems. Be cautious about "informal" requests from attorneys, particularly if they involve your own patients. Maintain solid business practices and make sure your role, relationship, and financial agreement with the person or entity retaining you are clear, ethical, and well documented before you begin work on a case.

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

PubMed

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

2006-01-01

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

On Using a Pilot Sample Variance for Sample Size Determination in the Detection of Differences between Two Means: Power Consideration

ERIC Educational Resources Information Center

Shieh, Gwowen

2013-01-01

The a priori determination of a proper sample size necessary to achieve some specified power is an important problem encountered frequently in practical studies. To establish the needed sample size for a two-sample "t" test, researchers may conduct the power analysis by specifying scientifically important values as the underlying population means…

AMDIS Case Conference: Intrusive Medication Safety Alerts.

PubMed

Graham, J; Levick, D; Schreiber, R

2010-01-01

Clinical decision support that provides enhanced patient safety at the point of care frequently encounters significant pushback from clinicians who find the process intrusive or time-consuming. We present a hypothetical medical center's dilemma about its allergy alerting system and discuss similar problems faced by real hospitals. We then share some lessons learned and best practices for institutions who wish to implement these tools themselves.

Resources for Adapting Low Vision Training Materials for the Adult with Low Literacy Skills. Practice Report

ERIC Educational Resources Information Center

Tucker, Laurel A.

2004-01-01

Adults with low vision who seek clinical low vision services need to be able to read (that is, to interpret or understand words, numbers, and symbols in print meaningfully). Reading difficulties that adults encounter during low vision therapy may be directly connected to a visual impairment or may be related to other reading problems, such as…

Learning for Economic Self-Sufficiency: Constructing Pedagogies of Hope among Low-Income, Low-Literate Adults. Adult Education Special Topics: Theory, Research and Practice in LifeLong Learning

ERIC Educational Resources Information Center

Alfred, Mary V., Ed.

2010-01-01

In a most timely volume addressing many of the connections among current fiscal and employment crises to adult education, Learning for Economic Self-Sufficiency highlights the problems and challenges that low-literate adults encounter in various environments. Moreover, this book presents strategies for addressing the chronic illiteracy among…

Charting the 7 c's of cultural change affecting foreign nurses: competency, communication, consistency, cooperation, customs, conformity and courage.

PubMed

Parrone, Joyce; Sedrl, Darlene; Donaubauer, Carolyn; Phillips, Marge; Miller, Marilyn

2008-01-01

Eighty-two percent of practicing RNs are located in metropolitan areas in which the predominant employment setting is the hospital according to the National Sample Survey of Registered Nurses (Services, 2000). However, despite current trends toward moderate increased enrollment in nursing schools, a 2001American Hospital Survey (AHA) among 715 member hospitals revealed that 126,000 registered nurse positions across America remain unfilled. As a result, hospitals have adopted creative solutions to ease the nursing shortage. One creative solution is to import foreign nurses. According to the Commission on Graduates of Foreign Nursing Schools (CGFNS) many come from the Philippines, are single, female and between 23-27 years of age. The foreign nurse will encounter many barriers and practice problems no matter his/her level of skill. This article explores seven areas of clinical competency that nurses from the Philippines will encounter and must surmount as well as some of the implications for nursing practice that veteran and newly graduated nurses might want to be aware of when working with foreign nurses.

Medical support for law enforcement-extended operations incidents.

PubMed

Levy, Matthew J; Tang, Nelson

2014-01-01

As the complexity and frequency of law enforcement-extended operations incidents continue to increase, so do the opportunities for adverse health and well-being impacts on the responding officers. These types of clinical encounters have not been well characterized nor have the medical response strategies which have been developed to effectively manage these encounters been well described. The purpose of this article is to provide a descriptive epidemiology of the clinical encounters reported during extended law enforcement operations, as well as to describe a best practices approach for their effective management. This study retrospectively examined the clinical encounters of the Maryland State Police (MSP) Tactical Medical Unit (TMU) during law enforcement extended operations incidents lasting 8 or more hours. In addition, a qualitative analysis was performed on clinical data collected by federal law enforcement agencies during their extended operations. Forty-four percent of missions (455/1,047) supported by the MSP TMU lasted 8 or more hours. Twenty-six percent of these missions (117/455) resulted in at least one patient encounter. Nineteen percent of patient chief complaints (45/238) were related to heat illness/ dehydration. Fifteen percent of encounters (36/238) were for musculoskeletal injury/pain. Eight percent of patients (19/238) had nonspecific sick call (minor illness) complaints. The next most common occurring complaints were cold-related injuries, headache, sinus congestion, and wound/laceration, each of which accounted for 7 percent of patients (16/238), respectively. Analysis of federal law enforcement agencies' response to such events yielded similar clinical encounters. A wide range of health problems are reported by extended law enforcement operations personnel. Timely and effective treatment of these problems can help ensure that the broader operations mission is not compromised. An appropriate operational strategy for managing health complaints reported during extended operations involves the deployment of a well-trained medical support team using the core concepts of tactical emergency medical support.

Professional or administrative value patterns? Clinical pathways in medical problem-solving processes.

PubMed

Holmberg, Leif

2007-11-01

A health-care organization simultaneously belongs to two different institutional value patterns: a professional and an administrative value pattern. At the administrative level, medical problem-solving processes are generally perceived as the efficient application of familiar chains of activities to well-defined problems; and a low task uncertainty is therefore assumed at the work-floor level. This assumption is further reinforced through clinical pathways and other administrative guidelines. However, studies have shown that in clinical practice such administrative guidelines are often considered inadequate and difficult to implement mainly because physicians generally perceive task uncertainty to be high and that the guidelines do not cover the scope of encountered deviations. The current administrative level guidelines impose uniform structural features that meet the requirement for low task uncertainty. Within these structural constraints, physicians must organize medical problem-solving processes to meet any task uncertainty that may be encountered. Medical problem-solving processes with low task uncertainty need to be organized independently of processes with high task uncertainty. Each process must be evaluated according to different performance standards and needs to have autonomous administrative guideline models. Although clinical pathways seem appropriate when there is low task uncertainty, other kinds of guidelines are required when the task uncertainty is high.

U.S. healthcare providers’ experience with Lyme and other tick-borne diseases

PubMed Central

Brett, Meghan E.; Hinckley, Alison F.; Zielinski-Gutierrez, Emily C.; Mead, Paul S.

2015-01-01

Surveillance indicates that tick-borne diseases are a common problem in the United States. Nevertheless, little is known regarding the experience or management practices of healthcare providers who treat these conditions. The purpose of the present study was to characterize the frequency of tick-borne diseases in clinical practice and the knowledge of healthcare providers regarding their management. Four questions about tick-borne diseases were added to the 2009 Docstyles survey, a nationally representative survey of >2000 U.S. healthcare providers. Topics included diseases encountered, management of patients with early Lyme disease (LD), provision of tick-bite prophylaxis, and sources of information on tick-borne diseases. Overall, 51.3% of practitioners had treated at least one patient for a tick-borne illness in the previous year. Among these, 75.1% had treated one type of disease, 19.0% two types of disease, and 5.9% three or more diseases. LD was encountered by 936 (46.8%) providers; Rocky Mountain spotted fever was encountered by 184 (9.2%) providers. Given a scenario involving early LD, 89% of providers would prescribe antibiotics at the first visit, with or without ordering a blood test. Tick-bite prophylaxis was prescribed by 31.0% of all practitioners, including 41.1% in high-LD-incidence states and 26.0% in low-incidence states. Tick-borne diseases are encountered frequently in clinical practice. Most providers would treat early LD promptly, suggesting they are knowledgeable regarding the limitations of laboratory testing in this setting. Conversely, providers in low-LD-incidence states frequently prescribe tick-bite prophylaxis, suggesting a need for education to reduce potential misdiagnosis and overtreatment. PMID:24713280

Citizenship as practice: Handling communication problems in encounters between persons with dementia and social workers.

PubMed

Jh, Österholm; L-C, Hydén

2016-11-01

The overall aim of the study was to investigate if and how persons with dementia were able to take part in negotiations for formal support, as cases of citizenship as practice The transcripts used for analysis were from 11 assessment meetings conducted in Sweden, in which the formal applicant was a person with dementia. The findings suggest that the actual participation of persons with dementia in assessment meetings varies. Communication problems were found in the meetings to different degrees and were dealt with differently and with various consequences. For those persons with dementia contributing at the same levels as the other participants, there was an attempt at mutual understanding. For those making fewer contributions, the other interlocutors took over the initiative and thus affected the practice of citizenship by persons with dementia in a negative way. The practice of citizenship is situation based and varies depending on all participants. When the person with dementia is able to participate in the conversation, social workers can facilitate for them to overcome communication problems by giving them more time and signaling acceptance. If the person with dementia has great problems in participating, the other participants can find different strategies to at least involve her or him in the conversation. © The Author(s) 2014.

Filing Reprints: Can Office Staff Help?

PubMed Central

Putnam, R. W.; Gass, D. A.; Curry, Lynn

1985-01-01

Filing systems for reprints must be tailored to the individual's practice profile, to maximize usefulness as a resource for clinical problem solving. However, the clerical time involved often reduces the physician's ability to maintain such a filing system. The authors tested two hypotheses that using the International Classification of Health Problems in Primary Care (ICHPPC) nurses or receptionists could code, cross reference and file reprints after the physician has selected the articles. Contents pages of five primary care journals were given to two academic family physicians, two practicing physicians, a research assistant and two receptionists, one of whom had used ICHPPC to record patient encounters. All coders except the second receptionist, who was unfamiliar with ICHPPC, reached good agreement in coding. Filing reprints may therefore be done by trained staff for groups of physicians. PMID:21274020

How a Small Family Run Business Adopted Critical Reflection Action Learning Using Hand Drawn Images to Initiate Organisational Change

ERIC Educational Resources Information Center

Shepherd, Gary

2016-01-01

In this account of practice I would like to share my experiences of facilitating a Critical Reflection Action Learning (CRAL) set with a small family run business, struggling to make change and expand their services due to the problems they encountered in separating their business lives from their family lives. The account I present here is based…

Introduction to Geostatistics

NASA Astrophysics Data System (ADS)

Kitanidis, P. K.

1997-05-01

Introduction to Geostatistics presents practical techniques for engineers and earth scientists who routinely encounter interpolation and estimation problems when analyzing data from field observations. Requiring no background in statistics, and with a unique approach that synthesizes classic and geostatistical methods, this book offers linear estimation methods for practitioners and advanced students. Well illustrated with exercises and worked examples, Introduction to Geostatistics is designed for graduate-level courses in earth sciences and environmental engineering.

Children learn spurious associations in their math textbooks: Examples from fraction arithmetic.

PubMed

Braithwaite, David W; Siegler, Robert S

2018-04-26

Fraction arithmetic is among the most important and difficult topics children encounter in elementary and middle school mathematics. Braithwaite, Pyke, and Siegler (2017) hypothesized that difficulties learning fraction arithmetic often reflect reliance on associative knowledge-rather than understanding of mathematical concepts and procedures-to guide choices of solution strategies. They further proposed that this associative knowledge reflects distributional characteristics of the fraction arithmetic problems children encounter. To test these hypotheses, we examined textbooks and middle school children in the United States (Experiments 1 and 2) and China (Experiment 3). We asked the children to predict which arithmetic operation would accompany a specified pair of operands, to generate operands to accompany a specified arithmetic operation, and to match operands and operations. In both countries, children's responses indicated that they associated operand pairs having equal denominators with addition and subtraction, and operand pairs having a whole number and a fraction with multiplication and division. The children's associations paralleled the textbook input in both countries, which was consistent with the hypothesis that children learned the associations from the practice problems. Differences in the effects of such associative knowledge on U.S. and Chinese children's fraction arithmetic performance are discussed, as are implications of these differences for educational practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

General aviation avionics equipment maintenance

NASA Technical Reports Server (NTRS)

Parker, C. D.; Tommerdahl, J. B.

1978-01-01

Maintenance of general aviation avionics equipment was investigated with emphasis on single engine and light twin engine general aviation aircraft. Factors considered include the regulatory agencies, avionics manufacturers, avionics repair stations, the statistical character of the general aviation community, and owners and operators. The maintenance, environment, and performance, repair costs, and reliability of avionics were defined. It is concluded that a significant economic stratification is reflected in the maintenance problems encountered, that careful attention to installations and use practices can have a very positive impact on maintenance problems, and that new technologies and a general growth in general aviation will impact maintenance.

Practical problems which women encounter with available contraception in Australia.

PubMed

Weisberg, E

1994-06-01

Australian women face major difficulties with contraception because of the limited range of choices, the need for meticulous attention to compliance with most available methods and because of cost limitations for a significant minority of the population. The most commonly used methods are oral contraceptive pills and barrier methods, and each has substantial compliance problems which can be minimized with care and counselling. There is an urgent need for a wider range of options in Australia and for good information and publicity about them. Present progress in this direction gives some hope for the near future.

Applying evidence to support ethical decisions: is the placebo really powerless?.

PubMed

Porzsolt, Franz; Schlotz-Gorton, Nicole; Biller-Andorno, Nikola; Thim, Anke; Meissner, Karin; Roeckl-Wiedmann, Irmgard; Herzberger, Barbara; Ziegler, Renatus; Gaus, Wilhelm; Pöppe, Ernst

2004-01-01

Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and "knowledge framing". While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing--which is only conceptually different from placebo--is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need to investigate the effects of knowledge framing and its impact on ethical, medical, economical and legal decisions.

Evidence-based medicine and the development of medical libraries in China.

PubMed

Huang, Michael Bailou; Cheng, Aijun; Ma, Lu

2009-07-01

This article elaborates on the opportunities and challenges that evidence-based medicine (EBM) has posed to the development of medical libraries and summarizes the research in the field of evidence-based medicine and achievements of EBM practice in Chinese medical libraries. Issues such as building collections of information resources, transformation of information services models, human resources management, and training of medical librarians, clinicians, and EBM users are addressed. In view of problems encountered in EBM research and practice, several suggestions are made about important roles medical libraries can play in the future development of EBM in China.

The pond is wider than you think! Problems encountered when searching family practice literature.

PubMed Central

Rosser, W. W.; Starkey, C.; Shaughnessy, R.

2000-01-01

OBJECTIVE: To explain differences in the results of literature searches in British general practice and North American family practice or family medicine. DESIGN: Comparative literature search. SETTING: The Department of Family and Community Medicine at the University of Toronto in Ontario. METHOD: Literature searches on MEDLINE demonstrated that certain search strategies ignored certain key words, depending on the search engine and the search terms chosen. Literature searches using the key words "general practice," "family practice," and "family medicine" combined with the topics "depression" and then "otitis media" were conducted in MEDLINE using four different Web-based search engines: Ovid, HealthGate, PubMed, and Internet Grateful Med. MAIN OUTCOME MEASURES: The number of MEDLINE references retrieved for both topics when searched with each of the three key words, "general practice," "family practice," and "family medicine" using each of the four search engines. RESULTS: For each topic, each search yielded very different articles. Some search engines did a better job of matching the term "general practice" to the terms "family medicine" and "family practice," and thus improved retrieval. The problem of language use extends to the variable use of terminology and differences in spelling between British and American English. CONCLUSION: We need to heighten awareness of literature search problems and the potential for duplication of research effort when some of the literature is ignored, and to suggest ways to overcome the deficiencies of the various search engines. Images Figure 1 Figure 2 PMID:10660792

Laboratory errors and patient safety.

PubMed

Miligy, Dawlat A

2015-01-01

Laboratory data are extensively used in medical practice; consequently, laboratory errors have a tremendous impact on patient safety. Therefore, programs designed to identify and reduce laboratory errors, as well as, setting specific strategies are required to minimize these errors and improve patient safety. The purpose of this paper is to identify part of the commonly encountered laboratory errors throughout our practice in laboratory work, their hazards on patient health care and some measures and recommendations to minimize or to eliminate these errors. Recording the encountered laboratory errors during May 2008 and their statistical evaluation (using simple percent distribution) have been done in the department of laboratory of one of the private hospitals in Egypt. Errors have been classified according to the laboratory phases and according to their implication on patient health. Data obtained out of 1,600 testing procedure revealed that the total number of encountered errors is 14 tests (0.87 percent of total testing procedures). Most of the encountered errors lay in the pre- and post-analytic phases of testing cycle (representing 35.7 and 50 percent, respectively, of total errors). While the number of test errors encountered in the analytic phase represented only 14.3 percent of total errors. About 85.7 percent of total errors were of non-significant implication on patients health being detected before test reports have been submitted to the patients. On the other hand, the number of test errors that have been already submitted to patients and reach the physician represented 14.3 percent of total errors. Only 7.1 percent of the errors could have an impact on patient diagnosis. The findings of this study were concomitant with those published from the USA and other countries. This proves that laboratory problems are universal and need general standardization and bench marking measures. Original being the first data published from Arabic countries that evaluated the encountered laboratory errors and launch the great need for universal standardization and bench marking measures to control the laboratory work.

[Errors in wound management].

PubMed

Filipović, Marinko; Novinscak, Tomislav

2014-10-01

Chronic ulcers have adverse effects on the patient quality of life and productivity, thus posing financial burden upon the healthcare system. Chronic wound healing is a complex process resulting from the interaction of the patient general health status, wound related factors, medical personnel skill and competence, and therapy related products. In clinical practice, considerable improvement has been made in the treatment of chronic wounds, which is evident in the reduced rate of the severe forms of chronic wounds in outpatient clinics. However, in spite of all the modern approaches, efforts invested by medical personnel and agents available for wound care, numerous problems are still encountered in daily practice. Most frequently, the problems arise from inappropriate education, of young personnel in particular, absence of multidisciplinary approach, and inadequate communication among the personnel directly involved in wound treatment. To perceive them more clearly, the potential problems or complications in the management of chronic wounds can be classified into the following groups: problems mostly related to the use of wound coverage and other etiology related specificities of wound treatment; problems related to incompatibility of the agents used in wound treatment; and problems arising from failure to ensure aseptic and antiseptic performance conditions.

Levinas's ethics as a basis of healthcare - challenges and dilemmas.

PubMed

Nordtug, Birgit

2015-01-01

Levinas's ethics has in the last decades exerted a significant influence on Nursing and Caring Science. The core of Levinas's ethics - his analyses of how our subjectivity is established in the ethical encounter with our neighbour or the Other - is applied both to healthcare practice and in the project of building an identity of Nursing and Caring Science. Levinas's analyses are highly abstract and metaphysical, and also non-normative. Thus, his analyses cannot be applied directly to practical problems and questions. Theorists in Nursing and Caring Science are generally aware of this. Nevertheless, many of them use Levinas's analyses to explore and solve questions of practical and normative character. This article focuses on the challenges and dilemmas of using Levinas in this manner. The article is divided into two parts. The first part presents some central ideas of Levinas's ethics based on the latter part of his authorship. The main focus is on the radicalism of Levinas's critique of the symbolic order (which includes concepts, categories, knowledge, etc.) - or as he puts it 'the said' - as a basis for subjectivity and responsibility. Levinas's notions of saying, anarchy, and singularity accentuate this point of view. These notions refer to conditions in the language, which counteract the symbolic order in the ethical encounter to such an extent that it becomes an incomprehensible. Levinas gives the argumentation a metaphysical frame: The encounter with the incomprehensible is an encounter with the Holy, which is not the ontological God, but a metaphysical desire. It is a mystery as to what this means, and herein lies possibly the main challenge when using Levinas's ethics in science and research: How to maintain the radicalism of his critique of the symbolic order when this is to be communicated in a scientific context that expects clarification of statements and ideas? The second part of the article explores this question by examining how some theorists use Levinas's ethics on questions and problems in the area of healthcare and Nursing and Caring Science. The focus is especially on the theorists' reception and use of the just mentioned notions. The study reveals that these theorists to a large extent transform Levinas's ethics according to their own approaches, with the result that his ethics loses its critical radicalism. Thus, I question the reason why they use Levinas. © 2014 John Wiley & Sons Ltd.

The effect of heat sinks in GTA microwelding

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

Knorovsky, G.A.; Burchett, S.N.

1989-01-01

When miniature devices containing glass-to-metal seals are closure welded it is accepted practice to incorporate thermal heat sinks into the fixturing. This is intended to assure that the heat from gas tungsten arc (GTA) welding will not cause thermal stress-induced cracking of the seals and loss of hermeticity. The design of these heat sinks has never been systematically studied; instead only ''engineering horse sense'' has been applied. This practice has been successful in the past; however, the component being GTA welded have become smaller and more complex (i.e., more pins) and glass cracking problems are being encountered. The technology ofmore » producing glass seal-containing lids (called ''headers'') has benefited from finite element analyses in deciding how to optimally dimension pin-to-glass seal diameter ratios and glass-to-metal thickness ratios in order to minimize thermal stresses locked in during manufacture. It appeared likely that an analysts of the stresses generated by welding would also be beneficial. Recently, computer speed and code capabilities have increased to the point where finite element analysis of a close simulation of real hardware can be made, including the effect of external heat sinks. The work reported here involves an analysis (with some supporting experimental data) of a miniature thermal battery which encountered glass cracking problems. In the course of the analysis various heat sink practices were examined. Among other findings, through-thickness thermal gradients in a header with a heat sink were found to equal in-plane thermal gradients in a header without any heat sinking at the glass seal positions. Also noted were significant variations due to relatively minor changes in the weld preparation geometry. A summary of good practice for heat sinking will be presented. 4 refs., 6 figs., 2 tabs.« less

[Residency in family medicine: problems and solutions].

PubMed

Boulé, Richard; Girard, Gilles

2003-04-01

To identify the problems encountered by residents during training and the solutions they proposed. Qualitative study. Family practice program at Sherbrooke University. Sixty-eight residents in the Family practice program between 1999 and 2000. We used the nominal group technique with four groups of participants. Then we held five 3-hour discussion groups to explore difficulties and solutions in depth. Finally, data were validated with a written questionnaire. At least 20% of respondents confirmed 65 difficulties and 61 solutions. Three major themes emerged: the many demands of the residence program, residents' personal experience of the program, and the lack of time for personal life. Publication of these results could help residents develop proactive adaptive strategies to deal with the stress of their training programs. Certain adjustments will be made by the program administration to make it easier for residents to manage their stress.

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study.

PubMed

Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

2003-03-01

The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31-246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3-13)) although no specific disease or patient characteristics were identified as associated with such difficulties. This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices.

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study

PubMed Central

Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

2003-01-01

Background and aims: The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. Methods: A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. Results: In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31–246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3–13)) although no specific disease or patient characteristics were identified as associated with such difficulties. Conclusions: This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices. PMID:12584216

Urological considerations in space medicine.

NASA Technical Reports Server (NTRS)

Cockett, A. T. K.; Adey, W. R.; Roberts, A. P.

1972-01-01

Urological problems encountered during the preparation phases of Biosatellite III, flight of Bonny the Space Monkey, are detailed. The solution to each problem is detailed. The catheter system employed, antibiotic coverage used, and bacteria encountered in the urine of the five animals are detailed. Urinary calcium levels in three ground based animals are illustrated. Testicular alterations encountered in all animals are mentioned. It is concluded that space flights of duration beyond nine days may present serious problems of a urological nature.

Hybridization of Practices in Teacher-Researcher Collaboration

ERIC Educational Resources Information Center

Hamza, Karim; Palm, Ola; Palmqvist, Jenny; Piqueras, Jesús; Wickman, Per-Olof

2018-01-01

In this paper we present experiences from a joint collaborative research project which may be described as an encounter between a school science teaching practice and a university science didactics research practice. We provide narratives which demonstrate how the encounter between these two communities of practice interacted to produce…

Identification and Management of Information Problems by Emergency Department Staff

PubMed Central

Murphy, Alison R.; Reddy, Madhu C.

2014-01-01

Patient-care teams frequently encounter information problems during their daily activities. These information problems include wrong, outdated, conflicting, incomplete, or missing information. Information problems can negatively impact the patient-care workflow, lead to misunderstandings about patient information, and potentially lead to medical errors. Existing research focuses on understanding the cause of these information problems and the impact that they can have on the hospital’s workflow. However, there is limited research on how patient-care teams currently identify and manage information problems that they encounter during their work. Through qualitative observations and interviews in an emergency department (ED), we identified the types of information problems encountered by ED staff, and examined how they identified and managed the information problems. We also discuss the impact that these information problems can have on the patient-care teams, including the cascading effects of information problems on workflow and the ambiguous accountability for fixing information problems within collaborative teams. PMID:25954457

Morbidity and process of care in urban Malaysian general practice: the impact of payment system.

PubMed

Teng, C L; Aljunid, S M; Cheah, Molly; Leong, K C; Kwa, S K

2003-08-01

The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting. We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities. 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index. During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections. This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system results in important differences in patient mix and influences some types of practice activities.

How to save distressed IDS-physician marriages: a case study.

PubMed

Collins, H; Johnson, B A

1998-04-01

A hospital-driven IDS that encounters serious problems resulting from ownership of a physician practice should address those problems by focusing on three core areas: vision and leadership, effectiveness of operations, and physician compensation arrangements. If changes in these areas do not lead to improvements, the IDS may need to consider organizational restructuring. In one case study, a hospital-driven IDS faced the problem of owning a poorly performing MSO with a captive physician group. The IDS's governing board determined that the organization lacked effective communication with the physicians and that realization of the organization's vision would require greater physician involvement in organizational decision making. The organization is expected to undergo some corporate reorganization in which physicians will acquire an equity interest in the enterprise.

Methodological troubles as problems and phenomena: ethnomethodology and the question of 'method' in the social sciences.

PubMed

Greiffenhagen, Christian; Mair, Michael; Sharrock, Wes

2015-09-01

Across the disciplinary frontiers of the social sciences, studies by social scientists treating their own investigative practices as sites of empirical inquiry have proliferated. Most of these studies have been retrospective, historical, after-the-fact reconstructions of social scientific studies mixing interview data with the (predominantly textual) traces that investigations leave behind. Observational studies of in situ work in social science research are, however, relatively scarce. Ethnomethodology was an early and prominent attempt to treat social science methodology as a topic for sociological investigations and, in this paper, we draw out what we see as its distinctive contribution: namely, a focus on troubles as features of the in situ, practical accomplishment of method, in particular, the way that research outcomes are shaped by the local practices of investigators in response to the troubles they encounter along the way. Based on two case studies, we distinguish methodological troubles as problems and methodological troubles as phenomena to be studied, and suggest the latter orientation provides an alternate starting point for addressing social scientists' investigative practices. © London School of Economics and Political Science 2015.

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

PubMed

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

2017-01-01

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

Common Speech Problems Encountered in General Practice

PubMed Central

Godfrey, Charles M.; Ward, Jean F.

1962-01-01

The authors consider speech and communication in the light of whole patient care and point out that defects may be signs and symptoms of underlying organic disease. They describe the four classifications of speech disorders—articulation, rhythm, voice and language, with an indication of the speech therapy required and duration of treatment. Special emphasis has been given to those speech problems which are seen by the family physician; these are usually of the articulation group. A short discussion of stuttering and aphasia is given. Emphasis is put on the direction of treatment by the physician and the use of well-qualified personnel as members of the rehabilitation team. PMID:13963265

On inconsistency in frictional granular systems

NASA Astrophysics Data System (ADS)

Alart, Pierre; Renouf, Mathieu

2018-04-01

Numerical simulation of granular systems is often based on a discrete element method. The nonsmooth contact dynamics approach can be used to solve a broad range of granular problems, especially involving rigid bodies. However, difficulties could be encountered and hamper successful completion of some simulations. The slow convergence of the nonsmooth solver may sometimes be attributed to an ill-conditioned system, but the convergence may also fail. The prime aim of the present study was to identify situations that hamper the consistency of the mathematical problem to solve. Some simple granular systems were investigated in detail while reviewing and applying the related theoretical results. A practical alternative is briefly analyzed and tested.

Australian men's sexual practices in saunas, sex clubs and other male sex on premises venues.

PubMed

Lyons, Anthony; Smith, Anthony M A; Grierson, Jeffrey W; von Doussa, Henry

2010-06-01

Sex on premises venues (SOPVs) where men have sex with men have been implicated in the spread of sexually transmissible infections, but few studies have described men's sexual encounters in SOPVs, particularly the degree to which men from different backgrounds engage in risky sexual practices. Interviewer administered surveys were conducted with 186 Australian men who have sex with men (MSM) within 48 h of visiting an SOPV. They reported their sexual practices, the characteristics of their partners and other circumstances surrounding their sexual encounters. All analyses were based on the number of sexual encounters (n = 430). Oral sex was the most common practice, occurring in 74.9% of encounters, followed by massage, frottage or kissing (53.7%), solo or mutual masturbation (36.3%), and anal sex (32.1%). Multivariate analyses revealed age as a significant factor for having protected anal sex (P = 0.001), insertive anal sex (P = 0.004) and receptive anal sex (P < 0.001). These practices were more frequent in encounters among younger men, while masturbation (P = 0.03) was more frequent among older men. When men's sexual partners were affected by alcohol, encounters were less likely to involve unprotected anal intercourse (P = 0.006) and more likely to involve massage, frottage or kissing (P = 0.009). Men disclosed their HIV status in only 7.7% of encounters. With the likelihood of risky sexual practices varying according to background, results from this study should be used to guide interventions aiming to promote safer sex in SOPVs.

Optimization of the convection volume in online post-dilution haemodiafiltration: practical and technical issues

PubMed Central

Chapdelaine, Isabelle; de Roij van Zuijdewijn, Camiel L.M.; Mostovaya, Ira M.; Lévesque, Renée; Davenport, Andrew; Blankestijn, Peter J.; Wanner, Christoph; Nubé, Menso J.; Grooteman, Muriel P.C.

2015-01-01

In post-dilution online haemodiafiltration (ol-HDF), a relationship has been demonstrated between the magnitude of the convection volume and survival. However, to achieve high convection volumes (>22 L per session) detailed notion of its determining factors is highly desirable. This manuscript summarizes practical problems and pitfalls that were encountered during the quest for high convection volumes. Specifically, it addresses issues such as type of vascular access, needles, blood flow rate, recirculation, filtration fraction, anticoagulation and dialysers. Finally, five of the main HDF systems in Europe are briefly described as far as HDF prescription and optimization of the convection volume is concerned. PMID:25815176

Diagnosis of gastrointestinal bleeding: A practical guide for clinicians

PubMed Central

Kim, Bong Sik Matthew; Li, Bob T; Engel, Alexander; Samra, Jaswinder S; Clarke, Stephen; Norton, Ian D; Li, Angela E

2014-01-01

Gastrointestinal bleeding is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is not apparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Obscure gastrointestinal bleeding is recurrent bleeding when the source remains unidentified after upper endoscopy and colonoscopic evaluation and is usually from the small intestine. Accurate clinical diagnosis is crucial and guides definitive investigations and interventions. This review summarizes the overall diagnostic approach to gastrointestinal bleeding and provides a practical guide for clinicians. PMID:25400991

Problems Encountered during the Scientific Research Process in Graduate Education: The Institute of Educational Sciences

ERIC Educational Resources Information Center

Akyürek, Erkan; Afacan, Özlem

2018-01-01

This study was conducted to determine the problems faced by graduate students when conducting scientific research and to make suggestions for solving these problems. The research model was a case study. Semi-structured interviews were conducted with participants in the study with questions about the problems encountered during scientific research…

Response problems in a vacation panel study

Treesearch

Christine A. Vogt; Susan I. Stewart

2001-01-01

This paper investigates response problems encountered in a panel study of travel behavior. Though the overall response rate to the three-wave panel study was acceptable (over 60%), three types of response problems were encountered: refusal, non-response, and attrition. In a follow-up phone survey, a sample of individuals from each problem response group was questioned...

Similitude design for the vibration problems of plates and shells: A review

NASA Astrophysics Data System (ADS)

Zhu, Yunpeng; Wang, You; Luo, Zhong; Han, Qingkai; Wang, Deyou

2017-06-01

Similitude design plays a vital role in the analysis of vibration and shock problems encountered in large engineering equipment. Similitude design, including dimensional analysis and governing equation method, is founded on the dynamic similitude theory. This study reviews the application of similitude design methods in engineering practice and summarizes the major achievements of the dynamic similitude theory in structural vibration and shock problems in different fields, including marine structures, civil engineering structures, and large power equipment. This study also reviews the dynamic similitude design methods for thin-walled and composite material plates and shells, including the most recent work published by the authors. Structure sensitivity analysis is used to evaluate the scaling factors to attain accurate distorted scaling laws. Finally, this study discusses the existing problems and the potential of the dynamic similitude theory for the analysis of vibration and shock problems of structures.

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

PubMed

Taslakian, Bedros; Sridhar, Divya

2017-09-01

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

Energy Dispersive Spectrometry and Quantitative Analysis Short Course. Introduction to X-ray Energy Dispersive Spectrometry and Quantitative Analysis

NASA Technical Reports Server (NTRS)

Carpenter, Paul; Curreri, Peter A. (Technical Monitor)

2002-01-01

This course will cover practical applications of the energy-dispersive spectrometer (EDS) to x-ray microanalysis. Topics covered will include detector technology, advances in pulse processing, resolution and performance monitoring, detector modeling, peak deconvolution and fitting, qualitative and quantitative analysis, compositional mapping, and standards. An emphasis will be placed on use of the EDS for quantitative analysis, with discussion of typical problems encountered in the analysis of a wide range of materials and sample geometries.

Patients with cardiac disease: considerations for the dental practitioner.

PubMed

Jowett, N I; Cabot, L B

2000-09-23

The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.

New Developments of Computational Fluid Dynamics and Their Applications to Practical Engineering Problems

NASA Astrophysics Data System (ADS)

Chen, Hudong

2001-06-01

There have been considerable advances in Lattice Boltzmann (LB) based methods in the last decade. By now, the fundamental concept of using the approach as an alternative tool for computational fluid dynamics (CFD) has been substantially appreciated and validated in mainstream scientific research and in industrial engineering communities. Lattice Boltzmann based methods possess several major advantages: a) less numerical dissipation due to the linear Lagrange type advection operator in the Boltzmann equation; b) local dynamic interactions suitable for highly parallel processing; c) physical handling of boundary conditions for complicated geometries and accurate control of fluxes; d) microscopically consistent modeling of thermodynamics and of interface properties in complex multiphase flows. It provides a great opportunity to apply the method to practical engineering problems encountered in a wide range of industries from automotive, aerospace to chemical, biomedical, petroleum, nuclear, and others. One of the key challenges is to extend the applicability of this alternative approach to regimes of highly turbulent flows commonly encountered in practical engineering situations involving high Reynolds numbers. Over the past ten years, significant efforts have been made on this front at Exa Corporation in developing a lattice Boltzmann based commercial CFD software, PowerFLOW. It has become a useful computational tool for the simulation of turbulent aerodynamics in practical engineering problems involving extremely complex geometries and flow situations, such as in new automotive vehicle designs world wide. In this talk, we present an overall LB based algorithm concept along with certain key extensions in order to accurately handle turbulent flows involving extremely complex geometries. To demonstrate the accuracy of turbulent flow simulations, we provide a set of validation results for some well known academic benchmarks. These include straight channels, backward-facing steps, flows over a curved hill and typical NACA airfoils at various angles of attack including prediction of stall angle. We further provide numerous engineering cases, ranging from external aerodynamics around various car bodies to internal flows involved in various industrial devices. We conclude with a discussion of certain future extensions for complex fluids.

Lack of Impact of Direct-to-Consumer Advertising on the Physician-Patient Encounter in Primary Care: A SNOCAP Report

PubMed Central

Parnes, Bennett; Smith, Peter C.; Gilroy, Christine; Quintela, Javan; Emsermann, Caroline B.; Dickinson, L. Miriam; Westfall, John M.

2009-01-01

PURPOSE Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their influence on clinical encounters in primary care. METHODS Our methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters. RESULTS One hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specific new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P<.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their first choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%. CONCLUSIONS Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specific socioeconomic groups and reasons for clinicians’ willingness to prescribe these medications. PMID:19139448

Lack of impact of direct-to-consumer advertising on the physician-patient encounter in primary care: a SNOCAP report.

PubMed

Parnes, Bennett; Smith, Peter C; Gilroy, Christine; Quintela, Javan; Emsermann, Caroline B; Dickinson, L Miriam; Westfall, John M

2009-01-01

Direct-to-consumer advertising (DTCA) has increased tremendously during the past decade. Recent changes in the DTCA environment may have affected its impact on clinical encounters. Our objective was to determine the rate of patient medication inquiries and their influence on clinical encounters in primary care. Our methods consisted of a cross-sectional survey in the State Networks of Colorado Ambulatory Practices and Partners, a collaboration of 3 practice-based research networks. Clinicians completed a short patient encounter form after consecutive patient encounter for one-half or 1 full day. The main outcomes were the rate of inquiries, independent predictors of inquiries, and overall impact on clinical encounters. One hundred sixty-eight clinicians in 22 practices completed forms after 1,647 patient encounters. In 58 encounters (3.5%), the patient inquired about a specific new prescription medication. Community health center patients made fewer inquiries than private practice patients (1.7% vs 7.2%, P<.001). Predictors of inquiries included taking 3 or more chronic medications and the clinician being female. Most clinicians reported the requested medication was not their first choice for treatment (62%), but it was prescribed in 53% of the cases. Physicians interpreted the overall impact on the visit as positive in 24% of visits, neutral in 66%, and negative in 10%. Patient requests for prescription medication were uncommon overall, and even more so among patients in lower income groups. These requests were rarely perceived by clinicians as having a negative impact on the encounter. Future mixed methods studies should explore specific socioeconomic groups and reasons for clinicians' willingness to prescribe these medications.

Shuttle Orbiter Active Thermal Control Subsystem design and flight experience

NASA Technical Reports Server (NTRS)

Bond, Timothy A.; Metcalf, Jordan L.; Asuncion, Carmelo

1991-01-01

The paper examines the design of the Space Shuttle Orbiter Active Thermal Control Subsystem (ATCS) constructed for providing the vehicle and payload cooling during all phases of a mission and during ground turnaround operations. The operation of the Shuttle ATCS and some of the problems encountered during the first 39 flights of the Shuttle program are described, with special attention given to the major problems encountered with the degradation of the Freon flow rate on the Orbiter Columbia, the Flash Evaporator Subsystem mission anomalies which occurred on STS-26 and STS-34, and problems encountered with the Ammonia Boiler Subsystem. The causes and the resolutions of these problems are discussed.

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

ERIC Educational Resources Information Center

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

2017-01-01

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

Problems Encountered by Novice Pair Programmers

ERIC Educational Resources Information Center

Hanks, Brian

2008-01-01

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

California residential energy standards: problems and recommendations relating to implementation, enforcement, and design. [Thermal insulation

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

Not Available

1977-08-01

Documents relevant to the development and implementation of the California energy insulation standards for new residential buildings were evaluated and a survey was conducted to determine problems encountered in the implementation, enforcement, and design aspects of the standards. The impact of the standards on enforcement agencies, designers, builders and developers, manufacturers and suppliers, consumers, and the building process in general is summarized. The impact on construction costs and energy savings varies considerably because of the wide variation in prior insulation practices and climatic conditions in California. The report concludes with a series of recommendations covering all levels of government andmore » the building process. (MCW)« less

Practical use and pitfalls of hepatocyte-specific contrast agents (HSCAs) for pediatric hepatic and biliary magnetic resonance imaging.

