Critical Technology Determination for Future Human Space Flight

NASA Technical Reports Server (NTRS)

Mercer, Carolyn R.; Vangen, Scott D.; Williams-Byrd, Julie A.; Steckleim, Jonette M.; Alexander, Leslie; Rahman, Shamin A.; Rosenthal, Matthew; Wiley, Dianne S.; Davison, Stephan C.; Korsmeyer, David J.;

Critical Technology Determination for Future Human Space Flight

NASA Technical Reports Server (NTRS)

Mercer, Carolyn R.; Vangen, Scott D.; Williams-Byrd, Julie A.; Stecklein, Jonette M.; Rahman, Shamim A.; Rosenthal, Matthew E.; Hornyak, David M.; Alexander, Leslie; Korsmeyer, David J.; Tu, Eugene L.;

The development of multi-level critical care competency statements for self-assessment by ICU nurses.

PubMed

Bourgault, Annette M; Smith, Sherry

2004-01-01

Multi-levelled critical care competency statements were developed based on the levels of novice to expert (Benner, 1984). These competency statements provide a framework for the development of knowledge and skills specific to critical care. The purpose of this tool is to guide personal development in critical care, facilitating the assessment of individual learning needs. Competency levels are attained through the completion of performance criteria. Multi-levelled competency statements define clear expectations for the new orientee, in addition to providing a framework for the advancement of the intermediate and experienced nurse.

Integrating advanced practice providers into medical critical care teams.

PubMed

McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

2013-03-01

Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

An International Career Development Survey of Critical Care Practitioners

PubMed Central

Patel, Mayur B.; Laudanski, Krzysztof; Pandharipande, Pratik P.

2014-01-01

OBJECTIVE To understand the career development needs of an international multidisciplinary group of critical care practitioners in the 21st century. DESIGN A web-accessible survey deployed by the In-Training Section of the Society of Critical Care Medicine (SCCM). SETTING University health sciences center. SUBJECTS Physicians (MD, DO), Advanced Practice Provider (NP, PA), Nurses (RN), Pharmacists, and Student members of the SCCM. INTERVENTIONS The survey covered domains of demographics, opinions about career development, and opinions about the SCCM In-Training Section. MEASUREMENTS AND MAIN RESULTS 1,049 of approximately 16,000 SCCM members responded to the survey (7% response rate). Continuing education (280, 26.7%), leadership skills (197, 18.8%), and scientific development (192, 18.3%) are among the most important issues for the respondents. Many critical care practitioners would like to assist SCCM's efforts in career development (948, 90.4%) and many would consider some aspect of committee involvement (796, 75.9%). The SCCM In-Training Section, whose primary mission is career development across the spectrum of providers and expertise levels, needs improved advertisement (981, 93.7%). There is strong support for upcoming Annual Congresses dedicated to career development (834, 79.5%). Of the three main methods of information dissemination for SCCM career development initiatives from the In-Training Section, respondents rank email highest (762, 72.6%), followed by webpages (228, 21.7%) and I-rooms (59, 5.6%). Over half of the SCCM membership surveyed lack a career development mentor in critical care. CONCLUSIONS This is the largest assessment of the international critical care community regarding the career development needs of 21st century critical care practitioner, although the limited response rate makes this work prone to sampling bias. Career development issues are broad and in need of further development by the SCCM In-Training Section. Although these initiatives need improved marketing, the SCCM membership is willing to help support them and work to further shape them in the future. PMID:24335441

Travel importance and strategic investment in Vermont's transportation assets.

DOT National Transportation Integrated Search

2013-12-01

This project advances a new type of system-wide measurement of link criticality : that will provide the tools needed for strategic disinvestment in roads that are not : critical to the health and welfare of Vermonters. This new approach requires a : ...

An analysis of narratives to identify critical thinking contexts in psychiatric clinical practice.

PubMed

Mun, Mi Suk

2010-02-01

The development of students' critical thinking abilities is one of the greatest challenges facing contemporary nursing educators. Nursing educators should know about what kind of contents or situations need critical thinking. The research was undertaken to identify the critical thinking contexts that nursing students confront in psychiatric clinical practices. Students were asked to document their everyday experience. The narratives were analysed and interpreted from the philosophical notion of hermeneutics. Four themes emerged as critical thinking contexts: anxiety, conflict, hyper-awareness, dilemmas. Writing narratives appear to provide opportunities for reflection in addition to facilitating critical thinking and communicative skills in students. Also, for the instructor, students' clinical narratives could provide insight to understand how students are thinking and to share student's personal difficulties.

Forging a critical alliance: Addressing the research needs of the United States critical illness and injury community.

PubMed

Cobb, J Perren; Ognibene, Frederick P; Ingbar, David H; Mann, Henry J; Hoyt, David B; Angus, Derek C; Thomas, Alvin V; Danner, Robert L; Suffredini, Anthony F

2009-12-01

Discuss the research needs of the critical illness and injury communities in the United States. Workshop session held during the 5 National Institutes of Health Symposium on the Functional Genomics of Critical Illness and Injury (November 15, 2007). The current clinical research infrastructure misses opportunities for synergy and does not address many important needs. In addition, it remains challenging to rapidly and properly implement system-wide changes based upon reproducible evidence from clinical research. Author presentations, panel discussion, attendee feedback. The critical illness and injury research communities seek better communication and interaction, both of which will improve the breadth and quality of acute care research. Success in meeting these needs should come from cooperative and strategic actions that favor collaboration, standardization of protocols, and strong leadership. An alliance framed on common goals will foster collaboration among experts to better promote clinical trials within the critically ill or injured patient population. The U.S. Critical Illness and Injury Trials Group was funded to create a clinical research framework that can reduce the barriers to investigation using an investigator-initiated, evidence-driven, inclusive approach that has proven successful elsewhere. This alliance will provide an annual venue for systematic review and strategic planning that will include framing the research agenda, raising awareness for the value of acute care research, gathering and promoting best practices, and bolstering the critical care workforce.

What critical care nurses need to know about health care access when caring for elders in acute care settings.

PubMed

Jennings, Bonnie Mowinski; Lamb, Gerri

2007-09-01

Health care system issues, in general, and access to care, in particular, are not problems typically studied by critical care nurses. Rather, initial and continuing education focuses on clinical aspects of care. This focus is necessary to assure that critical care nurses have the expertise to care for patients who need astute surveillance for complicated physical problems and their emotional sequelae, as well as in-depth knowledge and skills related to care coordination for patient stabilization and transfer. However, evidence is growing that patients benefit when critical care nurses expand their knowledge about access to care. This article provides insights regarding access to health care and how it relates to many of the admission and readmission patterns that critical care nurses observe.

Nutritional requirements of the critically ill patient.

PubMed

Chan, Daniel L

2004-02-01

The presence or development of malnutrition during critical illness has been unequivocally associated with increased morbidity and mortality in people. Recognition that malnutrition may similarly affect veterinary patients emphasizes the need to properly address the nutritional requirements of hospitalized dogs and cats. Because of a lack in veterinary studies evaluating the nutritional requirements of critically ill small animals, current recommendations for nutritional support of veterinary patients are based largely on sound clinical judgment and the best information available, including data from experimental animal models and human studies. This, however, should not discourage the veterinary practitioner from implementing nutritional support in critically ill patients. Similar to many supportive measures of critically ill patients, nutritional interventions can have a significant impact on patient morbidity and may even improve survival. The first step of nutritional support is to identify patients most likely to benefit from nutritional intervention. Careful assessment of the patient and appraisal of its nutritional needs provide the basis for a nutritional plan, which includes choosing the optimal route of nutritional support, determining the number of calories to provide, and determining the composition of the diet. Ultimately, the success of the nutritional management of critically ill dogs and cats will depend on close monitoring and frequent reassessment.

QoS enabled dissemination of managed information objects in a publish-subscribe-query information broker

NASA Astrophysics Data System (ADS)

Loyall, Joseph P.; Carvalho, Marco; Martignoni, Andrew, III; Schmidt, Douglas; Sinclair, Asher; Gillen, Matthew; Edmondson, James; Bunch, Larry; Corman, David

2009-05-01

Net-centric information spaces have become a necessary concept to support information exchange for tactical warfighting missions using a publish-subscribe-query paradigm. To support dynamic, mission-critical and time-critical operations, information spaces require quality of service (QoS)-enabled dissemination (QED) of information. This paper describes the results of research we are conducting to provide QED information exchange in tactical environments. We have developed a prototype QoS-enabled publish-subscribe-query information broker that provides timely delivery of information needed by tactical warfighters in mobile scenarios with time-critical emergent targets. This broker enables tailoring and prioritizing of information based on mission needs and responds rapidly to priority shifts and unfolding situations. This paper describes the QED architecture, prototype implementation, testing infrastructure, and empirical evaluations we have conducted based on our prototype.

Gender, religion, and sociopolitical issues in cross-cultural online education.

PubMed

Zaidi, Zareen; Verstegen, Daniëlle; Naqvi, Rahat; Morahan, Page; Dornan, Tim

2016-05-01

Cross-cultural education is thought to develop critical consciousness of how unequal distributions of power and privilege affect people's health. Learners in different sociopolitical settings can join together in developing critical consciousness-awareness of power and privilege dynamics in society-by means of communication technology. The aim of this research was to define strengths and limitations of existing cross-cultural discussions in generating critical consciousness. The setting was the FAIMER international fellowship program for mid-career interdisciplinary health faculty, whose goal is to foster global advancement of health professions education. Fellows take part in participant-led, online, written, task-focused discussions on topics like professionalism, community health, and leadership. We reflexively identified text that brought sociopolitical topics into the online environment during the years 2011 and 2012 and used a discourse analysis toolset to make our content analysis relevant to critical consciousness. While references to participants' cultures and backgrounds were infrequent, narratives of political-, gender-, religion-, and other culture-related topics did emerge. When participants gave accounts of their experiences and exchanged cross-cultural stories, they were more likely to develop ad hoc networks to support one another in facing those issues than explore issues relating to the development of critical consciousness. We suggest that cross-cultural discussions need to be facilitated actively to transform learners' frames of reference, create critical consciousness, and develop cultural competence. Further research is needed into how to provide a safe environment for such learning and provide faculty development for the skills needed to facilitate these exchanges.

International comparisons in critical care: a necessity and challenge.

PubMed

Wunsch, Hannah; Rowan, Kathryn M; Angus, Derek C

2007-12-01

Understanding variation in critical care resources, and delivery of care between countries will allow for improved disaster planning, evaluation of research findings, and assessment of the utility of critical care itself. This review describes the available data for international comparisons and the many factors that need to be addressed for an appropriate interpretation of results. Recent studies on subgroups of critical care patients include data from many different countries. These new studies provide important information on the overall incidence of these disease states, but most of these international studies do not take into account the critical care resources of the countries being discussed. For an appropriate interpretation of findings the relevant baseline critical care resources, prevalence of diseases, and cultural practices, need to be quantified. The existence of these other factors prevents the use of a severity of illness scoring system alone to account for differences between countries. Many recent critical care studies include data from multiple countries. With continued movement towards international studies, and improvements in data collection systems, comparisons between countries are becoming easier. These findings need to be interpreted in the context of all the relevant country information.

The Energy and Security Nexus: A Strategic Dilemma

DTIC Science & Technology

2012-11-01

constructive criticism where it was most needed. ix Joseph Caddell also provided crucial guidance in framing the conference proposal. Finally, my thanks...conflict. Critics of biofuels further claim that diversion of land for fuel in the United States has driven up world food prices and arguably triggered...recycle and consume all actinides may provide a solution. But they arguably carry a proliferation risk. Steps can be taken to safeguard and secure

A silk-based scaffold platform with tunable architecture for engineering critically-sized tissue constructs.

PubMed

Wray, Lindsay S; Rnjak-Kovacina, Jelena; Mandal, Biman B; Schmidt, Daniel F; Gil, Eun Seok; Kaplan, David L

2012-12-01

In the field of tissue engineering and regenerative medicine there is significant unmet need for critically-sized, fully degradable biomaterial scaffold systems with tunable properties for optimizing tissue formation in vitro and tissue regeneration in vivo. To address this need, we have developed a silk-based scaffold platform that has tunable material properties, including localized and bioactive functionalization, degradation rate, and mechanical properties and that provides arrays of linear hollow channels for delivery of oxygen and nutrients throughout the scaffold bulk. The scaffolds can be assembled with dimensions that range from millimeters to centimeters, addressing the need for a critically-sized platform for tissue formation. We demonstrate that the hollow channel arrays support localized and confluent endothelialization. This new platform offers a unique and versatile tool for engineering 'tailored' scaffolds for a range of tissue engineering and regenerative medicine needs. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessment of critical thinking: a Delphi study.

PubMed

Paul, Sheila A

2014-11-01

Nurse educators are responsible for preparing nurses who critically analyze patient information and provide meaningful interventions in today's complex health care system. By using the Delphi research method, this study, utilized the specialized and experiential knowledge of Certified Nurse Educators. This original Delphi research study asked Certified Nurse Educators how to assess the critical-thinking ability of nursing students in the clinical setting. The results showed that nurse educators need time, during the clinical experience, to accurately assess each individual nursing student. This study demonstrated the need for extended student clinical time, and a variety of clinical learning assessment tools. Copyright © 2014 Elsevier Ltd. All rights reserved.

Tele-Pediatric Intensive Care for Critically Ill Children in Syria.