PubMed

Ayyala, Rama S; Anupindi, Sudha A; Callahan, Michael J

2017-02-01

Magnetic resonance imaging is commonly used to evaluate for hepatic and biliary pathology in the pediatric population. Recently, there has been increased use of hepatocyte-specific contrast agents (HSCAs), such as Gadoxetate disodium in children. Traditionally, HSCAs have been used to characterize focal liver lesions. However, these agents can also be used to problem solve specific hepatic or biliary diagnostic dilemmas. The purpose of this manuscript is to review the practical uses of HSCA in children with both hepatic and biliary indications, and review the corresponding imaging findings. We will highlight the diagnostic uses of HSCA in children, as well as pitfalls encountered.

Annealed Importance Sampling Reversible Jump MCMC algorithms

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

Karagiannis, Georgios; Andrieu, Christophe

2013-03-20

It will soon be 20 years since reversible jump Markov chain Monte Carlo (RJ-MCMC) algorithms have been proposed. They have significantly extended the scope of Markov chain Monte Carlo simulation methods, offering the promise to be able to routinely tackle transdimensional sampling problems, as encountered in Bayesian model selection problems for example, in a principled and flexible fashion. Their practical efficient implementation, however, still remains a challenge. A particular difficulty encountered in practice is in the choice of the dimension matching variables (both their nature and their distribution) and the reversible transformations which allow one to define the one-to-one mappingsmore » underpinning the design of these algorithms. Indeed, even seemingly sensible choices can lead to algorithms with very poor performance. The focus of this paper is the development and performance evaluation of a method, annealed importance sampling RJ-MCMC (aisRJ), which addresses this problem by mitigating the sensitivity of RJ-MCMC algorithms to the aforementioned poor design. As we shall see the algorithm can be understood as being an “exact approximation” of an idealized MCMC algorithm that would sample from the model probabilities directly in a model selection set-up. Such an idealized algorithm may have good theoretical convergence properties, but typically cannot be implemented, and our algorithms can approximate the performance of such idealized algorithms to an arbitrary degree while not introducing any bias for any degree of approximation. Our approach combines the dimension matching ideas of RJ-MCMC with annealed importance sampling and its Markov chain Monte Carlo implementation. We illustrate the performance of the algorithm with numerical simulations which indicate that, although the approach may at first appear computationally involved, it is in fact competitive.« less

Beyond Ockham's razor: redefining problem-solving in clinical sleep medicine using a "five-finger" approach.

PubMed

McCarty, David E

2010-06-15

The rule of diagnostic parsimony--otherwise known as "Ockham's Razor"--teaches students of medicine to find a single unifying diagnosis to explain a given patient's symptoms. While this approach has merits in some settings, a more comprehensive approach is often needed for patients with chronic, nonspecific presentations for which there is a broad differential diagnosis. The cardinal manifestations of sleep disorders--daytime neurocognitive impairment and subjective sleep disturbances-are examples of such presentations. Successful sleep medicine clinicians therefore approach every patient with the knowledge that multiple diagnoses-rather than simply one-are likely to be found. Teaching an integrated and comprehensive approach to other clinicians in an organized and reproducible fashion is challenging, and the evaluation of effectiveness of such teaching is even more so. As a practical aid for teaching the approach to--and evaluation of--a comprehensive sleep medicine encounter, five functional domains of sleep medicine clinical problem-solving are presented as potential sources for sleep/wake disruption: (1) circadian misalignment, (2) pharmacologic factors, (3) medical factors, (4) psychiatric/psychosocial factors, and (5) primary sleep medicine diagnoses. These domains are presented and explained in an easy-to-remember "five finger" format. The five finger format can be used in real time to evaluate the completeness of a clinical encounter, or can be used in the design of standardized patients to identify areas of strength and potential weakness. A score sheet based upon this approach is offered as an alternative to commonly used Likert scales as a potentially more objective and practical measure of clinical problem-solving competence, making it useful for training programs striving to achieve or maintain fellowship accreditation.

Management of children's psychological problems in general practice 1970-1971, 1990-1991 and 2008-2009.

PubMed

Charles, Janice; Harrison, Christopher M; Britt, Helena

2011-11-01

The aim of this study was to examine changes over four decades in children's psychological problems managed in Australian general practice and to describe recent management of these problems. Analysis of GP encounters with children, using data from the BEACH study, an on-going, cross-sectional, national survey of general practice, provides contemporary results. Comparisons with two related studies: 1970-1971 (from published reports), and 1990-1991 (secondary analysis), describe changes over time. Changes over time: psychological problems accounted for 2% of all children's problems managed in 1971, 1.3% in 1990-1991 and 2.6% in 2008-2009. In 1971, non-organic enuresis accounted for 30% of children's psychological problems but only 2.7% in 2008-2009. Insomnia showed a similar pattern. Between 1990-1991 and 2008-2009, ADHD increased from 0.8% to 14.7%, and from 2000-2001 to 2008-2009, autism spectrum disorders rose from 4.9% to 11%. Current practice: most common psychological problems managed for children less than 18 years were anxiety, depression, intellectual impairment and ADHD. Among children aged 0-5 years, sleep disturbance and intellectual impairment were the main problems, for 6-11 year olds, anxiety and ADHD, and for 12-17 year olds, depression. Boys were significantly more likely to be managed for intellectual impairment, ADHD and autism spectrum disorders than were girls, who were more likely to be managed for depression. The medication rate was low at 19 per 100 psychological problems although higher for depression and ADHD. Referrals were given at a high rate. Counselling was also provided often, except in management of ADHD. Access to the three studies allowed consideration of trends over a forty year period, showing the development of newly defined conditions which have replaced childhood diagnoses of past decades. The results demonstrate that GP involvement in children's mental health care management has grown significantly over the past 20 years.

Defining competency-based evaluation objectives in family medicine

PubMed Central

Allen, Tim; Brailovsky, Carlos; Rainsberry, Paul; Lawrence, Katherine; Crichton, Tom; Carpentier, Marie-Pierre; Visser, Shaun

2011-01-01

Abstract Objective To develop a definition of competence in family medicine sufficient to guide a review of Certification examinations by the Board of Examiners of the College of Family Physicians of Canada. Design Delphi analysis of responses to a 4-question postal survey. Setting Canadian family practice. Participants A total of 302 family physicians who have served as examiners for the College of Family Physicians of Canada’s Certification examination. Methods A survey comprising 4 short-answer questions was mailed to the 302 participating family physicians asking them to list elements that define competence in family medicine among newly certified family physicians beginning independent practice. Two expert groups used a modified Delphi consensus process to analyze responses and generate 2 basic components of this definition of competence: first, the problems that a newly practising family physician should be competent to handle; second, the qualities, behaviour, and skills that characterize competence at the start of independent practice. Main findings Response rate was 54%; total number of elements among all responses was 5077, for an average 31 per respondent. Of the elements, 2676 were topics or clinical situations to be dealt with; the other 2401 were skills, behaviour patterns, or qualities, without reference to a specific clinical problem. The expert groups identified 6 essential skills, the phases of the clinical encounter, and 99 priority topics as the descriptors used by the respondents. More than 20% of respondents cited 30 of the topics. Conclusion Family physicians define the domain of competence in family medicine in terms of 6 essential skills, the phases of the clinical encounter, and priority topics. This survey represents the first level of definition of evaluation objectives in family medicine. Definition of the interactions among these elements will permit these objectives to become detailed enough to effectively guide assessment. PMID:21918130

Separation in Logistic Regression: Causes, Consequences, and Control.

PubMed

Mansournia, Mohammad Ali; Geroldinger, Angelika; Greenland, Sander; Heinze, Georg

2018-04-01

Separation is encountered in regression models with a discrete outcome (such as logistic regression) where the covariates perfectly predict the outcome. It is most frequent under the same conditions that lead to small-sample and sparse-data bias, such as presence of a rare outcome, rare exposures, highly correlated covariates, or covariates with strong effects. In theory, separation will produce infinite estimates for some coefficients. In practice, however, separation may be unnoticed or mishandled because of software limits in recognizing and handling the problem and in notifying the user. We discuss causes of separation in logistic regression and describe how common software packages deal with it. We then describe methods that remove separation, focusing on the same penalized-likelihood techniques used to address more general sparse-data problems. These methods improve accuracy, avoid software problems, and allow interpretation as Bayesian analyses with weakly informative priors. We discuss likelihood penalties, including some that can be implemented easily with any software package, and their relative advantages and disadvantages. We provide an illustration of ideas and methods using data from a case-control study of contraceptive practices and urinary tract infection.

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

ERIC Educational Resources Information Center

Almannie, Mohamed

2015-01-01

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

Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience.

PubMed

Fairley, Debra

2005-06-01

This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.

Beyond Ockham's Razor: Redefining Problem-Solving in Clinical Sleep Medicine using a “Five-Finger” Approach

PubMed Central

McCarty, David E.

2010-01-01

The rule of diagnostic parsimony—otherwise known as “Ockham's Razor”—teaches students of medicine to find a single unifying diagnosis to explain a given patient's symptoms. While this approach has merits in some settings, a more comprehensive approach is often needed for patients with chronic, nonspecific presentations for which there is a broad differential diagnosis. The cardinal manifestations of sleep disorders—daytime neurocognitive impairment and subjective sleep disturbances—are examples of such presentations. Successful sleep medicine clinicians therefore approach every patient with the knowledge that multiple diagnoses—rather than simply one—are likely to be found. Teaching an integrated and comprehensive approach to other clinicians in an organized and reproducible fashion is challenging, and the evaluation of effectiveness of such teaching is even more so. As a practical aid for teaching the approach to—and evaluation of—a comprehensive sleep medicine encounter, five functional domains of sleep medicine clinical problem-solving are presented as potential sources for sleep/wake disruption: (1) circadian misalignment, (2) pharmacologic factors, (3) medical factors, (4) psychiatric/psychosocial factors, and (5) primary sleep medicine diagnoses. These domains are presented and explained in an easy-to-remember “five finger” format. The five finger format can be used in real time to evaluate the completeness of a clinical encounter, or can be used in the design of standardized patients to identify areas of strength and potential weakness. A score sheet based upon this approach is offered as an alternative to commonly used Likert scales as a potentially more objective and practical measure of clinical problem-solving competence, making it useful for training programs striving to achieve or maintain fellowship accreditation. Citation: McCarty DE. Beyond Ockham's Razor: redefining problem-solving in clinical sleep medicine using a “five-finger” approach. J Clin Sleep Med 2010;6(3):292-269. PMID:20572425

Cosmetic Professionals' Awareness of Body Dysmorphic Disorder.

PubMed

Bouman, Theo K; Mulkens, Sandra; van der Lei, Berend

2017-02-01

Preoccupation with a perceived appearance flaw is the main feature of body dysmorphic disorder. The majority of these patients seek and often receive some sort of cosmetic procedure, although this condition is considered to be a contraindication. This study evaluates cosmetic professionals' recognition of body dysmorphic disorder and the way they act on this. Members of Dutch professional associations for aesthetic plastic surgery, dermatology, and cosmetic medicine received an online survey by means of their association's digital mailing lists; the survey was completed by 173 respondents. Most participants indicated being more or less familiar with the diagnostic criteria and clinical picture of body dysmorphic disorder. Approximately two-thirds of the participants reported that they had encountered between one and five of these patients in their practice over the past year, a percentage that is significantly lower than the estimated prevalence of body dysmorphic disorder. The majority of professionals sometimes or often address body image problems during consultation, most of them collaborate with psychologists or psychiatrists when encountering a patient with body dysmorphic disorder, and approximately 70 percent had refused to perform a procedure in such a patient. Our results converge with those of previous studies, showing that most cosmetic professionals have some degree of awareness of body dysmorphic disorder, although the number they report encountering in clinical practice departs from prevalence figures. When a patient is identified as having body dysmorphic disorder, the professionals use this knowledge to guide their decision to perform a cosmetic procedure.

Challenges in conducting research in pediatric long-term care facilities.

PubMed

Larson, Elaine L; Cohen, Bevin; Murray, Meghan; Saiman, Lisa

2014-10-01

Children residing in long-term care facilities (LTCFs) have complex medical problems and unique care needs, yet research in this setting is rare. As part of an intervention study to improve patient safety (Keep It Clean for Kids [KICK]), we describe the challenges encountered and recommend approaches to build a successful and sustained collaborative relationship between pediatric LTCFs and the research team. We implemented a program with 5 components: leadership commitment, active staff participation by the creation of KICK teams, workflow assessments, staff training in the World Health Organization's "5 Moments for Hand Hygiene," and electronic monitoring and feedback to staff regarding hand hygiene practices. Major challenges encountered were establishing trust, building research teams, enhancing staff participation, and engaging families and visitors. Approaches to deal with these challenges are discussed. Conducting research in pediatric LTCFs requires sustained commitment to dealing with challenges and establishing collaborative relationships with administrative and frontline staff. © The Author(s) 2014.

Education in the workplace for the physician: clinical management states as an organizing framework.

PubMed

Greenes, R A

2000-01-01

Medical educators are interested in approaches to making selected relevant knowledge available in the context of problem-based care. This is of value both during the process of care and as a means of organizing information for offline self-study. Four trends in health information technology are relevant to achieving the goal and can be expected to play a growing role in the future. First, health care enterprises are developing approaches for access to information resources related to the care of a patient, including clinical data and images but also communication tools, referral and other logistic tools, decision support, and educational materials. Second, information for patients and methods for patient-doctor interaction and decision making are becoming available. Third, computer-based methods for representation of practice guidelines are being developed to support applications that can incorporate their logic. Finally, considering patients as being in particular "clinical management states" (or CMSs) for specific problems, approaches are being developed to use guidelines as a kind of "predictive" framework to enable development of interfaces for problem-based clinical encounters. The guidelines for a CMS can be used to identify the kinds of resources specifically needed for clinical encounters of that type. As the above trends converge to produce problem-specific environments, professional specialty organizations and continuing medical education course designers will need to focus energies on organizing and updating medical knowledge to make it available in CMS-specific contexts.

Child temperament, parent emotions, and perceptions of the child's feeding experience.

PubMed

Hughes, Sheryl O; Shewchuk, Richard M

2012-05-29

Associations between parent and child characteristics and how they influence the approach parents take toward children in the feeding environment have not been examined extensively, especially in low-income minority families who are at a higher risk for obesity. The primary aim of the study was to examine positive and negative parent emotions as potential mediators of the relationship between child temperament and parents' perceptions of strategy effectiveness and problems encountered in feeding children fruit and vegetables. Participants were low-income families (n = 639, 73% minority, children aged 3-5 years) participating in Head Start programs in two states. Parents completed the Children's Behavior Questionnaire (CBQ), Positive and Negative Affect Schedule (PANAS), and measures of strategy effectiveness (teachable moments, practical methods, restriction, and enhanced availability) and problems encountered (vegetable characteristics, child attributions for dislike, external influences, and parental demands) in feeding children fruit and vegetables. Positive parent emotions partially mediated the relationship between child Effortful Control and strategy effectiveness and fully mediated the relationship between Surgency and strategy effectiveness. Although negative parent emotions were associated with increased perception of problems in feeding children fruit and vegetables, the relationship between Negative Affectivity and problems in feeding was partially mediated by negative parent emotions. Positive parent emotions facilitated perceived effectiveness of feeding strategies, with child Effortful Control and Surgency instrumental to this process. Understanding mechanisms in parent-child feeding is important when developing interventions designed to promote healthy child eating behaviors.

Evidence-based use of electronic clinical tracking systems in advanced practice registered nurse education: an integrative review.

PubMed

Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F

2014-07-01

Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.

Domestic Sex Trafficking of Minors: Medical Student and Physician Awareness.

PubMed

Titchen, Kanani E; Loo, Dyani; Berdan, Elizabeth; Rysavy, Mary Becker; Ng, Jessica J; Sharif, Iman

2017-02-01

Our aim was to assess: (1) medical trainee and practicing physician awareness about domestic sex trafficking of minors; and (2) whether respondents believe that awareness of trafficking is important to their practice. We designed an anonymous electronic survey, and a convenience sample was collected from June through October 2013. Voluntary participants were 1648 medical students, residents, and practicing physicians throughout the United States. Data were analyzed for correlations between study cohort characteristics and: (1) agreement with the statement: "knowing about sex trafficking in my state is important to my profession"; (2) knowledge of national statistics regarding the sex trafficking of minors; and (3) knowledge of appropriate responses to encountering a trafficked victim. More practicing physicians than residents or medical students: (1) agreed or strongly agreed that knowledge about human trafficking was important to their practice (80.6%, 71.1%, and 69.2%, respectively; P = .0008); (2) correctly estimated the number of US trafficked youth according to the US Department of State data (16.1%, 11.7%, and 7.9%, respectively; P = .0011); and (3) were more likely to report an appropriate response to a trafficked victim (40.4%, 20.4%, and 8.9%, respectively; P = .0001). Although most medical trainees and physicians place importance on knowing about human trafficking, they lack knowledge about the scope of the problem, and most would not know where to turn if they encountered a trafficking victim. There exists a need for standardized trafficking education for physicians, residents, and medical students. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

The effect of families on the process of outpatient visits in family practice.

PubMed

Main, D S; Holcomb, S; Dickinson, P; Crabtree, B F

2001-10-01

Our goal was to describe how physician knowledge of patients' families affects the processes of patient care in family practices. Using a multimethod comparative case study design, detailed dictated field notes were recorded after direct observation of patient encounters and the office environment as part of the Prevention and Competing Demands in Primary Care Study. We identified domains of outpatient visits in which patients were accompanied by a family member or in which family-oriented content was discussed. Outpatient encounters with 1637 patients presenting in 18 family practices in the Midwest were analyzed using an editing style. We developed a typology for ways in which family context affects outpatient visits. Patients were accompanied during 35% of all outpatient visits, the vast majority of these visits involving children. Family history or a family member's problems were discussed during 35% of visits during which no family member was present. An analysis of these "family-oriented" visits resulted in a typology of 6 ways that family context informs and affects the outpatient visit: (1) using family social context to illuminate patient disease, illness, and health; (2) using family to discover the source of an illness; (3) discussing and managing the health and illness of family members; (4) family concern for patient's health; (5) using the family as a care resource and care collaborator; and, (6) giving family members unscheduled care. Family context is an important feature of family practice that influences the processes of patient care. Since family-oriented care is an essential feature of family practice, outcomes of this largely hidden part of care deserve further study.

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

PubMed

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

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

Medical students' and residents' clinical and educational experiences with defensive medicine.

PubMed

O'Leary, Kevin J; Choi, Jennifer; Watson, Katie; Williams, Mark V

2012-02-01

To assess medical students' and residents' experiences with defensive medicine, which is any deviation from sound medical practice due to a perceived threat of liability through either assurance or avoidance behaviors. Assurance behaviors include providing additional services of minimal clinical value. Avoidance behaviors include withholding services that are, or avoiding patients who are, perceived as high risk. The authors conducted a cross-sectional survey of fourth-year medical students and third-year residents in 2010. Respondents rated how often malpractice liability concerns caused their teams to engage in four types of assurance and two types of avoidance behaviors using a four-point scale (never, rarely, sometimes, often). Respondents also rated how often their attending physicians explicitly recommended that liability concerns be taken into account when making clinical decisions. Overall, 126 of 194 medical students (65%) and 76 of 141 residents (54%) completed the survey. Of the responding medical students, 116 (92%) reported sometimes or often encountering at least one assurance practice, and 43 (34%) reported encountering at least one avoidance practice. Of the responding residents, 73 (96%) reported encountering at least one assurance practice, and 33 (43%) reported encountering at least one avoidance practice. Overall, 50 of 121 medical students (41%) and 36 of 68 residents (53%) reported that their attending physicians sometimes or often explicitly taught them to take liability into account when making clinical decisions. Medical trainees reported frequently encountering defensive medicine practices and often being taught to take malpractice liability into consideration during clinical decision making.

[Physician-patient with AIDS-relationship, as a model of clinical relation within the framework of the social security institutions in Mexico].

PubMed

Valdez-Martínez, Edith; Bedolla, Miguel; Rico, Rosalía

2011-01-01

To examine the nature and level of physician involvement during a clinical encounter with a patient with a chronic condition, such as AIDS, and to explore how it is understood and constructed by them. Qualitative design with participant observation and semi-structured interviews, with physicians and patients, conducted in hospitals of Social Security Institutions in Mexico City Data were analyzed using the constant comparative method developed in the grounded theory tradition. The emergent themes studied were the dynamics of the encounters, levels of participation of the physician, and attitudes of both participants. Irrespective of whether patients were seen for the first time, or subsequently, in outpatient consultation or in hospital, the physician focused on the solution of the biological problem and on the performance of a work commitment with the Institution. This study highlights the need to strengthen the incorporation of the ethics into daily clinical practice in order to transform a physician-patient relationship which is merely bureaucratic, focused on the solution of a biological problem and on the fulfillment of an institutional commitment, into a relationship which is truly professional and at the service of the patient.

Pedagogy of stereographic projection

NASA Astrophysics Data System (ADS)

Blenkinsop, Tom

1999-05-01

Three sorts of problem are encountered by students learning stereographic projection. Lack of familiarity with compass directions and with the specification of planar and linear orientations is the most fundamental problem. The second problem is one of poor visualisation which prohibits the correct understanding of the principles and practice of projection, although students can sometimes perform remarkably well on certain exercises without this understanding. A third problem is a lack of interest or appreciation of the usefulness of the technique. A solution to the first problem is to provide a thorough grounding in compass directions, and concepts of strike, dip, dip direction, plunge and plunge bearing immediately before teaching stereographic projection. Visual aids, such as a transparent hemisphere to represent half of the projection sphere, and a large stereonet, are helpful for visualisation. Estimation and sketching exercises help to develop an understanding of the geometry of projection. Computer-aided teaching and plotting is recommended after an introduction to manual techniques. Interest can be stimulated through the use of exercises based on real geological maps.

Addressing Problems Encountered in Case-Based Teaching

ERIC Educational Resources Information Center

Turgeon, A. J.

2007-01-01

TURF 436 (Case Studies in Turfgrass Management) is the capstone course for turfgrass science majors at the Pennsylvania State University. Students are introduced to problems and complex problematic situations encountered in the management of golf and sports turf and in professional lawn-care operations. Following completion of the orientation case…

Quality planning in Construction Project

NASA Astrophysics Data System (ADS)

Othman, I.; Shafiq, Nasir; Nuruddin, M. F.

2017-12-01

The purpose of this paper is to investigate deeper on the factors that contribute to the effectiveness of quality planning, identifying the common problems encountered in quality planning, practices and ways for improvements in quality planning for construction projects. This paper involves data collected from construction company representatives across Malaysia that are obtained through semi-structured interviews as well as questionnaire distributions. Results shows that design of experiments (average index: 4.61), inspection (average index: 4.45) and quality audit as well as other methods (average index: 4.26) rank first, second and third most important factors respectively.

Management of impacted all canines with surgical exposure and alignment by orthodontic treatment

PubMed Central

Katiyar, Radha; Tandon, Pradeep; Singh, Gyan P.; Agrawal, Akhil; Chaturvedi, T. P.

2013-01-01

Canine impaction is a dental problem very often encountered in orthodontic practice. After the third molar, the canine is the most frequently impacted tooth. Bringing the impacted canine into a normal position is important for functional occlusion and the final esthetics of the orthodontic treatment. This article illustrates a peculiar case, in which all four permanent canines maintained their unerupted status at age of 16 years. All four impacted canines were surgically exposed, attachment bonded, traction given with K-9 spring and ideally positioned with fixed orthodontic mechanotherapy. PMID:24124308

Structural interaction with transportation and handling systems

NASA Technical Reports Server (NTRS)

1973-01-01

Problems involved in the handling and transportation of finished space vehicles from the factory to the launch site are presented, in addition to recommendations for properly accounting for in space vehicle structural design, adverse interactions during transportation. Emphasis is given to the protection of vehicle structures against those environments and loads encountered during transportation (including temporary storage) which would exceed the levels that the vehicle can safely withstand. Current practices for verifying vehicle safety are appraised, and some of the capabilities and limitations of transportation and handling systems are summarized.

Cable Effects Study. Tangents, Rabbit Holes, Dead Ends, and Valuable Results

DOE PAGES

Ardelean, Emil V.; Babuška, Vít; Goodding, James C.; ...

2014-08-04

Lessons learned during a study on the effects that electrical power and signal wiring harness cables introduce on the dynamic response of precision spacecraft is presented, along with the most significant results. Our study was a three year effort to discover a set of practical approaches for updating well-defined dynamic models of harness-free structures where knowledge of the cable type, position, and tie-down method are known. Although cables are found on every satellite, the focus was on precision, low damping, and very flexible structures. Obstacles encountered, classified as tangents, rabbit holes, and dead ends, offer practical lessons for structural dynamicsmore » research. The paper traces the historical, experiential progression of the project, describing how the obstacles affected the project. Methods were developed to estimate cable properties. Problems were encountered because of the flexible, highly damped nature of cables. A beam was used as a test article to validate experimentally derived cable properties and to refine the assumptions regarding boundary conditions. Furthermore, a spacecraft bus-like panel with cables attached was designed, and finite element models were developed and validated through experiment. Various paths were investigated at each stage before a consistent test and analysis methodology was developed« less

Cable Effects Study. Tangents, Rabbit Holes, Dead Ends, and Valuable Results

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

Ardelean, Emil V.; Babuška, Vít; Goodding, James C.

Lessons learned during a study on the effects that electrical power and signal wiring harness cables introduce on the dynamic response of precision spacecraft is presented, along with the most significant results. Our study was a three year effort to discover a set of practical approaches for updating well-defined dynamic models of harness-free structures where knowledge of the cable type, position, and tie-down method are known. Although cables are found on every satellite, the focus was on precision, low damping, and very flexible structures. Obstacles encountered, classified as tangents, rabbit holes, and dead ends, offer practical lessons for structural dynamicsmore » research. The paper traces the historical, experiential progression of the project, describing how the obstacles affected the project. Methods were developed to estimate cable properties. Problems were encountered because of the flexible, highly damped nature of cables. A beam was used as a test article to validate experimentally derived cable properties and to refine the assumptions regarding boundary conditions. Furthermore, a spacecraft bus-like panel with cables attached was designed, and finite element models were developed and validated through experiment. Various paths were investigated at each stage before a consistent test and analysis methodology was developed« less

Problems encountered in the use of neutron methods for elemental analysis on planetary surfaces

USGS Publications Warehouse

Senftle, F.; Philbin, P.; Moxham, R.; Boynton, G.; Trombka, J.

1974-01-01

From experimental studies of gamma rays from fast and thermal neutron reactions in hydrogeneous and non-hydrogeneous, semi-infinite samples and from Monte Carlo calculations on soil of a composition which might typically be encountered on planetary surfaces, it is found that gamma rays from fast or inelastic scattering reactions would dominate the observed spectra. With the exception of gamma rays formed by inelastically scattered neutrons on oxygen, useful spectra would be limited to energies below 3 MeV. Other experiments were performed which show that if a gamma-ray detector were placed within 6 m of an isotopic neutron source in a spacecraft, it would be rendered useless for gamma-ray spectrometry below 3 MeV because of internal activation produced by neutron exposure during space travel. Adequate shielding is not practicable because of the size and weight constraints for planetary missions. Thus, it is required that the source be turned off or removed to a safe distance during non-measurement periods. In view of these results an accelerator or an off-on isotopic source would be desirable for practical gamma-ray spectral analysis on planetary surfaces containing but minor amounts of hydrogen. ?? 1974.

Conquering common breast-feeding problems.

PubMed

Walker, Marsha

2008-01-01

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

Encountering Pedagogy through Relational Art Practices

ERIC Educational Resources Information Center

Irwin, Rita L.; O'Donoghue, Donal

2012-01-01

Two artists involved in "socially engaged art" practice were invited to work with art education teacher candidates and instructors in an effort to rethink notions of teaching, learning and art. We initiated this residency, which we called "The Summerhill Residency", to examine how learning encounters might create environments…

The Fate of Progressive Language Policies and Practices.

ERIC Educational Resources Information Center

Dudley-Marling, Curt, Ed.; Edelsky, Carole, Ed.

Noting that progressive language policies have encountered and will always encounter fierce resistance, this book presents a collection of essays by progressive language educators, theorists, and policymakers that reflect on the fate of progressive language practices and policies. Part 1 comprises three contextualizing chapters that provide a…

Fabricated Childhoods: Uncanny Encounters with the More-than-Human

ERIC Educational Resources Information Center

Blaise, Mindy

2016-01-01

This article is based on uncanny encounters with Julia deVille's exhibit, "Phantasmagoria". Inspired by Deleuzian-informed research practices, the author experiments with provoking practices to defy dominant developmental notions of childhood. This article reworks a humanist ontology by bringing together the discursive, the material, the…

Implantation of radio frequency identification device (RFID) microchip in disaster victim identification (DVI).

PubMed

Meyer, Harald J; Chansue, Nantarika; Monticelli, Fabio

2006-03-10

The tsunami catastrophe of December 2004 left more than 200,000 dead. Disaster victim identification (DVI) teams were presented with the unprecedented challenge of identifying thousands of mostly markedly putrefied and partially skeletised bodies. To this end, an adequate body tagging method is essential. Conventional body bag tagging in terms of writing on body bags and placing of tags inside body bags proved unsatisfactory and problem prone due to consequences of cold storage, formalin (formaldehyde) embalming and body numbers inside storage facilities. The placement of radio frequency identification device (RFID) microchips inside victim bodies provided a practical solution to problems of body tagging and attribution in the DVI setting encountered by the Austrian DVI team in Thailand in early 2005.

Multiple cranial neuropathy: a common diagnostic problem.

PubMed

Garg, R K; Karak, B

1999-10-01

Syndrome of multiple cranial palsies is a common clinical problem routinely encountered in neurological practice. Anatomical patterns of cranial nerves involvement help in localizing the lesion. Various infections, malignant neoplasms and autoimmune vasculitis are common disorders leading to various syndromes of multiple cranial nerve palsies. A large number of diffuse neurological disorders (e.g. Gullian-Barre syndrome, myopathies) may also present with syndrome of multiple cranial nerve palsies. Despite extensive biochemical and radiological work-up the accurate diagnosis may not be established. Few such patients represent "idiopathic" variety of multiple cranial nerve involvement and show good response to corticosteroids. Widespread and sequential involvements of cranial nerves frequently suggest possibility of malignant infiltration of meninges, however, confirmation of diagnosis may not be possible before autopsy.

Case-based learning facilitates critical thinking in undergraduate nutrition education: students describe the big picture.

PubMed

Harman, Tara; Bertrand, Brenda; Greer, Annette; Pettus, Arianna; Jennings, Jill; Wall-Bassett, Elizabeth; Babatunde, Oyinlola Toyin

2015-03-01

The vision of dietetics professions is based on interdependent education, credentialing, and practice. Case-based learning is a method of problem-based learning that is designed to heighten higher-order thinking. Case-based learning can assist students to connect education and specialized practice while developing professional skills for entry-level practice in nutrition and dietetics. This study examined student perspectives of their learning after immersion into case-based learning in nutrition courses. The theoretical frameworks of phenomenology and Bloom's Taxonomy of Educational Objectives triangulated the design of this qualitative study. Data were drawn from 426 written responses and three focus group discussions among 85 students from three upper-level undergraduate nutrition courses. Coding served to deconstruct the essence of respondent meaning given to case-based learning as a learning method. The analysis of the coding was the constructive stage that led to configuration of themes and theoretical practice pathways about student learning. Four leading themes emerged. Story or Scenario represents the ways that students described case-based learning, changes in student thought processes to accommodate case-based learning are illustrated in Method of Learning, higher cognitive learning that was achieved from case-based learning is represented in Problem Solving, and Future Practice details how students explained perceived professional competency gains from case-based learning. The skills that students acquired are consistent with those identified as essential to professional practice. In addition, the common concept of Big Picture was iterated throughout the themes and demonstrated that case-based learning prepares students for multifaceted problems that they are likely to encounter in professional practice. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification.

PubMed

Hurst, Dominic; Mickan, Sharon

2017-03-14

Implementation science seeks to promote the uptake of research and other evidence-based findings into practice, but for healthcare professionals, this is complex as practice draws on, in addition to scientific principles, rules of thumb and a store of practical wisdom acquired from a range of informational and experiential sources. The aims of this review were to identify sources of information and professional experiences encountered by healthcare workers and from this to build a classification system, for use in future observational studies, that describes influences on how healthcare professionals acquire and use information in their clinical practice. This was a mixed studies systematic review of observational studies. OVID MEDLINE and Embase and Google Scholar were searched using terms around information, knowledge or evidence and sharing, searching and utilisation combined with terms relating to healthcare groups. Studies were eligible if one of the intentions was to identify information or experiential encounters by healthcare workers. Data was extracted by one author after piloting with another. Studies were assessed using the Mixed Methods Appraisal Tool (MMAT). The primary outcome extracted was the information source or professional experience encounter. Similar encounters were grouped together as single constructs. Our synthesis involved a mixed approach using the top-down logic of the Bliss Bibliographic Classification System (BC2) to generate classification categories and a bottom-up approach to develop descriptive codes (or "facets") for each category, from the data. The generic terms of BC2 were customised by an iterative process of thematic content analysis. Facets were developed by using available theory and keeping in mind the pragmatic end use of the classification. Eighty studies were included from which 178 discreet knowledge encounters were extracted. Six classification categories were developed: what information or experience was encountered; how was the information or experience encountered; what was the mode of encounter; from whom did the information originate or with whom was the experience; how many participants were there; and where did the encounter take place. For each of these categories, relevant descriptive facets were identified. We have sought to identify and classify all knowledge encounters, and we have developed a faceted description of key categories which will support richer descriptions and interrogations of knowledge encounters in healthcare research.

Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice?

PubMed

Goff, Iain; Wise, Elspeth Mary; Coady, David; Walker, David

2016-02-01

Musculoskeletal conditions are common in general practice, but clinicians express poor self confidence in dealing with them. Training in general practice relies on clinical exposure to a range of presentations in order to gain competence. It has been suggested that trainees are exposed to a different case mix from qualified general practices (GPs), due to seeing more minor illness and less chronic disease and that this may be responsible in part for their subsequent lack of confidence. The aims of this study were to analyse the case mix of musculoskeletal conditions encountered by general practice trainees and to compare this to the overall population consulting behaviour. This is a prospective observational study. Thirteen general practices in North East England were recruited. Musculoskeletal disorders encountered by 13 GP trainees (7 junior and 6 senior) were prospectively recorded using a handheld diary. Disorders were classified according to working diagnosis or body region if diagnosis was unclear. Musculoskeletal (MSK) disorders comprised 17 % of consultations, and the distribution of diagnoses of these was in proportion to epidemiological studies of MSK disorders in the UK as they present in primary care. Back pain was the most frequent label with 141 (29 %) consultations with a further 43 (9 %) for neck pain. Inflammatory arthritis accounted for the same number 43 (9 %). Individual joint problems were 115 (24 %) with knee being most common. A specific diagnosis was more likely to be applied when symptoms were more distal and less likely when axial. Trainees are exposed to the same spectrum of MSK disorders as are present in the population as a whole. Case mix does not appear to be a significant factor in low confidence levels in dealing with MSK disorders.

Development and validation of a low-cost mobile robotics testbed

NASA Astrophysics Data System (ADS)

Johnson, Michael; Hayes, Martin J.

2012-03-01

This paper considers the design, construction and validation of a low-cost experimental robotic testbed, which allows for the localisation and tracking of multiple robotic agents in real time. The testbed system is suitable for research and education in a range of different mobile robotic applications, for validating theoretical as well as practical research work in the field of digital control, mobile robotics, graphical programming and video tracking systems. It provides a reconfigurable floor space for mobile robotic agents to operate within, while tracking the position of multiple agents in real-time using the overhead vision system. The overall system provides a highly cost-effective solution to the topical problem of providing students with practical robotics experience within severe budget constraints. Several problems encountered in the design and development of the mobile robotic testbed and associated tracking system, such as radial lens distortion and the selection of robot identifier templates are clearly addressed. The testbed performance is quantified and several experiments involving LEGO Mindstorm NXT and Merlin System MiaBot robots are discussed.

Distributed parallel computing in stochastic modeling of groundwater systems.

PubMed

Dong, Yanhui; Li, Guomin; Xu, Haizhen

2013-03-01

Stochastic modeling is a rapidly evolving, popular approach to the study of the uncertainty and heterogeneity of groundwater systems. However, the use of Monte Carlo-type simulations to solve practical groundwater problems often encounters computational bottlenecks that hinder the acquisition of meaningful results. To improve the computational efficiency, a system that combines stochastic model generation with MODFLOW-related programs and distributed parallel processing is investigated. The distributed computing framework, called the Java Parallel Processing Framework, is integrated into the system to allow the batch processing of stochastic models in distributed and parallel systems. As an example, the system is applied to the stochastic delineation of well capture zones in the Pinggu Basin in Beijing. Through the use of 50 processing threads on a cluster with 10 multicore nodes, the execution times of 500 realizations are reduced to 3% compared with those of a serial execution. Through this application, the system demonstrates its potential in solving difficult computational problems in practical stochastic modeling. © 2012, The Author(s). Groundwater © 2012, National Ground Water Association.

A Study of the Causes of Physical and Emotional Problems Encountered by Older Women Returning to Secretarial Employment After A Prolonged Absence. Final Report.

ERIC Educational Resources Information Center

Lloyd, Glenna G.

The problem of this study was to identify the cause of the physical and emotional problems encountered by older women who have returned to work after a prolonged absence. Such information, it was believed, would be valuable to business and educational institutions in retraining or updating prospective secretarial employees. Data for the study were…

Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs.

PubMed

Magin, Parker J; Adams, Jon; Sibbritt, David W; Joy, Elyssa; Ireland, Malcolm C

2005-10-03

To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. Occupational violence towards general practitioners during the previous 12 months. 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug- and alcohol-related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after-hours care (P = 0.033 for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.

Management in general practice: the challenge of the new General Medical Services contract.

PubMed

Checkland, Kath

2004-10-01

Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role.

Management in general practice: the challenge of the new General Medical Services contract

PubMed Central

Checkland, Kath

2004-01-01

Background: Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. Aim: To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. Design of study: In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Setting: Three general practices in England, chosen using purposeful sampling. Method: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results: Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. Conclusion: The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role. PMID:15469672

An Acuity Tool for Heart Failure Case Management: Quantifying Workload, Service Utilization, and Disease Severity.