PubMed

Ghbeis, Muhammad Bakr; Steffen, Katherine M; Braunlin, Elizabeth A; Beilman, Gregory J; Dahman, Jay; Ostwani, Waseem; Steiner, Marie E

2017-12-12

Armed conflicts can result in humanitarian crises and have major impacts on civilians, of whom children represent a significant proportion. Usual pediatric medical care is often disrupted and trauma resulting from war-related injuries is often devastating. High pediatric mortality rates are thus experienced in these ravaged medical environments. Using simple communication technology to provide real-time management recommendations from highly trained pediatric personnel can provide substantive clinical support and have a significant impact on pediatric morbidity and mortality. We implemented a "Tele-Pediatric Intensive Care" program (Tele-PICU) to provide real-time management consultation for critically ill and injured pediatric patients in Syria with intensive care needs. Over the course of 7 months, 19 cases were evaluated, ranging in age from 1 day to 11 years. Consultation questions addressed a wide range of critical care needs. Five patients are known to have survived, three were transferred, five died, and six outcomes were unknown. Based on this limited undertaking with its positive impact on survival, further development of Tele-PICU-based efforts with attention to implementation and barriers identified through this program is desirable. Even limited Tele-PICU can provide timely and potentially lifesaving assistance to pediatric care providers. Future efforts are encouraged.

Taiwanese nurses' appraisal of a lecture on spiritual care for patients in critical care units.

PubMed

Shih, F J; Gau, M L; Mao, H C; Chen, C H

1999-04-01

The purpose of this study is to develop a lecture on spiritual care for adult critical care trainees, and to evaluate the trainees' appraisal of the effectiveness of this lecture in preparing them to provide spiritual care for their clients in a critical care setting. A between-method triangulation research design encompassing a questionnaire and descriptive qualitative content analysis was used. A convenience sample consisting of 64 registered nurses who attended an adult critical care nurse training programme in a leading medical centre in northern Taiwan were invited to participate in this study. A total of 64 female participants completed the questionnaire. Ninety-two per cent (59) of the subjects considered the lecture on spiritual care to be helpful in assisting them to provide holistic care for critically ill patients in the Intensive Care Unit (ICU). Three types of help were identified by the subjects: (1) help in clarifying the abstract concepts related to spiritual care (86%); (2) help in self-disclosing the nurses' personal beliefs and values regarding life goals, nursing, and spiritual needs (67%); (3) help in learning how to provide spiritual care to patients in a critical care setting (34%). Twenty per cent of the subjects thought that inclusion of the following content in the lecture would have been helpful to provide a more comprehensive picture of spiritual care: religious practices and rituals (11%); the culturally bonded nursing care plan (9%); the development of human spirituality (3%); patients' families' spiritual needs in the ICU (3%); and resources for nurses in providing spiritual care (2%). Thirteen per cent of the subjects suggested that the instructor might employ the following strategies to improve the quality of teaching: providing more empirical examples (5%); discussion with the students in classes of smaller size following the lecture or extending the instruction time (5%); and providing a syllabus with detailed information (3%).

The Role of Nurse Leaders in Advancing Carer Communication Needs across Transitions of Care: A Call to Action.

PubMed

Udod, Sonia A; Lobchuk, Michelle

2017-01-01

This paper focuses on the central role of senior nurse leaders in advancing organizational resources and support for communication between healthcare providers and carers that influences patient and carer outcomes during the transition from hospital to the community. A Think Tank (Lobchuk 2012) funded by the Canadian Institutes of Health Research (CIHR) gathered interdisciplinary and intersectoral stakeholders from local, national and international levels to develop a Family Carer Communication Research Collaboration. Workshop stakeholders addressed critical challenges in meeting communication needs of carers as partners with clinicians in promoting safe care for the elderly, chronically or seriously ill or disabled individuals in the community. Key priority areas identified the need to uncover nurse leader perspectives at the system, nurse leader, healthcare provider and patient levels where communication with carers occurs. The overarching outcome from the workshop focuses on the need for nurse leaders to advocate for patients and their families in meeting carer communication needs. The authors' "call to action" requires commitment and investment from nurse leaders in the critical juncture of healthcare delivery to strengthen communication between healthcare providers and carers that influence patient and carer outcomes in seamless transitions of care.

Critical thinking as an educational outcome: an evaluation of current tools of measurement.

PubMed

Adams, M H; Whitlow, J F; Stover, L M; Johnson, K W

1996-01-01

Critical thinking, an outcome criterion of the National League for Nursing and the Council of Baccalaureate and Higher Degree Programs, is an abstract skill difficult to measure. The authors provide a comprehensive review of four instruments designed to measure critical thinking and summarize research in which the tools were used. Analysis of this information will empower nursing faculty members to select a critical-thinking instrument that is individualized to the needs of their respective nursing programs.

Toward a more reliable federal survey for tracking health insurance coverage and access.

PubMed

Kenney, Genevieve; Holahan, John; Nichols, Len

2006-06-01

Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance. Assessment of the major federal household surveys that regularly provide information on health insurance and access to care based on an examination of each survey instrument and related survey documentation and the methodological literature. Identification of the data needed to address key policy questions on insurance coverage, assessment of how well existing surveys meet this need, definition of the critical elements of an ideal survey, and examination of the potential for building on existing surveys. Collection and critical assessment of pertinent survey documentation and methodological studies. While all the federal surveys examined provide valuable information, the information available to guide key policy decisions still has major gaps. Issues include measurement of insurance coverage and critical content gaps, inadequate sample sizes to support precise state and substate estimates, considerable delays between data collection and availability, and concerns about response rates and item nonresponse. Our assessment is that the Current Population Survey (CPS) and the National Health Interview Survey could be most readily modified to address these issues. The vast resources devoted to health care and the magnitude of the uninsurance problem make it critical that we have a reliable source for tracking health care and coverage at the national and state levels and for major local areas. It is plausible that this could be more cost effectively done by building on existing surveys than by designing and fielding a new one, but further research is needed to make a definitive judgment. At a minimum, the health insurance information collected on the CPS should be revised to address existing measurement problems.

Human Spaceflight Technology Needs - A Foundation for JSC's Technology Strategy

NASA Technical Reports Server (NTRS)

Stecklein, Jonette M.

2013-01-01

Human space exploration has always been heavily influenced by goals to achieve a specific mission on a specific schedule. This approach drove rapid technology development, the rapidity of which adds risks as well as provides a major driver for costs and cost uncertainty. The National Aeronautics and Space Administration (NASA) is now approaching the extension of human presence throughout the solar system by balancing a proactive yet less schedule-driven development of technology with opportunistic scheduling of missions as the needed technologies are realized. This approach should provide cost effective, low risk technology development that will enable efficient and effective manned spaceflight missions. As a first step, the NASA Human Spaceflight Architecture Team (HAT) has identified a suite of critical technologies needed to support future manned missions across a range of destinations, including in cis-lunar space, near earth asteroid visits, lunar exploration, Mars moons, and Mars exploration. The challenge now is to develop a strategy and plan for technology development that efficiently enables these missions over a reasonable time period, without increasing technology development costs unnecessarily due to schedule pressure, and subsequently mitigating development and mission risks. NASA's Johnson Space Center (JSC), as the nation s primary center for human exploration, is addressing this challenge through an innovative approach in allocating Internal Research and Development funding to projects. The HAT Technology Needs (TechNeeds) Database has been developed to correlate across critical technologies and the NASA Office of Chief Technologist Technology Area Breakdown Structure (TABS). The TechNeeds Database illuminates that many critical technologies may support a single technical capability gap, that many HAT technology needs may map to a single TABS technology discipline, and that a single HAT technology need may map to multiple TABS technology disciplines. The TechNeeds Database greatly clarifies understanding of the complex relationships of critical technologies to mission and architecture element needs. Extensions to the core TechNeeds Database allow JSC to factor in and appropriately weight JSC Center Core Technology Competencies, and considerations of Commercialization Potential and Partnership Potential. The inherent coupling among these, along with an appropriate importance weighting, has provided an initial prioritization for allocation of technology development research funding for JSC. The HAT Technology Needs Database, with a core of built-in reports, clarifies and communicates complex technology needs for cost effective human space exploration such that an organization seeking to assure that research prioritization supports human spaceflight of the future can be successful.

A missing ethical competency? A review of critical reflection in health promotion.

PubMed

Tretheway, Rebecca; Taylor, Jane; O'Hara, Lily; Percival, Nikki

2015-12-01

There is increasing emphasis in the health promotion literature on the ethical imperative for the profession to move towards critical practice. A key challenge for health promotion is that critical practice appears both under-developed and under-practiced. This is evident in the omission of critical reflection from Australian and international competencies for health promotion practitioners. A narrative literature review was undertaken to explore the current use of critical reflection in health promotion. Critical reflection models relevant to health promotion were identified and critiqued. There was a dearth of literature on critical reflection within health promotion, despite recognition of its potential to support critical practice. The discipline of critical social work provided literature on the use, effect and outcome of critical reflection in practice. The interdisciplinary critical reflection model was identified as the model most applicable to health promotion. Underpinned by critical theory, this model emphasises both critical and ethical practice. Critical reflection is a core competency for health promotion practitioners to address the ethical imperative to move towards critical practice. There is a need to explore the application of a critical reflection model in health promotion to determine how it may support critical and ethical practice. So what? If health promotion is to meet its ethical responsibilities, then critical reflection needs to be articulated as a core health promotion competency and a model for its application in health promotion developed.

Critical Literacy and Social Justice

ERIC Educational Resources Information Center

Comber, Barbara

2015-01-01

Given the global escalation of gaps between rich and poor, contemporary work in critical literacy needs to overtly question the politics of poverty. How and where is poverty produced, by what means, by whom and for whom and how are educational systems stratified to provide different kinds of education to the rich and the poor? Yet rather than…

The Limits of Children's Voices: From Authenticity to Critical, Reflexive Representation

ERIC Educational Resources Information Center

Spyrou, Spyros

2011-01-01

This article provides a critique of the preoccupation with children's voices in child-centred research by exploring their limits and problematizing their use in research. The article argues that critical, reflexive researchers need to reflect on the processes which produce children's voices in research, the power imbalances that shape them and the…

Information needs for the rapid response team electronic clinical tool.

PubMed

Barwise, Amelia; Caples, Sean; Jensen, Jeffrey; Pickering, Brian; Herasevich, Vitaly

2017-10-02

Information overload in healthcare is dangerous. It can lead to critical errors and delays. During Rapid Response Team (RRT) activations providers must make decisions quickly to rescue patients from physiological deterioration. In order to understand the clinical data required and how best to present that information in electronic systems we aimed to better assess the data needs of providers on the RRT when they respond to an event. A web based survey to evaluate clinical data requirements was created and distributed to all RRT providers at our institution. Participants were asked to rate the importance of each data item in guiding clinical decisions during a RRT event response. There were 96 surveys completed (24.5% response rate) with fairly even distribution throughout all clinical roles on the RRT. Physiological data including heart rate, respiratory rate, and blood pressure were ranked by more than 80% of responders as being critical information. Resuscitation status was also considered critically useful by more than 85% of providers. There is a limited dataset that is considered important during an RRT. The data is widely available in EMR. The findings from this study could be used to improve user-centered EMR interfaces.

[The future of intensive medicine].

PubMed

Palencia Herrejón, E; González Díaz, G; Mancebo Cortés, J

2011-05-01

Although Intensive Care Medicine is a young specialty compared with other medical disciplines, it currently plays a key role in the process of care for many patients. Experience has shown that professionals with specific training in Intensive Care Medicine are needed to provide high quality care to critically ill patients. In Europe, important steps have been taken towards the standardization of training programs of the different member states. However, it is now necessary to take one more step forward, that is, the creation of a primary specialty in Intensive Care Medicine. Care of the critically ill needs to be led by specialists who have received specific and complete training and who have the necessary professional competences to provide maximum quality care to their patients. The future of the specialty presents challenges that must be faced with determination, with the main objective of meeting the needs of the population. Copyright © 2011 Elsevier España, S.L. y SEMICYUC. All rights reserved.

The trajectory of experience of critical care nurses in providing end-of-life care: A qualitative descriptive study.

PubMed

Ong, Keh Kiong; Ting, Kit Cheng; Chow, Yeow Leng

2018-01-01

To understand the perceptions of critical care nurses towards providing end-of-life care. There has been an increasing interest in end-of-life care in the critical care setting. In Singapore, approximately half of deaths in the hospital occur during critical care. While nurses are well positioned to provide end-of-life care to patients and their family members, they faced barriers to providing end-of-life care. Also, providing end-of-life care has profound positive and negative psychological effects on nurses, with the latter being more prominent. Qualitative descriptive design. Data collection was performed in a medical intensive care unit of a public tertiary hospital in Singapore. Ten registered nurses were purposively sampled and interviewed individually using a semi-structured interview guide. A codebook was developed to guide coding, and data were thematically analysed. Rigour was maintained. Nurses went through a trajectory of experience. They experienced the culture of care and developed dissatisfaction with it. The tension shaped their perception and meaning of life and death, and they developed mechanisms to reach resolution. This study provides insight on nurses' perception as a trajectory of experience and raised several implications on clinical practice, policy and research. There is a need to alleviate the tension nurses face and to facilitate coming to terms with the tension by improving the culture of care and supporting nurses. Nurses could be involved more in decision-making and empowered to start end-of-life care conversations within the team and with family members. Communication with family members and between nurses and doctors could be improved. Support for nurses providing end-of-life care could be enhanced through promoting social networks, education and bereavement support. Further research is needed to explore ways to support and empower nurses to provide end-of-life care in critical care. © 2017 John Wiley & Sons Ltd.

Science to Protect Public Health and the Environment--EPA Research Program Overview 2016-2019

EPA Pesticide Factsheets

This document provides an overview of EPA’s research programs within the Office of Research and Development. This critically important work is providing the science needed to address the biggest problems facing environmental science.

Moral distress experienced by health care professionals who provide home-based palliative care.

PubMed

Brazil, Kevin; Kassalainen, Sharon; Ploeg, Jenny; Marshall, Denise

2010-11-01

Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

Malaysian Rural ESL Students' Critical Thinking Literacy Level: A Case Study

ERIC Educational Resources Information Center

Baki, Nurshila Umar; Rafik-Galea, Shameem; Nimehchisalem, Vahid

2016-01-01

In recent years, there has been much interest in the development of thinking skills in the education circles in Malaysia. Nevertheless, more effort needs to be placed on providing skills in developing the critical thinking literacy level of English as a second language (ESL) secondary school students, and its implication on the practice of…

Creating an Alternate Reality: Critical, Creative, and Empathic Thinking Generated in the "Global Village Playground" Capstone Experience

ERIC Educational Resources Information Center

Dondlinger, Mary Jo; Wilson, Douglas A.