PubMed

Kilgore, Matthew D

The cardiology service line director at a health maintenance organization (HMO) in Washington State required a valid, reliable, and practical means for measuring workloads and other productivity factors for six heart failure (HF) registered nurse case managers located across three geographical regions. The Kilgore Heart Failure Case Management (KHFCM) Acuity Tool was systematically designed, developed, and validated to measure workload as a dependent function of the number of heart failure case management (HFCM) services rendered and the duration of times spent on various care duties. Research and development occurred at various HMO-affiliated internal medicine and cardiology offices throughout Western Washington. The concepts, methods, and principles used to develop the KHFCM Acuity Tool are applicable for any type of health care professional aiming to quantify workload using a high-quality objective tool. The content matter, scaling, and language on the KHFCM Acuity Tool are specific to HFCM settings. The content matter and numeric scales for the KHFCM Acuity Tool were developed and validated using a mixed-method participant action research method applied to a group of six outpatient HF case managers and their respective caseloads. The participant action research method was selected, because the application of this method requires research participants to become directly involved in the diagnosis of research problems, the planning and execution of actions taken to address those problems, and the implementation of progressive strategies throughout the course of the study, as necessary, to produce the most credible and practical practice improvements (; ; ; ). Heart failure case managers served clients with New York Heart Association Functional Class III-IV HF (), and encounters were conducted primarily by telephone or in-office consultation. A mix of qualitative and quantitative results demonstrated a variety of quality improvement outcomes achieved by the design and practice application of the KHFCM Acuity Tool. Quality improvement outcomes included a more valid reflection of encounter times and demonstration of the KHFCM Acuity Tool as a reliable, practical, credible, and satisfying tool for reflecting HF case manager workloads and HF disease severity. The KHFCM Acuity Tool defines workload simply as a function of the number of HFCM services performed and the duration of time spent on a client encounter. The design of the tool facilitates the measure of workload, service utilization, and HF disease characteristics, independently from the overall measure of acuity, so that differences in individual case manager practice, as well as client characteristics within sites, across sites, and potentially throughout annual seasons, can be demonstrated. Data produced from long-term applications of the KHFCM Acuity Tool, across all regions, could serve as a driver for establishing systemwide HFCM productivity benchmarks or standards of practice for HF case managers. Data produced from localized applications could serve as a reference for coordinating staffing resources or developing HFCM productivity benchmarks within individual regions or sites.

Affirmative Action and Women in Higher Education.

ERIC Educational Resources Information Center

Hazzard, Terry

The purposes of this paper are to: (1) discuss the historical development of women in higher education; (2) describe the implementation of federal policies for women; (3) focus on selected problems encountered by women in the work-place; and (4) offer recommendations and suggestions for eliminating some of the problems that women encounter. The…

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion.

PubMed

Jones, Christine D; Scott, Serena J; Anoff, Debra L; Pierce, Read G; Glasheen, Jeffrey J

2015-01-01

Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001), uninsured encounters decreased (18.4% to 6.3%, P < 0.001), and private payer encounters also decreased (14.1% to 13.3%, P = .001). The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001). In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for -0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. © The Author(s) 2015.

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

PubMed Central

Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

2015-01-01

Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001), uninsured encounters decreased (18.4% to 6.3%, P < 0.001), and private payer encounters also decreased (14.1% to 13.3%, P = .001). The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001). In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

Family medicine outpatient encounters are more complex than those of cardiology and psychiatry.

PubMed

Katerndahl, David; Wood, Robert; Jaén, Carlos Roberto

2011-01-01

comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings. secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity. there is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry. care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care.

A Pilot Quality Improvement Collaborative to Improve Safety Net Dental Access for Pregnant Women and Young Children.

PubMed

Vander Schaaf, Emily B; Quinonez, Rocio B; Cornett, Amanda C; Randolph, Greg D; Boggess, Kim; Flower, Kori B

2018-02-01

Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women. We analyzed quantitative data using paired t-tests before and after the collaborative and collected supplemental qualitative feedback from clinic staff through focus groups and directed email. Results All mean measures improved, including: higher monthly revenue ($28,380-$33,102, p = 0.37), decreased no-show rate (17.7-14.3%, p = 0.11), higher monthly dental health encounters (283-328, p = 0.08), and higher monthly encounters for young children (8.8-10.5, p = 0.65), and pregnant women (2.8-9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult. Conclusion for practice Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.

State of family medicine practice in Lebanon

PubMed Central

Helou, Mariana; Rizk, Grace Abi

2016-01-01

Background: Many difficulties are encountered in family medicine practice and were subject to multinational studies. To date, no study was conducted in Lebanon to assess the challenges that family physicians face. This study aims to evaluate the family medicine practice in Lebanon stressing on the difficulties encountered by Lebanese family physicians. Materials and Methods: A questionnaire was sent to all 96 family medicine physicians practicing in Lebanon. Participants answered questions about characteristics of family medicine practice, evaluation of the quality of work, identification of obstacles, and their effect on the medical practice. Results: The response rate was 59%, and the average number of years of practice was 10.7 years. Physicians complain mainly of heavy load at work, too many bureaucratic tasks, demanding patients, and being undervalued by the specialists. Most physicians are able to adapt between their professional and private life. Conclusion: Despite all the obstacles encountered, Lebanese family physicians have a moderate satisfaction toward their practice. They remain positive and enthusiastic about their profession. Until the ministry of public health revises its current health system, the primary care profession in Lebanon will remain fragile as a profession. PMID:27453843

State of family medicine practice in Lebanon.

PubMed

Helou, Mariana; Rizk, Grace Abi

2016-01-01

Many difficulties are encountered in family medicine practice and were subject to multinational studies. To date, no study was conducted in Lebanon to assess the challenges that family physicians face. This study aims to evaluate the family medicine practice in Lebanon stressing on the difficulties encountered by Lebanese family physicians. A questionnaire was sent to all 96 family medicine physicians practicing in Lebanon. Participants answered questions about characteristics of family medicine practice, evaluation of the quality of work, identification of obstacles, and their effect on the medical practice. The response rate was 59%, and the average number of years of practice was 10.7 years. Physicians complain mainly of heavy load at work, too many bureaucratic tasks, demanding patients, and being undervalued by the specialists. Most physicians are able to adapt between their professional and private life. Despite all the obstacles encountered, Lebanese family physicians have a moderate satisfaction toward their practice. They remain positive and enthusiastic about their profession. Until the ministry of public health revises its current health system, the primary care profession in Lebanon will remain fragile as a profession.

Private pharmacy staff in Hanoi dispensing steroids - theory and practice

PubMed Central

Larsson, Mattias; Binh, Nguyen Thanh; Tomson, Göran; Chuc, Nguyen TK; Falkenberg, Torkel

Objective To investigate self reported practice and actual practice of private pharmacy staff in relation to drug regulations and provision of prednisolone (a prescription-only corticosteroid) on request to treat lower back pain. Method Sixty private pharmacies in Hanoi were randomly selected. Self reported practice was assessed through interviews with pharmacy staff using a questionnaire; actual practice was assessed with the Simulated Client Method with 5 encounters in each pharmacy (a total of 295 encounters). Results Sixty percent of the pharmacy staff interviewed said that they would not dispense corticosteroids without prescription and 60% could mention some adverse effects. In practice all but one pharmacy dispensed corticosteroids without prescription in 76 % of all the encounters. Questions and advice given to the clients were associated with significantly lower dispensing of corticosteroids. Conclusion The low compliance with prescription regulations and the discrepancy between stated practice and actual practice raises concerns. This study indicates that commercial pressures exceed the deterrent effect of current drug regulations and their implementation and hence enforcement of regulations needs to be improved. PMID:25247001

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

PubMed Central

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

2012-01-01

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

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

PubMed

Crnjanski, Tatjana; Krajnovic, Dusanka; Savic, Mirko

2017-05-23

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

Using National Health Care Databases and Problem-Based Practice Analysis to Inform Integrated Curriculum Development.

PubMed

Baker, Amy J; Raymond, Mark R; Haist, Steven A; Boulet, John R

2017-04-01

One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals.Selected data from the National Hospital Ambulatory Medical Care Survey: Emergency Department illustrate how instructional materials can be derived from the results of such public-use health care data. Using fever as the reason for visit to the ED, the patient management path is depicted in the form of a case drill-down by exploring the most common diagnoses, blood tests, diagnostic studies, procedures, and medications associated with fever.Although these types of data are quite useful, they should not serve as the sole basis for determining which instructional cases to include. Additional sources of information should be considered to ensure the inclusion of cases that represent infrequent but high-impact problems and those that illustrate fundamental principles that generalize to other cases.

Technology Implementation and Workarounds in the Nursing Home

PubMed Central

Vogelsmeier, Amy A.; Halbesleben, Jonathon R.B.; Scott-Cawiezell, Jill R.

2008-01-01

Objective This study sought to explore the relationship of workarounds related to the implementation of an electronic medication administration record and medication safety practices in five Midwestern nursing homes. Design As a part of a larger study, this qualitative evaluation was conducted to identify workarounds associated with the implementation of an electronic medication administration record. Data were collected using multimethods including direct observation, process mapping, key informant interviews, and review of field notes from medication safety team meetings. Measurements Open and axial coding techniques were used to identify and categorize types of workarounds in relation to work flow blocks. Results Workarounds presented in two distinct patterns, those related to work flow blocks introduced by technology and those related to organizational processes not reengineered to effectively integrate with the technology. Workarounds such as safety alert overrides and shortcuts to documentation resulted from first-order problem solving of immediate blocks. Nursing home staff as individuals frequently used first-order problem solving instead of the more sophisticated second-order problem solving approach used by the medication safety team. Conclusion This study provides important practical examples of how nursing home staff work around work flow blocks encountered during the implementation of technology. Understanding these workarounds as a means of first-order problem solving is an important consideration to understanding risk to medication safety. PMID:17947626

[Forensic evidence-based medicine in computer communication networks].

PubMed

Qiu, Yun-Liang; Peng, Ming-Qi

2013-12-01

As an important component of judicial expertise, forensic science is broad and highly specialized. With development of network technology, increasement of information resources, and improvement of people's legal consciousness, forensic scientists encounter many new problems, and have been required to meet higher evidentiary standards in litigation. In view of this, evidence-based concept should be established in forensic medicine. We should find the most suitable method in forensic science field and other related area to solve specific problems in the evidence-based mode. Evidence-based practice can solve the problems in legal medical field, and it will play a great role in promoting the progress and development of forensic science. This article reviews the basic theory of evidence-based medicine and its effect, way, method, and evaluation in the forensic medicine in order to discuss the application value of forensic evidence-based medicine in computer communication networks.

Parallel computing for probabilistic fatigue analysis

NASA Technical Reports Server (NTRS)

Sues, Robert H.; Lua, Yuan J.; Smith, Mark D.

1993-01-01

This paper presents the results of Phase I research to investigate the most effective parallel processing software strategies and hardware configurations for probabilistic structural analysis. We investigate the efficiency of both shared and distributed-memory architectures via a probabilistic fatigue life analysis problem. We also present a parallel programming approach, the virtual shared-memory paradigm, that is applicable across both types of hardware. Using this approach, problems can be solved on a variety of parallel configurations, including networks of single or multiprocessor workstations. We conclude that it is possible to effectively parallelize probabilistic fatigue analysis codes; however, special strategies will be needed to achieve large-scale parallelism to keep large number of processors busy and to treat problems with the large memory requirements encountered in practice. We also conclude that distributed-memory architecture is preferable to shared-memory for achieving large scale parallelism; however, in the future, the currently emerging hybrid-memory architectures will likely be optimal.

Improving stability margins in discrete-time LQG controllers

NASA Technical Reports Server (NTRS)

Oranc, B. Tarik; Phillips, Charles L.

1987-01-01

Some of the problems are discussed which are encountered in the design of discrete-time stochastic controllers for problems that may adequately be described by the Linear Quadratic Gaussian (LQG) assumptions; namely, the problems of obtaining acceptable relative stability, robustness, and disturbance rejection properties. A dynamic compensator is proposed to replace the optimal full state feedback regulator gains at steady state, provided that all states are measurable. The compensator increases the stability margins at the plant input, which may possibly be inadequate in practical applications. Though the optimal regulator has desirable properties the observer based controller as implemented with a Kalman filter, in a noisy environment, has inadequate stability margins. The proposed compensator is designed to match the return difference matrix at the plant input to that of the optimal regulator while maintaining the optimality of the state estimates as directed by the measurement noise characteristics.

Sparse Reconstruction of Regional Gravity Signal Based on Stabilized Orthogonal Matching Pursuit (SOMP)

NASA Astrophysics Data System (ADS)

Saadat, S. A.; Safari, A.; Needell, D.

2016-06-01

The main role of gravity field recovery is the study of dynamic processes in the interior of the Earth especially in exploration geophysics. In this paper, the Stabilized Orthogonal Matching Pursuit (SOMP) algorithm is introduced for sparse reconstruction of regional gravity signals of the Earth. In practical applications, ill-posed problems may be encountered regarding unknown parameters that are sensitive to the data perturbations. Therefore, an appropriate regularization method needs to be applied to find a stabilized solution. The SOMP algorithm aims to regularize the norm of the solution vector, while also minimizing the norm of the corresponding residual vector. In this procedure, a convergence point of the algorithm that specifies optimal sparsity-level of the problem is determined. The results show that the SOMP algorithm finds the stabilized solution for the ill-posed problem at the optimal sparsity-level, improving upon existing sparsity based approaches.

Improvising in the Vulnerable Encounter: Using Improvised Participatory Theatre in Change for Healthcare Practice

ERIC Educational Resources Information Center

Larsen, Henry; Friis, Preben; Heape, Chris

2018-01-01

Healthcare practitioners are often presented with vulnerable encounters where their professional experience is insufficient when dealing with patients who suffer from illnesses such as chronic pain. How can one otherwise understand chronic pain and develop practices whereby medical healthcare practitioners can experience alternative ways of doing…

Is linking research, teaching and practice in communication in health care the way forward?

PubMed

van Weel-Baumgarten, Evelyn

2016-09-01

This paper is based on the keynote lecture given at the ICCH conference in New Orleans in October 2015. With as background the observation that even though research and teaching of communication have been receiving attention for some time now, patients still encounter many problems when they visit clinicians because of health problems, it subsequently touches upon research on integration of communication with correct medical content, person centered communication and the role of placebo on outcomes. For teaching it emphasizes methods working best to teach clinical communication skills and lead to behavior changes in professionals: experiential teaching methods but taking care of a balance with cognitive methods. It then discusses the challenge of transfer to clinical practice and what is needed to overcome these challenges: learning from reflecting on undesired outcomes in clinical practice, feedback from clinicians who are open to communication and support learners with effective feedback in that specific context. It adds suggestions about where linking more between research, teaching and clinical practice could help moving communication in health care forward and builds the case for involving policymakers and members of hospital boards to help manage the necessary climate change in clinical settings. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Are we pharmacovigilant enough in ophthalmic practice?

PubMed Central

Dubey, Ashok; Handu, Shailendra S

2013-01-01

No drug is absolutely safe. Pharmacovigilance is the science related to detection, assessment, understanding and prevention of adverse effects or any other possible drug-related problems. The ocular medications and devices can cause localized and systemic adverse effects. Not all adverse effects are known when a drug or device is launched in market because of limitations of clinical trials. Many adverse effects are recognized due to the spontaneous reporting of the vigilant doctors who observe and report such events encountered in their practice. Despite a large ophthalmic patient population base, India does not have robust adverse drug reaction (ADR) database because of lack of reporting culture. Government of India recently launched the Pharmacovigilance Programme of India (PvPI) to monitor ADRs and create awareness among the healthcare professionals about the importance of ADRs. Suspecting and reporting a possible drug reaction is very important in developing a safe and rational ophthalmic practice. PMID:23571233

Sustainable yield in theory and practice: bridging scientific and mainstream vernacular.

PubMed

Rudestam, Kirsten; Langridge, Ruth

2014-09-01

Groundwater is a vital resource in California, and the concept of "sustainable yield" is an attempt to determine a metric that can ensure the long-term resilience of groundwater systems. However, its meaning is ambiguous and quantification is challenging. To provide insight into developing a working definition that encompasses the inherent uncertainty and complexity of the term, this paper examines how sustainable yield in groundwater is interpreted by (1) scientists, (2) the courts in groundwater adjudications, (3) state agencies, and (4) local water practitioners. Through qualitative interviews, this paper identifies problems that local water agencies in the state encounter in engaging with sustainable yield as they incorporate the term in groundwater management practices. The authors recommend that any definitions make explicit the human dimensions of, and assumptions embedded in, the use of these terms in groundwater management practices, and they point to the value of participation in this process. © 2014, National Ground Water Association.

Considerations for multiple hypothesis correlation on tactical platforms

NASA Astrophysics Data System (ADS)

Thomas, Alan M.; Turpen, James E.

2013-05-01

Tactical platforms benefit greatly from the fusion of tracks from multiple sources in terms of increased situation awareness. As a necessary precursor to this track fusion, track-to-track association, or correlation, must first be performed. The related measurement-to-track fusion problem has been well studied with multiple hypothesis tracking and multiple frame assignment methods showing the most success. The track-to-track problem differs from this one in that measurements themselves are not available but rather track state update reports from the measuring sensors. Multiple hypothesis, multiple frame correlation systems have previously been considered; however, their practical implementation under the constraints imposed by tactical platforms is daunting. The situation is further exacerbated by the inconvenient nature of reports from legacy sensor systems on bandwidth- limited communications networks. In this paper, consideration is given to the special difficulties encountered when attempting the correlation of tracks from legacy sensors on tactical aircraft. Those difficulties include the following: covariance information from reporting sensors is frequently absent or incomplete; system latencies can create temporal uncertainty in data; and computational processing is severely limited by hardware and architecture. Moreover, consideration is given to practical solutions for dealing with these problems in a multiple hypothesis correlator.

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

ERIC Educational Resources Information Center

Baysal, Zeliha Nurdan

2017-01-01

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

Quota sampling in internet research: practical issues.

PubMed

Im, Eun-Ok; Chee, Wonshik

2011-07-01

Quota sampling has been suggested as a potentially good method for Internet-based research and has been used by several researchers working with Internet samples. However, very little is known about the issues or concerns in using a quota sampling method in Internet research. The purpose of this article was to present the practical issues using quota sampling in an Internet-based study. During the Internet study, the research team recorded all recruitment issues that arose and made written notes indicating the possible reasons for the problems. In addition, biweekly team discussions were conducted for which written records were kept. Overall, quota sampling was effective in ensuring that an adequate number of midlife women were recruited from the targeted ethnic groups. However, during the study process, we encountered the following practical issues using quota sampling: (1) difficulty reaching out to women in lower socioeconomic classes, (2) difficulty ensuring authenticity of participants' identities, (3) participants giving inconsistent answers for the screening questions versus the Internet survey questions, (4) potential problems with a question on socioeconomic status, (5) resentment toward the research project and/or researchers because of rejection, and (6) a longer time and more expense than anticipated.

The theory-practice gap and skill acquisition: an issue for nursing education.

PubMed

Scully, Natashia Josephine

2011-01-01

Matching textbook descriptions of clinical situations with the reality of practice is an ongoing problem faced by members of the nursing profession and is commonly referred to as the "theory-practice gap". This ubiquitous gap is inevitably encountered by all nurses at various times; yet it is widely agreed that it is student nurses--given their novice, rule governed status--who find themselves in the midst of the theory-practice void. This paper will discuss the nature of the theory-practice gap and skill acquisition, in relation to a personal experience of mine as an undergraduate nursing student, and its significance in relation to student anxiety levels, nurse education (specifically the roles of the classroom teacher and clinical educators), teaching methods and the responsibility of the student to become accountable for their own education. I intend to communicate how my personal situation was dealt with and evaluate that experience in relation to current nursing literature. Ultimately, this discussion will demonstrate the value of reflection underpinning the development of competency in nursing and its role in bridging the theory-practice gap.

Steady state solutions to dynamically loaded periodic structures

NASA Technical Reports Server (NTRS)

Kalinowski, A. J.

1980-01-01

The general problem of solving for the steady state (time domain) dynamic response (i.e., NASTRAN rigid format-8) of a general elastic periodic structure subject to a phase difference loading of the type encountered in traveling wave propagation problems was studied. Two types of structural configurations were considered; in the first type, the structure has a repeating pattern over a span that is long enough to be considered, for all practical purposes, as infinite; in the second type, the structure has structural rotational symmetry in the circumferential direction. The theory and a corresponding set of DMAP instructions which permits the NASTRAN user to automatically alter the rigid format-8 sequence to solve the intended class of problems are presented. Final results are recovered as with any ordinary rigid format-8 solution, except that the results are only printed for the typical periodic segment of the structure. A simple demonstration problem having a known exact solution is used to illustrate the implementation of the procedure.

Knowledge, management and perceived barriers to treatment of molar-incisor hypomineralisation in general dental practitioners and dental nurses in Malaysia.

PubMed

Hussein, A S; Ghanim, A M; Abu-Hassan, M I; Manton, D J

2014-10-01

Molar-incisor hypomineralisation (MIH) is a global dental problem, yet little is known about the knowledge of the general dental practitioners (GDPs) and dental nurses (DNs) regarding this defect in South East Asia. To assess and compare the knowledge of the GDPs and DNs in Malaysia regarding the frequency of occurrence of MIH within their practice, its diagnosis, putative aetiological factors and management. A questionnaire was distributed to GDPs and DNs during a nationwide dental conference in Melaka, Malaysia and who were asked to answer questions about demographic variables, knowledge, attitudes and practices in the management of MIH. Descriptive statistics and bivariate analysis were performed. A 5% level of statistical significance was applied for the analyses. A response rate of 58.2% (131/225) was obtained. Most respondents were aware of MIH and encountered it in their practice (GDPs = 82.5%, DNs = 82.4%). The condition was observed by respondents less in primary molars compared to first permanent molars. Full agreement between GDPs and DNs did not exist concerning the aetiological factors and management of MIH. Glass ionomer cements were the most popular material used in treating MIH. Most respondents (GDPs = 93%, DNs = 76.5%) indicated that they had not received sufficient information about MIH and were willing to have clinical training in the diagnosis and therapeutic modalities of MIH. MIH is identified and encountered by most respondents. Agreement did not exist between GDPs and DNs concerning MIH frequency of occurrence within their practice, its diagnosis, aetiological factors and management.

Chemical water shutoff profile research status and development trends

NASA Astrophysics Data System (ADS)

Xu, L. T.

2017-08-01

Excess water production is now a common problem encountered in almost every water flooding mature oilfield. The exploitation of oil field is faced with great challenge because of the decrease of oil field production. For the development of high water cut rare the status quo chemical water shutoff profile control technology is an important solution to solve this problem. Oilfield chemical water shutoff has important application prospects. This paper analyzes the water shutoff profile control and water shutoff profile control agent currently oilfield applications, moreover the use and development of blocking agent profile technology is to improve reservoir recovery and propose solutions. With the constant increase in water cut, profile technology should be simple, efficient, practical and profile control agent of development should be economic, environmental, and long period

The Challenges of Measuring Glycemic Variability

PubMed Central

Rodbard, David

2012-01-01

This commentary reviews several of the challenges encountered when attempting to quantify glycemic variability and correlate it with risk of diabetes complications. These challenges include (1) immaturity of the field, including problems of data accuracy, precision, reliability, cost, and availability; (2) larger relative error in the estimates of glycemic variability than in the estimates of the mean glucose; (3) high correlation between glycemic variability and mean glucose level; (4) multiplicity of measures; (5) correlation of the multiple measures; (6) duplication or reinvention of methods; (7) confusion of measures of glycemic variability with measures of quality of glycemic control; (8) the problem of multiple comparisons when assessing relationships among multiple measures of variability and multiple clinical end points; and (9) differing needs for routine clinical practice and clinical research applications. PMID:22768904

A Grignard-like Organic Reaction in Water

NASA Astrophysics Data System (ADS)

Breton, Gary W.; Hughey, Christine A.

1998-01-01

The addition of a Grignard reagent to a carbonyl-containing compound to form an alcohol is an important reaction to demonstrate in organic chemistry laboratory courses. However, the reaction presents several practical problems for the lab instructor including the need for anhydrous solvents (e.g., ether), dry glassware, and the occasional problem of slow reaction initiation. We have scaled, and tested, a known Grignard-like reaction between allyl bromide and benzaldehyde mediated by zinc metal in aqueous media. The procedure retains the desirable features of the traditional Grignard reaction, while eliminating some of the commonly encountered difficulties. Thus, addition of allyl bromide (1.2 eq) to benzaldehyde and zinc in a two-phase mixture of THF and saturated aqueous NH4Cl afforded addition product 1-phenyl-3-buten-1-ol in 70-85% yields.

The Hispanic family and male-female relationships: an overview.

PubMed

Galanti, Geri-Ann

2003-07-01

An overview of the traditional Hispanic family and male-female relationships is presented, with an emphasis on issues relevant to providing health care to Hispanic populations. Aspects of the family presented include visitation, decision making, self-care, and emotional problems. Male-female relationships stem from traditional gender roles. Machismo and patriarchal authority characterize the male role; the roles of a traditional woman are housewife and mother. Women are expected to defer to the authority of their husbands. The negative aspects of machismo can result in heavy drinking and the pursuit of high-risk activities, leading to domestic violence and HIV/AIDS. These health risks are exacerbated by such cultural factors as male dominance, female modesty, and the practice of keeping problems within the family. The importance of personalism in patient-provider encounters is emphasized.

Translation of an experimental oral vaccine formulation into a commercial product.

PubMed

Carter, K C; Ferro, V A; Alexander, J; Mullen, A B

2006-02-01

An effective experimental vaccine may fail to become a therapeutic reality for a number of scientific, regulatory or commercial reasons. In this review, we share some of our personal experiences as University-based researchers and provide an account of some of the problems that we have encountered during preliminary scale-up and assessment of an oral influenza vaccine formulation. Many of the problems we have faced have been non-scientific and related to identifying project-funding sources, finding suitable contract manufacturing companies that are GMP compliant, and protecting intellectual property generated from the scientific studies. The review is intended as a practical guide that will allow other researchers to adopt effective strategies to permit the translation of an effective experimental formulation to a viable commercial product.

Presentation and management of chronic pain.

PubMed

Rajapakse, Dilini; Liossi, Christina; Howard, Richard F

2014-05-01

Chronic pain is an important clinical problem affecting significant numbers of children and their families. The severity and impact of chronic pain on everyday function is shaped by the complex interaction of biological, psychological and social factors that determine the experience of pain for each individual, rather than a straightforward reflection of the severity of disease or extent of tissue damage. In this article we present the research findings that strongly support a biopsychosocial concept of chronic pain, describe the current best evidence for management strategies and suggest a common general pathway for all types of chronic pain. The principles of management of some of the most important or frequently encountered chronic pain problems in paediatric practice; neuropathic pain, complex regional pain syndrome (CRPS), musculoskeletal pain, abdominal pain and headache are also described.

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

PubMed

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

2018-02-01

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

[Patients' need for consultation after a geriatric assessment in family practice : Survey].

PubMed

Afshar, Kambiz; Bokhof, Beate; Wiese, Birgitt; Dierks, Marie-Luise; Junius-Walker, Ulrike

2016-10-01

During a doctor-patient consultation patients usually seek information by disclosing their reasons for requesting the encounter. Geriatric assessment allows a proactive examination of patients' overall health and function and provides an opportunity to broach issues beyond the initial purposes of the consultation. The study aimed at investigating older patients' information seeking behavior following a geriatric assessment and the kind of topics they wished to discuss, taking a variety of patient and health-related factors into account. A total of 317 patients (≥ 70 years) underwent a geriatric assessment in 40 general practices. Subsequently they obtained a list of the problems uncovered and rated the relevance and information needs for each problem. Analyses consisted of determining the prevalence of information need for each health topic and identifying predictors in a mixed model (multilevel regression analysis). The 317 patients presented with a median of 11 health problems (interquartile range, IQR 8-14) and 80 % of the patients had information needs concerning only a few of the problems. High information needs were present for physical complaints and for vaccination issues. Little information seeking behavior was evident for unhealthy lifestyles, falls, limitations in daily activities and psychosocial problems. In the mixed model the personal relevance and the type of health problem both had a significant and independent effect on information seeking behavior. A geriatric assessment generates a moderate need for information. It provides physicians with an opportunity to focus on those health problems that are important to older patients but not usually addressed in normal consultations. This particularly applies to limitations in daily activities and psychosocial problems.

Formulation and implementation of a practical algorithm for parameter estimation with process and measurement noise

NASA Technical Reports Server (NTRS)

Maine, R. E.; Iliff, K. W.

1980-01-01

A new formulation is proposed for the problem of parameter estimation of dynamic systems with both process and measurement noise. The formulation gives estimates that are maximum likelihood asymptotically in time. The means used to overcome the difficulties encountered by previous formulations are discussed. It is then shown how the proposed formulation can be efficiently implemented in a computer program. A computer program using the proposed formulation is available in a form suitable for routine application. Examples with simulated and real data are given to illustrate that the program works well.

Introduction to veterinary clinical oncology

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

Weller, R.E.

1991-10-01

Veterinary clinical oncology involves a multidisciplinary approach to the recognition and management of spontaneously occurring neoplasms of domestic animals. This requires some knowledge of the causes, incidence, and natural course of malignant disease as it occurs in domestic species. The purpose of this course is to acquaint you with the more common neoplastic problems you will encounter in practice, so that you can offer your clients an informed opinion regarding prognosis and possible therapeutic modalities. A major thrust will be directed toward discussing and encouraging treatment/management of malignant disease. Multimodality therapy will be stressed. 10 refs., 3 tabs.

Zoonotic diseases associated with reptiles and amphibians: an update.

PubMed

Mitchell, Mark A

2011-09-01

Reptiles and amphibians are popular as pets. There are increased concerns among public health officials because of the zoonotic potential associated with these animals. Encounters with reptiles and amphibians are also on the rise in the laboratory setting and with wild animals; in both of these practices, there is also an increased likelihood for exposure to zoonotic pathogens. It is important that veterinarians remain current with the literature as it relates to emerging and reemerging zoonotic diseases attributed to reptiles and amphibians so that they can protect themselves, their staff, and their clients from potential problems.

Multiple targets detection method in detection of UWB through-wall radar

NASA Astrophysics Data System (ADS)

Yang, Xiuwei; Yang, Chuanfa; Zhao, Xingwen; Tian, Xianzhong

2017-11-01

In this paper, the problems and difficulties encountered in the detection of multiple moving targets by UWB radar are analyzed. The experimental environment and the penetrating radar system are established. An adaptive threshold method based on local area is proposed to effectively filter out clutter interference The objective of the moving target is analyzed, and the false target is further filtered out by extracting the target feature. Based on the correlation between the targets, the target matching algorithm is proposed to improve the detection accuracy. Finally, the effectiveness of the above method is verified by practical experiment.

Tactics Employed and Problems Encountered by University English Majors in Hong Kong in Using a Dictionary

ERIC Educational Resources Information Center

Chan, Alice Yin Wa

2005-01-01

Building on the results of a small-scale survey which investigated the general use of dictionaries by university English majors in Hong Kong using a questionnaire survey and their specific use of dictionaries using an error correction task, this article discusses the tactics these students employed and the problems they encountered when using a…

Correlation between patients' reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC).

PubMed

Kaneko, Makoto; Ohta, Ryuichi; Nago, Naoki; Fukushi, Motoharu; Matsushima, Masato

2017-09-13

The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system. We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density. We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems. This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan need to be able to deal with "non-internal-medicine-related" RFEs and health problems, and that curriculum including practical non-internal medicine-related training is likely to be important.

Physician-patient interaction in reproductive counseling.

PubMed

Lipkin, M

1996-09-01

To review the scientific and clinical bases for effective patient counseling in contraceptive care. All articles and chapters in the Annotated Bibliography of Doctor Patient Communication of the Task Force on Doctor and Patient of the American Academy on Physician and Patient were searched and included. This is an expert-derived data base based on MEDLINE review from 1969 to 1994 and including expert-selected additions from PsychLit and a variety of other social science data bases, books, and reviews. Expert consensus was used from the Committee on Bibliography of the American Academy on Physician and Patient. The doctor-patient interaction is the main determinant of the accuracy and completeness of patient data, diagnostic accuracy, efficiency in the encounter, compliance, patient understanding of problems, and patient and physician satisfaction. Yet this critical skill is inadequately taught and practiced, with serious consequences for patient care and physician job satisfaction. Use of the 14 structural elements (preparing the environment, preparing oneself, observation, greeting, introduction, detecting and overcoming barriers to communication, surveying problems, negotiating a priority problem, developing a narrative thread, establishing the life context of the patient, establishing a safety net, presenting findings and options, negotiating plans, and closing) and three functions (gathering information, developing a therapeutic relationship, and patient education) and their associated behaviors improves encounter results significantly. Other helpful activities are patient activation, facilitating partnership, review of findings and plans, eliciting and responding to patients' attitudes and emotions about contraception and fertility, and use of empathy and positive regard. The use of scientifically derived, empirically validated interview skills substantially improves outcomes in contraceptive and other patient education and counseling. Use of appropriate structure and functions of the encounter, patient participation and partnership, review of patient understanding and reactions, and relating to the patients' attitudes and emotions about the subject each improve the outcomes of contraceptive care.

Teaching biotechnology in NSW schools

NASA Astrophysics Data System (ADS)

Steele, Frances A.

Agriculture, industry and medicine are being altered by new biological technologies. Today's students are the citizens who will make decisions about associated ethical issues. They need to have the knowledge that will enable them to make informed choices. Hence biotechnology has an important place in science education. The aims of the research were to: 1. describe the state of biotechnology teaching in NSW; 2. determine whether teachers in NSW do not teach biotechnology because they do not have the necessary knowledge and experience; 3. identify other reasons why NSW teachers choose not to teach biotechnology; 4. describe problems encountered in teaching biotechnology in NSW; 5. suggest ways in which the problems encountered in the teaching of biotechnology can be overcome. Quantitative and qualitative methods were used in a complementary way to investigate these aims. In a sample of teachers surveyed, many reported that they chose not to teach biotechnology because they did not have adequate knowledge and experience. Other obstacles were identified. These were: 1. the difficulty of the subject matter; 2. the lack of practical work; 3. lack of a program for biotechnology in junior science. The results of this trial suggested that a biotechnology unit should be developed in collaboration with the teacher and that time needs to be made available for school based program development.

Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India.

PubMed

Acharya, Rajesh V; Rai, Jasuma J

2016-01-01

Telemedicine incorporates electronic information and medical technology. It connects healthcare through vast distances which would benefit both patients and doctors. The aim of this questionnaire study was to evaluate the effects of telemedicine on patients and medical specialists. A cross-sectional study was conducted among 122 participants (71 patients and 51 doctors) on satisfaction in quality of service, cost-effectiveness, and problems encountered in healthcare provided by the telemedicine in Apollo Tele Health Services, Hyderabad, Telangana, India. The data for each group were calculated and compared. About 80% patients and all the doctors reported their satisfaction on the quality of treatment given through telemedicine. Approximately, 90% of the participants found telemedicine cost-effective and 61% of the doctors found an increase in patient's inflow apart for their regular practice. Problems encountered in telemedicine were 47% in technical issues and 39% in time scheduling by doctors and 31% of patients were uncomfortable to face the camera, and 24% had technical issues. The results of the present study showed that telemedicine in healthcare could prove to be useful to patients in distant regions and to rural doctors in India. In the near future, telemedicine can be considered as an alternate to face to face patient care.

Empathy in general practice-the gap between wishes and reality: comparing the views of patients and physicians.

PubMed

Derksen, F A W M; Olde Hartman, Tim; Bensing, Jozien; Lagro-Janssen, Antoine

2018-03-27

Empathy is regarded by patients and general practitioners (GPs) as fundamental in patient-GP communication. Patients do not always experience empathy and GPs encounter circumstances which hamper applying it. To explore why receiving and offering empathy during the encounter in general practice does not always meet the wishes of both patients and GPs. A qualitative research method, based on focus group interviews with patients and in-depth interviews with GPs, was carried out. Within the research process, iterative data collection and analysis were applied. Both patients and GPs perceive a gap between what they wish for with regard to empathy, and what they actually encounter in general practice. Patients report on circumstances which hamper receiving empathy and GPs on circumstances offering it. Various obstacles were mentioned: (i) circumstances related to practice organization, (ii) circumstances related to patient-GP communication or connectedness, (iii) differences between the patient's and the GP's expectations, (iv) time pressure and its causes and (v) the GP's individual capability to offer empathy. When patients do not receive empathy from their GP or practice staff, they feel frustrated. This causes a gap between their expectations on the one hand and their actual experiences on the other. GPs generally want to incorporate empathy; the GP's private, professional and psychological well-being appears to be an important contributing factor in practicing empathy in daily practice. But they encounter various obstacles to offer this. It is up to GPs to take responsibility for showing practice members the importance of an appropriate empathical behaviour towards patients.

Children living with a mentally ill parent: the role of public health nurses.

PubMed

Mahoney, Laurie

2010-08-01

Public Health Nurses work with children under 18 years in schools and the community. Increasingly children are living with a parent suffering from a mental illness. Consequently Public Health Nurses are encountering more mental illness as part of their practice. The research reported in this article aimed to identify the Public Health Nurse's role with regard to children in these circumstances. A qualitative research design was used with eight Public Health Nurses working in rural and urban settings. Participants engaged in a focus group from which data were gathered and analysed thematically using axial coding. To evaluate the identified themes six of the participants went on to take part in a further focus group. The three key themes identified were Advocacy, Assessment, and Relational Knowing and Clinical Practice. It emerged that the role of Public Health Nurses working with such families involved advocating for the child, using a range of assessment skills to gather relevant information and make referrals, with all informed by expert knowledge and clinical experience. Findings indicate the need for more acknowledgement of the frequency with which Public Health Nurses are encountering problems associated with mental illness; and hence the need for provision of appropriate education and support that will enable them to effectively advocate for children's safety and wellbeing.

An adaptive robust controller for time delay maglev transportation systems

NASA Astrophysics Data System (ADS)

Milani, Reza Hamidi; Zarabadipour, Hassan; Shahnazi, Reza

2012-12-01

For engineering systems, uncertainties and time delays are two important issues that must be considered in control design. Uncertainties are often encountered in various dynamical systems due to modeling errors, measurement noises, linearization and approximations. Time delays have always been among the most difficult problems encountered in process control. In practical applications of feedback control, time delay arises frequently and can severely degrade closed-loop system performance and in some cases, drives the system to instability. Therefore, stability analysis and controller synthesis for uncertain nonlinear time-delay systems are important both in theory and in practice and many analytical techniques have been developed using delay-dependent Lyapunov function. In the past decade the magnetic and levitation (maglev) transportation system as a new system with high functionality has been the focus of numerous studies. However, maglev transportation systems are highly nonlinear and thus designing controller for those are challenging. The main topic of this paper is to design an adaptive robust controller for maglev transportation systems with time-delay, parametric uncertainties and external disturbances. In this paper, an adaptive robust control (ARC) is designed for this purpose. It should be noted that the adaptive gain is derived from Lyapunov-Krasovskii synthesis method, therefore asymptotic stability is guaranteed.

Conducting longitudinal, process-oriented research with conflict-affected youth: Solving the inevitable challenges.