2012-01-01

The "Global Village Playground" ("GVP") was a capstone learning experience designed to address institutional assessment needs while providing an integrated and authentic learning experience for students aimed at fostering critical and creative thinking. In the "GVP", students work on simulated and real-world problems as a design team tasked with…

The Liberal Arts Department Chairs' Leadership Approach for Providing Faculty Professional Development

ERIC Educational Resources Information Center

White, Kevin C.

2017-01-01

Colleges and universities have a need to prepare faculty to educate students to be critical thinkers and well-rounded individuals. In accomplishing this goal, the undergraduate academic department chair takes on a critical role to assist with the process of faculty professional development. Currently, there is a call from different stakeholders…

Forest ecohydrological research in the 21st century: what are the critical needs?

Treesearch

James Vose; Ge Sun; Chelcy Ford; Michael Bredemeier; Kyoichi Ostsuki; Adam Wei; Zhiqiang Zhang; Lu. Zang

2011-01-01

Modern ecohydrologic science will be critical for providing the best information to policy makers and society to address water resource challenges in the 21st century. Implicitly, ecohydrology involves understanding both the functional interactions among vegetation, soils, and hydrologic processes at multiple scales and the linkages among upland, riparian, and aquatic...

Evaluating Teacher Education Curricula's Facilitation of the Development of Critical Thinking Skills

ERIC Educational Resources Information Center

Tanriverdi, Belgin; Öztan Ulusoy, Yildiz; Turan, Hakan

2012-01-01

Problem Statement: The economic and social changes in the 21st century have wide-ranging consequences for education systems. To acquire necessary competencies, what learners need most is to learn to learn by reflecting critically on their learning aims. To provide this kind of learning experience, teacher education curricula should be revised to…

"The Horror" of Structural Racism: Helping Students Take a Critical Stance Using Classic Literature

ERIC Educational Resources Information Center

McCardle, Todd

2017-01-01

The goal of this piece is to provide educators with the knowledge and practical application needed to build critical literacy within their students using a traditional text that might not be considered multicultural. This essay challenges the idea that "outdated" literary works have no place in today's multicultural classroom, as it…

Designing Instruction for Critical Thinking: A Case of a Graduate Course on Evaluation of Training

ERIC Educational Resources Information Center

Darabi, Aubteen; Arrington, Thomas Logan

2017-01-01

As students graduate and enter the workforce, they face the job market's demand for critical thinking (CT) skills. The demand is caused by the market's increasing need for providing professional services that require performing complex tasks. In response to this demand, institutions of higher education are expected to prepare their graduate…

What Helps and Hinders Indigenous Student Success in Higher Education Health Programmes: A Qualitative Study Using the Critical Incident Technique

ERIC Educational Resources Information Center

Curtis, Elana; Wikaire, Erena; Kool, Bridget; Honey, Michelle; Kelly, Fiona; Poole, Phillippa; Barrow, Mark; Airini; Ewen, Shaun; Reid, Papaarangi

2015-01-01

Tertiary institutions aim to provide high quality teaching and learning that meet the academic needs for an increasingly diverse student body including indigenous students. "Tatou Tatou" is a qualitative research project utilising Kaupapa "Maori" research methodology and the Critical Incident Technique interview method to…

Space Electrochemical Research and Technology (SERT)

NASA Technical Reports Server (NTRS)

1987-01-01

The conference provided a forum to assess critical needs and technologies for the NASA electrochemical energy conversion and storage program. It was aimed at providing guidance to NASA on the appropriate direction and emphasis of that program. A series of related overviews were presented in the areas of NASA advanced mission models (space stations, low and geosynchronous Earth orbit missions, planetary missions, and space transportation). Papers were presented and workshops conducted in a variety of technical areas, including advanced rechargeables, advanced concepts, critical physical electrochemical issues, and modeling.

Activities of the DOE Nuclear Criticality Safety Program (NCSP) at the Oak Ridge Electron Linear Accelerator (ORELA)

NASA Astrophysics Data System (ADS)

Valentine, Timothy E.; Leal, Luiz C.; Guber, Klaus H.

2002-12-01

The Department of Energy established the Nuclear Criticality Safety Program (NCSP) in response to the Recommendation 97-2 by the Defense Nuclear Facilities Safety Board. The NCSP consists of seven elements of which nuclear data measurements and evaluations is a key component. The intent of the nuclear data activities is to provide high resolution nuclear data measurements that are evaluated, validated, and formatted for use by the nuclear criticality safety community to provide improved and reliable calculations for nuclear criticality safety evaluations. High resolution capture, fission, and transmission measurements are performed at the Oak Ridge Electron Linear Accelerator (ORELA) to address the needs of the criticality safety community and to address known deficiencies in nuclear data evaluations. The activities at ORELA include measurements on both light and heavy nuclei and have been used to identify improvements in measurement techniques that greatly improve the measurement of small capture cross sections. The measurement activities at ORELA provide precise and reliable high-resolution nuclear data for the nuclear criticality safety community.

INNOVATION AND RESEARCH FOR WATER INFRASTRUCTURE FOR THE 21ST CENTURY RESEARCH PLAN

EPA Science Inventory

This plan has been developed to provide the Office of Research and Development (ORD) with a guide for implementing a research program that addresses high priority needs of the Nation relating to its drinking water and wastewater infrastructure. By identifying these critical need...

What Is the Question?

ERIC Educational Resources Information Center

Woodruff, Melba D.

Second language educators need to examine in greater depth the learning processes of young children in order to provide them with the kind of teaching they need in order to really learn. This means searching other fields to learn as much as possible about: questioning strategies and the development of critical thinking skills; hemispheric…

TOOLS FOR DIAGNOSING IMPAIRMENT BY NUTRIENTS TO AQUATIC SYSTEMS

EPA Science Inventory

The main goal of this project is to provide information needed by States to set nutrient criteria at a level appropriately protective of their water bodies' aquatic life uses. The information that would be generated by this study is critically needed in order for states to use i...

Watching what widlife want and need

Treesearch

Natasha Vizcarra; Mary Rowland; Christina Vojta

2016-01-01

National forests and grasslands are home to a diverse array of wildlife. To keep tabs on the general viability and wellbeing of these inhabitants, land managers need practical, defensible monitoring protocols. Population monitoring is one method. Another is habitat monitoring, which provides critical information about the quantity and quality of key habitat attributes...

Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers

PubMed Central

Pati, Shibani; Pilia, Marcello; Grimsley, Juanita M.; Karanikas, Alexia T.; Oyeniyi, Blessing; Holcomb, John B.; Cap, Andrew P.; Rasmussen, Todd E.