PubMed

Dubow, Eric F; Aber, J Lawrence; Betancourt, Theresa S; Cummings, E Mark; Huesmann, L Rowell

2017-02-01

The reader might get the impression that the four projects described in this Special Section proceeded in a systematic and predictable way. Of course, those of us engaged in each research project encountered pitfalls and challenges along the way. A main goal of this Special Section is to provide pathways and encouragement for those who may be interested in advancing high-quality research on this topic. In this paper, we describe a set of practical and ethical challenges that we encountered in conducting our longitudinal, process-oriented, and translational research with conflict-affected youth, and we illustrate how problems can be solved with the goal of maintaining the internal and external validity of the research designs. We are hopeful that by describing the challenges of our work, and how we overcame them, which are seldom treated in this or any other literature on research on child development in high-risk contexts, we can offer a realistic and encouraging picture of conducting methodologically sound research in conflict-affected contexts.

Antiservice Within the Medical Service Encounter: Lessons for Radiologists Beyond Service Recovery.

PubMed

Hill, Paul Armstrong; Hill, Ronald Paul

2015-12-01

Recent modifications in the metrics for reimbursement have reinforced the importance of radiology service-delivery experiences of patients. Evaluating current radiology practices calls for reflection on the various touch points with patients, as well as their overall satisfaction. If problems occur during encounters, service failure, or lack of satisfactory medical experiences can be transformed through service recovery, whereby patients-as-customers are given chances to voice their concerns, and health care providers across the spectrum can work together to resolve problematic issues. This paper takes a systemic view of the patient experience as embedded in the care continuum, recognizing that different beliefs, attitudes, and behaviors of members of the health care team can negatively affect or sabotage patient satisfaction. Although radiologists are only one of many roles in the care continuum, recommendations are discussed for how they can integrate service satisfaction as a pervasive communal goal among all health care team members. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.

PubMed

Roberts, Nicole K; Williams, Reed G; Schwind, Cathy J; Sutyak, John A; McDowell, Christopher; Griffen, David; Wall, Jarrod; Sanfey, Hilary; Chestnut, Audra; Meier, Andreas H; Wohltmann, Christopher; Clark, Ted R; Wetter, Nathan

2014-02-01

Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care. Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations. Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention. Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams. Copyright © 2014 Elsevier Inc. All rights reserved.

Development of a banding database for North Pacific albatross: Implications for future data collection

USGS Publications Warehouse

Doherty, P.F.; Kendall, W.L.; Sillett, S.; Gustafson, M.; Flint, B.; Naughton, M.; Robbins, C.S.; Pyle, P.; Macintyre, Ian G.

2006-01-01

The effects of fishery practices on black-footed (Phoebastria nigripes) and Laysan albatross (Phoebastria immutabilis) continue to be a source of contention and uncertainty. Some of this uncertainty is a result of a lack of estimates of albatross demographic parameters such as survival. To begin to address these informational needs, a database of albatross banding and encounter records was constructed. Due to uncertainty concerning data collection and validity of assumptions required for mark-recapture analyses, these data should be used with caution. Although demographic parameter estimates are of interest to many, band loss rates, temporary emigration rates, and discontinuous banding effort can confound these estimates. We suggest a number of improvements in data collection that can help ameliorate problems, including the use of double banding and collecting data using a `robust? design. Additionally, sustained banding and encounter efforts are needed to maximize the value of these data. With these modifications, the usefulness of the banding data could be improved markedly.

Chronic hand eczema: perception and knowledge in non-affected individuals from general and dermatological practice.

PubMed

Letulé, Valerie; Herzinger, Thomas; Schirner, Astrid; Hertrich, Frank; Lange, Dirk; Ruzicka, Thomas; Molin, Sonja

2014-11-01

Misunderstanding and stigmatisation are common problems encountered by patients with hand eczema. Various misconceptions about the disease circulate in the general population. Although hand eczema has gained more attention in dermatology during the past years, information on public perception of the disease is still lacking. The aim of our study was to investigate perception of and level of knowledge on the subject hand eczema. There were 624 patients included from 2 general medicine practices and 2 dermatological practices. A self-administered questionnaire was filled out by the participants, covering issues on history of hand eczema, level of knowledge and attitude towards a clinical photograph of hand eczema. We found that a larger proportion of individuals from dermatological practice were more familiar with hand eczema as a disease than those from general medical practice. Women knew significantly more about and had a more positive perception of the disease than men. Our results imply that the level of knowledge on hand eczema in the general public is rather low and influenced by prejudice.

Analysis of the Problems Encountered in Education of Teachers and Solution Recommendations in Accordance with the Opinions of Faculty of Education Students

ERIC Educational Resources Information Center

Sahan, Gülsün

2016-01-01

The purpose of this study is to put forth the problems encountered in education of teachers and solution recommendations in accordance with the opinions of faculty of education students. Within this framework, the opinions of 182 first grade students from the departments of classroom, social sciences, science and mathematics teaching at Bartin…

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

PubMed

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

2009-03-01

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

Educating the humanitarian engineer.

PubMed

Passino, Kevin M

2009-12-01

The creation of new technologies that serve humanity holds the potential to help end global poverty. Unfortunately, relatively little is done in engineering education to support engineers' humanitarian efforts. Here, various strategies are introduced to augment the teaching of engineering ethics with the goal of encouraging engineers to serve as effective volunteers for community service. First, codes of ethics, moral frameworks, and comparative analysis of professional service standards lay the foundation for expectations for voluntary service in the engineering profession. Second, standard coverage of global issues in engineering ethics educates humanitarian engineers about aspects of the community that influence technical design constraints encountered in practice. Sample assignments on volunteerism are provided, including a prototypical design problem that integrates community constraints into a technical design problem in a novel way. Third, it is shown how extracurricular engineering organizations can provide a theory-practice approach to education in volunteerism. Sample completed projects are described for both undergraduates and graduate students. The student organization approach is contrasted with the service-learning approach. Finally, long-term goals for establishing better infrastructure are identified for educating the humanitarian engineer in the university, and supporting life-long activities of humanitarian engineers.

Interkulturelles Lernen — Zur Grundlegung eines didaktischen Prinzips interkultureller Begegnungen

NASA Astrophysics Data System (ADS)

Sandhaas, Bernd

1988-12-01

In the Federal Republic of Germany there have in recent years been many varied encounters between Germans and representatives of other cultures, particularly those from Third World countries. These have increasingly been organized with an awareness of global interdependence and have as a result opened the door to the influence of foreign cultures and to an unmistakeable movement in the direction of a multicultural society. An intercultural pedagogical approach and didactic theory are faced with the task of resolving the consequent problems related to education and training. The author firstly attempts to systematize as a typology the practice of learning as it occurs in intercultural encounters in so far as this relates to the Federal Republic of Germany. He suggests that `intercultural learning' should be seen as the didactic principle underlying the organization of learning in such encounters. Through a detailed discussion of his central concepts of `culture' and `learning' and of the issue of `interculturalism', and by sketching a theoretical model of the stages and goals of the learning taking place, he then makes plain the necessary enlargement of the German concept of `Kultur' and the process of differentiation which the concept of learning will have to engage in if it is to be applicable to educational activity in international or intercultural contexts.

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

PubMed Central

McNichol, Laurie; Boarini, Joy

2017-01-01

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

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

PubMed

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

2016-05-01

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

Pharmacy users’ expectations of pharmacy encounters: a Q‐methodological study

PubMed Central

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Åsa; Tully, Mary P.

2010-01-01

Abstract Background  Pharmacy practice is evolving according to general health‐care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients’ expectations of service encounters at pharmacies is an under‐explored topic but crucial to understanding how pharmacy practice can evolve efficiently. Objective  To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Methods  Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Setting and participants  Eighty‐five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Results  Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual’s own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health‐care and lifestyle support. Discussion and conclusions  The systematic Q‐methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients’ expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. PMID:21199199

Pharmacy users' expectations of pharmacy encounters: a Q-methodological study.

PubMed

Renberg, Tobias; Wichman Törnqvist, Kristina; Kälvemark Sporrong, Sofia; Kettis Lindblad, Asa; Tully, Mary P

2011-12-01

Pharmacy practice is evolving according to general health-care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients' expectations of service encounters at pharmacies is an under-explored topic but crucial to understanding how pharmacy practice can evolve efficiently. To identify and describe different normative expectations of the pharmacy encounter among pharmacy clients. Q methodology, an approach to systematically explore subjectivity that retains complete patterns of responses and organizes these into factors of operant subjectivity. Eighty-five regular prescription medication users recruited at Swedish community pharmacies and by snowballing. Seven factors of operant subjectivity were identified, and organized into two groups. Factors that emphasized the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and supply of individual's own drugs. Factors that emphasized personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical health-care and lifestyle support. The systematic Q-methodological approach yielded valuable insights into how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints may be important for developing and prioritizing among efficient pharmacy services. Clients' expectations do not correspond with trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends. © 2010 Blackwell Publishing Ltd.

Identifying and separating the effects of practice and of cognitive ageing during a large longitudinal study of elderly community residents.

PubMed

Rabbitt, P; Diggle, P; Smith, D; Holland, F; Mc Innes, L

2001-01-01

In protracted longitudinal studies of cognitive changes in old age volunteers must be repeatedly tested. Even with intervals of several years between assessment, this raises the possibility that improvements due to practice mask other changes. This problem is much more acute in brief studies of cognitive changes associated with progressive pathologies such as Alzheimer's disease or the effects of clinical interventions. Both types of study also encounter problems of selective dropout of frail and less able individuals leaving relatively 'elite' survivors. An analysis of data from repeated testing at 2-3 years intervals on the AH4 (1) intelligence test is presented to illustrate how a random effects model can be used to identify and disassociate age-related changes and practice effects at the population level, after effects of selective dropout and of background demographical variables have been taken into consideration. This analysis also provides some new, substantive empirical findings. Age-related changes are relatively slight between 49 and 70 years but much more marked between 70 and 80 years. Even with assessment points, several years apart the population average effect of practice is large relative to that of age-related change. Variation between individuals increases as samples age, providing the first clear evidence from a longitudinal study for marked individual differences in trajectories of cognitive ageing.

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

ERIC Educational Resources Information Center

Norman, Donald A.

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

Manualization of Occupational Therapy Using Ayres Sensory Integration® for Autism.

PubMed

Hunt, Joanne; van Hooydonk, Elke; Faller, Patricia; Mailloux, Zoe; Schaaf, Roseann

2017-07-01

This article reports on the development of a Stage 3 manual (following pilot effectiveness study) for implementing occupational therapy using Ayres Sensory Integration® (OT/ASI) for children with autism spectrum disorders to enhance participation in daily occupations. Three stakeholder groups were surveyed to aid in translation of manual from research to practice (i.e., Stage 3 manual) and an expert consensus meeting was held to finalize recommendations. Data indicated that the manuals usability could be improved by including a section on frequently encountered problems and solutions, and by including video case examples. Also recommended were greater chapter uniformity, improved clarity of forms and charts, and inclusion of a glossary. Changes were made and subject to expert review and consensus using modified Delphi process. The Stage 3 manual has been rigorously vetted and is ready for practice and research replication.

Adapting Experiential Learning to Develop Problem-Solving Skills in Deaf and Hard-of-Hearing Engineering Students.

PubMed

Marshall, Matthew M; Carrano, Andres L; Dannels, Wendy A

2016-10-01

Individuals who are deaf and hard-of-hearing (DHH) are underrepresented in science, technology, engineering, and mathematics (STEM) professions, and this may be due in part to their level of preparation in the development and retention of mathematical and problem-solving skills. An approach was developed that incorporates experiential learning and best practices of STEM instruction to give first-year DHH students enrolled in a postsecondary STEM program the opportunity to develop problem-solving skills in real-world scenarios. Using an industrial engineering laboratory that provides manufacturing and warehousing environments, students were immersed in real-world scenarios in which they worked on teams to address prescribed problems encountered during the activities. The highly structured, Plan-Do-Check-Act approach commonly used in industry was adapted for the DHH student participants to document and communicate the problem-solving steps. Students who experienced the intervention realized a 14.6% improvement in problem-solving proficiency compared with a control group, and this gain was retained at 6 and 12 months, post-intervention. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Outcomes of planetary close encounters - A systematic comparison of methodologies

NASA Technical Reports Server (NTRS)

Greenberg, Richard; Carusi, Andrea; Valsecchi, G. B.

1988-01-01

Several methods for estimating the outcomes of close planetary encounters are compared on the basis of the numerical integration of a range of encounter types. An attempt is made to lay the foundation for the development of predictive rules concerning the encounter outcomes applicable to the refinement of the statistical mechanics that apply to planet-formation and similar problems concerning planetary swarms. Attention is given to Oepik's (1976) formulation of the two-body approximation, whose predicted motion differs from the correct three-body behavior.

Balint work and the creation of medical knowledge.

PubMed

Muench, John

2018-01-01

Michael Balint's pioneering work in primary care was not simply the application of psychodynamic theory to the complex problems and relationships encountered by clinicians. Rather, Balint's work was part of a wider conversation in Western epistemology that had already begun to break down the enlightenment rationalist agenda. Since the time of Descartes, we sought to find certain truth through decontextualizing and abstracting problems, and through separation of the observer from the thing observed, with a focus on finding universal timeless laws that could be generalized. By the mid-1950s, it was clear that this agenda was insufficient to answer important questions about what it means to be human and to live a healthy and happy life. Balint's experiment was a return to a method of knowledge creation that is case based, narrative, local, timely, particular, and especially considers specific contexts for finding solutions to problems. For current healthcare reform efforts to be effective, we must include Balint's focus on the context of the doctor, patient, and their relationship, as well as development of practical wisdom (i.e. Aristotelian phronesis) that we know in medicine as professional judgment. The case study method of the Balint group is one of the few and best formal methods to teach and practice this way of knowing.

Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition.

PubMed

Minakami, Hisanori; Maeda, Tsugio; Fujii, Tomoyuki; Hamada, Hiromi; Iitsuka, Yoshinori; Itakura, Atsuo; Itoh, Hiroaki; Iwashita, Mitsutoshi; Kanagawa, Takeshi; Kanai, Makoto; Kasuga, Yoshio; Kawabata, Masakiyo; Kobayashi, Kosuke; Kotani, Tomomi; Kudo, Yoshiki; Makino, Yasuo; Matsubara, Shigeki; Matsuda, Hideo; Miura, Kiyonori; Murakoshi, Takeshi; Murotsuki, Jun; Ohkuchi, Akihide; Ohno, Yasumasa; Ohshiba, Yoko; Satoh, Shoji; Sekizawa, Akihiko; Sugiura, Mayumi; Suzuki, Shunji; Takahashi, Tsuneo; Tsukahara, Yuki; Unno, Nobuya; Yoshikawa, Hiroyuki

2014-06-01

The 'Clinical Guidelines for Obstetrical Practice, 2011 edition' were revised and published as a 2014 edition (in Japanese) in April 2014 by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction of burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. The number of Clinical Questions and Answers items increased from 87 in the 2011 edition to 104 in the 2014 edition. The Japanese 2014 version included a Discussion, a List of References, and some Tables and Figures following the Answers to the 104 Clinical Questions; these additional sections covered common problems and questions encountered in obstetrical practice, helping Japanese readers to achieve a comprehensive understanding. Each answer with a recommendation level of A, B or C was prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' was weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 104 Clinical Questions and Answers items, with the omission of the Discussion, List of References, and Tables and Figures, are presented herein to promote a better understanding among English readers of the current standard care practices for pregnant women in Japan. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Sampling errors in blunt dust samplers arising from external wall loss effects

NASA Astrophysics Data System (ADS)

Vincent, J. H.; Gibson, H.

Evidence is given that, with some forms of blunt dust sampler under conditions relating to those encountered in practical occupational hygiene and environmental monitoring, particles which impact onto the outer surface of the sampler body may not adhere permanently, and may eventually enter the sampling orifice. The effect of such external wall loss is to bring about excess sampling, where errors as high as 100% could arise. The problem is particularly important in the sampling of dry airborne particulates of the type commonly found in practical situations. For a given sampler configuration, the effect becomes more marked as the particle size increases or as the ratio of sampling velocity to ambient wind speed increases. We would expect it be greater for gritty, crystalline material than for smoother, amorphous material. Possible mechanisms controlling external wall losses were examined, and it was concluded that particle 'blow-off' (as opposed to particle 'bounce') is the most plausible. On the basis of simple experiments, it might be possible to make corrections for the sampling errors in question, but caution is recommended in doing so because of the unpredictable effects of environmental factors such as temperature and relative humidity. Of the possible practical solutions to the problem, it is felt that the best approach lies in the correct choice of sampler inlet design.

Casebooks in Early Modern England:

PubMed Central

Kassell, Lauren

2014-01-01

summary Casebooks are the richest sources that we have for encounters between early modern medical practitioners and their patients. This article compares astrological and medical records across two centuries, focused on England, and charts developments in the ways in which practitioners kept records and reflected on their practices. Astrologers had a long history of working from particular moments, stellar configurations, and events to general rules. These practices required systematic notation. Physicians increasingly modeled themselves on Hippocrates, recording details of cases as the basis for reasoned expositions of the histories of disease. Medical records, as other scholars have demonstrated, shaped the production of medical knowledge. Instead, this article focuses on the nature of casebooks as artifacts of the medical encounter. It establishes that casebooks were serial records of practice, akin to diaries, testimonials, and registers; identifies extant English casebooks and the practices that led to their production and preservation; and concludes that the processes of writing, ordering, and preserving medical records are as important for understanding the medical encounter as the records themselves. PMID:25557513

Casebooks in early modern England: medicine, astrology, and written records.

PubMed

Kassell, Lauren

2014-01-01

Casebooks are the richest sources that we have for encounters between early modern medical practitioners and their patients. This article compares astrological and medical records across two centuries, focused on England, and charts developments in the ways in which practitioners kept records and reflected on their practices. Astrologers had a long history of working from particular moments, stellar configurations, and events to general rules. These practices required systematic notation. Physicians increasingly modeled themselves on Hippocrates, recording details of cases as the basis for reasoned expositions of the histories of disease. Medical records, as other scholars have demonstrated, shaped the production of medical knowledge. Instead, this article focuses on the nature of casebooks as artifacts of the medical encounter. It establishes that casebooks were serial records of practice, akin to diaries, testimonials, and registers; identifies extant English casebooks and the practices that led to their production and preservation; and concludes that the processes of writing, ordering, and preserving medical records are as important for understanding the medical encounter as the records themselves.

Insights into software development in Japan

NASA Technical Reports Server (NTRS)

Duvall, Lorraine M.

1992-01-01

The interdependence of the U.S.-Japanese economies makes it imperative that we in the United States understand how business and technology developments take place in Japan. We can gain insight into these developments in software engineering by studying the context in which Japanese software is developed, the practices that are used, the problems encountered, the setting surrounding these problems, and the resolution of these problems. Context includes the technological and sociological characteristics of the software development environment, the software processes applied, personnel involved in the development process, and the corporate and social culture surrounding the development. Presented in this paper is a summary of results of a study that addresses these issues. Data for this study was collected during a three month visit to Japan where the author interviewed 20 software managers representing nine companies involved in developing software in Japan. These data are compared to similar data from the United States in which 12 managers from five companies were interviewed.

An approach to complex acid-base problems

PubMed Central

Herd, Anthony M.

2005-01-01

OBJECTIVE To review rules and formulas for solving even the most complex acid-base problems. SOURCES OF INFORMATION MEDLINE was searched from January 1966 to December 2003. The search was limited to English-language review articles involving human subjects. Nine relevant review papers were found and provide the background. As this information is well established and widely accepted, it is not judged for strength of evidence, as is standard practice. MAIN MESSAGE An understanding of the body’s responses to acidemia or alkalemia can be gained through a set of four rules and two formulas that can be used to interpret almost any acid-base problems. Physicians should, however, remember the “golden rule” of acid-base interpretation: always look at a patient’s clinical condition. CONCLUSION Physicians practising in acute care settings commonly encounter acid-base disturbances. While some of these are relatively simple and easy to interpret, some are more complex. Even complex cases can be resolved using the four rules and two formulas. PMID:15751566

Problems in processing Rheinische Braunkohle (soft coal) (in German)

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

von Hartmann, G.B.

At Wesseling, difficulties were encountered with the hydrogenation of Rhine brown coal. The hydrogenation reaction was proceeding too rapidly at 600 atm pressure under relatively low temperature and throughput conditions. This caused a build-up of ''caviar'' deposits containing ash and asphalts. This flocculation of asphalt seemed to arise because the rapid reaction produced a liquid medium unable to hold the heavy asphalt particles in suspension. A stronger paraffinic character of the oil was also a result. To obtain practical, problem-free yields, throughput had to be increased (from .4 kg/liter/hr to more than .5), and temperature had to be increased (frommore » 24.0 MV to 24,8 MV). Further, a considerable increase in sludge recycling was recommended. The Wesseling plant was unable to increase the temperature and throughput. However, more sludge was recycled, producing a paste better able to hold higher-molecular-weight particles in suspension. If this were not to solve the ''caviar'' deposit problems, further recommendations were suggested including addition of more heavy oil.« less

DSM-5 and neurodevelopmental and other disorders of childhood and adolescence.

PubMed

Wills, Cheryl D

2014-01-01

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the classification of mental disorders for children and adolescents has been revised. Although some changes are welcome and needed, others have been controversial. In this article, I examine the diagnostic changes along with some of the associated controversies and resolutions. The implications for the practice of child forensic psychiatry, including problems that may be encountered by forensic psychiatrists who evaluate adults with childhood-onset mental disorders, are examined. The pitfalls associated with improper use of The Manual by legal professionals are also reviewed. © 2014 American Academy of Psychiatry and the Law.

High power, high frequency helix TWT's

NASA Astrophysics Data System (ADS)

Sloley, H. J.; Willard, J.; Paatz, S. R.; Keat, M. J.

The design and performance characteristics of a 34-GHz pulse tube capable of 75 W peak power output at 30 percent duty cycle and a broadband CW tube are presented. Particular attention is given to the engineering problems encountered during the development of the tubes, including the suppression of backward wave oscillation, the design of electron guns for small-diameter high-current beams, and the thermal capability of small helix structures. The discussion also covers the effects of various design parameters and choice of engineering materials on the ultimate practical limit of power and gain at the operating frequencies. Measurements are presented for advanced experimental tubes.

Treatment of Fungal Urinary Tract Infection.

PubMed

Thomas, Lewis; Tracy, Chad R

2015-11-01

Funguria, and particularly candiduria, is an increasingly common problem encountered by the practicing urologist and is associated with high-acuity care, indwelling catheters, diabetes mellitus, antibiotic and steroid use, and urinary tract disease. In most cases, candiduria is asymptomatic and follows a benign clinical course with antifungal therapy only required in symptomatic or high-risk cases, because spontaneous resolution is common in patients with asymptomatic colonization. Rarely, invasive infections can occur (such as fungus balls or renal abscesses) and may require percutaneous and endoscopic interventions. This article highlights the workup and treatment of funguria and its related urologic manifestations. Copyright © 2015 Elsevier Inc. All rights reserved.

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

PubMed

Nishime, Robert S

2007-06-01

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

Iatrogenic Blood-borne Viral Infections in Refugee Children from War and Transition Zones

PubMed Central

2013-01-01

Pediatric infectious disease clinicians in industrialized countries may encounter iatrogenically transmitted HIV, hepatitis B virus, and hepatitis C virus infections in refugee children from Central Asia, Southeast Asia, and sub-Saharan Africa. The consequences of political collapse and/or civil war—work migration, prostitution, intravenous drug use, defective public health resources, and poor access to good medical care—all contribute to the spread of blood-borne viruses. Inadequate infection control practices by medical establishments can lead to iatrogenic infection of children. Summaries of 4 cases in refugee children in Australia are a salient reminder of this problem. PMID:23739597

Some comments upon current optical shop practices.

PubMed

Larmer, J W; Goldstein, E

1966-05-01

The fabrication of optical elements began as an art rather than a science and has tended to remain so throughout its history. Today's methods are largely extensions of the original techniques. With spaceage demands for rapid response as well as quality, some effort is being made to remove optical technology from the realm of wizardry by standardizing fabrication procedures and associated working materials. However, the diversity of problems encountered in modern optical fabrication requires a flexibility of approach which indicates that the artisan will always be with us. Examples of some optical fabrication and testing procedures employed at the Goddard Space Flight Center are presented.

Safety management in multiemployer worksites in the manufacturing industry: opinions on co-operation and problems encountered.

PubMed

Nenonen, Sanna; Vasara, Juha

2013-01-01

Co-operation between different parties and effective safety management play an important role in ensuring safety in multiemployer worksites. This article reviews safety co-operation and factors complicating safety management in Finnish multiemployer manufacturing worksites. The paper focuses on the service providers' opinions; however, a comparison of the customers' views is also presented. The results show that safety-related co-operation between providers and customers is generally considered as successful but strongly dependent on the partner. Safety co-operation is provided through, e.g., training, orientation and risk analysis. Problems encountered include ensuring adequate communication, identifying hazards, co-ordinating work tasks and determining responsibilities. The providers and the customers encounter similar safety management problems. The results presented in this article can help companies to focus their efforts on the most problematic points of safety management and to avoid common pitfalls.

Disrespect, harassment, and abuse

PubMed Central

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

2009-01-01

ABSTRACT OBJECTIVE To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. DESIGN Qualitative case study using semistructured interviews. SETTING Province of New Brunswick. PARTICIPANTS Forty-eight family physicians from across the province. METHODS A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation (< 10 years, 10 to 20 years, or > 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick’s physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. MAIN FINDINGS Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters—young, female, rural physicians appeared to experience such encounters most often. CONCLUSION Abusive encounters in the workplace are concerning. It is essential to address these issues of workplace harassment and abuse in order to protect physician safety and avoid workplace dissatisfaction. Abusive encounters might push family physicians to leave clinical practice prematurely or refuse to work in higher-risk environments, such as emergency departments or rural areas. PMID:19282539

Rational prescribing in paediatrics in a resource-limited setting.

PubMed

Risk, Rachel; Naismith, Hamish; Burnett, Alexander; Moore, Sophie E; Cham, Mamady; Unger, Stefan

2013-07-01

There is evidence of inappropriate medication use, causing unnecessary costs for health systems, particularly those with limited resources. Overprescription is commonly reported and can lead to antibiotic resistance. Prescribing patterns differ between countries; little is known about paediatric prescribing practices in Africa. To investigate prescribing practices in children in The Gambia, West Africa. A retrospective survey of prescribing practices in children under 5 years of age based on WHO protocol DAP/93.1 was conducted. Twenty government-run health centres across all six regions in The Gambia were assessed. The first 10 encounters each month in 2010 were recorded. For each encounter, patient demographics, diagnoses and medications were recorded as per protocol. Two thousand and four hundred patient encounters were included. The mean number of medications per encounter was 2.2 (median 2.0, IQR 2.0-3.0). Across different geographical regions within The Gambia antibiotics were prescribed in 63.4% (IQR 62.8-65.8%) and micronutrients in 21.7% (IQR 15.3-27.1%) of patient encounters. There was evidence of high antibiotic prescription in children with cough and coryzal symptoms (54.5%; IQR 35.8-59.0%) and simple diarrhoea without dehydration (44.8%; IQR 36.7-61.3%). 74.8% (IQR 71.8-76.1%) of medications were prescribed generically. The study showed an overprescription of antibiotics and substantial usage of micronutrients despite a lack of international evidence-based guidelines. Cost-effective interventions to improve prescribing practices are called for and more studies with a focus on rational prescribing in paediatrics in low-income settings are urgently required to fill the gap in current knowledge.

An online forum as a qualitative research method: practical issues.

PubMed

Im, Eun-Ok; Chee, Wonshik

2006-01-01

Despite the positive aspects of online forums as a qualitative research method, very little is known on the practical issues involved in using online forums for data collection, especially for a qualitative research project. The aim of this study was to describe the practical issues encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience. Throughout the study process, the research staff recorded issues ranging from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of the discussions were reviewed and analyzed using content analysis. Two practical issues related to credibility were identified: (a) a high response and retention rate and (b) automatic transcripts. An issue related to dependability was the participants' forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well. The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method.

Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences

PubMed Central

Pereira, Chrystian R.; Harris, Ila M.; Moon, Jean Y.; Westberg, Sarah M.; Kolar, Claire

2016-01-01

Objective. To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Design. Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students’ competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Assessment. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Conclusions. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs. PMID:26941440

The laser interferometer skin-friction meter - A numerical and experimental study

NASA Technical Reports Server (NTRS)

Murphy, J. D.; Westphal, R. V.

1986-01-01

Limits to the applicability of thin-film lubrication theory are established. The following two problems are considered: (1) the response of the oil film to a time-varying skin friction such as is encountered in turbulent boundary layers, and (2) a 'surface-wave instability' encountered at high skin-friction levels. Results corresponding to the first problem reveal that the laser interferometer skin-friction meter may, in principle, be applied to the measurement of instantaneous skin friction. In addressing the second problem, it is shown that the observed surface waves are not the result of a hydrodynamic instability.

Physical activity problem-solving inventory for adolescents: Development and initial validation

USDA-ARS?s Scientific Manuscript database

Youth encounter physical activity barriers, often called problems. The purpose of problem-solving is to generate solutions to overcome the barriers. Enhancing problem-solving ability may enable youth to be more physically active. Therefore, a method for reliably assessing physical activity problem-s...

Hardware problems encountered in solar heating and cooling systems

NASA Technical Reports Server (NTRS)

Cash, M.

1978-01-01

Numerous problems in the design, production, installation, and operation of solar energy systems are discussed. Described are hardware problems, which range from simple to obscure and complex, and their resolution.

What makes up good consultations? A qualitative study of GPs' discourses.

PubMed

Van Roy, Kaatje; Vanheule, Stijn; Deveugele, Myriam

2013-05-16

In medical literature, several principles that define 'good consultations' have been outlined. These principles tend to be prescriptive in nature, overlooking the complexity of general practitioners (GPs)' perspectives of everyday practice. Focusing on perspectives might be particularly relevant, since they may affect decisions and actions. Therefore, the present study adopts a bottom-up approach, analyzing GPs' narratives about 'good' and 'bad' consultations. We aimed at describing the range of discourses GPs use in relating on their practice. Semi-structured interviews were conducted with 19 Belgian GPs. By means of a qualitative analysis, the authors mapped patterns in the interview narratives and described the range of different discourses. Four discourses were identified: a biomedically-centered discourse, a communication-focused discourse, a problem-solving discourse and a satisfaction-oriented discourse. Each discourse was further specified in terms of predominant themes, problems the GPs prefer to deal with and inherent difficulties. Although most participants used elements from all four discourses, the majority of the GPs relied on an individual set of predominant discourses and focused on a limited number of themes. This study clearly indicates that there is no uniform way in which GPs perceive clinical practice. Each of the participants used a subtle mix of different criteria to define good and bad medical consultations. Some discourse elements appear to be rooted in medical literature, whereas others are of a more personal nature. By focusing on the limitations of each discourse, this study can shed new light on some of the difficulties GPs encounter in their daily practice: being confronted with specific problems might be an effect of adhering to a specific discourse. The typification of different discourses on consultations may function as a framework to help GPs reflect on how they perceive their practice, and help them manage some of the challenges met in daily practice.

Ambulatory Morning Report: A Case-Based Method of Teaching EBM Through Experiential Learning.

PubMed

Luciano, Gina L; Visintainer, Paul F; Kleppel, Reva; Rothberg, Michael B

2016-02-01

Evidence-based medicine (EBM) skills are important to daily practice, but residents generally feel unskilled incorporating EBM into practice. The Kolb experiential learning theory, as applied to curricular planning, offers a unique methodology to help learners build an EBM skill set based on clinical experiences. We sought to blend the learner-centered, case-based merits of the morning report with an experientially based EBM curriculum. We describe and evaluate a patient-centered ambulatory morning report combining the User's Guides to the Medical Literature approach to EBM and experiential learning theory in the internal medicine department at Baystate Medical Center. The Kolb experiential learning theory postulates that experience transforms knowledge; within that premise we designed a curriculum to build EBM skills incorporating residents' patient encounters. By developing structured clinical questions based on recent clinical problems, residents activate prior knowledge. Residents acquire new knowledge through selection and evaluation of an article that addresses the structured clinical questions. Residents then apply and use new knowledge in future patient encounters. To assess the curriculum, we designed an 18-question EBM test, which addressed applied knowledge and EBM skills based on the User's Guides approach. Of the 66 residents who could participate in the curriculum, 61 (92%) completed the test. There was a modest improvement in EBM knowledge, primarily during the first year of training. Our experiential curriculum teaches EBM skills essential to clinical practice. The curriculum differs from traditional EBM curricula in that ours blends experiential learning with an EBM skill set; learners use new knowledge in real time.

Advanced Materials and Coatings for Aerospace Applications

NASA Technical Reports Server (NTRS)

Miyoshi, Kazuhisa

2004-01-01

In the application area of aerospace tribology, researchers and developers must guarantee the highest degree of reliability for materials, components, and systems. Even a small tribological failure can lead to catastrophic results. The absence of the required knowledge of tribology, as Professor H.P. Jost has said, can act as a severe brake in aerospace vehicle systems-and indeed has already done so. Materials and coatings must be able to withstand the aerospace environments that they encounter, such as vacuum terrestrial, ascent, and descent environments; be resistant to the degrading effects of air, water vapor, sand, foreign substances, and radiation during a lengthy service; be able to withstand the loads, stresses, and temperatures encountered form acceleration and vibration during operation; and be able to support reliable tribological operations in harsh environments throughout the mission of the vehicle. This presentation id divided into two sections: surface properties and technology practice related to aerospace tribology. The first section is concerned with the fundamental properties of the surfaces of solid-film lubricants and related materials and coatings, including carbon nanotubes. The second is devoted to applications. Case studies are used to review some aspects of real problems related to aerospace systems to help engineers and scientists to understand the tribological issues and failures. The nature of each problem is analyzed, and the tribological properties are examined. All the fundamental studies and case studies were conducted at the NASA Glenn Research Center.

Nurses' perceptions and problems in the usability of a medication safety app.

PubMed

Ankem, Kalyani; Cho, Sookyung; Simpson, Diana

2017-10-16

The majority of medication apps support medication adherence. Equally, if not more important, is medication safety. Few apps report on medication safety, and fewer studies have been conducted with these apps. The usability of a medication safety app was tested with nurses to reveal their perceptions of the graphical user interface and to discover problems they encountered in using the app. Usability testing of the app was conducted with RN-BSN students and informatics students (n = 18). Perceptions of the graphical components were gathered in pretest and posttest questionnaires, and video recordings of the usability testing were transcribed. The significance of the difference in mean performance time for 8 tasks was tested, and qualitative analysis was deployed to identify problems encountered and to rate the severity of each problem. While all participants perceived the graphical user interface as easy to understand, nurses took significantly more time to complete certain tasks. More nurses found the medication app to be lacking in intuitiveness of user interface design, in capability to match real-world data, and in providing optimal information architecture. To successfully integrate mobile devices in healthcare, developers must address the problems that nurses encountered in use of the app.

Getting it right the second time.

PubMed

Szulanski, Gabriel; Winter, Sidney

2002-01-01

Once a business performs a complex activity well, the parent organization often wants to replicate that success. But doing that is surprisingly difficult, and businesses nearly always fail when they try to reproduce a best practice. The reason? People approaching best-practice replication are overly optimistic and overconfident. They try to perfect an operation that's running nearly flawlessly, or they try to piece together different practices to create the perfect hybrid. Getting it right the second time (and all the times after that) involves adjusting for overconfidence in your own abilities and imposing strict discipline on the process and the organization. The authors studied numerous business settings to find out how organizational routines were successfully reproduced, and they identified five steps for successful replication. First, make sure you've got something that can be copied and that's worth copying. Some processes don't lend themselves to duplication; others can be copied but maybe shouldn't be. Second, work from a single template. It provides proof success, performance measurements, a tactical approach, and a reference for when problems arise. Third, copy the example exactly, and fourth, make changes only after you achieve acceptable results. The people who developed the template have probably already encountered many of the problems you want to "fix," so it's best to create a working system before you introduce changes. Fifth, don't throw away the template. If your copy doesn't work, you can use the template to identify and solve problems. Best-practice replication, while less glamorous than pure innovation, contributes enormously to the bottom line of most companies. The article's examples--Banc One, Rank Xerox, Intel, Starbucks, and Re/Max Israel--prove that exact copying is a non-trivial, challenging accomplishment.

The role of maternal emotion regulation in overreactive and lax discipline.

PubMed

Lorber, Michael F

2012-08-01

The roles of cognitive reappraisal and expressive suppression as intentional methods mothers use to regulate their own emotion were investigated in relation to mothers' experience and expression of negative emotion and their overreactive and lax discipline practices. Eighty-two mothers of toddlers completed questionnaires that measured these constructs. Emotion regulation strategies were more consistently associated with overreactive than with lax discipline. More suppression in discipline encounters was associated with less overreactivity, an association partially mediated by expressed negative emotion. Reappraisal, both globally and in the context of discipline encounters, was inversely associated with overreactive discipline. The association of global reappraisal and overreactivity was mediated in parallel by experienced and expressed negative emotion. Surprisingly, global reappraisal, relative to reappraisal in discipline encounters, appears to have more consistent implications for mothers' emotion and parenting practices in discipline encounters. A reconceptualization of the nature of reappraisal in discipline encounters is suggested. The study is the first to systematically apply methods and concepts from the better-developed basic research literature on adults' emotion regulation to the domain of parenting. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Outpatient prescription practices in rural township health centers in Sichuan Province, China

PubMed Central

2012-01-01

Background Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. Methods This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. Results The average medication cost per encounter was 16.30 Yuan ($2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. Conclusions The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc. PMID:22988946

Jewish physicians' beliefs and practices regarding religion/spirituality in the clinical encounter.

PubMed

Stern, Robert M; Rasinski, Kenneth A; Curlin, Farr A

2011-12-01

We used data from a 2003 survey of US physicians to examine differences between Jewish and other religiously affiliated physicians on 4-D of physicians' beliefs and practices regarding religion and spirituality (R/S) in the clinical encounter. On each dimension, Jewish physicians ascribed less importance to the effect of R/S on health and a lesser role for physicians in addressing R/S issues. These effects were partially mediated by lower levels of religiosity among Jewish physicians and by differences in demographic and practice-level characteristics. The study provides a salient example of how religious affiliation can be an important independent predictor of physicians' clinically-relevant beliefs and practices.

Jewish Physicians' Beliefs and Practices Regarding Religion/Spirituality in the Clinical Encounter

PubMed Central

Stern, Robert M.; Rasinski, Kenneth A.; Curlin, Farr A.