2015-01-01

ABSTRACT Trauma is a leading cause of death in both military and civilian populations worldwide. Although medical advances have improved the overall morbidity and mortality often associated with trauma, additional research and innovative advancements in therapeutic interventions are needed to optimize patient outcomes. Cell-based therapies present a novel opportunity to improve trauma and critical care at both the acute and chronic phases that often follow injury. Although this field is still in its infancy, animal and human studies suggest that stem cells may hold great promise for the treatment of brain and spinal cord injuries, organ injuries, and extremity injuries such as those caused by orthopedic trauma, burns, and critical limb ischemia. However, barriers in the translation of cell therapies that include regulatory obstacles, challenges in manufacturing and clinical trial design, and a lack of funding are critical areas in need of development. In 2015, the Department of Defense Combat Casualty Care Research Program held a joint military–civilian meeting as part of its effort to inform the research community about this field and allow for effective planning and programmatic decisions regarding research and development. The objective of this article is to provide a “state of the science” review regarding cellular therapies in trauma and critical care, and to provide a foundation from which the potential of this emerging field can be harnessed to mitigate outcomes in critically ill trauma patients. PMID:26428845

Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers.

PubMed

Pati, Shibani; Pilia, Marcello; Grimsley, Juanita M; Karanikas, Alexia T; Oyeniyi, Blessing; Holcomb, John B; Cap, Andrew P; Rasmussen, Todd E

2015-12-01

Trauma is a leading cause of death in both military and civilian populations worldwide. Although medical advances have improved the overall morbidity and mortality often associated with trauma, additional research and innovative advancements in therapeutic interventions are needed to optimize patient outcomes. Cell-based therapies present a novel opportunity to improve trauma and critical care at both the acute and chronic phases that often follow injury. Although this field is still in its infancy, animal and human studies suggest that stem cells may hold great promise for the treatment of brain and spinal cord injuries, organ injuries, and extremity injuries such as those caused by orthopedic trauma, burns, and critical limb ischemia. However, barriers in the translation of cell therapies that include regulatory obstacles, challenges in manufacturing and clinical trial design, and a lack of funding are critical areas in need of development. In 2015, the Department of Defense Combat Casualty Care Research Program held a joint military-civilian meeting as part of its effort to inform the research community about this field and allow for effective planning and programmatic decisions regarding research and development. The objective of this article is to provide a "state of the science" review regarding cellular therapies in trauma and critical care, and to provide a foundation from which the potential of this emerging field can be harnessed to mitigate outcomes in critically ill trauma patients.

Agriculture: Soils

EPA Pesticide Factsheets

Productive soils, a favorable climate, and clean and abundant water resources are essential for growing crops, raising livestock, and for ecosystems to continue to provide the critical provisioning services that humans need.

Needs and experiences of intensive care patients' families: a Saudi qualitative study.

PubMed

Al-Mutair, Abbas S; Plummer, Virginia; Clerehan, Rosemary; O'Brien, Anthony

2014-05-01

To identify the perceived needs of Saudi families of patients in Intensive Care in relation to their culture and religion. Admission of a family member to an intensive care unit (ICU) is a deeply distressing and often unexpected life event to the family. Families of critically ill patients have needs that should be acknowledged and met by the ICU team. Literature is virtually silent on the issue of recognizing the ICU family needs in relation to the influence of their cultural values and religious beliefs. A descriptive exploratory qualitative study. Individual, semi-structured interviews of a purposive sample of 12 family members were carried out between November 2011 and February 2012. The closest family members were recruited to participate in the interviews with a mean age of 44·25 years in eight mixed medical-surgical ICUs of eight major trauma hospitals in Saudi Arabia. The family needs and experiences are described via six major themes: looking for information, maintaining reassurance, spiritual healing, maintaining close proximity, involvement in care and support not being facilitated. The results indicated that family members sought to access information readily to diminish their anxiety. They also needed to be reassured that the best care was being delivered to their loved one and to feel supported during this critical time. Saudi families have cultural and spiritual healing beliefs and practices including faith in God and that God is the ultimate healer, reading of the Qur'an, prayer and charity. These lessen their stress and connect them to hold on to hope. In addition, maintaining proximity to their ill family member was considered of the greatest importance to the families. The study provided an in-depth understanding of the family members' experience of having a relative in Intensive Care and focussed on a range of unmet needs, particularly those related to culture and religion. The ICU team need to work collaboratively with family members to improve their experience. The recognition of family needs, experiences and situations can enhance the care provided by the critical care team to patients and families. © 2013 British Association of Critical Care Nurses.

Children's safety initiative: a national assessment of pediatric educational needs among emergency medical services providers.

PubMed

Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

2015-01-01

Emergency medical services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps that most need to be addressed to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. The Children's Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care, including physicians, nurses, and prehospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them "highly likely" (Likert-type score 7-10 out of 10) to contribute to safety events. There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents, EMT-basics/first responders were 22%, and physicians 11.4%. The top educational priorities identified in the final round of the survey include pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform an advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseous access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. This is the first large-scale Delphi survey related to pediatric prehospital education. Our results provide foundational information related to the educational needs of prehospital providers. Medical directors and educators can use the results to shape future curricular development.

Proposal and Justification for Establishing Strategic Technology Information Analysis Center.

DTIC Science & Technology

1981-12-04

decision to establish a Strategic Technology Information Analysis Center (STIAC). This Center would provide a mission-oriented focus for Strategic Technology...SECTION 1. INTRODUCTION This proposal provides the Defense Logistic Agency with the following critical data to assist them in making the decision on...time consuming for the strategic BID community to acquire. 1.2 EVOLVING NEED FOR STIAC The need for a STIAC has been surfacing along multiple paths

Clinical review: Critical care in the global context – disparities in burden of illness, access, and economics

PubMed Central

Fowler, Robert A; Adhikari, Neill KJ; Bhagwanjee, Satish

2008-01-01

World health care expenditures exceed US $4 trillion. However, there is marked variation in global health care spending, from upwards of US $7,000 per capita in the US to under US $25 per capita in most of sub-Saharan Africa. In developed countries, care of the critically ill comprises a large proportion of health care spending; however, in developing countries, with a greater burden of both illness and critical illness, there is little infrastructure to provide care for these patients. There is sparse research to inform the needs of critically ill patients, but often basic requirements such as trained personnel, medications, oxygen, diagnostic and therapeutic equipment, reliable power supply, and safe transportation are unavailable. Why should this be a focus of intensivists of the developed world? Nearly all of those dying in developing countries would be our patients without the accident of latitude. Tailored to the needs of the region, the provision of critical care has a role, even in the context of limited preventive and primary care. Internationally and locally driven solutions are needed. We can help by recognizing the '10/90 gap' that is pervasive within global health care and our profession by educating ourselves of needs, contacting and collaborating with colleagues in the developing world, and advocating that our professional societies and funding agencies consider an increasingly global perspective in education and research. PMID:19014409

Transfusion-related immunomodulation: review of the literature and implications for pediatric critical illness.