2013-01-01

We used data from a 2003 survey of US physicians to examine differences between Jewish and other religiously affiliated physicians on 4-D of physicians' beliefs and practices regarding religion and spirituality (R/S) in the clinical encounter. On each dimension, Jewish physicians ascribed less importance to the effect of R/S on health and a lesser role for physicians in addressing R/S issues. These effects were partially mediated by lower levels of religiosity among Jewish physicians and by differences in demographic and practice-level characteristics. The study provides a salient example of how religious affiliation can be an important independent predictor of physicians' clinically-relevant beliefs and practices. PMID:21706257

An arbitrary-order staggered time integrator for the linear acoustic wave equation

NASA Astrophysics Data System (ADS)

Lee, Jaejoon; Park, Hyunseo; Park, Yoonseo; Shin, Changsoo

2018-02-01

We suggest a staggered time integrator whose order of accuracy can arbitrarily be extended to solve the linear acoustic wave equation. A strategy to select the appropriate order of accuracy is also proposed based on the error analysis that quantitatively predicts the truncation error of the numerical solution. This strategy not only reduces the computational cost several times, but also allows us to flexibly set the modelling parameters such as the time step length, grid interval and P-wave speed. It is demonstrated that the proposed method can almost eliminate temporal dispersive errors during long term simulations regardless of the heterogeneity of the media and time step lengths. The method can also be successfully applied to the source problem with an absorbing boundary condition, which is frequently encountered in the practical usage for the imaging algorithms or the inverse problems.

Computation of Asteroid Proper Elements: Recent Advances

NASA Astrophysics Data System (ADS)

Knežević, Z.

2017-12-01

The recent advances in computation of asteroid proper elements are briefly reviewed. Although not representing real breakthroughs in computation and stability assessment of proper elements, these advances can still be considered as important improvements offering solutions to some practical problems encountered in the past. The problem of getting unrealistic values of perihelion frequency for very low eccentricity orbits is solved by computing frequencies using the frequency-modified Fourier transform. The synthetic resonant proper elements adjusted to a given secular resonance helped to prove the existence of Astraea asteroid family. The preliminary assessment of stability with time of proper elements computed by means of the analytical theory provides a good indication of their poorer performance with respect to their synthetic counterparts, and advocates in favor of ceasing their regular maintenance; the final decision should, however, be taken on the basis of more comprehensive and reliable direct estimate of their individual and sample average deviations from constancy.

Developing an acute-physical-examination template for a Tegional EHR system aimed at improving inexperienced physician's documentation.

PubMed

Lilholt, Lars; Haubro, Camilla Dremstrup; Møller, Jørn Munkhof; Aarøe, Jens; Højen, Anne Randorff; Gøeg, Kirstine Rosenbeck

2013-01-01

It is well-established that to increase acceptance of electronic clinical documentation tools, such as electronic health record (EHR) systems, it is important to have a strong relationship between those who document the clinical encounters and those who reaps the benefit of digitalized and more structured documentation. [1] Therefore, templates for EHR systems benefit from being closely related to clinical practice with a strong focus on primarily solving clinical problems. Clinical use as a driver for structured documentation has been the focus of the acute-physical-examination template (APET) development in the North Denmark Region. The template was developed through a participatory design where precision and clarity of documentation was prioritized as well as fast registration. The resulting template has approximately 700 easy accessible input possibilities and will be evaluated in clinical practice in the first quarter of 2013.

Documenting the doable and doing the documented: bridging strategies at the UK Stem Cell Bank.

PubMed

Stephens, Neil; Atkinson, Paul; Glasner, Peter

2011-12-01

We explore the local negotiation of regulatory practice at the UK Stem Cell Bank, the first Bank of its type in the world. Basing our empirical work on a detailed analysis of one aspect of the Bank's regulatory commitment--the completion of the Cell Line Information form--we make visible the necessary judgements and labour involved in interpreting and operationalizing externally imposed regulation. The discussion opens by detailing the problems encountered when the Bank completes the form: reconciling a bureaucratic system of accountability with craft-like laboratory skills involving multiple kinds of tacit knowledge. We follow this by explicating the emergent 'bridging strategies' pursued by the Bank to address these issues, highlighting their reliance upon the formation of trust and social networks. The closing discussion emphasizes the contingent assembly of regulatory practices that emerge in the local setting.

PubMed Central

Boulé, Richard; Girard, Gilles

2003-01-01

OBJECTIVE: To identify the problems encountered by residents during training and the solutions they proposed. DESIGN: Qualitative study. SETTING: Family practice program at Sherbrooke University. PARTICIPANTS: Sixty-eight residents in the Family practice program between 1999 and 2000. METHOD: We used the nominal group technique with four groups of participants. Then we held five 3-hour discussion groups to explore difficulties and solutions in depth. Finally, data were validated with a written questionnaire. MAIN FINDINGS: At least 20% of respondents confirmed 65 difficulties and 61 solutions. Three major themes emerged: the many demands of the residence program, residents' personal experience of the program, and the lack of time for personal life. CONCLUSION: Publication of these results could help residents develop proactive adaptive strategies to deal with the stress of their training programs. Certain adjustments will be made by the program administration to make it easier for residents to manage their stress. PMID:12729243

Reconciling pairs of concurrently used clinical practice guidelines using Constraint Logic Programming.

PubMed

Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Hing, Marisela Mainegra; Farion, Ken

2011-01-01

This paper describes a new methodological approach to reconciling adverse and contradictory activities (called points of contention) occurring when a patient is managed according to two or more concurrently used clinical practice guidelines (CPGs). The need to address these inconsistencies occurs when a patient with more than one disease, each of which is a comorbid condition, has to be managed according to different treatment regimens. We propose an automatic procedure that constructs a mathematical guideline model using the Constraint Logic Programming (CLP) methodology, uses this model to identify and mitigate encountered points of contention, and revises the considered CPGs accordingly. The proposed procedure is used as an alerting mechanism and coupled with a guideline execution engine warns the physician about potential problems with the concurrent application of two or more guidelines. We illustrate the operation of our procedure in a clinical scenario describing simultaneous use of CPGs for duodenal ulcer and transient ischemic attack.

Aspects of sleep disorders in children and adolescents

PubMed Central

Stores, Gregory

2009-01-01

Sleep disorders in children and adolescents is a topic that has been, and remains, neglected in both public health education and professional training. Although much knowledge has been accumulated in recent times, it has been poorly disseminated and, therefore, relatively little is put into practice. Only some general issues can be discussed in this article. The aspects chosen relate mainly to clinical practice, but they also have relevance for research. They concern various differences between sleep disorders in children and those in adults, the occurrence of such disorders in young people, their effects on psychological and physical development, the essential (but often ignored) distinction between sleep problems and their underlying causes (ie, sleep disorders), types of sleep disturbance encountered at different ages during development, and the differential diagnosis of certain parasomnias that are at particular risk of being confused with each other. PMID:19432390

Holistic integrative medicine: toward a new era of medical advancement.

PubMed

Fan, Daiming

2017-03-01

Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.

Estimation variance bounds of importance sampling simulations in digital communication systems

NASA Technical Reports Server (NTRS)

Lu, D.; Yao, K.

1991-01-01

In practical applications of importance sampling (IS) simulation, two basic problems are encountered, that of determining the estimation variance and that of evaluating the proper IS parameters needed in the simulations. The authors derive new upper and lower bounds on the estimation variance which are applicable to IS techniques. The upper bound is simple to evaluate and may be minimized by the proper selection of the IS parameter. Thus, lower and upper bounds on the improvement ratio of various IS techniques relative to the direct Monte Carlo simulation are also available. These bounds are shown to be useful and computationally simple to obtain. Based on the proposed technique, one can readily find practical suboptimum IS parameters. Numerical results indicate that these bounding techniques are useful for IS simulations of linear and nonlinear communication systems with intersymbol interference in which bit error rate and IS estimation variances cannot be obtained readily using prior techniques.

Multiscale Phenomena in the Solid-Liquid Transition State of a Granular Material: Analysis and Modelling of Dense Granular Materials

DTIC Science & Technology

2011-09-26

most challenging to characterize and model of the gamut of granular behaviour encountered in practice. In particular, it exhibits self-organized...is intrinsically multiscale and is arguably one of, if not, the most challenging to characterize and model of the gamut of granular behaviour...the most challenging to characterize and model of the gamut of granular behaviour encountered in practice. In particular, it exhibits self-organized

Do internal medicine interns practice etiquette-based communication? A critical look at the inpatient encounter.

PubMed

Block, Lauren; Hutzler, Lindsey; Habicht, Robert; Wu, Albert W; Desai, Sanjay V; Novello Silva, Kathryn; Niessen, Timothy; Oliver, Nora; Feldman, Leonard

2013-11-01

Etiquette-based communication may improve the inpatient experience but is not universally practiced. We sought to determine the extent to which internal medicine interns practice behaviors that characterize etiquette-based medicine. Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. Participants at 1 site then completed a survey estimating how frequently they performed each of the observed behaviors. A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. Interns at 1 site estimated introducing themselves and their role and sitting with patients significantly more frequently than was observed (80% vs 40%, P < 0.01; 80% vs 37%, P < 0.01; and 58% vs 9%, P < 0.01, respectively). Resident physicians introduced themselves to patients, explained their role, and sat down with patients infrequently during observed inpatient encounters. Residents surveyed tended to overestimate their own practice of etiquette-based medicine. © 2013 Society of Hospital Medicine.

Patterns of Clinical Reasoning in Physical Therapist Students.

PubMed

Gilliland, Sarah; Wainwright, Susan Flannery

2017-05-01

Clinical reasoning is a complex, nonlinear problem-solving process that is influenced by models of practice. The development of physical therapists' clinical reasoning abilities is a crucial yet underresearched aspect of entry-level (professional) physical therapist education. The purpose of this qualitative study was to examine the types of clinical reasoning strategies physical therapist students engage in during a patient encounter. A qualitative descriptive case study design involving within and across case analysis was used. Eight second-year, professional physical therapist students from 2 different programs completed an evaluation and initial intervention for a standardized patient followed by a retrospective think-aloud interview to explicate their reasoning processes. Participants' clinical reasoning strategies were examined using a 2-stage qualitative method of thematic analysis. Participants demonstrated consistent signs of development of physical therapy-specific reasoning processes, yet varied in their approach to the case and use of reflection. Participants who gave greater attention to patient education and empowerment also demonstrated greater use of reflection-in-action during the patient encounter. One negative case illustrates the variability in the rate at which students may develop these abilities. Participants demonstrated development toward physical therapist--specific clinical reasoning, yet demonstrated qualitatively different approaches to the patient encounter. Multiple factors, including the use of reflection-in-action, may enable students to develop greater flexibility in their reasoning processes. © 2017 American Physical Therapy Association

Department of Homeland Security (DHS) Proficiency Testing on Small-Scale Safety and Thermal Testing of Improvised Explosives

NASA Astrophysics Data System (ADS)

Reynolds, John; Sandstrom, Mary; Brown, Geoffrey; Warner, Kirstin; Phillips, Jason; Shelley, Timothy; Reyes, Jose; Hsu, Peter

2013-06-01

One of the first steps in establishing safe handling procedures for explosives is small-scale safety and thermal (SSST) testing. To better understand the response of improvised materials or HMEs to SSST testing, 18 HME materials were compared to 3 standard military explosives in a proficiency-type round robin study among five laboratories--2 DoD and 3 DOE--sponsored by DHS. The testing matrix has been designed to address problems encountered with improvised materials--powder mixtures, liquid suspensions, partially wetted solids, immiscible liquids, and reactive materials. Over 30 issues have been identified that indicate standard test methods may require modification when applied to HMEs to derive accurate sensitivity assessments needed for development safe handling and storage practices. This presentation will discuss experimental difficulties encountered when testing these problematic samples, show inter-laboratory testing results, show some statistical interpretation of the results, and highlight some of the testing issues. Some of the work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. LLNL-ABS-617519 (721812).

District nurses' involvement in mental health: an exploratory survey.

PubMed

Lee, Soo; Knight, Denise

2006-04-01

This article reports on a survey of district nurses' involvement in mental health interventions in one county. Seventy-nine questionnaires were sent and 46 were returned. Descriptive analysis was carried out using statistical software. The DNs reported encountering a wide range of mental health issues and interventions in practice: dementia, anxiety and depression featured highly. Over half (55%) of the respondents reported involvement in bereavement counselling, and 28% and 23% of respondents reported encountering anxiety management, and problem solving and alcohol advice respectively. A large proportion, however, reported no involvement in mental health interventions. Among the psychiatric professionals, district nurses tended to have most frequent contacts with social workers. GPs were the most likely person to whom DNs made referrals, followed by community psychiatric nurses. Despite the apparent awareness of the values of psychosocial interventions, DNs were equally influenced by the medical model of treatment. In order to realize the potential contribution of district nurses in mental health interventions, there is a need for primary care teams to foster a closer working relationship with mental health specialist services.

Sex of the GP--20 years on.

PubMed

Harrison, Christopher M; Britt, Helena C; Charles, Janice

2011-08-15

Previous research with the Australian Morbidity and Treatment Survey (1990-1991) showed significant differences in general practitioner characteristics and patient mix of male and female GPs. Even after adjusting for these, it was seen that male and female GPs managed different types of medical conditions. The proportion of female GPs increased from 19.6% in 1990-1991 to 37.1% in 2009-2010. This study investigates whether differences remain two decades later. Analysis of 2009-2010 Bettering the Evaluation and Care of Health (BEACH) data examining GP characteristics, patient encounter characteristics, patient reasons for encounter (RFE), problem types managed and management methods used, by GP sex. Whether GP sex was an independent predictor of problem types being managed, or management methods used, was tested using multiple logistic regressions and Poisson regression. 988 GPs recorded 98 800 GP-patient encounters. Adjusted differences in clinical activity of male and female GPs. After adjustment, compared with male GPs, females recorded more RFEs about general and unspecified issues and endocrine, female genital, pregnancy and family planning problems; and fewer concerning the musculoskeletal, respiratory, skin and male genital systems. Female GPs managed more general and unspecified, digestive, circulatory, psychological, endocrine, female genital and social problems; recorded nearly 20% more clinical treatments and referrals; recorded nearly 10% more imaging and pathology tests; and 4.3% fewer medications. After two decades, even with increased numbers of female GPs, the differences in problems managed by male and female GPs remain, and will probably continue. Female GPs use more resources per encounter, but may not use more resources in terms of annual patient care.

Problem based learning in midwifery - the teachers perspective.

PubMed

Rowan, Catherine J; McCourt, Christine; Bick, Debra; Beake, Sarah

2007-02-01

Problem- or evidence-based learning (PBL or EBL) has become more widely used in the education of health professionals. Although there has been research exploring its effectiveness and the student's perspective, there has been little research exploring the perceptions of the teacher. The objective of this study was to investigate the experiences of teachers facilitating a problem based learning curriculum in midwifery. The study took place at Thames Valley University, which has implemented this approach across the entire curriculum. Semi-structured interviews were undertaken following random selection from two groups of teachers; those more experienced as teachers and those who had entered teaching more recently. Aspects of the teacher's role identified included questioning students to draw out their knowledge and understanding and to help students challenge each other, discuss and evaluate their learning. Strategies used varied depending on the stage of the programme. Difficulties encountered were mostly in relation to facilitating groups of differing backgrounds and ability and seeking to enable the students to work well together. Key challenges for teachers were in relation to developing facilitation skills, balancing input or guidance with facilitating independent learning. Problem based learning was perceived to be beneficial in helping students relate theory to practice and in encouraging an active and enquiring approach to evidence, but teachers raised important questions about its practice. Tensions were identified between the constructivist theories on which the model of PBL rests and the formal requirements of an externally regulated professional curriculum.

The Mariner Mars 1971 radio frequency subsystem

NASA Technical Reports Server (NTRS)

Hughes, R. S.

1972-01-01

The radio frequency subsystem (RFS) for the Mariner Mars 1971 (MM'71) spacecraft is described. The MM'69 RFS was used as the baseline design for the MM'71 RFS, and the report describes the design changes made to the 1969 RFS for use on MM'71. It also cites various problems encountered during the fabrication and testing of the RFS, as well as the types of tests to which the RFS was subjected. In areas where significant problems were encountered, a detailed description of the problem and its solution is presented. In addition, some recommendations are given for modifications to the RFS and test techniques for future programs.

A case of learning to teach elementary science: Investigating beliefs, experiences, and tensions

NASA Astrophysics Data System (ADS)

Bryan, Lynn Ann

This study examines how preservice elementary teacher beliefs and experiences within the context of reflective science teacher education influence the development of professional knowledge. From a cognitive constructivist theoretical perspective, I conducted a case analysis to investigate the beliefs about science teaching and learning held by a preservice teacher (Barbara), identify the tensions she encountered in learning to teach elementary science, understand the frames from which she identified problems of practice, and discern how her experiences influenced the process of reflecting on her own science teaching. From an analysis of interviews, observation, and written documents, I constructed a profile of Barbara's beliefs that consisted of three foundational and three dualistic beliefs about science teaching and learning. Her foundational beliefs concerned: (a) the value of science and science teaching, (b) the nature of scientific concepts and goals of science instruction, and (c) control in the science classroom. Barbara held dualistic beliefs about: (a) how children learn science, (b) the science students' role, and (c) the science teacher's role. The dualistic beliefs formed two contradictory nests of beliefs. One nest, grounded in life-long science learner experiences, reflected a didactic teaching orientation and predominantly guided her practice. The second nest, not well-grounded in experience, embraced a hands-on approach and predominantly guided her vision of practice. Barbara encountered tensions in thinking about science teaching and learning as a result of inconsistencies between her vision of science teaching and her actual practice. Confronting these tensions prompted Barbara to rethink the connections between her classroom actions and students' learning, create new perspectives for viewing her practice, and consider alternative practices more resonant with her visionary beliefs. However, the self-reinforcing belief system created by her didactic nest of beliefs, control beliefs, and belief about the goals of science instruction prevented Barbara from enacting new frames in practice. The findings contribute to an understanding of the relationship between beliefs and experiences in learning to teach and indicate that reframing is crucial in developing professional knowledge. Furthermore, the findings underscore the significance of (a) identifying prospective teachers' beliefs for designing teacher preparation programs, and (b) offering experiences as professionals early in the careers of prospective teachers.

The use of films as a teaching tool for the teaching-learning process in bioethics.

PubMed

Pereira Rates, Camila Maria; Maciel Silva, Larriny; Moura Pereira, Lívia; Reis Pessalacia, Juliana Dias

2014-01-01

Identifying the contribution of using films in the process of teaching-learning in bioethics and verifying the facilities and difficulties in using this teaching resource. A qualitative study analyzed from the Bardin referential. Semi-structured interviews were carried out, recorded, and transcribed in full. For definition of the sample was used the criteria of repetition. In total, participated in the study 21 students of Nursing and Biochemistry, members of a Center for Teaching and Research in Bioethics of a public federal university in the city of Divinópolis, Minas Gerais, Brazil. During the analysis of interviews, two thematic categories and two subcategories emerged. In their responses, students indicated the importance of viewing the bioethical problem for the reflection and decision-making in professional practice. Many reported that from the experience in discussions of the films showed, were made changes in the ethical position. The use of films as a teaching resource contributes to the process of teaching-learning in bioethics for undergraduate students. The discussions of the films are stimulating and provide a space for reflection and dialogue on bioethical problems that students may encounter in their professional practice.

Physics Teachers' Education (PTE): Problems and Challenges

NASA Astrophysics Data System (ADS)

Sassi, Elena; Michelini, Marisa

A vast majority of the research results acknowledge the crucial role of teacher's education, as a vital tool in enhancing the quality of physics education. The projects like PISA, ROSE and TIMMS showcase the impact of teacher's education as a qualitative improvement in the physics learning environment. In Physics Education Research (PER), the impact of teacher's education had been addressed for the its role in the enhancement of positive interest among the students. The current world-wide state of the art characterizes a large variety of boundary conditions, traditions and practices that are being followed. In our present context, we foucus and discuss on the multidimensional challanges such as competencies needed, degrees required, problems encountered, support to be provided and the basic pre-requirements of Teacher's education for the secondary schools. We present some of the teaching methods and practices followed in coherent with, both, the Student centered and open learning environments along with some of the useful didactical indicators. Also, we potray a couple of research-based examples successfully experimented in Italy. Finally we propose some useful recommendations along with the criteria to be followed in the teachers education for the overall improvement.

Psychiatric services in primary care settings: a survey of general practitioners in Thailand

PubMed Central

Lotrakul, Manote; Saipanish, Ratana

2006-01-01

Background General Practitioners (GPs) in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. Methods We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. Results Four hundred and thirty-four questionnaires (36.4%) were returned. Sixty-seven of the respondents (15.4%) who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years). 65.6% (SD = 19.3) of the total patients examined had physical problems, 10.7% (SD = 7.9) had psychiatric problems and 23.9% (SD = 16.0) had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%), alcohol and drugs abuse (28.1%), and depressive disorders (29.2%). Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. Conclusion Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients. PMID:16867187

Further Studies of the Response of Single Rotor Helicopters to Vortex Encounters

DOT National Transportation Integrated Search

1985-09-01

This report is a continuation of the studies described in Reference where a simplified approach to the problem of predicting the uncontrolled response of a single rotor helicopter to an encounter with the wing tip vortex of a large transport aircraft...

Energy Problems and Environmental Concern

ERIC Educational Resources Information Center

Train, Russell E.

1973-01-01

Discusses problems encountered in energy extraction and consumption, involving nuclear power plant construction, environmental consequences of energy systems, and energy conservation ethics. Indicates that the increasing concern over environmental quality is not the true cause of present energy problems. (CC)

HFL-10 lifting body flight control system characteristics and operational experience

NASA Technical Reports Server (NTRS)

Painter, W. D.; Sitterle, G. J.

1974-01-01

A flight evaluation was made of the mechanical hydraulic flight control system and the electrohydraulic stability augmentation system installed in the HL-10 lifting body research vehicle. Flight tests performed in the speed range from landing to a Mach number of 1.86 and the altitude range from 697 meters (2300 feet) to 27,550 meters (90,300 feet) were supplemented by ground tests to identify and correct structural resonance and limit-cycle problems. Severe limit-cycle and control sensitivity problems were encountered during the first flight. Stability augmentation system structural resonance electronic filters were modified to correct the limit-cycle problem. Several changes were made to control stick gearing to solve the control sensitivity problem. Satisfactory controllability was achieved by using a nonlinear system. A limit-cycle problem due to hydraulic fluid contamination was encountered during the first powered flight, but the problem did not recur after preflight operations were improved.

Ambulatory EHR functionality: a comparison of functionality lists.

PubMed

Drury, Barbara M

2006-01-01

There is a proliferation of lists intended to define and clarify the functionality of an ambulatory electronic health record system. These lists come from both private and public entities and vary in terminology, granularity, usability, and comprehensiveness. For example, functionality regarding a problem list includes the following possible definitions: * "Create and maintain patient-specific problem lists," from the HL7 Electronic Health Record Draft Standard for Trial Use. * "Provide a flexible mechanism for retrieval of encounter information that can be organized by diagnosis, problem, problem type," from the Bureau of Primary Health Care. * "The system shall associate encounters, orders, medications and notes with one or more problems," from the Certification Commission on Health Information Technology. * "Displays dates of problems on problem list," from COPIC Insurance Co. * "Shall automatically close acute problems using an automated algorithm," from the Physicians Foundations HIT Subcommittee. This article will compare the attributes of these five electronic health record functionality lists and their usefulness to different audiences-clinicians, application developers and payers.

Ergonomic problems encountered by the surgical team during video endoscopic surgery.

PubMed

Kaya, Oskay I; Moran, Munevver; Ozkardes, Alper B; Taskin, Emre Y; Seker, Gaye E; Ozmen, Mahir M

2008-02-01

The aim of this study is to analyze the problems related to the ergonomic conditions faced by video endoscopic surgical teams during video endoscopic surgery by means of a questionnaire. A questionnaire was distributed to 100 medical personnel, from 8 different disciplines, who performed video endoscopic surgeries. Participants were asked to answer 13 questions related to physical, perceptive, and cognitive problems. Eighty-two questionnaires were returned. Although there were differences among the disciplines, participants assessment of various problems ranged from 32% to 72% owing to poor ergonomic conditions. As the problems encountered by the staff during video endoscopic surgery and the poor ergonomic conditions of the operating room affect the productivity of the surgical team and the safety and efficiency of the surgery, redesigning of the instruments and the operating room is required.

Analysis of eco-innovation with triple helix approach: case-study of biofloc catfish farming in Yogyakarta

NASA Astrophysics Data System (ADS)

Purwadi, D.; Nurlaily, I.

2018-03-01

Concerning environmental into focus of innovation process will expand the number of actor involved. Eco-innovation and triple helix are often frameworks applied to analyse how environmental concern are integrated in innovation process and how different stakeholder groups are having inter relation. Case study from biofloc catfish farming in Yogyakarta is presented to demonstrate a possible approach for researching the success of triple helix frameworks. This case is considered on basic of the result of a survey among farmers, academician and government. The paper concludes the creating of full triple helix encounters problem in practice. It also includes suggestion for further research on fisheries development.

Apollo experience report: Launch escape propulsion subsystem

NASA Technical Reports Server (NTRS)

Townsend, N. A.

1973-01-01

The Apollo launch escape propulsion subsystem contained three solid rocket motors. The general design, development, and qualification of the solid-propellant pitch-control, tower-jettison, and launch-escape motors of the Apollo launch escape propulsion subsystem were completed during years 1961 to 1966. The launch escape system components are described in general terms, and the sequence of events through the ground-based test programs and flight-test programs is discussed. The initial ground rules established for this system were that it should use existing technology and designs as much as possible. The practicality of this decision is proved by the minimum number of problems that were encountered during the development and qualification program.

Orthodontics

PubMed Central

Hemrend, Bernard; Altuna, Gurkan; Tompson, Bryan

1989-01-01

The authors of this article offer an introduction to the field of orthodontics. They present the latest advances in orthodontic appliances and some of the possible consequences of orthodontic treatment. They discuss a number of cases and offer examples of some of the more common problems that the orthodontist is asked to treat. Such cases include severe Class II, division 1 malocclusion, surgical orthodontics, “long-face” syndrome, adult orthodontics-TMJ-periodontics, late adult growth, and post-retention changes. Practical information useful to the physician who encounters patient with these disorders is balanced with good research data to support the various claims. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9 PMID:21249042

Broken bones: common pediatric fractures--part I.

PubMed

Hart, Erin S; Albright, Maurice B; Rebello, Gleeson N; Grottkau, Brian E

2006-01-01

Musculoskeletal injuries are one of the most frequently encountered problems in pediatric practice, with fractures accounting for a surprisingly large percentage of these injuries. A fracture occurs when bone is subjected to more energy than it can absorb. Pediatric healthcare providers must have a good understanding of normal bone growth and development and must recognize common mechanisms of injury and fracture patterns seen in children. Nearly 20% of children who present with an injury have a fracture, and it is estimated that 42% of boys and 27% of girls will sustain a fracture during childhood (Wilkins, 1996). The immature skeleton has several unique properties that directly affect the management of fractures in children.

Orthopaedic Problems of the Mentally Retarded

ERIC Educational Resources Information Center

McSweeney, Anthony

1972-01-01

Problems encountered by orthopedic surgeons treating the mentally retarded are identified, and cooperation among pediatricians, psychiatrists, psychologists, social workers, physiotherapists, occupational therapists, and orthopedic surgeons is recommended. (GW)

Identifying influenza-like illness presentation from unstructured general practice clinical narrative using a text classifier rule-based expert system versus a clinical expert.

PubMed

MacRae, Jayden; Love, Tom; Baker, Michael G; Dowell, Anthony; Carnachan, Matthew; Stubbe, Maria; McBain, Lynn

2015-10-06

We designed and validated a rule-based expert system to identify influenza like illness (ILI) from routinely recorded general practice clinical narrative to aid a larger retrospective research study into the impact of the 2009 influenza pandemic in New Zealand. Rules were assessed using pattern matching heuristics on routine clinical narrative. The system was trained using data from 623 clinical encounters and validated using a clinical expert as a gold standard against a mutually exclusive set of 901 records. We calculated a 98.2 % specificity and 90.2 % sensitivity across an ILI incidence of 12.4 % measured against clinical expert classification. Peak problem list identification of ILI by clinical coding in any month was 9.2 % of all detected ILI presentations. Our system addressed an unusual problem domain for clinical narrative classification; using notational, unstructured, clinician entered information in a community care setting. It performed well compared with other approaches and domains. It has potential applications in real-time surveillance of disease, and in assisted problem list coding for clinicians. Our system identified ILI presentation with sufficient accuracy for use at a population level in the wider research study. The peak coding of 9.2 % illustrated the need for automated coding of unstructured narrative in our study.

Computer Security Incident Response Team Effectiveness: A Needs Assessment

PubMed Central

Van der Kleij, Rick; Kleinhuis, Geert; Young, Heather

2017-01-01

Computer security incident response teams (CSIRTs) respond to a computer security incident when the need arises. Failure of these teams can have far-reaching effects for the economy and national security. CSIRTs often have to work on an ad hoc basis, in close cooperation with other teams, and in time constrained environments. It could be argued that under these working conditions CSIRTs would be likely to encounter problems. A needs assessment was done to see to which extent this argument holds true. We constructed an incident response needs model to assist in identifying areas that require improvement. We envisioned a model consisting of four assessment categories: Organization, Team, Individual and Instrumental. Central to this is the idea that both problems and needs can have an organizational, team, individual, or technical origin or a combination of these levels. To gather data we conducted a literature review. This resulted in a comprehensive list of challenges and needs that could hinder or improve, respectively, the performance of CSIRTs. Then, semi-structured in depth interviews were held with team coordinators and team members of five public and private sector Dutch CSIRTs to ground these findings in practice and to identify gaps between current and desired incident handling practices. This paper presents the findings of our needs assessment and ends with a discussion of potential solutions to problems with performance in incident response. PMID:29312051

Computer Security Incident Response Team Effectiveness: A Needs Assessment.

PubMed

Van der Kleij, Rick; Kleinhuis, Geert; Young, Heather

2017-01-01

Computer security incident response teams (CSIRTs) respond to a computer security incident when the need arises. Failure of these teams can have far-reaching effects for the economy and national security. CSIRTs often have to work on an ad hoc basis, in close cooperation with other teams, and in time constrained environments. It could be argued that under these working conditions CSIRTs would be likely to encounter problems. A needs assessment was done to see to which extent this argument holds true. We constructed an incident response needs model to assist in identifying areas that require improvement. We envisioned a model consisting of four assessment categories: Organization, Team, Individual and Instrumental. Central to this is the idea that both problems and needs can have an organizational, team, individual, or technical origin or a combination of these levels. To gather data we conducted a literature review. This resulted in a comprehensive list of challenges and needs that could hinder or improve, respectively, the performance of CSIRTs. Then, semi-structured in depth interviews were held with team coordinators and team members of five public and private sector Dutch CSIRTs to ground these findings in practice and to identify gaps between current and desired incident handling practices. This paper presents the findings of our needs assessment and ends with a discussion of potential solutions to problems with performance in incident response.

Agents for Change: Nonphysician Medical Providers and Health Care Quality

PubMed Central

Boucher, Nathan A; McMillen, Marvin A; Gould, James S

2015-01-01

Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization’s quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts. PMID:25663213

Methodological Problems Encountered in the Review of Research in Science Teaching

ERIC Educational Resources Information Center

Lawlor, E. P.; Lawlor, F. X.

1972-01-01

Describes the difficulties encountered in selecting material to be included in the reviews of science education research in the Curtis Series'' published by the Columbia Teachers' College Press. Presents evidence outlining the weaknesses of using a jury'' to determine so-called superior research. (AL)

Developing Multiplicative Thinking from Additive Reasoning

ERIC Educational Resources Information Center

Tobias, Jennifer M.; Andreasen, Janet B.

2013-01-01

As students progress through elementary school, they encounter mathematics concepts that shift from additive to multiplicative situations (NCTM 2000). When they encounter fraction problems that require multiplicative thinking, they tend to incorrectly extend additive properties from whole numbers (Post et al. 1985). As a result, topics such as …

Organs and organisations: Situating ethics in organ donation after circulatory death in the UK.

PubMed

Cooper, Jessie

2018-05-25

Controlled organ donation after circulatory death (DCD) has recently been revived in the UK, as part of attempts to increase organ donation rates. The re-introduction of DCD has subsequently become the focus of bioethical controversy, since it necessitates intervening in the care of dying patients to obtain quality donor organs. Transplant policy responses to these concerns have generated new legal and ethical guidelines to address uncertainties around DCD, producing claims that the UK has overcome' the ethical challenge of DCD. In contrast, by drawing on Lynch's call to 'respecify' ethics, this paper argues that ethics in DCD cannot be reduced to abstract directives for practice, but, instead, are composed and dealt with as an organisational problem. To do this, I utilise data from an ethnographic study examining the production of the 'minority ethnic organ donor' within UK organ donation settings; in particular, the data pertains to a case hospital which was in the process of developing a DCD programme during the period of fieldwork. Findings show that the ethics of DCD are encountered as practical sets of problems, constructed in relation to particular institutional locales. I describe how these issues are worked-around by creating conditions to make DCD organisationally possible, and through the animation of standard procedures into acceptable forms of practice. I argue that ethics in DCD go far beyond normative bioethical principles, to encompass concerns around: the reputation of hospital Trusts, public perceptions of organ donation, the welfare of potential donor families, and challenges to the work of health professionals caring for dying patients. The paper enriches understanding of ethics in science and medicine by showing how ethics are assembled and negotiated as a practical-organisational concern, and calls for further examination of how DCD gets constructed as a potential problem and is made to happen in practice. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.

PubMed

Levine, Michael; Sanko, Stephen; Eckstein, Marc

2016-01-01

EMS providers frequently encounter opioid-toxic patients who receive naloxone and then refuse further medical care. Older studies revealed this practice to be safe. In light of the evolving patterns of opioid abuse, this study attempted to determine the safety of this practice. This is a retrospective review of all patient encounters by the Los Angeles Fire Department (LAFD) between July 1, 2011-December 31, 2013. All LAFD patient encounters are stored electronically. These electronic records were reviewed for subjects who received naloxone had a documented respiratory rate (RR) less than 12, and subsequently refused transport. Data abstracted included name, social security number (SSN), date of birth (DOB), date of EMS encounter, age, and treatment rendered. The names, SSN, and DOB, as available, were supplied to the coroner's office. The Coroner's records were reviewed to determine if a patient with the same or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days, or 6 months of the initial EMS encounter. The abstractor was blinded to the study hypothesis. 205 subjects were identified; the median (IQR) age was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within 24 hours of the initial EMS encounter. The cause of death (COD) was coronary artery disease and heroin use. Two additional subjects (1. %) died within 30 days. One of these subjects died 6 days later; the COD is unknown. The other subject died 20 days after the EMS encounter; the COD was cardiovascular disease and liver cirrhosis. No additional subjects were identified at the 6 month follow up. A third subject died of a heroin overdose 16 months after the initial EMS encounter, but was beyond the pre-defined follow up period. The practice of receiving pre-hospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate-term mortality. Despite an evolving pattern of opioid abuse, the results of this study are consistent with previously reported studies.

[Aims and core contents of basic and post basic courses of nursing management].

PubMed

Saiani, Luisa; Brugnolli, Anna

2006-01-01

The second part of the issue, dedicated to the nursing management offers a discussion on some of the relevant areas of debate for the organization of nursing care. A reflection on the core contents and main aims of basic and post basic (master, advanced level, specialistic degree) nursing courses is proposed in the first contribution. Then a selection of topics is presented, focusing on the main research contributions available in the literature and on the ongoing debate for the following areas: the role of communication at the inter-shift handover and the new model of bedside reporting; the problems and challenges of doctors nurses collaboration in the health care team; the problems and expectations of new nurses joining the health care team and the process of development of practical skills; the hot debate on nursing roles and level of practice and the difficulties in differentiating between elementary, specialist and advanced nursing practice; the new emerging roles: the characteristics and achievements of Nurse Consultant; the new challenges of coordinators of the health care teams with the management of the multigenerational nursing team. For each topic a definition of the problem is presented, an example of relevant study, a critical debate and suggestions for further studies and areas of research. A list of the main journals that deal with nursing management is proposed with comments on the main characteristics of each journal. A study protocol that aims at describing the outcomes of the different styles and models of organization of medical wards on patients and nurses is presented as an example of organizative research; an experience of, and a model for, participation of the nurses to health policy planning is proposed. Nurses were, asked to identify health care problems encountered in their daily practice, their causes and propose solutions at basic and policy level. The session of International Observatory explores the main problems and difficulties of the research on the organization of care, focusing more on opportunities than on the challenges and drawbacks of the available literature.

Clue Insensitivity in Remote Associates Test Problem Solving

ERIC Educational Resources Information Center

Smith, Steven M.; Sifonis, Cynthia M.; Angello, Genna

2012-01-01

Does spreading activation from incidentally encountered hints cause incubation effects? We used Remote Associates Test (RAT) problems to examine effects of incidental clues on impasse resolution. When solution words were seen incidentally 3-sec before initially unsolved problems were retested, more problems were resolved (Experiment 1). When…

CPR Drilling.

ERIC Educational Resources Information Center

Kittleson, Mark

1980-01-01

Problems encountered by cardiopulmonary resuscitation (CPR) instructors are discussed and some possible solutions to these problems are suggested. Management techniques for effective use of class size, time, and instructional materials are described. (JN)

Ritual and ceremony in intraoperative magnetic resonance imaging-assisted brain surgery.

PubMed

Gellert, Vance

2012-01-01

Previous photographic research into traditional and shamanic healing practices in Peru and Bolivia and a review of the literature suggested that all medical practices have cultural determined nonmedical activities as integral parts of the healing encounter. These include costume, ritual, ceremony, environment factors that were looked for in a western clinical encounter for this paper. A patient was followed through pre-op preparation and iMRI assisted brain surgery. All activities were photographed extensively and evaluated in a broader healing context. A number of activities were visually and metaphorically comparable with those seen in other practices. These are discussed as rituals of intention on the part of the caregivers to focus their skills on healing and also to mindfully engage the patient in the healing process. Artistic observation and analysis may be an effective way to identify these non quantifiable elements of the healing encounter and suggest directions for further research into the emotional components of the healing process. Copyright © 2012 Elsevier Inc. All rights reserved.

Role of plastic surgeons in hepatic artery anastomosis in living donor liver transplantation: our experience of 10 cases.

PubMed

Mangal, Mahesh; Gambhir, Swaroop; Gupta, Anubhav; Shah, Amiti

2012-07-01

To understand the practical difficulties encountered while performing hepatic artery anastomosis by microsurgical technique in living donor liver transplantation. We undertook a retrospective study of 10 cases of hepatic artery anastomosis done at the level of bifurcation of the right hepatic artery and proximal when the plastic surgery team was called in for assistance. All the anastomoses were performed under an operating microscope (up to 24× magnification). In seven of these cases, anterior wall anastomosis was performed primarily, and in three cases, posterior wall approach was chosen. The main indications of calling in the plastic surgery team were to overcome these technical hurdles: (1) in cases where the caliber of the vessel was less than 2 mm in size; (2) dissection (separation of mucosa and adventitia) of the recipient vessel wall; (3) donor pedicle being so short that possibility of revision of the anastomosis seemed unlikely, necessitating single, sure-shot anastomosis without a chance of revision. The problems encountered by our microsurgical team were: (1) a special set of instruments was warranted because of the depth of the hepatic artery; (2) anastomosis had to be done in standing, stooped position with unsupported hands; (3) excessive movements due to respiration and profuse fluid collection in the field added to the hurdles encountered. All patients were prospectively followed by color Doppler ultrasound protocol for the first 5 days after surgery. Hepatic artery thrombosis was encountered in one case on postoperative day 10, which was successfully treated by thrombolytic therapy, but unfortunately the patient died of multiorgan failure on posttransplant day 30. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Time Trends in the Family Physician Management of Insomnia: The Australian Experience (2000-2015).