PubMed

Muszynski, Jennifer A; Spinella, Philip C; Cholette, Jill M; Acker, Jason P; Hall, Mark W; Juffermans, Nicole P; Kelly, Daniel P; Blumberg, Neil; Nicol, Kathleen; Liedel, Jennifer; Doctor, Allan; Remy, Kenneth E; Tucci, Marisa; Lacroix, Jacques; Norris, Philip J

2017-01-01

Transfusion-related immunomodulation (TRIM) in the intensive care unit (ICU) is difficult to define and likely represents a complicated set of physiologic responses to transfusion, including both proinflammatory and immunosuppressive effects. Similarly, the immunologic response to critical illness in both adults and children is highly complex and is characterized by both acute inflammation and acquired immune suppression. How transfusion may contribute to or perpetuate these phenotypes in the ICU is poorly understood, despite the fact that transfusion is common in critically ill patients. Both hyperinflammation and severe immune suppression are associated with poor outcomes from critical illness, underscoring the need to understand potential immunologic consequences of blood product transfusion. In this review we outline the dynamic immunologic response to critical illness, provide clinical evidence in support of immunomodulatory effects of blood product transfusion, review preclinical and translational studies to date of TRIM, and provide insight into future research directions. © 2016 AABB.

Pedagogy and Practice: Providing Opportunities for Students to Develop Criticality in an Undergraduate Black Studies Course

ERIC Educational Resources Information Center

Reid, Jacqueline M.

2012-01-01

A growing number of researchers claim that diverse students with potentially diverse literacies are unable to take up the necessary literate practices to be successful in the university and upon leaving they are unable to master these literate practices, specifically the need to address critical thinking, problem-solving, and writing and to…

"Hands-On" Undergraduate Research Opportunities in the Life Sciences: Preparing the Next Generation of Biological Researchers

ERIC Educational Resources Information Center

Levis-Fitzgerald, Marc; Denson, Nida; Kerfeld, Cheryl A.

2004-01-01

Over the past decade, a number of scholars have publicly criticized large research universities for failing to provide undergraduate students with the skills and abilities needed to succeed both in life and in the workforce. At the heart of this criticism is the concern that research institutions have de-emphasized teaching by increasing the size…

Assessment team report on flight-critical systems research at NASA Langley Research Center

NASA Technical Reports Server (NTRS)

Siewiorek, Daniel P. (Compiler); Dunham, Janet R. (Compiler)

1989-01-01

The quality, coverage, and distribution of effort of the flight-critical systems research program at NASA Langley Research Center was assessed. Within the scope of the Assessment Team's review, the research program was found to be very sound. All tasks under the current research program were at least partially addressing the industry needs. General recommendations made were to expand the program resources to provide additional coverage of high priority industry needs, including operations and maintenance, and to focus the program on an actual hardware and software system that is under development.

Exploring the Relationship Between Students Needing Accommodations and Instructor Self-Efficacy in Complying with Accommodations

ERIC Educational Resources Information Center

Wright, Anna M.; Meyer, Kevin R.

2017-01-01

The willingness and flexibility of university instructors to comply with and provide accommodations for students with disabilities is critical to academic success. The authors examine how communication between students needing accommodations and university instructors impacts instructor self-efficacy, or instructors' perception that they can meet…

University Infrastructural Needs and Decisions in Moving towards Online Delivery Programmes

ERIC Educational Resources Information Center

Hillman, Susan J.; Corkery, Martha G.

2010-01-01

Successful transition into an online delivery programme requires several critical considerations. This paper provides insight with respect to initiating a systemic needs assessment from the micro to the macro level for any university moving to the online delivery of a complete programme. Moreover, the following four topics are essential in…

Intervention to Improve Expository Reading Comprehension Skills in Older Children and Adolescents with Language Disorders

ERIC Educational Resources Information Center

Ward-Lonergan, Jeannene M.; Duthie, Jill K.

2016-01-01

With the recent renewed emphasis on the importance of providing instruction to improve expository discourse comprehension and production skills, speech-language pathologists need to be prepared to implement effective intervention to meet this critical need in older children and adolescents with language disorders. The purpose of this review…

Meeting the Communication Needs of Students with Severe and Multiple Disabilities in General Education Classrooms.

ERIC Educational Resources Information Center

Downing, June E.

2001-01-01

The importance of communication skills for students with the most significant disabilities is highlighted. Specific attention is paid to the need to recognize and understand unconventional means of communication. Ideas for augmenting the student's communicative efforts are provided, and the critical importance of team collaboration is emphasized.…

What Instructional Coaches Need from Principals to Impact Teacher Effectiveness: Developing a Grounded Theory

ERIC Educational Resources Information Center

Lauer, Diane L.

2013-01-01

Principals that work with instructional coaches need to understand the conditions necessary to maximize their impact on teacher effectiveness. With any school improvement initiative, the positive presence and explicit support provided by the principal is critical to its overall success (Leithwood & Riehl, 2003; Leithwood et al, 2008; Waters,…

Interprofessional Care and Teamwork in the ICU.

PubMed

Donovan, Anne L; Aldrich, J Matthew; Gross, A Kendall; Barchas, Denise M; Thornton, Kevin C; Schell-Chaple, Hildy M; Gropper, Michael A; Lipshutz, Angela K M

2018-06-01

We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. Original articles, review articles, and systematic reviews were considered. Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.

The Critical Research Evaluation Tool (CRET): A Teaching and Learning Tool to Evaluate Research for Cultural Competence.

PubMed

Love, Katie L

The aim of this study was to present the Critical Research Evaluation Tool (CRET) which teaches evaluation of the researchers' worldview, applicability to multicultural populations, and ethics surrounding potential harms to communities. To provide best cultural care nurses' need to understand how historical/social/political experiences impact health and also influence research. The Student using the CRET reported receiving a strong foundation in research fundamentals, gaining a better understanding of critical frameworks in research, and learning more about themselves and reflecting on their own privileges and biases. The CRET provides nursing students and nursing faculty with a tool for examining diversity and ultimately decreasing health disparity.

A confidence metric for using neurobiological feedback in actor-critic reinforcement learning based brain-machine interfaces

PubMed Central

Prins, Noeline W.; Sanchez, Justin C.; Prasad, Abhishek

2014-01-01

Brain-Machine Interfaces (BMIs) can be used to restore function in people living with paralysis. Current BMIs require extensive calibration that increase the set-up times and external inputs for decoder training that may be difficult to produce in paralyzed individuals. Both these factors have presented challenges in transitioning the technology from research environments to activities of daily living (ADL). For BMIs to be seamlessly used in ADL, these issues should be handled with minimal external input thus reducing the need for a technician/caregiver to calibrate the system. Reinforcement Learning (RL) based BMIs are a good tool to be used when there is no external training signal and can provide an adaptive modality to train BMI decoders. However, RL based BMIs are sensitive to the feedback provided to adapt the BMI. In actor-critic BMIs, this feedback is provided by the critic and the overall system performance is limited by the critic accuracy. In this work, we developed an adaptive BMI that could handle inaccuracies in the critic feedback in an effort to produce more accurate RL based BMIs. We developed a confidence measure, which indicated how appropriate the feedback is for updating the decoding parameters of the actor. The results show that with the new update formulation, the critic accuracy is no longer a limiting factor for the overall performance. We tested and validated the system onthree different data sets: synthetic data generated by an Izhikevich neural spiking model, synthetic data with a Gaussian noise distribution, and data collected from a non-human primate engaged in a reaching task. All results indicated that the system with the critic confidence built in always outperformed the system without the critic confidence. Results of this study suggest the potential application of the technique in developing an autonomous BMI that does not need an external signal for training or extensive calibration. PMID:24904257