PubMed

Miller, Christopher B; Valenti, Lisa; Harrison, Christopher M; Bartlett, Delwyn J; Glozier, Nick; Cross, Nathan E; Grunstein, Ronald R; Britt, Helena C; Marshall, Nathaniel S

2017-06-15

To evaluate changes in rates of family physician (FP) management of insomnia in Australia from 2000-2015. The Bettering the Evaluation And Care of Health (BEACH) program is a nationally representative cross-sectional survey of 1,000 newly randomly sampled family physicians' activity in Australia per year, who each record details of 100 consecutive patient encounters. This provided records of approximately 100,000 encounters each year. We identified all encounters with patients older than 15 years where insomnia or difficulty sleeping was managed and assessed trends in these encounters from 2000-2015. There was no change in the management rate of insomnia from 2000-2007 (1.54 per 100 encounters [95% confidence interval [CI]: 1.49-1.58]). This rate was lower from 2008-2015 (1.31 per 100 encounters [95% CI: 1.27-1.35]). There was no change in FP management: pharmacotherapy was used in approximately 90% of encounters; nonpharmacological advice was given at approximately 20%; and onward referral at approximately 1% of encounters. Prescription of temazepam changed from 54.6 [95% CI: 51.4-57.9] per 100 insomnia problems in 2000-2001 to 43.6 [95% CI: 40.1-47.0] in 2014-2015, whereas zolpidem increased steadily from introduction in 2000 to 14.6 [95% CI: 12.2-17.1] per 100 insomnia problems in 2006-2007, and then decreased to 7.3 [95% CI: 5.4-9.2] by 2014-2015. Insomnia management frequency decreased after 2007 in conjunction with ecologically associated Australian media reporting of adverse effects linked to zolpidem use. Australian FPs remain reliant on pharmacotherapy for the management of insomnia. © 2017 American Academy of Sleep Medicine

Challenges Encountered by 17 Autistic Young Adults in Hong Kong

ERIC Educational Resources Information Center

Wong, Shui-wai

2017-01-01

The self-portrayals of 17 young persons with autism spectrum disorder reveal the challenges encountered by them, including study problems, inter-personal relationships, being bullied by classmates at school, discrimination by the public in general and teachers, social workers, and peers in particular, obstacles to post-secondary education,…

Value of Family and Group Counseling Models where Grandparents Function as Parents to Their Grandchildren

ERIC Educational Resources Information Center

Edwards, Oliver W.; Ray, Shannon L.

2010-01-01

Those involved in circumstances in which children are raised by their grandparents often encounter serious problems that require assistance from counselors. Research suggests that grandparents and parents in these families typically experience heightened stress and psychosocial distress. Additionally, the children often encounter behavioral,…

Israeli Adolescents and Military Service: Encounters.

ERIC Educational Resources Information Center

Levy, Amihay; And Others

1987-01-01

Asserts that inadequate attention has been paid to the problems of the young soldier entering army life in Israel. Delineates some areas of friction and vulnerability between the worlds of the youth and the military. Describes the systematization of these encounters into groups, creating the "Binary Model," which helps in locating and…

A Method to Determine the Impact of Patient-Centered Care Interventions in Primary Care

PubMed Central

Daaleman, Timothy P.; Shea, Christopher M.; Halladay, Jacqueline; Reed, David

2014-01-01

INTRODUCTION The implementation of patient-centered care (PCC) innovations continues to be poorly understood. We used the implementation effectiveness framework to pilot a method for measuring the impact of a PCC innovation in primary care practices. METHODS We analyzed data from a prior study that assessed the implementation of an electronic geriatric quality-of-life (QOL) module in 3 primary care practices in central North Carolina in 2011–12. Patients responded to the items and the subsequent patient-provider encounter was coded using the Roter Interaction Analysis System (RIAS) system. We developed an implementation effectiveness measure specific to the QOL module (i.e., frequency of usage during the encounter) using RIAS and then tested if there were differences with RIAS codes using analysis of variance. RESULTS A total of 60 patient-provider encounters examined differences in the uptake of the QOL module (i.e., implementation-effectiveness measure) with the frequency of RIAS codes during the encounter (i.e., patient-centeredness measure). There was a significant association between the effectiveness measure and patient-centered RIAS codes. CONCLUSION The concept of implementation effectiveness provided a useful framework determine the impact of a PCC innovation. PRACTICE IMPLICATIONS A method that captures real-time interactions between patients and care staff over time can meaningfully evaluate PCC innovations. PMID:25269410

Using Option Grids: steps toward shared decision-making for neonatal circumcision.

PubMed

Fay, Mary; Grande, Stuart W; Donnelly, Kyla; Elwyn, Glyn

2016-02-01

To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Coordination and resource-related difficulties encountered by Quebec's public health specialists and infectious diseases/medical microbiologists in the management of A (H1N1)--a mixed-method, exploratory survey.

PubMed

Nhan, Charles; Laprise, Réjean; Douville-Fradet, Monique; Macdonald, Mary Ellen; Quach, Caroline

2012-02-10

In Quebec, the influenza A (H1N1) pandemic was managed using a top-down style that left many involved players with critical views and frustrations. We aimed to describe physicians' perceptions--infectious diseases specialists/medical microbiologists (IDMM) and public health/preventive medicine specialists (PHPMS)--in regards to issues encountered with the pandemics management at the physician level and highlight suggested improvements for future healthcare emergencies. In April 2010, Quebec IDMM and PHPMS physicians were invited to anonymously complete a web-based learning needs assessment. The survey included both open-ended and multiple-choice questions. Descriptive statistics were used to report on the frequency distribution of multiple choice responses whereas thematic content analysis was used to analyse qualitative data generated from the survey and help understand respondents' experience and perceptions with the pandemics. Of the 102 respondents, 85.3% reported difficulties or frustrations in their practice during the pandemic. The thematic analysis revealed two core themes describing the problems experienced in the pandemic management: coordination and resource-related difficulties. Coordination issues included communication, clinical practice guidelines, decision-making, roles and responsibilities, epidemiological investigation, and public health expert advisory committees. Resources issues included laboratory resources, patient management, and vaccination process. Together, the quantitative and qualitative data suggest a need for improved coordination, a better definition of roles and responsibilities, increased use of information technologies, merged communications, and transparency in the decisional process. Increased flexibility and less contradiction in clinical practice guidelines from different sources and increased laboratory/clinical capacity were felt critical to the proper management of infectious disease emergencies.

Strategy Keys as Tools for Problem Solving

ERIC Educational Resources Information Center

Herold-Blasius, Raja

2017-01-01

Problem solving is one of the main competences we seek to teach students at school for use in their future lives. However, when dealing with mathematical problems, teachers encounter a wide variety of difficulties. To foster students' problem-solving skills, the authors developed "strategy keys." Strategy keys can serve as material to…

Exploring healthcare communication models in private physiotherapy practice.

PubMed

Hiller, Amy; Guillemin, Marilys; Delany, Clare

2015-10-01

This project explored whether models of healthcare communication are evident within patient-physiotherapist communication in the private practice setting. Using qualitative ethnographic methods, fifty-two patient-physiotherapist treatment sessions were observed and interviews with nine physiotherapists were undertaken. Data were analyzed using thematic analysis. In these clinical encounters physiotherapists led the communication. The communication was structured and focussed on physical aspects of the patient's presentation. These features were mediated via casual conversation and the use of touch to respond to the individual patient. Physiotherapists did not explicitly link their therapeutic communication style to established communication models. However, they described a purposeful approach to how they communicated within the treatment encounter. The communication occurring in the private practice physiotherapy treatment encounter is predominantly representative of a 'practitioner-centred' model. However, the subtle use of touch and casual conversation implicitly communicate competence and care, representative of a patient-centred model. Physiotherapists do not explicitly draw from theories of communication to inform their practice. Physiotherapists may benefit from further education to achieve patient-centred communication. Equally, the incorporation of casual conversation and the use of touch into theory of physiotherapy patient-centred communication would highlight these specific skills that physiotherapists already utilize in practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A multi-period distribution network design model under demand uncertainty

NASA Astrophysics Data System (ADS)

Tabrizi, Babak H.; Razmi, Jafar

2013-05-01

Supply chain management is taken into account as an inseparable component in satisfying customers' requirements. This paper deals with the distribution network design (DND) problem which is a critical issue in achieving supply chain accomplishments. A capable DND can guarantee the success of the entire network performance. However, there are many factors that can cause fluctuations in input data determining market treatment, with respect to short-term planning, on the one hand. On the other hand, network performance may be threatened by the changes that take place within practicing periods, with respect to long-term planning. Thus, in order to bring both kinds of changes under control, we considered a new multi-period, multi-commodity, multi-source DND problem in circumstances where the network encounters uncertain demands. The fuzzy logic is applied here as an efficient tool for controlling the potential customers' demand risk. The defuzzifying framework leads the practitioners and decision-makers to interact with the solution procedure continuously. The fuzzy model is then validated by a sensitivity analysis test, and a typical problem is solved in order to illustrate the implementation steps. Finally, the formulation is tested by some different-sized problems to show its total performance.

Problem-based learning: Using students' questions to drive knowledge construction

NASA Astrophysics Data System (ADS)

Chin, Christine; Chia, Li-Gek

2004-09-01

This study employed problem-based learning for project work in a year 9 biology class. The purpose of the study was to investigate (a) students' inspirations for their self-generated problems and questions, (b) the kinds of questions that students asked individually and collaboratively, and (c) how students' questions guided them in knowledge construction. Data sources included observation and field notes, students' written documents, audiotapes and videotapes of students working in groups, and student interviews. Sources of inspiration for students' problems and questions included cultural beliefs and folklore; wonderment about information propagated by advertisements and the media; curiosity arising from personal encounters, family members' concerns, or observations of others; and issues arising from previous lessons in the school curriculum. Questions asked individually pertained to validation of common beliefs and misconceptions, basic information, explanations, and imagined scenarios. The findings regarding questions asked collaboratively are presented as two assertions. Assertion 1 maintained that students' course of learning were driven by their questions. Assertion 2 was that the ability to ask the right'' questions and the extent to which these could be answered, were important in sustaining students' interest in the project. Implications of the findings for instructional practice are discussed.

Calibration plots for risk prediction models in the presence of competing risks.

PubMed

Gerds, Thomas A; Andersen, Per K; Kattan, Michael W

2014-08-15

A predicted risk of 17% can be called reliable if it can be expected that the event will occur to about 17 of 100 patients who all received a predicted risk of 17%. Statistical models can predict the absolute risk of an event such as cardiovascular death in the presence of competing risks such as death due to other causes. For personalized medicine and patient counseling, it is necessary to check that the model is calibrated in the sense that it provides reliable predictions for all subjects. There are three often encountered practical problems when the aim is to display or test if a risk prediction model is well calibrated. The first is lack of independent validation data, the second is right censoring, and the third is that when the risk scale is continuous, the estimation problem is as difficult as density estimation. To deal with these problems, we propose to estimate calibration curves for competing risks models based on jackknife pseudo-values that are combined with a nearest neighborhood smoother and a cross-validation approach to deal with all three problems. Copyright © 2014 John Wiley & Sons, Ltd.

[Ethics in clinical practice and in health care].

PubMed

Pintor, S; Mennuni, G; Fontana, M; Nocchi, S; Giarrusso, P; Serio, A; Fraioli, A

2015-01-01

The clinical ethics is the identification, analysis and solution of moral problems that can arise during the care of a patient. Given that when dealing with ethical issues in health care some risks will be encountered (talking about ethics in general, or as a problem overlapped with others in this area, or by delegation to legislative determinations) in the text certain important aspects of the topic are examined. First of all ethics as human quality of the relationship between people for the common good, especially in health services where there are serious problems like the life and the health. It is also necessary a "humanizing relationship" between those who work in these services in order to achieve quality and efficiency in this business. It is important a proper training of health professionals, especially doctors, so that they can identify the real needs and means of intervention. It is also important that scientific research must respect fundamental ethical assumptions. In conclusion, ethics in health care is not a simple matter of "cookbook" rules, but involves the responsibility and consciousness of individual operators.

Learning about general practice through qualitative interviews: lessons from a seminar course with medical students.

PubMed

von Unger, Hella; Werwick, Katrin; Lichte, Thomas; Herrmann, Markus

2010-01-01

A seminar course was developed in order to train medical students in qualitative research methods, while providing an introduction to the field of General Practice. Students were enabled to conduct semi-structured interviews with general practitioners (GPs), during which they learned about the prevention, diagnosis, and treatment of frequently encountered medical problems. The course was carried out four times at two universities in Germany. The study explores the students' learning experiences focusing on their research experience. Data were collected in four focus groups and analyzed. The students perceived the course as very different from their usual medical education. This was appreciated, but also caused some difficulties. Three themes emerged: (1) Missing 'facts', (2) New horizons: 'Thinking outside the box', and (3) The challenge of interpretation: 'Reading between the lines'. Learning qualitative research methods can be particularly challenging for medical students as the tasks and epistemology of qualitative research run counter to the usual learning formats and research paradigms in medical education. When teaching qualitative research, special care should be taken to address the cognitive dissonance experienced by students and to explain the unique contribution of qualitative research to medical practice and the field of General Practice especially.

An Online Forum As a Qualitative Research Method: Practical Issues

PubMed Central

Im, Eun-Ok; Chee, Wonshik

2008-01-01

Background Despite positive aspects of online forums as a qualitative research method, very little is known about practical issues involved in using online forums for data collection, especially for a qualitative research project. Objectives The purpose of this paper is to describe the practical issues that the researchers encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience. Method Throughout the study process, the research staff recorded issues ranged from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of discussions were reviewed and analyzed using the content analysis suggested by Weber. Results Two practical issues related to credibility were identified: a high response and retention rate and automatic transcripts. An issue related to dependability was the participants’ easy forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well. Discussion The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method. PMID:16849979

Launching a Laboratory Testing Process Quality Improvement Toolkit: From the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

PubMed

Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David

2015-01-01

Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.

Small-Group Standardized Patient Encounter Improves Athletic Training Students' Psychosocial Intervention and Referral Skills

ERIC Educational Resources Information Center

Walker, Stacy E.; Weidner, Thomas G.; Thrasher, Ashley B.

2016-01-01

Context: Athletic trainers provide psychological support, counseling, intervention, and referral to patients during clinical practice. However, students are rarely exposed to real-life opportunities to develop these skills. Objective: To determine if a small-group standardized patient (SP) encounter improved athletic training students'…

Risk Evaluation and Mitigation Strategies (REMS) for extended-release and long-acting opioid analgesics: considerations for palliative care practice.

PubMed

Gudin, Jeffrey

2012-06-01

Prescription opioid analgesics are an essential treatment option for patients with moderate to severe pain. Over the last decade the increased medical use of these agents has contributed to a public health epidemic of abuse, addiction, and overdose-related deaths. These medications remain mainstays in both primary care and pain management practices. As palliative services are incorporated at earlier stages of the disease process and the number of individuals with chronic illness increases, palliative care specialists may encounter an increasing number of patients with opioid abuse and addiction problems. Extended-release (ER) and long-acting (LA) opioid formulations are administered to patients with moderate to severe chronic pain requiring around-the-clock analgesia. Given the large quantity of active ingredient contained within some dosage strengths, this medication class is associated with serious risks when taken improperly. In response to growing reports of abuse and overdose deaths, the US Food and Drug Administration (FDA) announced the need for a risk mitigation strategy for the entire class of medication. The class-wide Risk Evaluation and Mitigation Strategy (REMS) for ER/LA opioids will emphasize prescriber training and patient education to ensure that the therapeutic benefits outweigh the risks of addiction, unintentional overdose, and death. As primary care, pain management, and palliative care clinicians often encounter patients who require ER/LA opioids, an understanding of the suggested requirements and potential impact of this regulation is essential.

Democracy in NGOs: Making the Cooperative Option Work.

ERIC Educational Resources Information Center

Wardle, Chris

1988-01-01

Discusses several problems encountered by nongovernmental organizations (NGOs) that structure themselves as cooperatives, with all members being equal. Presents four problem areas--(1) decision making, (2) meetings, (3) job rotation, and (4) growth--as well as strategies to solve potential problems. (CH)

The Effect of New Vocabulary on Problem Solving in Novice Physics Students.

ERIC Educational Resources Information Center

Sobolewski, Stanley J.

One of the difficulties encountered by novice problem solvers in introductory physics is in the area of problem solving. It has been shown in other studies that poor problem solvers are affected by the surface aspects of the problem in contrast with more efficient problem solvers who are capable of constructing a mental model of the physical…

Problems Implementing Problem-Based Learning by a Private Malaysian University

ERIC Educational Resources Information Center

Tik, Chan Chang

2014-01-01

In this case study the focus is on lecturers' readiness in the design of PBL problems and to facilitate students' learning. This paper also looks into students' readiness in terms of acquiring metacognitive skills and collaborating in group to solve PBL problems. Problems encountered by both lecturers and students are discussed in the context of…

Determining the Performances of Pre-Service Primary School Teachers in Problem Posing Situations

ERIC Educational Resources Information Center

Kilic, Cigdem

2013-01-01

This study examined the problem posing strategies of pre-service primary school teachers in different problem posing situations (PPSs) and analysed the issues they encounter while posing problems. A problem posing task consisting of six PPSs (two free, two structured, and two semi-structured situations) was delivered to 40 participants.…

Nurse's Awareness on Ethico-legal Aspects of Nursing Profession.

PubMed

Paudel Subedi, Krishna Kumari; Timalsina, Kalpana; Bhele, Raja Laxmi

2018-03-13

Nursing practice amicably includes practical efficacy and ethics. Now a days legal and ethical problems associated with client care are arising day by day. Therefore, nurses should have adequate understanding of basic legal concepts and issues relevant to nursing profession in order to protect the rights of the clients and the nurses. A cross sectional descriptive design was adopted for the study. 142 nurses were included by using purposive sampling technique. Data was collected with self-administered structured questionnaire. Descriptive statistics was used to reveal demographic information. Kruskal Wallis and Mann Whitney test were used to find out association of selected demographic variables and ethico legal aspects of nursing. Majority of participants were belonging to 20-29 years of age. More than half nurses had complete bachelor's degree and had less than 10 year's experiences. Majority of participants reported that they did not encounter any legal issues in their professional life till date. Similarly, majority of participants had average level knowledge and equate level of practice. Years of experiences and education level did not affect in knowledge level and existing practice related to ethico legal aspect of nursing. There was no significant relationship between level of knowledge and existing practice. Nurses have average knowledge and practice on ethico legal aspects. There is positive relationship between knowledge and practice though it is not statistically significant.

Benchmarking Gas Path Diagnostic Methods: A Public Approach

NASA Technical Reports Server (NTRS)

Simon, Donald L.; Bird, Jeff; Davison, Craig; Volponi, Al; Iverson, R. Eugene

2008-01-01

Recent technology reviews have identified the need for objective assessments of engine health management (EHM) technology. The need is two-fold: technology developers require relevant data and problems to design and validate new algorithms and techniques while engine system integrators and operators need practical tools to direct development and then evaluate the effectiveness of proposed solutions. This paper presents a publicly available gas path diagnostic benchmark problem that has been developed by the Propulsion and Power Systems Panel of The Technical Cooperation Program (TTCP) to help address these needs. The problem is coded in MATLAB (The MathWorks, Inc.) and coupled with a non-linear turbofan engine simulation to produce "snap-shot" measurements, with relevant noise levels, as if collected from a fleet of engines over their lifetime of use. Each engine within the fleet will experience unique operating and deterioration profiles, and may encounter randomly occurring relevant gas path faults including sensor, actuator and component faults. The challenge to the EHM community is to develop gas path diagnostic algorithms to reliably perform fault detection and isolation. An example solution to the benchmark problem is provided along with associated evaluation metrics. A plan is presented to disseminate this benchmark problem to the engine health management technical community and invite technology solutions.

Multi-UAV Routing for Area Coverage and Remote Sensing with Minimum Time.

PubMed

Avellar, Gustavo S C; Pereira, Guilherme A S; Pimenta, Luciano C A; Iscold, Paulo

2015-11-02

This paper presents a solution for the problem of minimum time coverage of ground areas using a group of unmanned air vehicles (UAVs) equipped with image sensors. The solution is divided into two parts: (i) the task modeling as a graph whose vertices are geographic coordinates determined in such a way that a single UAV would cover the area in minimum time; and (ii) the solution of a mixed integer linear programming problem, formulated according to the graph variables defined in the first part, to route the team of UAVs over the area. The main contribution of the proposed methodology, when compared with the traditional vehicle routing problem's (VRP) solutions, is the fact that our method solves some practical problems only encountered during the execution of the task with actual UAVs. In this line, one of the main contributions of the paper is that the number of UAVs used to cover the area is automatically selected by solving the optimization problem. The number of UAVs is influenced by the vehicles' maximum flight time and by the setup time, which is the time needed to prepare and launch a UAV. To illustrate the methodology, the paper presents experimental results obtained with two hand-launched, fixed-wing UAVs.

Towards a practical Johnson noise thermometer for long-term measurements in harsh environments

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

Greenen, Adam; Pearce, Jonathan; Cruickshank, David

The impact of mechanical and chemical changes in conventional sensors such as thermocouples and resistance thermometers can be avoided by instead using temperature sensors based on fundamental thermometry. A prime example of this is Johnson noise thermometry, which is based on measurement of the fluctuations in the voltage of a resistor arising from thermal motion of charge carriers - i.e. the 'Johnson noise'. A Johnson noise thermometer never needs calibration and is insensitive to the condition of the sensor material. It is therefore ideally suited to long-term temperature measurements in harsh environments, such as nuclear reactor coolant circuits, in-pile measurements,more » nuclear waste management and storage, and severe accident monitoring. There have been a number of previous attempts to develop a Johnson noise thermometer for the nuclear industry, but none have reached commercial exploitation because of technical problems in practical implementation. The main challenge is to extract the tiny Johnson noise signal from ambient electrical noise influences, both from the internal amplification electronics, and from external electrical noise sources. Recent advances in electronics technology and digital signal processing techniques have opened up new possibilities for developing a viable, practical Johnson noise thermometer. We describe a project funded by the UK Technology Strategy Board (now Innovate UK) 'Developing the nuclear supply chain' call, currently underway, to develop a practical Johnson noise thermometer that makes use of innovative electronics for ultralow noise amplification and signal processing. The new electronics technology has the potential to help overcome the problems encountered with previous attempts at constructing a practical Johnson noise thermometer. An outline of the new developments is presented, together with an overview of the current status of the project. (authors)« less

Defining and Measuring Diagnostic Uncertainty in Medicine: A Systematic Review.

PubMed

Bhise, Viraj; Rajan, Suja S; Sittig, Dean F; Morgan, Robert O; Chaudhary, Pooja; Singh, Hardeep

2018-01-01

Physicians routinely encounter diagnostic uncertainty in practice. Despite its impact on health care utilization, costs and error, measurement of diagnostic uncertainty is poorly understood. We conducted a systematic review to describe how diagnostic uncertainty is defined and measured in medical practice. We searched OVID Medline and PsycINFO databases from inception until May 2017 using a combination of keywords and Medical Subject Headings (MeSH). Additional search strategies included manual review of references identified in the primary search, use of a topic-specific database (AHRQ-PSNet) and expert input. We specifically focused on articles that (1) defined diagnostic uncertainty; (2) conceptualized diagnostic uncertainty in terms of its sources, complexity of its attributes or strategies for managing it; or (3) attempted to measure diagnostic uncertainty. We identified 123 articles for full review, none of which defined diagnostic uncertainty. Three attributes of diagnostic uncertainty were relevant for measurement: (1) it is a subjective perception experienced by the clinician; (2) it has the potential to impact diagnostic evaluation-for example, when inappropriately managed, it can lead to diagnostic delays; and (3) it is dynamic in nature, changing with time. Current methods for measuring diagnostic uncertainty in medical practice include: (1) asking clinicians about their perception of uncertainty (surveys and qualitative interviews), (2) evaluating the patient-clinician encounter (such as by reviews of medical records, transcripts of patient-clinician communication and observation), and (3) experimental techniques (patient vignette studies). The term "diagnostic uncertainty" lacks a clear definition, and there is no comprehensive framework for its measurement in medical practice. Based on review findings, we propose that diagnostic uncertainty be defined as a "subjective perception of an inability to provide an accurate explanation of the patient's health problem." Methodological advancements in measuring diagnostic uncertainty can improve our understanding of diagnostic decision-making and inform interventions to reduce diagnostic errors and overuse of health care resources.

Helping Students Navigate Faith Challenges in the Biblical Studies Classroom

ERIC Educational Resources Information Center

Sharp, Carolyn J.; Clark-Soles, Jaime

2012-01-01

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

Tips for Novice Researchers: Operational Difficulties Encountered in Underdeveloped Countries.

ERIC Educational Resources Information Center

Belcher El-Nahhas, Susan M.

This paper provides a general overview of the type of problems encountered in the field of research so that individuals who are contemplating conducting research in an underdeveloped country for the first time are better prepared, and hence, better able to complete their research. The paper recounts a female researcher's personal experiences in…

Problem-Solving Examples as Interactive Learning Objects for Educational Digital Libraries

ERIC Educational Resources Information Center

Brusilovsky, Peter; Yudelson, Michael; Hsiao, I-Han

2009-01-01

The paper analyzes three major problems encountered by our team as we endeavored to turn problem solving examples in the domain of programming into highly reusable educational activities, which could be included as first class objects in various educational digital libraries. It also suggests three specific approaches to resolving these problems,…

ADOPTING THE PROBLEM BASED LEARNING APPROACH IN A GIS PROJECT MANAGEMENT CLASS

EPA Science Inventory

Problem Based Learning (PBL) is a process that emphasizes the need for developing problem solving skills through hands-on project formulation and management. A class adopting the PBL method provides students with an environment to acquire necessary knowledge to encounter, unders...

Problems in Evaluating Adult Literacy Programmes.

ERIC Educational Resources Information Center

Rajyalakshmi, C.

1980-01-01

The study of the Functional Literacy Program in India encountered problems of opposition to evaluation, inappropriate respondents, and difficulties in contacting participants, which point to changes that should be made in the evaluation methods. (SK)

76 FR 6054 - Use of Less-Than-Lethal Force: Delegation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-03

... report any medical problems encountered by subjects being subdued and arrested, and no medical problems.... Therefore, for accuracy in terminology, we replace the term ``non-lethal'' with the more accurate term...

Common statistical and research design problems in manuscripts submitted to high-impact psychiatry journals: what editors and reviewers want authors to know.

PubMed

Harris, Alex H S; Reeder, Rachelle; Hyun, Jenny K

2009-10-01

Journal editors and statistical reviewers are often in the difficult position of catching serious problems in submitted manuscripts after the research is conducted and data have been analyzed. We sought to learn from editors and reviewers of major psychiatry journals what common statistical and design problems they most often find in submitted manuscripts and what they wished to communicate to authors regarding these issues. Our primary goal was to facilitate communication between journal editors/reviewers and researchers/authors and thereby improve the scientific and statistical quality of research and submitted manuscripts. Editors and statistical reviewers of 54 high-impact psychiatry journals were surveyed to learn what statistical or design problems they encounter most often in submitted manuscripts. Respondents completed the survey online. The authors analyzed survey text responses using content analysis procedures to identify major themes related to commonly encountered statistical or research design problems. Editors and reviewers (n=15) who handle manuscripts from 39 different high-impact psychiatry journals responded to the survey. The most commonly cited problems regarded failure to map statistical models onto research questions, improper handling of missing data, not controlling for multiple comparisons, not understanding the difference between equivalence and difference trials, and poor controls in quasi-experimental designs. The scientific quality of psychiatry research and submitted reports could be greatly improved if researchers became sensitive to, or sought consultation on frequently encountered methodological and analytic issues.

Learning as discourse change: A sociocultural mechanism

NASA Astrophysics Data System (ADS)

Wickman, Per-Olof; Östman, Leif

2002-09-01

This paper deals with a theoretical mechanism for learning and a methodological approach for analyzing meaning making in classroom talk and action. It examines the potential of the approach for illuminating learning on a discursive level, i.e., how discourses change and how individuals become participants of new practices. Our approach involves a high-resolution analysis of how meaningful relations are built in encounters between individuals and between individuals and the world. The approach is based mainly on the work of the later Wittgenstein, but also on pragmatism and sociocultural research. To demonstrate how our approach can be used, we analyze what university students learn during a practical on insects. We specifically demonstrate how the encounters with physical pinned insects contribute to the meaning students make and how these encounters interact with other experiences during laboratory work.

Health profiles of foreigners attending primary care clinics in Malaysia.

PubMed

Ab Rahman, Norazida; Sivasampu, Sheamini; Mohamad Noh, Kamaliah; Khoo, Ee Ming

2016-06-14

The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia. Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care encounters from public and private primary care clinics sampled from five regions in Malaysia. Patients with foreign nationality were identified and analysed for demographic profiles, reasons for encounter (RFEs), diagnosis, and provision of care. Foreigners accounted for 7.7 % (10,830) of all patient encounters from NMCS. Most encounters were from private clinics (90.2 %). Median age was 28 years (IQR: 24.0, 34.8) and 69.9 % were male. Most visits to the primary care clinics were for symptom-based complaints (69.5 %), followed by procedures (23.0 %) and follow-up visit (7.4 %). The commonest diagnosis in public clinics was antenatal care (21.8 %), followed by high risk pregnancies (7.5 %) and upper respiratory tract infection (URTI) (6.8 %). Private clinics had more cases for general medical examination (13.5 %), URTI (13.1 %) and fever (3.9 %). Medications were prescribed to 76.5 % of these encounters. More foreigners were seeking primary medical care from private clinics and the encounters were for general medical examinations and acute minor ailments. Those who sought care from public clinics were for obstetric problems and chronic diseases. Medications were prescribed to two-thirds of the encounters while other interventions: laboratory investigations, medical procedures and follow-up appointment had lower rates in private clinics. Foreigners are generally of young working group and are expected to have mandatory medical checks. The preponderance of obstetrics seen in public clinics suggests a need for improved access to maternal care and pregnancy related care. This has implication on policy and health care provision and access for foreigners and future studies are needed to look into strategies to solve these problems.

Partnership and Recognition in Action Research: Understanding the Practices and Practice Architectures for Participation and Change

ERIC Educational Resources Information Center

Edwards-Groves, Christine; Olin, Anette; Karlberg-Granlund, Gunilla

2016-01-01

This article is the first and introductory article of this special issue. The article gives a societist account of the principles of partnership and recognition as they are encountered and experienced in practices in action research. A societist account of practices requires a social theory for understanding practices. Therefore, the article…

Ophthalmology resident surgical competency: a national survey.

PubMed

Binenbaum, Gil; Volpe, Nicholas J

2006-07-01

To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. Fourteen-question written survey. Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Beyond Dramatic Truth: Theatre within the Therapeutic Encounter

ERIC Educational Resources Information Center

Pendle, Andy; Rowe, Nick

2010-01-01

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

Concentrated Language Encounter Approach in Practice for Global Teaching of Literacy: Lighthouse Strategy Implementation

ERIC Educational Resources Information Center

Rattanavich, Saowalak

2015-01-01

This article presents the lighthouse literacy strategies model using the concentrated language encounter (CLE) approach that has been successfully replicated in many countries in different languages and cultures. A review of CLE research studies and the project implementation in Thailand showed highly significant results in students' literacy…

Fading Correction To Be Used In Clinical Thermoluminescence Dosimetry

NASA Astrophysics Data System (ADS)

Furetta, C.; Azorin, J.; Rivera, T.

2004-09-01

This paper presents some useful expressions for fading correction, which can be used in practical situations as they can be encountered in clinical dosimetry. The situations took into consideration can be encountered in hospital environments during and after radiotherapeutic treatments of patients as well as for radiation protection procedures concerning staff members.

Logic of Accounting: The Case of Reporting Previous Options in Norwegian Activation Encounters

ERIC Educational Resources Information Center

Solberg, Janne

2017-01-01

The article deals with the enactment of client resistance in Norwegian vocational rehabilitation encounters. More specific, a practice here called "reporting previous options" is analyzed by using the resources of ethnomethodological conversation analysis (CA) in five instances as doing some sort of accounting. In response to the…

Applications of remote sensing to water resources

NASA Technical Reports Server (NTRS)

1977-01-01

Analyses were made of selected long-term (1985 and beyond) objectives, with the intent of determining if significant data-related problems would be encountered and to develop alternative solutions to any potential problems. One long-term objective selected for analysis was Water Availability Forecasting. A brief overview was scheduled in FY-77 of the objective -- primarily a fact-finding study to allow Data Management personnel to gain adequate background information to perform subsequent data system analyses. This report, includes discussions on some of the larger problems currently encountered in water measurement, the potential users of water availability forecasts, projected demands of users, current sensing accuracies, required parameter monitoring, status of forecasting modeling, and some measurement accuracies likely to be achievable by 1980 and 1990.

Technical errors in planar bone scanning.

PubMed

Naddaf, Sleiman Y; Collier, B David; Elgazzar, Abdelhamid H; Khalil, Magdy M

2004-09-01

Optimal technique for planar bone scanning improves image quality, which in turn improves diagnostic efficacy. Because planar bone scanning is one of the most frequently performed nuclear medicine examinations, maintaining high standards for this examination is a daily concern for most nuclear medicine departments. Although some problems such as patient motion are frequently encountered, the degraded images produced by many other deviations from optimal technique are rarely seen in clinical practice and therefore may be difficult to recognize. The objectives of this article are to list optimal techniques for 3-phase and whole-body bone scanning, to describe and illustrate a selection of deviations from these optimal techniques for planar bone scanning, and to explain how to minimize or avoid such technical errors.

Gastrointestinal gas.

PubMed Central

Fardy, J; Sullivan, S

1988-01-01

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

Bridging the gap in care for children through the clinical nurse leader.

PubMed

O'Grady, Erin L; VanGraafeiland, Brigit

2012-01-01

Care coordination has been identified as a gap in the nursing care of children and families who experience an encounter within the health care system. The educational preparation of the clinical nurse leader (CNL) enables the CNL to address many gaps found in health care. Current evidence suggests various gaps in care, as reported by patients, families, nurses, and other health care providers. Identified gaps in care include problems with communication, coordination, education, research, advocacy, psychological and social support, and the needs of siblings. The CNL may improve quality of care for children through efficient care coordination by acting as a liaison and advocate between the patient, family, and health care team to bridge gaps in the current practices of care.

The keys to successful online continuing education programs for nurses.

PubMed

Sweeney, Nancy M; Saarmann, Lembi; Flagg, Joan; Seidman, Robert

2008-01-01

Asynchronous online tutorials that award continuing education units without cost and provide knowledge about computers and nursing informatics were made available to registered nurses in Southern California. Four hundred seventy-three nurses enrolled; 52% (246) completed tutorials. Nonsignificant differences in the number of tutorials completed were found across characteristics of participants, meaning that nurses were similarly disposed to participate regardless of age, educational preparation, experience, practice setting, or ethnicity. They tended to overestimate their computer capabilities at the time of enrollment and abandoned the tutorials when they encountered technical problems. Nurses need live workshops teaching computer basics, Internet skills, and how to enroll in and run asynchronous programs. Marketing of online programs should be multifaceted, including live and electronic strategies.

3-D imaging of large scale buried structure by 1-D inversion of very early time electromagnetic (VETEM) data

USGS Publications Warehouse

Aydmer, A.A.; Chew, W.C.; Cui, T.J.; Wright, D.L.; Smith, D.V.; Abraham, J.D.

2001-01-01

A simple and efficient method for large scale three-dimensional (3-D) subsurface imaging of inhomogeneous background is presented. One-dimensional (1-D) multifrequency distorted Born iterative method (DBIM) is employed in the inversion. Simulation results utilizing synthetic scattering data are given. Calibration of the very early time electromagnetic (VETEM) experimental waveforms is detailed along with major problems encountered in practice and their solutions. This discussion is followed by the results of a large scale application of the method to the experimental data provided by the VETEM system of the U.S. Geological Survey. The method is shown to have a computational complexity that is promising for on-site inversion.

Learning Impasses in Problem Solving

NASA Technical Reports Server (NTRS)

Hodgson, J. P. E.

1992-01-01

Problem Solving systems customarily use backtracking to deal with obstacles that they encounter in the course of trying to solve a problem. This paper outlines an approach in which the possible obstacles are investigated prior to the search for a solution. This provides a solution strategy that avoids backtracking.

Using CAS to Solve Classical Mathematics Problems

ERIC Educational Resources Information Center

Burke, Maurice J.; Burroughs, Elizabeth A.

2009-01-01

Historically, calculus has displaced many algebraic methods for solving classical problems. This article illustrates an algebraic method for finding the zeros of polynomial functions that is closely related to Newton's method (devised in 1669, published in 1711), which is encountered in calculus. By exploring this problem, precalculus students…

Beyond Utility Targeting: Toward Axiological Air Operations

DTIC Science & Technology

2000-01-01

encounter the leader- sociopath , bereft of values, quite willing to live underground in hiding and in- sensitive to the absence of human comforts...that is a mere one thousand value-analysis problems to begin solving. A more difficult problem to solve is the problem of the leader- sociopath

Patients' approaches to students' learning at a clinical education ward--an ethnographic study.

PubMed

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silén, Charlotte

2014-07-02

It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting. An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students' learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

Progress in Computational Electron-Molecule Collisions

NASA Astrophysics Data System (ADS)

Rescigno, Tn

1997-10-01

The past few years have witnessed tremendous progress in the development of sophisticated ab initio methods for treating collisions of slow electrons with isolated small molecules. Researchers in this area have benefited greatly from advances in computer technology; indeed, the advent of parallel computers has made it possible to carry out calculations at a level of sophistication inconceivable a decade ago. But bigger and faster computers are only part of the picture. Even with today's computers, the practical need to study electron collisions with the kinds of complex molecules and fragments encountered in real-world plasma processing environments is taxing present methods beyond their current capabilities. Since extrapolation of existing methods to handle increasingly larger targets will ultimately fail as it would require computational resources beyond any imagined, continued progress must also be linked to new theoretical developments. Some of the techniques recently introduced to address these problems will be discussed and illustrated with examples of electron-molecule collision calculations we have carried out on some fairly complex target gases encountered in processing plasmas. Electron-molecule scattering continues to pose many formidable theoretical and computational challenges. I will touch on some of the outstanding open questions.

Occupational neurology.

PubMed Central

Feldman, R. G.

1987-01-01

The nervous system is vulnerable to the effects of certain chemicals and physical conditions found in the work environment. The activities of an occupational neurologist focus on the evaluation of patients with neurological disorders caused by occupational or environmental conditions. When one is making a differential diagnosis in patients with neurological disorders, the possibility of toxic exposure or encounters with physical factors in the workplace must not be overlooked. Central to an accurate clinical diagnosis is the patient's history. A diagnosis of an occupational or environmental neurological problem requires a careful assessment of the clinical abnormalities and confirmation of these disabilities by objective tests such as nerve conduction velocity, evoked potentials, electroencephalogram, neuropsychological batteries, or nerve biopsy. On the basis of information about hazards in the workplace, safety standards and environmental and biological monitoring can be implemented in the workplace to reduce the risks of undue injury. Clinical manifestations of headache, memory disturbance, and peripheral neuropathy are commonly encountered presentations of the effects of occupational hazards. Physicians in everyday clinical practice must be aware of the signs and symptoms associated with exposure to possible neurotoxins and work methods. Occupational and environmental circumstances must be explored when evaluating patients with neurologic disorders. PMID:3577214

The BAPE 2 balloon-borne CO2

NASA Technical Reports Server (NTRS)

Degnan, J. J.; Walker, H. E.; Peruso, C. J.; Johnson, E. H.; Klein, B. J.; Mcelroy, J. H.

1972-01-01

The systems and techniques which were utilized in the experiment to establish an air-to-ground CO2 laser heterodyne link are described along with the successes and problems encountered when the heterodyne receiver and laser transmitter package were removed from the controlled environment of the laboratory. Major topics discussed include: existing systems and the underlying principles involved in their operation; experimental techniques and optical alignment methods which were found to be useful; theoretical calculations of signal strengths expected under a variety of test conditions and in actual flight; and the experimental results including problems encountered and their possible solutions.

Customer Service: Implications for Reference Practice.

ERIC Educational Resources Information Center

Whitlatch, Jo Bell

1995-01-01

The past decade has seen an increasing emphasis on customer service in business research and management. Two concepts in understanding business customer service practices are discussed: the service encounter and total quality management. Highlights include customer service research and practices in business; implications for library reference…

'A good fit?' Bringing the sociology of footwear to the clinical encounter in podiatry services: a narrative review.

PubMed

Nicholls, Emily; Robinson, Victoria; Farndon, Lisa; Vernon, Wesley

2018-01-01

This narrative review explores the ways in which drawing on theories and methods used in sociological work on footwear and identity can contribute to healthcare research with podiatrists and their patients, highlighting recent research in this field, implications for practice and potential areas for future development.Traditionally, research within Podiatry Services has tended to adopt a quantitative, positivist focus, developing separately from a growing body of sociological work exploring the importance of shoes in constructing identity and self-image. Bringing qualitative research drawing on sociological theory and methods to the clinical encounter has real potential to increase our understanding of patient values, motivations and - crucially - any barriers to adopting 'healthier' footwear that they may encounter. Such work can help practitioners to understand why patients may resist making changes to their footwear practices, and help us to devise new ways for practitioners to explore and ultimately break down individual barriers to change (including their own preconceptions as practitioners). This, in turn, may lead to long-term, sustainable changes to footwear practices and improvements in foot health for those with complex health conditions and the wider population. A recognition of the complex links between shoes and identity is opening up space for discussion of patient resistance to footwear changes, and paving the way for future research in this field beyond the temporary 'moment' of the clinical encounter.

Ethical problems in nursing management: The views of nurse managers.

PubMed

Aitamaa, Elina; Leino-Kilpi, Helena; Iltanen, Silja; Suhonen, Riitta

2016-09-01

Nurse managers have responsibilities relating to the quality of care, the welfare of the staff and running of the organization. Ethics plays significant role in these responsibilities. Ethical problems are part of daily management, but research in this area is limited. The aim of this study was to identify and describe ethical problems nurse managers encounter in their work to get more detailed and extensive view of these problems. The data consisted of nine interviews with nurse managers at different management levels in primary healthcare and specialized healthcare organizations, and it was analysed by inductive content analysis. Permission to conduct the interviews including ethical approval was given at all participating organizations according to national standards. The respondents were informed about the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them. Four main categories were found: conflicts in practical situations, lack of appreciation, disregard of problems and experienced inadequacy. Problems could also be divided to patient-related, staff-related, organization-related and other problems. The findings correspond with results from earlier studies but add knowledge of the nature and details of nurse managers' ethical problems. New information is produced related to the ethical problems with nurse managers' own courage, motivation and values. Nurse managers identified a variety of different ethical problems in their work. This information is useful in the development of ethics in nursing management. Further research about the frequency and intensity of nurse managers' ethical problems is needed as well as possible differences in different levels of management. © The Author(s) 2015.

Chinese approaches to understanding and building resilience in at-risk children and adolescents.

PubMed

Lee, Tak-Yan; Shek, Daniel T L; Kwong, Wai-Man

2007-04-01

This article discusses the prevailing Chinese belief systems that have bearings on the perception and practices of promoting resilience among children and youth in a major city in China. It briefly describes a huge social intervention program entitled "Understanding the Adolescent Project" to combat the problems among grade 7 students identified as adolescents at risk from 2001 to 2004 in Hong Kong Special Administrative Region. A critical review of the problems encountered by social workers in the delivery of the program is presented to support the move to provide the preventive program for grade 4 students with clinical symptoms on a screening tool for identification of at-risk status. Starting in 2005, a large-scale positive youth development program was being developed for all secondary one to three (grades 7 to 9) students. Encouraging results of the evaluation studies demonstrated the effectiveness of this new preventive program, entitled Positive Adolescent Training through Holistic Social Programs.

Specialty Task Force: A Strategic Component to Electronic Health Record (EHR) Optimization.

PubMed

Romero, Mary Rachel; Staub, Allison

2016-01-01

Post-implementation stage comes after an electronic health record (EHR) deployment. Analyst and end users deal with the reality that some of the concepts and designs initially planned and created may not be complementary to the workflow; creating anxiety, dissatisfaction, and failure with early adoption of system. Problems encountered during deployment are numerous and can vary from simple to complex. Redundant ticket submission creates backlog for Information Technology personnel resulting in delays in resolving concerns with EHR system. The process of optimization allows for evaluation of system and reassessment of users' needs. A solid and well executed optimization infrastructure can help minimize unexpected end-user disruptions and help tailor the system to meet regulatory agency goals and practice standards. A well device plan to resolve problems during post implementation is necessary for cost containment and to streamline communication efforts. Creating a specialty specific collaborative task force is efficacious and expedites resolution of users' concerns through a more structured process.

Unresolved questions associated with the management of ventricular pre-excitation syndrome.

PubMed

Brembilla-Perrot, Béatrice; Girerd, Nicolas; Sellal, Jean-Marc

2018-05-13

many recent recommendations concern the management of pre-excitation syndrome. In clinical practice, they are sometimes difficult to use. The purpose of the authors was to discuss the main problems associated with this management. This article is protected by copyright. All rights reserved Three problems are encountered: 1) the reality of the absence of symptoms or the interpretation of atypical symptoms, 2) the electrocardiographic diagnosis of pre-excitation syndrome that can be missed and 3) the exact electrophysiological protocol and its interpretation used for the evaluation of the prognosis Because of significant progress largely related to the development of curative treatment, it seems easy to propose ablation in many patients despite the related risks of invasive studies and to minimize the invasive risk by only performing ablation for patients with at-risk pathways. However, there is a low risk of spontaneous events in truly asymptomatic patients and the indication of accessory pathway ablation should be discussed case by case. This article is protected by copyright. All rights reserved.

Role of Enhancing Visual Effects Education Delivery to Encounter Career Challenges in Malaysia

ERIC Educational Resources Information Center

Ng, Lynn-Sze

2017-01-01

Problem-based Learning (PBL) is one of the most effective methods of instruction that helps Visual Effects (VFX) students to be more adaptable at encountering career challenges in Malaysia. These challenges are; lack of several important requirements such as, the basic and fundamental knowledge of VFX concepts, the ability to understand real-world…

Crafting interactivity for stakeholder engagement: transforming assumptions about communication in science and policy.

PubMed

Aakhus, Mark

2011-11-01

The International Radiation Protection Association's guiding principles for stakeholder engagement focus on fostering, facilitating, and enabling interaction among stakeholders that is inclusive and fosters competent decision making. Implicit in these standards is a call to cultivate knowledge and competence in designing communication for stakeholder engagement among radiation protection professionals. Communication as design is an approach to risk communication in science and policy that differs from, yet complements, the more well-known communication practices of informing and persuading. Design focuses on the recurring practical problem faced by professionals in making communication possible among stakeholders where it has otherwise been difficult, impossible, or even unimagined. The knowledge and competence associated with design involves principles for crafting interactivity across a variety of mediated and non-mediated encounters among stakeholders. Risk communication can be improved by cultivating expertise in scalable communication design that embraces the demands of involvement without abandoning the need for competence in science and policy communication.

Reconciling Pairs of Concurrently Used Clinical Practice Guidelines Using Constraint Logic Programming

PubMed Central

Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Hing, Marisela Mainegra; Farion, Ken

2011-01-01

This paper describes a new methodological approach to reconciling adverse and contradictory activities (called points of contention) occurring when a patient is managed according to two or more concurrently used clinical practice guidelines (CPGs). The need to address these inconsistencies occurs when a patient with more than one disease, each of which is a comorbid condition, has to be managed according to different treatment regimens. We propose an automatic procedure that constructs a mathematical guideline model using the Constraint Logic Programming (CLP) methodology, uses this model to identify and mitigate encountered points of contention, and revises the considered CPGs accordingly. The proposed procedure is used as an alerting mechanism and coupled with a guideline execution engine warns the physician about potential problems with the concurrent application of two or more guidelines. We illustrate the operation of our procedure in a clinical scenario describing simultaneous use of CPGs for duodenal ulcer and transient ischemic attack. PMID:22195153

Fortuitous phenomena: on complexity, pragmatic randomised controlled trials, and knowledge for evidence-based practice.

PubMed

Thompson, Carl

2004-01-01

Many of the interventions that nurses develop and implement are in themselves complex and have to operate in situations of irreducible complexity and uncertainty. This article argues that the primary means of generating knowledge for the evidence-based deployment of complex interventions should be the pragmatic randomised controlled trial. Randomised controlled trials represent the only research design to adequately deal with that which we know and (far more importantly) that which we do not. Using the example of practice development as an exemplar for complexity, and drawing on the objections often voiced as a response to calls to make use of randomised controlled trials in nursing and nursing research, the article presents a developmental framework and some methodological solutions to problems often encountered. Randomised controlled trials, whilst undoubtedly methodologically and strategically challenging, offer the most robust basis for developing primary research knowledge on the effects of complex interventions in nursing and their active components.

Preemptive financial strategies help IPAs avoid insolvency.

PubMed

Karling, J; Silberman, L

2000-11-01

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

A practical model for pressure probe system response estimation (with review of existing models)

NASA Astrophysics Data System (ADS)

Hall, B. F.; Povey, T.

2018-04-01

The accurate estimation of the unsteady response (bandwidth) of pneumatic pressure probe systems (probe, line and transducer volume) is a common practical problem encountered in the design of aerodynamic experiments. Understanding the bandwidth of the probe system is necessary to capture unsteady flow features accurately. Where traversing probes are used, the desired traverse speed and spatial gradients in the flow dictate the minimum probe system bandwidth required to resolve the flow. Existing approaches for bandwidth estimation are either complex or inaccurate in implementation, so probes are often designed based on experience. Where probe system bandwidth is characterized, it is often done experimentally, requiring careful experimental set-up and analysis. There is a need for a relatively simple but accurate model for estimation of probe system bandwidth. A new model is presented for the accurate estimation of pressure probe bandwidth for simple probes commonly used in wind tunnel environments; experimental validation is provided. An additional, simple graphical method for air is included for convenience.

The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students.

PubMed

Defenbaugh, Nicole; Chikotas, Noreen E

2016-01-01

The purpose of this qualitative study was to examine the impact of standardized patient experiences (SPE) in the education of the Advanced Practice Nurse (APN). The education of the APN requires educators to make every attempt to promote competency in the areas of communication and clinical-decision making. SPE programs have been found to improve the interpersonal, problem solving, and critical thinking skills of nursing students. For this research twenty-nine APN students participated in SPEs over the course of two semesters. Fifteen student volunteers of those 29 participants were then interviewed three months after the experience. Results revealed that having an expert in the field of communication studies increased awareness of communication skills and how to improve nurse-patient encounters in the clinical setting. The interprofessional collaboration during the SPEs assisted in facilitating the application of learned communication skills into patient-centered care of the APN student. Copyright © 2015 Elsevier Ltd. All rights reserved.

Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa.

PubMed Central

Deen, Jacqueline L.; Funk, Matthias; Guevara, Victor C.; Saloojee, Haroon; Doe, James Y.; Palmer, Ayo; Weber, Martin W.

2003-01-01

OBJECTIVE: To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition. METHODS: A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation. FINDINGS: Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition. CONCLUSION: Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality. PMID:12764489

Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa.

PubMed

Deen, Jacqueline L; Funk, Matthias; Guevara, Victor C; Saloojee, Haroon; Doe, James Y; Palmer, Ayo; Weber, Martin W

2003-01-01

To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition. A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation. Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition. Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality.

Problem Solving Skills for Children.

ERIC Educational Resources Information Center

Youngs, Bettie B.

This guide was written for children, to help them handle problems they might encounter, learn about other children and how they have handled similar problems, and learn what to do when things go wrong or when they feel misunderstood. In the introduction, children are assured that, even when they have problems, they can be happy again. The body of…

Problem Solving Instruction for Overcoming Students' Difficulties in Stoichiometric Problems

ERIC Educational Resources Information Center

Shadreck, Mandina; Enunuwe, Ochonogor Chukunoye

2017-01-01

The study sought to find out difficulties encountered by high school chemistry students when solving stoichiometric problems and how these could be overcome by using a problem-solving approach. The study adopted a quasi-experimental design. 485 participants drawn from 8 highs schools in a local education district in Zimbabwe participated in the…

Alcohol and Other Drugs on Campus: The Scope of the Problem. Infofacts/Resources

ERIC Educational Resources Information Center

Kapner, Daniel Ari

2008-01-01

The most widespread health problem on college and university campuses in the United States is high-risk alcohol and other drug (AOD) use. Recent reports confirm that the nation's campuses continue to encounter significant consequences as a result of this problem. This "Infofacts/Resources" offers an overview of the problem and highlights effective…

Enveloped Lives: Practicing Health and Care in Lithuania.

PubMed

Praspaliauskiene, Rima

2016-12-01

This article analyzes informal medical payments that the majority of Lithuanians give or feel compelled to give to doctors before or after treatment. It focuses on how patients and their caretakers encounter, practice, and enact informal payments in health care and how these payments create a reality of health care that is not limited to an economic rationality. Within such a frame, rather than being considered a gift or bribe, it conceptualizes these little white envelopes as a practice of health and care. The article shows how an envelope of money given to a doctor transcends the material patient-doctor transaction and emerges as a productive force for coping with illness, medical encounters, and misfortunes. © 2016 by the American Anthropological Association.

Mariner 10 Venus encounter. [scientific objectives and instruments for flyby observations

NASA Technical Reports Server (NTRS)

Dunne, J. A.

1974-01-01

Review of the scientific objectives of the Mariner 10 mission with regard to observations of Venus during a flyby, and description of the equipment installed on the spacecraft to fulfill these objectives. A detailed description is given of the hardware modifications made to the payload specifically for the Venus sequence. In discussing the encounter operations, two spacecraft problems which significantly affected the Venus encounter sequence are cited - namely, a failure of the television optic heaters to come on shortly after launch, and the occurrence of a roll gyro oscillation.

Automation--planning to implementation; the problems en route.

PubMed Central

Pizer, I H

1976-01-01

Once the major decision to automate library processes is made, there are a variety of problems which may be encountered before the planned system becomes operational. These include problems of personnel, budget, procurement of adjunct services, institutional priorities, and manufacturing uncertainties. Actual and potential difficulties are discussed. PMID:1247703

Conceptualizing Perseverance in Problem Solving as Collective Enterprise

ERIC Educational Resources Information Center

Sengupta-Irving, Tesha; Agarwal, Priyanka

2017-01-01

Students are expected to learn mathematics such that when they encounter challenging problems they will persist. Creating opportunities for students to persist in problem solving is therefore argued as essential to effective teaching and to children developing positive dispositions in mathematical learning. This analysis takes a novel approach to…

Problem Solving.

ERIC Educational Resources Information Center

Pollak, Ave

This guide is intended for use in presenting a three-session course designed to develop the problem-solving skills required of persons employed in the manufacturing and service industries. The course is structured so that, upon its completion, students will be able to accomplish the following: describe and analyze problems encountered at work;…

Twenty Recent Novels (and More) about Adolescents for Bibliotherapy.

ERIC Educational Resources Information Center

Hipple, Ted; Comer, Melissa; Boren, Dodie

1997-01-01

Lists 20 problems adolescents may encounter, with a description of one young adult novel in which that problem is a central feature. Some of the problems addressed include abuse, AIDS, alcohol, alienation, crime, death, disabilities, divorce, drugs, ethics, homosexuality, peer pressure, pregnancy, prejudice, rape, religious pressure, school, sex,…

Support Services for Remote Users of Online Public Access Catalogs.

ERIC Educational Resources Information Center

Kalin, Sally W.

1991-01-01

Discusses the needs of remote users of online public access catalogs (OPACs). User expectations are discussed; problems encountered by remote-access users are examined, including technical problems and searching problems; support services are described, including instruction, print guides, and online help; and differences from the needs of…

Exploring Principals' Nonroutine Problems in Bilingual Immersion Schools: Lessons Learned for Multicultural Leadership

ERIC Educational Resources Information Center

Schwabsky, Nitza

2013-01-01

The present study examines the nonroutine problems that eight Anglo-American principals encountered in managing three elementary bilingual immersion schools in the Northwest United States. Using qualitative inquiry to collect data, I employed the multisited ethnographic research model. The principals reported nonroutine problems in the following…

Another Look at the Language Difficulties of International Students

ERIC Educational Resources Information Center

Zhang, Yanyin; Mi, Yinan

2010-01-01

International students encounter language-related problems in their academic studies. Specific problem areas have been identified and possible underlying causes have been explored. The present study investigates the impact of two variables--length of study and academic disciplines--in relation to the problems. The findings from a survey and…

Pedagogical encounters between nurses and patients in a medical ward--a field study.

PubMed

Friberg, F; Andersson, E Pilhammar; Bengtsson, J

2007-05-01

Patient teaching is regarded as an important aspect of nursing care as well as an essential part of the nursing profession. In nursing practice, a distinction can be made between formal (planned) and informal (spontaneous) patient teaching. The major part of patient teaching research is within the area of formal teaching. In spite of the fact that spontaneous teaching occurs in everyday nursing practice, there is a lack of knowledge in this area. The aim was to illuminate pedagogical dimensions in nursing situations and informal teaching. The study is a fieldwork study within the frames of a life-world phenomenological tradition. Fifteen registered nurses in a general medical ward of a university hospital in Sweden were followed in their daily work with patients. Twelve patients suffering from various chronic diseases were interviewed. The observations comprised a total of 173 h on 34 separate occasions. Informal dialogues with nurses were carried through. Further, formal interviews were conducted with 12 of the observed patients. The data were analysed by means of a life-world phenomenological approach. Two different pedagogical encounters are presented: "Players in different field pedagogical encounters", in which there is a breakdown in the pedagogical dialogue, and "Players in same field pedagogical encounters", in which the pedagogical dialogue develops. Patients' experiences of seeking and acquiring knowledge within these two types of encounter are characterised as "worry" versus "preparedness". Patients' dignity is either threatened or supported, depending on the type of encounter. Health care organisations have to create a pedagogical climate where "Same field pedagogical encounters" can be created. The nurse has to view the patient as a learning person in order to help the patient to achieve "preparedness". "Preparedness" is described as a cognitive-emotive-existential state and emphasised as an important goal of patient teaching.

Monitoring InBaskets With Feedback to Providers Enhances the Timeliness of Patient Care.

PubMed

Trant, Amelia A; Strait, Michael; Kaplan, Rory; Dest, Vanna; Roshka, Adam; Lyons, Catherine A; Vest, Kevin A; Steffen, Tessa; Chiang, Anne; Adelson, Kerin B

2018-05-01

Electronic health records have changed providers' workflow. Epic's InBasket supplants traditional communication and is a central hub for clinical information. Failure to promptly complete records impairs communication and revenue collection. By tracking providers' InBasket activities and offering feedback, we hoped to improve InBasket management and interdisciplinary communication. We created a report to track 273 providers' InBasket activities, including ambulatory transcriptions, chart cosignatures, order cosignatures, patient calls, results, and billable encounters. The report showed how often and for how long each activity was delinquent. We completed three Plan-Do-Study-Act cycles. During cycle 1 (November to December 2015), we sent all providers automated e-mails with their monthly results. During cycle 2 (January to April 2016), we focused solely on billable encounter closure and sent targeted e-mails to providers with > 50 delinquent encounters. The e-mails stated that providers had 30 days to complete encounters or their practices would be closed to new patients; at 30 days, noncompliant providers had 60 days before practice suspension. During cycle 3 (May to September 2016), we continued to monitor and send targeted e-mails to providers who accumulated > 50 encounters. We modeled the financial impact of the intervention using net closure data, the report's aging function, and billing logs. InBasket monitoring with structured feedback decreased open encounters by 53.43%. We did not see improvements in the other metrics that the report tracked. We estimate that $231,724 was saved as a result of the intervention and $349,179 was lost to filing deadlines. Automated e-mails did not reduce open encounters; targeted e-mails to providers improved InBasket management.

An investigation of the effect of instruction in physics on the formation of mental models for problem-solving in the context of simple electric circuits

NASA Astrophysics Data System (ADS)

Beh, Kian Lim

2000-10-01

This study was designed to explore the effect of a typical traditional method of instruction in physics on the formation of useful mental models among college students for problem-solving using simple electric circuits as a context. The study was also aimed at providing a comprehensive description of the understanding regarding electric circuits among novices and experts. In order to achieve these objectives, the following two research approaches were employed: (1) A students survey to collect data from 268 physics students; and (2) An interview protocol to collect data from 23 physics students and 24 experts (including 10 electrical engineering graduates, 4 practicing electrical engineers, 2 secondary school physics teachers, 8 physics lecturers, and 4 electrical engineers). Among the major findings are: (1) Most students do not possess accurate models of simple electric circuits as presented implicitly in physics textbooks; (2) Most students display good procedural understanding for solving simple problems concerning electric circuits but have no in-depth conceptual understanding in terms of practical knowledge of current, voltage, resistance, and circuit connections; (3) Most students encounter difficulty in discerning parallel connections that are drawn in a non-conventional format; (4) After a year of college physics, students show significant improvement in areas, including practical knowledge of current and voltage, ability to compute effective resistance and capacitance, ability to identify circuit connections, and ability to solve problems; however, no significance was found in practical knowledge of resistance and ability to connect circuits; and (5) The differences and similarities between the physics students and the experts include: (a) Novices perceive parallel circuits more in terms of 'branch', 'current', and 'resistors with the same resistance' while experts perceive parallel circuits more in terms of 'node', 'voltage', and 'less resistance'; and (b) Both novices and experts use phrases such as 'side-by side' and 'one on top of the other' in describing parallel circuits which emphasize the geometry of the standard circuit drawing when describing parallel resistors.

Transit security : a description of problems and countermeasures

DOT National Transportation Integrated Search

1984-10-01

This report provides a broad perspective on transit security. It examines a wide range of transit security problems encountered by transit systems, namely: crime against passengers and employees; crimes involving revenues, including fare evasion by p...

The impact of an evolving profession on the frequency and perceived difficulty of ethical encounters among physical therapists in the clinic.

PubMed

Berg-Poppe, Patti; MacCabe, Angela; Karges, Joy

2018-05-14

Ethical decision making is situated within dynamic contexts specific to practice standards and environments, contemporary policy, and responsive educational systems. Reflecting on an evolving profession lends insight into the role of ethical codes of conduct. The purpose of this study was to gather information about the frequency and perceived difficulty physical therapists (PTs) experience with common ethical situations within contemporary clinical practice. PTs within the United States were invited to participate in an online questionnaire replicating a 1980 study. Subjects were 336 PTs from a variety of practice environments. Just 1 item was reported as moderately/extremely difficult by contemporary respondents, compared to 16 items in the 1980 study. The number of items meeting moderate/high encounter frequency was similar between the two groups (2015 = 16/19; 1980 = 15/19). While today's PTs report that they encounter ethical situations at a frequency similar to PTs in 1980, these same PTs report these ethical challenges as minimally difficult when compared to PTs responding to the 1980 survey. It is proposed that a move toward autonomous practice, the elevation of the entry level professional degree, and changing health care policy and environments have been influential in shaping these changes over time.

A valuable approach to the use of electronic medical data in primary care research: Panning for gold.

PubMed

Barnett, Stephen; Henderson, Joan; Hodgkins, Adam; Harrison, Christopher; Ghosh, Abhijeet; Dijkmans-Hadley, Bridget; Britt, Helena; Bonney, Andrew

2017-05-01

Electronic medical data (EMD) from electronic health records of general practice computer systems have enormous research potential, yet many variables are unreliable. The aim of this study was to compare selected data variables from general practice EMD with a reliable, representative national dataset (Bettering the Evaluation and Care of Health (BEACH)) in order to validate their use for primary care research. EMD variables were compared with encounter data from the nationally representative BEACH program using χ 2 tests and robust 95% confidence intervals to test their validity (measure what they reportedly measure). The variables focused on for this study were patient age, sex, smoking status and medications prescribed at the visit. The EMD sample from six general practices in the Illawarra region of New South Wales, Australia, yielded data on 196,515 patient encounters. Details of 90,553 encounters were recorded in the 2013 BEACH dataset from 924 general practitioners. No significant differences in patient age ( p = 0.36) or sex ( p = 0.39) were found. EMD had a lower rate of current smokers and higher average scripts per visit, but similar prescribing distribution patterns. Validating EMD variables offers avenues for improving primary care delivery and measuring outcomes of care to inform clinical practice and health policy.

Adaptation of Social Problem Solving for Children Questionnaire in 6 Age Groups and its Relationships with Preschool Behavior Problems

ERIC Educational Resources Information Center

Dereli-Iman, Esra

2013-01-01

Social Problem Solving for Child Scale is frequently used to determine behavioral problems of children with their own word and to identify ways of conflict encountered in daily life, and interpersonal relationships in abroad. The primary purpose of this study was to adapt the Wally Child Social Problem-Solving Detective Game Test. In order to…

Learning Clinical Skills during Bedside Teaching Encounters in General Practice: A Video-Observational Study with Insights from Activity Theory

ERIC Educational Resources Information Center

Ajjawi, Rola; Rees, Charlotte; Monrouxe, Lynn V.

2015-01-01

Purpose: This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. Design/methodology/approach: An audio and/or video observational study examining…

Private Perceptions, Public Reflections: Aesthetic Encounters as Vehicles for Shared Meaning Making

ERIC Educational Resources Information Center

White, Boyd

2011-01-01

This paper begins with a brief discussion of aesthetic theory, especially as it relates to art education. Then, to see how theory may apply to practice, it describes an investigation into the manner in which encounters with artworks unfold, how meanings are constructed and values articulated, based on the study of four volunteers' interactions…

Communicative Language Teaching: A Practical Scenario in the Context of Bangladesh

ERIC Educational Resources Information Center

Ahmed, Md. Kawser

2016-01-01

Communicative Language Teaching, popularly known as CLT, has become a newly adopted methodology in the teaching and learning context of Bangladesh. This methodology, since the initiation, has encountered and is still encountering a number of hurdles that need to be dealt with best care and feasible strategy. Of all methods, most of the educational…

Lattice Boltzmann computation of creeping fluid flow in roll-coating applications

NASA Astrophysics Data System (ADS)

Rajan, Isac; Kesana, Balashanker; Perumal, D. Arumuga

2018-04-01

Lattice Boltzmann Method (LBM) has advanced as a class of Computational Fluid Dynamics (CFD) methods used to solve complex fluid systems and heat transfer problems. It has ever-increasingly attracted the interest of researchers in computational physics to solve challenging problems of industrial and academic importance. In this current study, LBM is applied to simulate the creeping fluid flow phenomena commonly encountered in manufacturing technologies. In particular, we apply this novel method to simulate the fluid flow phenomena associated with the "meniscus roll coating" application. This prevalent industrial problem encountered in polymer processing and thin film coating applications is modelled as standard lid-driven cavity problem to which creeping flow analysis is applied. This incompressible viscous flow problem is studied in various speed ratios, the ratio of upper to lower lid speed in two different configurations of lid movement - parallel and anti-parallel wall motion. The flow exhibits interesting patterns which will help in design of roll coaters.

Practical Knowledge Storage among Preservice, Novice, and Experienced Educators of Students Who Are Deaf and Hard-of-Hearing.

ERIC Educational Resources Information Center

Marlatt, Edward A.

2004-01-01

Surveys of 163 preservice, novice, and experienced teachers of students who are deaf and hard-of-hearing addressed practical knowledge and adherence to classroom rules of practice (brief statements of how to behave in frequently encountered teaching situations) and practical principles (general constructs about expectations of students). No…

The New Racism in Education.

ERIC Educational Resources Information Center

Pressman, Harvey; Gartner, Alan

1986-01-01

Discusses the current practice in the U.S. of standardized testing of teachers as a response to the perceived failures of public schools. Focuses on the position that this practice reduces the already low percentage of minority teachers in the schools. Reviews testing practices in various states and the consequences encountered. (SA)

An analysis of the cultural problems encountered during caregiving by the nurses working in two different regions of Turkey.

PubMed

Kilic, Serap Parlar; Besen, Dilek Buyukkaya; Tokem, Yasemin; Fadiloglu, Cicek; Karadag, Gulendam

2014-06-01

The aim of this study was to identify the cultural problems encountered during caregiving by the nurses working in two university hospitals located in western and eastern Turkey. This descriptive, comparative study was conducted between July 2008 and October 2009 with 338 nurses who volunteered to take part in the study. The study data were collected using an individual description questionnaire consisting of 10 questions and another questionnaire consisting of 14 questions to identify the cultural problems encountered by nurses when giving care. The study showed with respect to training received on transcultural nursing that only 59 nurses had this training, but the percentage was higher in the nurses working at the hospital in the west (54.2%) (P > 0.05). It was found that a large number of nurses in the sample group (n = 286) gave care to at least one individual from another culture, but the percentage was significantly higher in the nurses working in the west (56.7%) than in the nurses working in the east (43.3%) (P < 0.05). When the problems experienced by the nurses during caregiving because of cultural characteristics of patients were explored, it was found that they experienced problems mostly in 'communication', and the percentage of those having problems was higher in the nurses working in the west (60.8%) (P > 0.05). The problem experienced in this area was mostly because of the fact that patients 'did not speak Turkish' (63.8%). In conclusion, the nurses gave care to patients from different cultures, and most of them had trouble when giving care to patients from different cultures. © 2013 Wiley Publishing Asia Pty Ltd.

Radio science ground data system for the Voyager-Neptune encounter, part 1

NASA Technical Reports Server (NTRS)

Kursinski, E. R.; Asmar, S. W.

1991-01-01

The Voyager radio science experiments at Neptune required the creation of a ground data system array that includes a Deep Space Network complex, the Parkes Radio Observatory, and the Usuda deep space tracking station. The performance requirements were based on experience with the previous Voyager encounters, as well as the scientific goals at Neptune. The requirements were stricter than those of the Uranus encounter because of the need to avoid the phase-stability problems experienced during that encounter and because the spacecraft flyby was faster and closer to the planet than previous encounters. The primary requirement on the instrument was to recover the phase and amplitude of the S- and X-band (2.3 and 8.4 GHz) signals under the dynamic conditions encountered during the occultations. The primary receiver type for the measurements was open loop with high phase-noise and frequency stability performance. The receiver filter bandwidth was predetermined based on the spacecraft's trajectory and frequency uncertainties.

Some problems of the design of highly directional spacecraft antennas

NASA Technical Reports Server (NTRS)

Prigoda, B. A.

1974-01-01

Problems of optimization and selection of the most expedient forms of design of directional antenna systems encountered in spacecraft design are discussed. Selection of a given type of antenna depends on its characteristic size, weight, and potential.

Community Work and Local Authority Decision Making: Potential and Problems

ERIC Educational Resources Information Center

Corina, Lewis

1976-01-01

British local authority and decision making procedures are described for community developers. Included are potential ways of influencing the authority system, and problems and areas of weakness that may be encountered in dealing with the system. (ABM)

An Analysis of Whistle-Blowers and Their Impact on Marketing Practices.

ERIC Educational Resources Information Center

Montgomery, D. Cameron; Starkey, Paul L.

1999-01-01

Describes types of ethical situations in the workplace and types of whistleblowing in which employees might engage. Urges business educators to prepare their students for encounters with illegal or unethical employer practices. (SK)

The Influence of Problems Faced during Internships on Interns' Views of Their Profession and Their Intention to Work in the Tourism Industry

ERIC Educational Resources Information Center

Kasli, Mehmet; Ilban, Mehmet Oguzhan

2013-01-01

Problem Statement: The problem of this research is identifying the difficulties that undergraduate students experience during their internships and assessing their future intention to work in the tourism industry. Purpose of Study: This research aims to identify the problems undergraduate students encounter as interns in tourism programs and to…

NOTES: a review of the technical problems encountered and their solutions.

PubMed

Mintz, Yoav; Horgan, Santiago; Cullen, John; Stuart, David; Falor, Eric; Talamini, Mark A

2008-08-01

Natural orifice translumenal endoscopic surgery (NOTES) is currently investigated and developed worldwide. In the past few years, multiple groups have confronted this challenge. Many technical problems are encountered in this technique due to the currently available tools for this approach. Some of the unique technical problems in NOTES include: blindly performed primary incisions; uncontrolled pneumoperitoneal pressure; no support for the endoscope in the abdominal cavity; inadequate vision; insufficient illumination; limited retraction and exposure; and the complexity of suturing and performing a safe anastomosis. In this paper, we review the problems encountered in NOTES and provide possible temporary solutions. Acute and survival studies were performed on 15 farm pigs. The hybrid technique approach (i.e., endoscopic surgery with the aid of laparoscopic vision) was performed in all cases. Procedures performed included liver biopsies, bilateral tubal ligation, oophprectomy, cholecystectomy, splenectomy and small bowel resection, and anastomosis. All attempted procedures were successfully performed. New methods and techniques were developed to overcome the technical problems. Closure of the gastrotomy was achieved by T-bar sutures and by stapler closure of the stomach incision. Small bowel anastomosis was achieved by the dual-lumen NOTES technique. The hybrid technique serves as a temporary approach to aid in developing the NOTES technique. A rectal or vaginal port of entry enables and facilitates gastrointestinal NOTES by using available laparoscopic instruments. The common operations performed today in the laparoscopic fashion could be probably performed in the NOTES approach. The safety of these procedures, however, is yet to be determined.

Conducting international nursing research: challenges and opportunities.

PubMed

Opollo, Jackline Gloria; Opollo, Diana Alaka; Gray, Jennifer; Spies, Lori

2014-11-01

To describe practical experiences before, during and after gaining entry into research fields in Kenya and Uganda. Planning, conducting and implementing international research can be an arduous task. Novice researchers need practical guides to accessing international fields and mitigating challenges met in the field. The researchers conducted three different studies in two developing nations. This paper reviews challenges encountered when conducting international research. Solutions used to overcome these challenges are discussed. Establishing and maintaining effective partnerships is critical to the success of international research efforts. Researchers must be tactful, flexible and creative when handling methodological, ethical and logistical challenges encountered in settings poor in resources. International research provides opportunities for increasing dedication, building cross-cultural competence and advancing health professional practice globally. This paper contributes to nursing scholarship by highlighting the practical challenges of conducting international research. Illustrations aimed at lending insight and encouraging others to expand their dedication to conducting international research are offered.

Finding a path through the health unit: practical experience of Ugandan patients.

PubMed

Mogensen, Hanne O

2005-01-01

Finding one's way through a health facility is not necessarily an easy task for Ugandan patients. Our understanding of how people succeed in doing so, and of the obstacles they encounter on their way, is incomplete if we focus only on the cognitive level of the clinical encounter. Much research in public health and medical anthropology implicitly works with the notion that agency is located in the mind and that cognitive understanding is a precondition for practice. Based on material from eastern Uganda, this article explores the practical experience of Ugandan patients and their relatives and reflects upon the ways in which this notion of agency has often caused us to confuse the spectator's point of view with the actor's point of view. Thus, as Pierre Bourdieu has argued, we are made to look for answers to "questions that practice never asks because it has no need to ask them."

Acts of Attention: An Exploration of Teacher Candidates' Attention to Educational Encounters, and How It Relates to Task Formulation

ERIC Educational Resources Information Center

Harvey, Victoria A.

2015-01-01

This study begins with the belief that the ways in which teachers see and attend to educational encounters matter for their actions in classrooms. Using microethnography as a framework, this dissertation explores the relationship between teacher candidate attention, problem formulation, and action. Through analysis of the M.Ed. inquiry reports of…

Unethical Behaviours Preservice Teachers Encounter on Social Networks

ERIC Educational Resources Information Center

Deveci Topal, Arzu; Kolburan Gecer, Aynur

2015-01-01

The development of web 2.0 technology has resulted in an increase in internet sharing. The scope of this study is social networking, which is one of the web 2.0 tools most heavily used by internet users. In this paper, the unethical behaviours that preservice teachers encounter on social networks and the ways to deal with these problems are…

Best management practices for newly weaned calves for improved health and well-being.

PubMed

Wilson, B K; Richards, C J; Step, D L; Krehbiel, C R

2017-05-01

Morbidity and mortality in newly weaned calves resulting from bovine respiratory disease (BRD) continue to be the most significant problems facing the beef industry. Morbidity attributed to BRD accounts for approximately 75% of total feedlot morbidity. Several experiments have documented the economic impacts of BRD. Direct costs attributable to BRD include death loss, treatment and labor costs, and prevention costs, while indirect costs associated with BRD include decreased growth performance and feed efficiency, increased days on feed, and decreased carcass merit and market value. In recent years, cattle treated for BRD have returned $50 to $250 less per head at harvest than cattle never treated for BRD. Best management practices for newly weaned calves vary depending on a multitude of factors including: season of year calves are purchased, calf genetics, length of time in the marketing and transport channels, previous management and vaccination programs, and other factors. In general, calves purchased directly from a ranch have fewer health problems than calves purchased through auction markets. The longer a calf is in the marketing chain, the more likely health problems will be encountered. Calves that have spent several days in the marketing chain may develop clinical BRD before or very soon after arrival, whereas cattle with less time in the marketing chain may get sick later (2 to 4 wk), due to the length of time it takes for BRD to develop. On or before arrival, calves should be given a risk score (high, medium, or low) that relates to the quantity and magnitude of stress they have encountered and the probability they will develop BRD. High-risk calves typically will have been recently weaned, received no vaccinations, not been castrated or dehorned, been commingled, and moved through an auction market. Low-risk calves will often originate from a single source and will have gone through a preconditioning program that includes vaccination, castration, dehorning, weaning, and potentially feed bunk adaptation. Variation exists within risk category, so the preliminary assessment should be combined with visual observation on arrival as additional health assessments and feed intake information becomes available. Cattle managers should adjust management strategies based on risk category to meet the perceived needs of individual lots of cattle to improve the health and well-being of newly weaned calves.

Multi-UAV Routing for Area Coverage and Remote Sensing with Minimum Time

PubMed Central

Avellar, Gustavo S. C.; Pereira, Guilherme A. S.; Pimenta, Luciano C. A.; Iscold, Paulo

2015-01-01

This paper presents a solution for the problem of minimum time coverage of ground areas using a group of unmanned air vehicles (UAVs) equipped with image sensors. The solution is divided into two parts: (i) the task modeling as a graph whose vertices are geographic coordinates determined in such a way that a single UAV would cover the area in minimum time; and (ii) the solution of a mixed integer linear programming problem, formulated according to the graph variables defined in the first part, to route the team of UAVs over the area. The main contribution of the proposed methodology, when compared with the traditional vehicle routing problem’s (VRP) solutions, is the fact that our method solves some practical problems only encountered during the execution of the task with actual UAVs. In this line, one of the main contributions of the paper is that the number of UAVs used to cover the area is automatically selected by solving the optimization problem. The number of UAVs is influenced by the vehicles’ maximum flight time and by the setup time, which is the time needed to prepare and launch a UAV. To illustrate the methodology, the paper presents experimental results obtained with two hand-launched, fixed-wing UAVs. PMID:26540055

A proposal to improve e-waste collection efficiency in urban mining: Container loading and vehicle routing problems - A case study of Poland.

PubMed

Nowakowski, Piotr

2017-02-01

Waste electrical and electronic equipment (WEEE), also known as e-waste, is one of the most important waste streams with high recycling potential. Materials used in these products are valuable, but some of them are hazardous. The urban mining approach attempts to recycle as many materials as possible, so efficiency in collection is vital. There are two main methods used to collect WEEE: stationary and mobile, each with different variants. The responsibility of WEEE organizations and waste collection companies is to assure all resources required for these activities - bins, containers, collection vehicles and staff - are available, taking into account cost minimization. Therefore, it is necessary to correctly determine the capacity of containers and number of collection vehicles for an area where WEEE need to be collected. There are two main problems encountered in collection, storage and transportation of WEEE: container loading problems and vehicle routing problems. In this study, an adaptation of these two models for packing and collecting WEEE is proposed, along with a practical implementation plan designed to be useful for collection companies' guidelines for container loading and route optimization. The solutions are presented in the case studies of real-world conditions for WEEE collection companies in Poland. Copyright © 2016 Elsevier Ltd. All rights reserved.

Problem-based learning: an approach to enhancing learning and understanding of optics for first-year students

NASA Astrophysics Data System (ADS)

Bowe, Brian W.; Daly, Siobhan; Flynn, Cathal; Howard, Robert

2003-03-01

In this paper a model for the implementation of a problem-based learning (PBL) course for a typical year physics one programme is described. Reference is made to how PBL has been implemented in relation to geometrical and physical optics. PBL derives from the theory that learning is an active process in which the learner constructs new knowledge on the basis of current knowledge, unlike traditional teaching practices in higher education, where the emphasis is on the transmission of factual knowledge. The course consists of a set of optics related real life problems that are carefully constructed to meet specified learning outcomes. The students, working in groups, encounter these problem-solving situations and are facilitated to produce a solution. The PBL course promotes student engagement in order to achieve higher levels of cognitive learning. Evaluation of the course indicates that the students adopt a deep learning approach and that they attain a thorough understanding of the subject instead of the superficial understanding associated with surface learning. The methodology also helps students to develop metacognitive skills. Another outcome of this teaching methodology is the development of key skills such as the ability to work in a group and to communicate, and present, information effectively.

The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010.

PubMed

Swender, David A; Chernin, Leah R; Mitchell, Chris; Sher, Theodore; Hostoffer, Robert; Tcheurekdjian, Haig

2012-01-01

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT.

The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010

PubMed Central

Chernin, Leah R.; Mitchell, Chris; Sher, Theodore; Hostoffer, Robert; Tcheurekdjian, Haig

2012-01-01

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT. PMID:23342290

Applications of Genetic Methods to NASA Design and Operations Problems

NASA Technical Reports Server (NTRS)

Laird, Philip D.

1996-01-01

We review four recent NASA-funded applications in which evolutionary/genetic methods are important. In the process we survey: the kinds of problems being solved today with these methods; techniques and tools used; problems encountered; and areas where research is needed. The presentation slides are annotated briefly at the top of each page.

Having the Memory of an Elephant: Long-Term Retrieval and the Use of Analogues in Problem Solving

ERIC Educational Resources Information Center

Chen, Zhe; Mo, Lei; Honomichl, Ryan

2004-01-01

The authors report 4 experiments exploring long-term analogical transfer from problem solutions in folk tales participants heard during childhood, many years before encountering the target problems. Substantial culture-specific analogical transfer was found when American and Chinese participants' performance was compared on isomorphs of problems…

Applying an Information Problem-Solving Model to Academic Reference Work: Findings and Implications.

ERIC Educational Resources Information Center

Cottrell, Janet R.; Eisenberg, Michael B.

2001-01-01

Examines the usefulness of the Eisenberg-Berkowitz Information Problem-Solving model as a categorization for academic reference encounters. Major trends in the data include a high proportion of questions about location and access of sources, lack of synthesis or production activities, and consistent presence of system problems that impede the…

Data System Implementation: A Leader Navigates People Problems around Technology and Data Use

ERIC Educational Resources Information Center

Cho, Vincent; Jimerson, Jo Beth; Wayman, Jeffrey C.

2015-01-01

Computer data systems have become a lynchpin to supporting school data use. However, successfully implementing such systems is no easy task. In this case, readers explore the ways in which "technology problems" and "people problems" can be intertwined. The case follows Dr. Molly Winters as she encounters social and…

Why Do Disadvantaged Filipino Children Find Word Problems in English Difficult?

ERIC Educational Resources Information Center

Bautista, Debbie; Mulligan, Joanne

2010-01-01

Young Filipino students are expected to solve mathematical word problems in English, a language that many encounter only in schools. Using individual interviews of 17 Filipino children, we investigated why word problems in English are difficult and the extent to which the language interferes with performance. Results indicate that children could…

School Nurses' Perceived Prevalence and Competence to Address Student Mental Health Problems

ERIC Educational Resources Information Center

Stephan, Sharon H.; Connors, Elizabeth H.

2013-01-01

Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their…

A Novel Approach to Supporting Relationship-Centered Care Through Electronic Health Record Ergonomic Training in Preclerkship Medical Education

PubMed Central

Silverman, Howard; Ho, Yun-Xian; Kaib, Susan; Ellis, Wendy Danto; Moffitt, Marícela P.; Chen, Qingxia; Nian, Hui; Gadd, Cynthia S.

2014-01-01

Problem How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion (“EHR ergonomics”)? Approach Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a pre-survey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A post-survey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training. Outcomes There was a significant positive effect of EHR ergonomics skills training on students’ relationship-centered EHR use (P < .005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students’ self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions was needed to see an overall improvement in EHR use. Next Steps In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments. PMID:24826851

Molten salt corrosion of SiC and Si3N4

NASA Technical Reports Server (NTRS)

Jacobson, N. S.; Smialek, J. L.; Fox, D. S.

1986-01-01

The most severe type of corrosion encountered in heat engines is corrosion by molten sodium sulfate, formed by the reaction of ingested sodium chloride and sulfur impurities in the fuel. This problem was studied extensively for superalloys, but only recently examined for ceramics. This problem is addressed with laboratory studies to understand the fundamental reaction mechanisms and with burner studies to provide a more realistic simulation of the conditions encountered in a heat engine. In addition the effect of corrosion on the strengths of these materials was assessed. Each of these aspects will be reviewed and some ideas toward possible solutions will be discussed.

Comparison of Low-Energy Lunar Transfer Trajectories to Invariant Manifolds

NASA Technical Reports Server (NTRS)

Anderson, Rodney L.; Parker, Jeffrey S.

2011-01-01

In this study, transfer trajectories from the Earth to the Moon that encounter the Moon at various flight path angles are examined, and lunar approach trajectories are compared to the invariant manifolds of selected unstable orbits in the circular restricted three-body problem. Previous work focused on lunar impact and landing trajectories encountering the Moon normal to the surface, and this research extends the problem with different flight path angles in three dimensions. The lunar landing geometry for a range of Jacobi constants are computed, and approaches to the Moon via invariant manifolds from unstable orbits are analyzed for different energy levels.

The Voyager spacecraft /James Watt International Gold Medal Lecture/

NASA Technical Reports Server (NTRS)

Heacock, R. L.

1980-01-01

The Voyager Project background is reviewed with emphasis on selected features of the Voyager spacecraft. Investigations by the Thermo-electric Outer Planets Spacecraft Project are discussed, including trajectories, design requirements, and the development of a Self Test and Repair computer, and a Computer Accessed Telemetry System. The design and configuration of the spacecraft are described, including long range communications, attitude control, solar independent power, sequencing and control data handling, and spacecraft propulsion. The development program, maintained by JPL, experienced a variety of problems such as design deficiencies, and process control and manufacturing problems. Finally, the spacecraft encounter with Jupiter is discussed, and expectations for the Saturn encounter are expressed.

A subcutaneous channeling probe for implanting long leads

NASA Technical Reports Server (NTRS)

Lund, G. F.; Simmonds, R. C.; Williams, B. A.

1977-01-01

The channeling probe described in the present paper was designed to overcome surgical problems of the type that were encountered when a multichannel radio transmitter had to be implanted in a cow. The probe was made of a flexible but sufficiently stiff 9.5-mm-diam nylon rod, consisting of 46-cm sections for convenience in sterilization and surgical handling. Stainless steel sleaves reinforced the threaded connecting joints. At one end, arrowhead-shaped channeling heads could be attached to produce wide channels for large sensors. The other end was tapered for narrow channels. Postoperative problems were not encountered in the use of this probe in cows, sheep, and dogs.

Understanding Social and Legal Justice Issues for Aboriginal Women within the Context of an Indigenous Australian Studies Classroom: A Problem-Based Learning Approach

ERIC Educational Resources Information Center

Mackinlay, Elizabeth; Thatcher, Kristy; Seldon, Camille

2004-01-01

Problem-based learning (PBL) is a pedagogical approach in which students encounter a problem and systematically set about finding ways to understand the problem through dialogue and research. PBL is an active process where students take responsibility for their learning by asking their own questions about the problem and in this paper we explore…

How to Measure and Interpret Quality Improvement Data.

PubMed

McQuillan, Rory Francis; Silver, Samuel Adam; Harel, Ziv; Weizman, Adam; Thomas, Alison; Bell, Chaim; Chertow, Glenn M; Chan, Christopher T; Nesrallah, Gihad

2016-05-06

This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting. Copyright © 2016 by the American Society of Nephrology.

Pharmacy practice simulations: performance of senior pharmacy students at a University in southern Brazil

PubMed Central

Galato, Dayani; Alano, Graziela M.; Trauthman, Silvana C.; França, Tainã F.

Objective A simulation process known as objective structured clinical examination (OSCE) was applied to assess pharmacy practice performed by senior pharmacy students. Methods A cross-sectional study was conducted based on documentary analysis of performance evaluation records of pharmacy practice simulations that occurred between 2005 and 2009. These simulations were related to the process of self-medication and dispensing, and were performed with the use of patients simulated. The simulations were filmed to facilitate the evaluation process. It presents the OSCE educational experience performed by pharmacy trainees of the University of Southern Santa Catarina and experienced by two evaluators. The student general performance was analyzed, and the criteria for pharmacy practice assessment often identified trainees in difficulty. Results The results of 291 simulations showed that students have an average yield performance of 70.0%. Several difficulties were encountered, such as the lack of information about the selected/prescribed treatment regimen (65.1%); inadequate communication style (21.9%); lack of identification of patients’ needs (7.7%) and inappropriate drug selection for self-medication (5.3%). Conclusions These data show that there is a need for reorientation of clinical pharmacy students because they need to improve their communication skills, and have a deeper knowledge of medicines and health problems in order to properly orient their patients. PMID:24367467

Alzheimer’s Disease Drug Development in 2008 and Beyond: Problems and Opportunities

PubMed Central

Becker, Robert E.; Greig, Nigel H.

2008-01-01

Recently, a number of Alzheimer’s disease (AD) multi-center clinical trials (CT) have failed to provide statistically significant evidence of drug efficacy. To test for possible design or execution flaws we analyzed in detail CTs for two failed drugs that were strongly supported by preclinical evidence and by proven CT AD efficacy for other drugs in their class. Studies of the failed commercial trials suggest that methodological flaws may contribute to the failures and that these flaws lurk within current drug development practices ready to impact other AD drug development [1]. To identify and counter risks we considered the relevance to AD drug development of the following factors: (1) effective dosing of the drug product, (2) reliable evaluations of research subjects, (3) effective implementation of quality controls over data at research sites, (4) resources for practitioners to effectively use CT results in patient care, (5) effective disease modeling, (6) effective research designs. New drugs currently under development for AD address a variety of specific mechanistic targets. Mechanistic targets provide AD drug development opportunities to escape from many of the factors that currently undermine AD clinical pharmacology, especially the problems of inaccuracy and imprecision associated with using rated outcomes. In this paper we conclude that many of the current problems encountered in AD drug development can be avoided by changing practices. Current problems with human errors in clinical trials make it difficult to differentiate drugs that fail to evidence efficacy from apparent failures due to Type II errors. This uncertainty and the lack of publication of negative data impede researchers’ abilities to improve methodologies in clinical pharmacology and to develop a sound body of knowledge about drug actions. We consider the identification of molecular targets as offering further opportunities for overcoming current failures in drug development. PMID:18690832

The logistics management and coordination in procurement phase of organ transplantation.

PubMed

Genç, Ruhet

2008-12-01

The number of organ transplantation surgeries has increased particularly in the last decade due to technological and scientific advances in medicine. Despite this increase, many patients, however, remain in waiting lists for transplantation surgery. Main reasons for these waiting lists are that there are limited number of organ donations and specifically problems in the management of organ transplantation activities. An efficient management of the allocation and transportation of organs (in other words, logistics management of organ transplantation) are thus extremely important. The aim of the paper is to review current practices of logistics management in the procurement phase of organ transplantation. It initially reviews the organizational structures of the international and national coordination centres, which are founded to coordinate organ transplantation activities and to enhance collaboration among physicians and medical staff. The paper, then, focuses on the possible managerial problems encountered during the procurement phase of organ transplantation. With this respect, common transportation difficulties from global and local perspective are also analyzed. This paper tries to take attention to a systematic regard of the organ transplantation from logistics point of view, thus providing applicable solutions to managerial problems in terms of allocation and transportation of organs.

Innovative discharge geometries for diffusion-cooled gas lasers

NASA Astrophysics Data System (ADS)

Lapucci, Antonio

2004-09-01

Large area, narrow discharge gap, diffusion cooled gas lasers are nowadays a well established technology for the construction of industrial laser sources. Successful examples exist both with the slab (Rofin-Sinar) or coaxial (Trumpf) geometry. The main physical properties and the associated technical problems of the transverse large area RF discharge, adopted for the excitation of high power diffusion cooled gas lasers, are reviewed here. The main problems of this technology are related to the maintenance of a uniform and stable plasma excitation between closely spaced large-area electrodes at high power-density loading. Some practical solutions such as distributed resonance of the discharge channel proved successful in the case of square or rectangular cross-sections but hardly applicable to geometries such as that of coaxial electrodes. In this paper we present some solutions, adopted by our group, for the development of slab and annular CO2 lasers and for CO2 laser arrays with linear or circular symmetry. We will also briefly mention the difficulties encountered in the extraction of a good quality beam from an active medium with such a cross section. A problem that has also seen some interesting solutions.

Challenges in sharing knowledge: reflections from the perspective of an expatriate nurse working in a South Sudanese hospital.

PubMed

Tjoflåt, I; Karlsen, B

2012-12-01

This account, based on the experience of the first author, aims to describe an example of practice from a hospital in South Sudan. The example illustrates a cross-cultural encounter and the challenges that a Sudanese nurse and an expatriate nurse face in sharing knowledge when providing patient care. The constructed practical example between nurses with different knowledge bases and experiences was characterized by the expatriate nurse giving her instructions and not allowing the Sudanese nurse to respond to them. This 'one-way' communication demonstrated that the expatriate nurse considered herself to have the better knowledge of nursing care. These aspects of the encounter formed the basis for the following discussion, which sheds light on how the expatriate nurse ideally could have worked by using a dialogue instead of one-way communication. The importance of having knowledge and understanding of the context in cross-cultural encounters was also emphasized. The discussion of this practical example can provide insight for other nurses when working in cultures other than their own into the importance of using a dialogue when sharing knowledge in a cross-cultural encounter. In addition, expatriates can be made aware of the importance of acquiring knowledge about the context for 'the other' when working cross culturally. Finally, it should be noted that the description and discussion of the experience reflect only the perspective of the expatriate nurse. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.

Learning to be Seen: The Depiction of Encounters Between Israeli and Newcomer Children in Children's Literature

ERIC Educational Resources Information Center

Golden, Deborah; Drubetskoy, Tatyana

2005-01-01

Books written for and about children may serve to convey central cultural tenets to new members of society. This paper looks at the depiction of encounters between newcomer and locally born children in contemporary Hebrew literature aimed at teenage readers and presents the major resources and practices by means of which the newcomer protagonists…

Into the Cracks: A Geology of Encounters with Addiction as Disease and Moral Failing

ERIC Educational Resources Information Center

McCoy, Kate

2010-01-01

The author is thinking with Deleuze's ethical practice of "being on the lookout" for encounters with the cracks. Drawing on research in the USA on access to health care for people who use illicit drugs, the author works with Deleuze and Guattari, Deleuze and Foucault in a geological and genealogical mode of inquiry to investigate the preoccupation…

Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research.

PubMed

Land, Victoria; Parry, Ruth; Seymour, Jane

2017-12-01

Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale). © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Optimal solution for travelling salesman problem using heuristic shortest path algorithm with imprecise arc length

NASA Astrophysics Data System (ADS)

Bakar, Sumarni Abu; Ibrahim, Milbah

2017-08-01

The shortest path problem is a popular problem in graph theory. It is about finding a path with minimum length between a specified pair of vertices. In any network the weight of each edge is usually represented in a form of crisp real number and subsequently the weight is used in the calculation of shortest path problem using deterministic algorithms. However, due to failure, uncertainty is always encountered in practice whereby the weight of edge of the network is uncertain and imprecise. In this paper, a modified algorithm which utilized heuristic shortest path method and fuzzy approach is proposed for solving a network with imprecise arc length. Here, interval number and triangular fuzzy number in representing arc length of the network are considered. The modified algorithm is then applied to a specific example of the Travelling Salesman Problem (TSP). Total shortest distance obtained from this algorithm is then compared with the total distance obtained from traditional nearest neighbour heuristic algorithm. The result shows that the modified algorithm can provide not only on the sequence of visited cities which shown to be similar with traditional approach but it also provides a good measurement of total shortest distance which is lesser as compared to the total shortest distance calculated using traditional approach. Hence, this research could contribute to the enrichment of methods used in solving TSP.

Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.

PubMed

Baer, Heather J; Wee, Christina C; DeVito, Katerina; Orav, E John; Frolkis, Joseph P; Williams, Deborah H; Wright, Adam; Bates, David W

2015-08-01

Primary care providers often fail to identify patients who are overweight or obese or discuss weight management with them. Electronic health record-based tools may help providers with the assessment and management of overweight and obesity. We describe the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients, as well as the challenges we encountered. We developed several new features within the electronic health record used by primary care practices affiliated with Brigham and Women's Hospital in Boston, MA. These features included (1) reminders to measure height and weight, (2) an alert asking providers to add overweight or obesity to the problem list, (3) reminders with tailored management recommendations, and (4) a Weight Management screen. We then conducted a pragmatic, cluster-randomized controlled trial in 12 primary care practices. We randomized 23 clinical teams ("clinics") within the practices to the intervention group (n = 11) or the control group (n = 12). The new features were activated only for clinics in the intervention group. The intervention was implemented in two phases: the height and weight reminders went live on 15 December 2011 (Phase 1), and all of the other features went live on 11 June 2012 (Phase 2). Study enrollment went from December 2011 through December 2012, and follow-up ended in December 2013. The primary outcomes were 6-month and 12-month weight change among adult patients with body mass index ≥25 who had a visit at one of the primary care clinics during Phase 2. Secondary outcome measures included the proportion of patients with a recorded body mass index in the electronic health record, the proportion of patients with body mass index ≥25 who had a diagnosis of overweight or obesity on the electronic health record problem list, and the proportion of patients with body mass index ≥25 who had a follow-up appointment about their weight or were prescribed weight loss medication. We encountered challenges in our development of an intervention within the existing structure of an electronic health record. For example, although we decided to randomize clinics within primary care practices, this decision may have introduced contamination and led to some imbalance of patient characteristics between the intervention and control practices. Using the electronic health record as the primary data source reduced the cost of the study, but not all desired data were recorded for every participant. Despite the challenges, this study should provide valuable information about the effectiveness of electronic health record-based tools for addressing overweight and obesity in primary care. © The Author(s) 2015.

Family practice residents' maternity leave experiences and benefits.

PubMed

Gjerdingen, D K; Chaloner, K M; Vanderscoff, J A

1995-09-01

A growing number of residents are having babies during residency training. While many businesses are working to improve maternity conditions and benefits for their employees, residency programs are often not prepared to accommodate pregnant residents. This study was conducted to examine the maternity leave experiences of women who delivered infants during their family practice residency training. Program directors from each of the 394 family practice residency programs listed in the 1993 Directory of Family Practice Residency Programs were asked to distribute surveys to female residents who gave birth during their residency training and had returned to work by the time of the study. Of 199 known eligible residents, 171 (86%) completed surveys; these women represented 127 programs located in 36 states and Puerto Rico. Only 56.8% of women were aware of their program having a written maternity leave policy. The average length of maternity leave was 8 weeks; 76% had leaves of 10 weeks or less. For many, the maternity leave was derived from more than one source, including vacation, sick time, or a mother-child elective. Nearly all (88.3%) the women breast-fed, and the mean duration of breast-feeding was more than 19 weeks. In general, participants believed that having a baby during residency was somewhat difficult. Problems frequently encountered by women after their return to work included sleep deprivation and tiredness, difficulty arranging for child care, guilt about child care, and breast-feeding. Factors that detracted most from the childbirth experience were too little sleep, problems arranging for child care, and lack of support from the partner, residency faculty, and other residents. Having a baby during residency is somewhat difficult for the average female resident. Factors that may ease this difficulty include getting adequate sleep and receiving support from one's partner, faculty, and other residents.

A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain.

PubMed

Kruschinski, Carsten; Wiese, Birgitt; Dierks, Marie-Luise; Hummers-Pradier, Eva; Schneider, Nils; Junius-Walker, Ulrike

2016-01-28

To investigate what a geriatric assessment in general practice adds towards previous findings of prevalence, location, impact and the dyadic doctor-patient perception of pain in this age group. Cross-sectional study. Consecutive patients aged 70 and over underwent a comprehensive geriatric assessment in general practice that included a basic pain assessment (severity, sites and impact). Patients with pain and their doctors then independently rated its importance. Pain was correlated with further findings from the assessment, such as overall health, physical impairments, everyday function, falls, mood, health related lifestyle, social circumstances, using bivariate and multivariate statistics. Patient-doctor agreement on the importance of pain was calculated using kappa statistics. 219 out of 297 patients (73.7 %) reported pain at any location. Pain was generally located at multiple sites. It was most often present at the knee (33.9%), the lumbar spine (33.5%) as well as the hip (13.8%) and correlated with specific impairments such as restrictions of daily living (knee) or sleep problems (spine). Patients with pain and their physicians poorly agreed on the importance of the pain problem. A basic pain assessment can identify older patients with pain in general practice. It has resulted in a high prevalence exceeding that determined by encounters in consultations. It has been shown that a geriatric assessment provides an opportunity to address pain in a way that is adapted to older patients' needs - addressing all sites, its specific impact on life, and the patients' perceived importance of pain. Since there is little doctor-patient agreement, this seems a valuable strategy to optimize concrete treatment decisions and patient centered care. This study is registered in the German Clinical Trial Register ( DRKS00000792 ).

Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing.

PubMed

Shusterman, Dennis; Baroody, Fuad M; Craig, Timothy; Friedlander, Samuel; Nsouli, Talal; Silverman, Bernard

Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance. To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps. Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources. Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity. Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep-disordered breathing. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

First UMTA and AoA National Conference on Transportation for the Elderly and Handicapped

DOT National Transportation Integrated Search

1985-05-01

The Conference was highly successful in detailing problems now encountered in : providing transportation services to the elderly and handicapped and in : recommending specific solutions to those problems. There was a strong focus on : realistic, prac...

Motor carrier concerns about transportation problems in Oregon : final report.

DOT National Transportation Integrated Search

2004-03-01

This report summarizes an analysis of data from a statewide survey of freight motor carrier firms, conducted by the Oregon Department of Transportation (ODOT) in the summer of 2001, to identify freight industry concerns about problems they encounter ...

Minding Your Business: How to Avoid the Seven Deadly Financial Pitfalls.

ERIC Educational Resources Information Center

Stephens, Keith

1990-01-01

Describes financial management problems typically encountered by child care center directors and owners. Offers suggestions for planning and management techniques to overcome problems of cash flow, budgeting, rising costs, underpricing, declining revenues, fee collection, and liquidity. (NH)

Parkes radio science system design and testing for Voyager Neptune encounter

NASA Technical Reports Server (NTRS)

Rebold, T. A.; Weese, J. F.

1989-01-01

The Radio Science System installed at Parkes, Australia for the Voyager Neptune encounter was specified to meet the same stringent requirements that were imposed upon the Deep Space Network Radio Science System. The system design and test methodology employed to meet these requirements at Parkes are described, and data showing the measured performance of the system are presented. The results indicate that the system operates with a comfortable margin on the requirements. There was a minor problem with frequency-dependent spurious signals which could not be fixed before the encounter. Test results characterizing these spurious signals are included.

"(Dis)Empowered by What We See … ": Exploring the Use of Video-Stimulated Reflection in Physical Education Pedagogy and Practice

ERIC Educational Resources Information Center

Mooney, Amanda; Hickey, Chris

2017-01-01

Reflexive accounts of physical education (PE) pedagogy and practice offer potential to reveal much about the intended and unintended learning, for both students and teachers, that can result from certain pedagogic encounters. Despite the promotion of reflective practice/s as a possible "panacea" for improved teaching and learning, there…

Ad Hoc Supervision of General Practice Registrars as a "Community of Practice": Analysis, Interpretation and Re-Presentation

ERIC Educational Resources Information Center

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

2016-01-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also…

Mindfulness training for parents of children with special needs: Guidance for nurses in mental health practice.

PubMed

Petcharat, Manika; Liehr, Patricia

2017-02-01

Parents of children with special needs encounter specific challenges in carrying out their caregiving roles. They experience difficulty accepting their children due to unrealistically high expectations. Mindfulness training (MT) may increase parental psychological well-being and acceptance. The purpose of this article is to examine the evidence-base for the effectiveness of MT in enhancing psychological well-being for parents of children with special needs as a foundation for guidance for nurses in mental health practice. A literature review of relevant research studies was undertaken using specific inclusion criteria. The literature was derived from three databases that identified 56 articles narrowed to 5, which met inclusion criteria. The studies indicated that cultivating a more mindful way of parenting is associated with reduced stress, anxiety, and depression. Parents experienced increased mindful awareness and improved psychological well-being, and they were more accepting of their children. Their children also had fewer behavior problems and enhanced positive interaction with their parents. Because mindfulness interventions fall within the scope of independent nursing practice, nurses can play a significant role in applying mindfulness to promote psychological well-being in parents who have children with special needs. © 2017 Wiley Periodicals, Inc.

Making the Most of Five Minutes: The Clinical Teaching Moment.

PubMed

Smith, Jo R; Lane, India F

2015-01-01

Clinical educators face the challenge of simultaneously caring for patients and teaching learners, often with an unpredictable caseload and learners of varied abilities. They also often have little control over the organization of their time. Effective clinical teaching must encourage student participation, problem solving, integration of basic and clinical knowledge, and deliberate practice. Close supervision and timely feedback are also essential. Just as one develops an effective lecture through training and practice, clinical teaching effectiveness may also be improved by using specific skills to teach in small increments. The purpose of this paper is to identify potential teachable moments and to describe efficient instructional methods to use in the clinical setting under time constraints. These techniques include asking better questions, performing focused observations, thinking aloud, and modeling reflection. Different frameworks for teaching encounters during case presentations can be selected according to learner ability and available time. These methods include modeling and deconstructing the concrete experience; guiding the thinking and reflecting process; and providing the setting and opportunity for active practice. Use of these educational strategies encourages the learner to acquire knowledge, clinical reasoning, and technical skills, and also values, attitudes, and professional judgment.

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

PubMed

Browne, Annette J

2007-05-01

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

Understanding non ulcer dyspepsia.

PubMed

Loh, K Y; Siang, T K

2008-06-01

Non ulcer dyspepsia is one of the most common problems encountered in primary care practice. The underlying pathophysiology of non ulcer dyspepsia is not fully understood, but it is known that this condition is associated with H. pylori infection and motility disorder. The presenting abdominal symptoms are non specific: they include bloating, belching, flatulence, excessive fullness after eating and nausea. Psychological condition such as anxiety, depression and stress do play a role in the recurrence of symptoms. Upper GI endoscopy is necessary in patients who presents with alarm symptoms suggestive of possible underlying organic condition before one makes the diagnosis of non ulcer dyspepsia. Pharmacological therapy using H2 receptor antagonist and proton pump inhibitors are effective for symptom relief. Patient's education and supportive care should be part of the management strategy in recurrent chronic dyspepsia.

CheckMyMetal: a macromolecular metal-binding validation tool

PubMed Central

Porebski, Przemyslaw J.

2017-01-01

Metals are essential in many biological processes, and metal ions are modeled in roughly 40% of the macromolecular structures in the Protein Data Bank (PDB). However, a significant fraction of these structures contain poorly modeled metal-binding sites. CheckMyMetal (CMM) is an easy-to-use metal-binding site validation server for macromolecules that is freely available at http://csgid.org/csgid/metal_sites. The CMM server can detect incorrect metal assignments as well as geometrical and other irregularities in the metal-binding sites. Guidelines for metal-site modeling and validation in macromolecules are illustrated by several practical examples grouped by the type of metal. These examples show CMM users (and crystallographers in general) problems they may encounter during the modeling of a specific metal ion. PMID:28291757

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients

PubMed Central

Shelgikar, Anita Valanju; Aronovich, Sharon; Stanley, Jeffrey J.

2017-01-01

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary “Alternatives to CPAP program” (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients. Citation: Shelgikar AV, Aronovich S, Stanley JJ. Multidisciplinary alternatives to CPAP program for CPAP-intolerant patients. J Clin Sleep Med. 2017;13(3):505–510. PMID:28095977

Medical treatment of acquired nystagmus.

PubMed

Ehrhardt, David; Eggenberger, Eric

2012-11-01

This article synthesises recent findings and addresses relevant anatomy, pathophysiologic considerations, and current treatment options for common forms of acquired nystagmus including vestibular and gaze holding dysfunction. Some forms of nystagmus have relatively specific treatments, such as baclofen for periodic alternating nystagmus, and repositioning for benign paroxysmal positional vertigo. Recent studies have brought changes to many of the treatments of nystagmus variants. Additionally, other recent advances in nystagmus treatment, like the usage of 4-aminopyridine, have added potent medications to the physician's armamentarium. Nystagmus is a commonly encountered entity in clinical practice. However, evidence supported treatments are scarce. Medical treatment of nystagmus is difficult, with often limited and variable response to pharmacologic therapies. This mandates a continued re-evaluation of patients and creation of an individualized approach to this common clinical problem.

Anonymity and live-donor transplantation: an ELPAT view.

PubMed

Mamode, Nizam; Lennerling, Annette; Citterio, Franco; Massey, Emma; Van Assche, Kristof; Sterckx, Sigrid; Frunza, Mihaela; Jung, Harald; Pascalev, Assya; Zuidema, Willij; Johnson, Rachel; Loven, Charlotte; Weimar, Willem; Dor, Frank J M F; Dor, Frank

2013-02-27

Anonymity of donors or recipients in living-donor transplantation is a complex issue and practice varies widely. There are compelling arguments for maintaining anonymity of both parties before unspecified donor transplantation and specified indirect transplantation. After transplantation, there are still good reasons to avoid disclosure of identities. Although anonymity could be lifted if both parties explicitly request it, there are significant, potentially negative consequences of such an approach. Both donor and recipient should be counseled regarding these, and transplant teams should consider the considerable financial and psychosocial costs if problems are encountered as a result of contact. Given the recent rise in the number of unspecified living-donor transplants and through paired exchange schemes, it is vital that data are collected regarding the effects of maintaining or revoking anonymity after transplantation.

Engaging Musical Practices: A Sourcebook for Middle School General Music

ERIC Educational Resources Information Center

Burton, Suzanne L., Ed.

2012-01-01

Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…

Life Story Reflection in Social Work Education: A Practical Model

ERIC Educational Resources Information Center

Spector-Mersel, Gabriela

2017-01-01

Drawing from the practice-oriented conception of reflection in social work, its applications in social work education typically focus on students' encounters with the field. Recognizing the value of practice-oriented reflection yet aware of its limitations, complementing it with life story reflection (LSR) is urged. The importance of LSR in social…

Synthetic Report of Research and Development of Professional Knowledge Practices

ERIC Educational Resources Information Center

Toiviainen, Hanna; Hoynalanmaa, Mikko; Lallimo, Jiri; Moen, Anne; Smordal, Ole; Morch, Anders; Toikka, Seppo

2006-01-01

This deliverable has been produced in the context of the Knowledge-Practice Laboratory (KP-Lab) project, which is aimed at facilitating innovative practices of working with knowledge in higher education, teacher training, and professional networks. This deliverable is a synopsis of the first experiences encountered during the first 6 months of the…

Use of computer modeling to investigate a dynamic interaction problem in the Skylab TACS quad-valve package

NASA Technical Reports Server (NTRS)

Hesser, R. J.; Gershman, R.

1975-01-01

A valve opening-response problem encountered during development of a control valve for the Skylab thruster attitude control system (TACS) is described. The problem involved effects of dynamic interaction among valves in the quad-redundant valve package. Also described is a detailed computer simulation of the quad-valve package which was helpful in resolving the problem.

Decision-problem state analysis methodology

NASA Technical Reports Server (NTRS)

Dieterly, D. L.

1980-01-01

A methodology for analyzing a decision-problem state is presented. The methodology is based on the analysis of an incident in terms of the set of decision-problem conditions encountered. By decomposing the events that preceded an unwanted outcome, such as an accident, into the set of decision-problem conditions that were resolved, a more comprehensive understanding is possible. All human-error accidents are not caused by faulty decision-problem resolutions, but it appears to be one of the major areas of accidents cited in the literature. A three-phase methodology is presented which accommodates a wide spectrum of events. It allows for a systems content analysis of the available data to establish: (1) the resolutions made, (2) alternatives not considered, (3) resolutions missed, and (4) possible conditions not considered. The product is a map of the decision-problem conditions that were encountered as well as a projected, assumed set of conditions that should have been considered. The application of this methodology introduces a systematic approach to decomposing the events that transpired prior to the accident. The initial emphasis is on decision and problem resolution. The technique allows for a standardized method of accident into a scenario which may used for review or the development of a training simulation.

Shared decision making for stroke prevention in atrial fibrillation: study protocol for a randomized controlled trial.

PubMed

Kunneman, Marleen; Branda, Megan E; Noseworthy, Peter A; Linzer, Mark; Burnett, Bruce; Dick, Sara; Spencer-Bonilla, Gabriela; Fernandez, Cara A; Gorr, Haeshik; Wambua, Mike; Keune, Shelly; Zeballos-Palacios, Claudia; Hargraves, Ian; Shah, Nilay D; Montori, Victor M

2017-09-29

Nonvalvular atrial fibrillation (AF) is a common ongoing health problem that places patients at risk of stroke. Whether and how a patient addresses this risk depends on each patient's goals, context, and values. Consequently, leading cardiovascular societies recommend using shared decision making (SDM) to individualize antithrombotic treatment in patients with AF. The aim of this study is to assess the extent to which the ANTICOAGULATION CHOICE conversation tool promotes high-quality SDM and influences anticoagulation uptake and adherence in patients with AF at risk of strokes. This study protocol describes a multicenter, encounter-level, randomized trial to assess the effect of using the ANTICOAGULATION CHOICE conversation tool in the clinical encounter, compared to usual care. The participating centers include an academic hospital system, a suburban community group practice, and an urban safety net hospital, all in Minnesota, USA. Patients with ongoing nonvalvular AF at risk of strokes (CHA 2 DS 2 -VASc score ≥ 1 in men, or ≥ 2 in women) will be eligible for participation. We aim to include 999 patients and their clinicians. The primary outcome is the quality of SDM as perceived by participants, and as assessed by a post-encounter survey that ascertains (a) knowledge transfer, (b) concordance of the decision made, (c) quality of communication, and (d) satisfaction with the decision-making process. Recordings of encounters will be reviewed to assess the extent of patient involvement and how participants use the tool (fidelity). Anticoagulant use, choice of agent, and adherence will be drawn from patients' medical and pharmacy records. Strokes and bleeding events will be drawn from patient records. This study will provide a valid and precise measure of the effect of the ANTICOAGULATION CHOICE conversation tool on SDM quality and processes, and on the treatment choices and adherence to therapy among AF patients at risk of stroke. ClinicalTrials.gov, NCT02905032 . Registered on 9 September 2016.

In Print or Out of Print? The Continuing Problem.

ERIC Educational Resources Information Center

Kayden, Mimi

1982-01-01

Briefly describes the problems encountered by libraries in attempting to purchase out-of-stock books and discusses some of the reasons for changes in the way publishers handle backlist materials, including sales volume and its relation to increased printing costs. (JL)

The Impaired Social Worker.

ERIC Educational Resources Information Center

Reamer, Frederic G.

1992-01-01

Discusses concept of the impaired professional; reviews research on various types of impairment (personality disorders, depression and other emotional problems, marital problems, and physical illness), prevalence and causes of impairment, and responses to it; and outlines model assessment and action plan for social workers who encounter an…

The Brown University Child and Adolescent Behavior Letter, 1999.

ERIC Educational Resources Information Center

Lipsitt, Lewis P., Ed.

1999-01-01

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

Segregation of asphalt mixes caused by surge silos : final report.

DOT National Transportation Integrated Search

1982-01-01

Segregation of asphalt mixes continues to be a problem in Virginia, particularly with base mixes and coarse surface mixes. Although the problem is encountered primarily on jobs using surge silos, it has been related to other factors such as mix desig...