Development of Critical Profilometers to Meet Current and Future NASA Composite Overwrapped Pressure Vessel (COPV) Inspection Needs

NASA Technical Reports Server (NTRS)

Saulsberry, Regor; Nichols, Charles

2012-01-01

This project is part of a multi-center effort to develop and validate critical NDE techniques which can be implemented into current and future NASA spacecraft COPV manufacturing processes. After decades of COPV development, manufacturing variance is still high and has necessitated higher safety factors and additional mass to be flown on spacecraft (reducing overall performance). Additionally, the NASA Engineering and Safety Center (NESC) indicated that nondestructive evaluation (NDE) was not adequately implemented during Shuttle and International Space Station (ISS) COPV manufacturing and provisions were not made for on-going structural integrity and health checks during the various spacecraft programs. This project helps to provide additional data needed to help address these issues. This project seeks to develop and install internal and external laser profilometers at COPV manufacturing facilities to provide data needed to improve COPV quality and consistency. This project also investigates other scanning techniques that will enhance the system to more completely meet manufacturing needs, thus transforming the profilometer into what has been termed the "Universal Manufacturing COPV Scanner".

U.S. National Cyberstrategy and Critical Infrastructure: The Protection Mandate and Its Execution

DTIC Science & Technology

2013-09-01

revising this thesis, and balancing the coordination needed for: (1) Piano; (2) Soccer /Baseball; (3) Cubmaster Cub Scout Pack-135; (4) Hospitality...disease and pest response; and provides nutritional assistance. Provides the financial infrastructure of the nation. This sector consists of commercial

Merchants of Death: Media Violence and American Empire.

ERIC Educational Resources Information Center

Trend, David

2003-01-01

Research has done little to advance understanding of who accesses the violent imagery in popular culture. The narrow perspective provided by mass-produced media violence must be broadened by critical viewpoints that provide information people need to participate in the democratic process. (Contains 85 reference notes.) (SK)

Children’s Safety Initiative: A National Assessment of Pediatric Educational Needs amongEmergency Medical Services Providers

PubMed Central

Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

2014-01-01

Objective Emergency Medical Services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps most likely to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. Methods The Children’s Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care including physicians, nurses and pre-hospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them “highly likely” (likert-type score 7–10 out of 10) to contribute to safety events. Results There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents; EMT-Basics/first responders were 22% and physicians 11.4%. The top educational priorities identified in the final round of the survey include: pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform and advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseos access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. Conclusions This is the first large-scale Delphi survey related to pediatric pre-hospital education. Our results provide foundational information related to the educational needs of pre-hospital providers. Medical directors and educators can use the results to shape future curricular development. PMID:25296191

The Certified Clinical Nurse Leader in Critical Care.

PubMed

L'Ecuyer, Kristine M; Shatto, Bobbi J; Hoffmann, Rosemary L; Crecelius, Matthew L

2016-01-01

Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed.

Von Glaserfeld`s Radical Constructivism: A Critical Review

NASA Astrophysics Data System (ADS)

Hardy, Michael D.

We explore Ernst von Glaserfelds radical constructivism, its criticisms, and our own thoughts on what it promises for the reform of science and mathematics teaching. Our investigation reveals that many criticisms of radical constructivism are unwarranted; nevertheless, in its current cognitivist form radical constructivism may be insufficient to empower teachers to overcome objectivist cultural traditions. Teachers need to be empowered with rich understandings of philosophies of science and mathematics that endorse relativist epistemologies; for without such they are unlikely to be prepared to reconstruct their pedagogical practices. More importantly, however, is a need for a powerful social epistemology to serve as a referent for regenerating the culture of science education. We recommend blending radical constructivism with Habermas theory of communicative action to provide science teachers with a moral imperative for adopting a constructivist epistemology.

New Dental Accreditation Standard on Critical Thinking: A Call for Learning Models, Outcomes, Assessments.

PubMed

Johnsen, David C; Williams, John N; Baughman, Pauletta Gay; Roesch, Darren M; Feldman, Cecile A

2015-10-01

This opinion article applauds the recent introduction of a new dental accreditation standard addressing critical thinking and problem-solving, but expresses a need for additional means for dental schools to demonstrate they are meeting the new standard because articulated outcomes, learning models, and assessments of competence are still being developed. Validated, research-based learning models are needed to define reference points against which schools can design and assess the education they provide to their students. This article presents one possible learning model for this purpose and calls for national experts from within and outside dental education to develop models that will help schools define outcomes and assess performance in educating their students to become practitioners who are effective critical thinkers and problem-solvers.

Overview of Materials Qualification Needs for Metal Additive Manufacturing

NASA Astrophysics Data System (ADS)

Seifi, Mohsen; Salem, Ayman; Beuth, Jack; Harrysson, Ola; Lewandowski, John J.

2016-03-01

This overview highlights some of the key aspects regarding materials qualification needs across the additive manufacturing (AM) spectrum. AM technology has experienced considerable publicity and growth in the past few years with many successful insertions for non-mission-critical applications. However, to meet the full potential that AM has to offer, especially for flight-critical components (e.g., rotating parts, fracture-critical parts, etc.), qualification and certification efforts are necessary. While development of qualification standards will address some of these needs, this overview outlines some of the other key areas that will need to be considered in the qualification path, including various process-, microstructure-, and fracture-modeling activities in addition to integrating these with lifing activities targeting specific components. Ongoing work in the Advanced Manufacturing and Mechanical Reliability Center at Case Western Reserve University is focusing on fracture and fatigue testing to rapidly assess critical mechanical properties of some titanium alloys before and after post-processing, in addition to conducting nondestructive testing/evaluation using micro-computerized tomography at General Electric. Process mapping studies are being conducted at Carnegie Mellon University while large area microstructure characterization and informatics (EBSD and BSE) analyses are being conducted at Materials Resources LLC to enable future integration of these efforts via an Integrated Computational Materials Engineering approach to AM. Possible future pathways for materials qualification are provided.

Intensive care survivors' experiences of ward-based care: Meleis' theory of nursing transitions and role development among critical care outreach services.

PubMed

Ramsay, Pam; Huby, Guro; Thompson, Andrew; Walsh, Tim

2014-03-01

To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.'s mid-range theory on experiencing transitions. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Meleis et al.'s work has resonance in terms of explicating intensive care patients' experiences of psychosocial distress throughout the transition to general ward-based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed. © 2013 John Wiley & Sons Ltd.

Student’s critical thinking skills in authentic problem based learning

NASA Astrophysics Data System (ADS)

Yuliati, L.; Fauziah, R.; Hidayat, A.

2018-05-01

This study aims to determine students’ critical thinking skills in authentic problem based learning, especially on geometric optics. The study was conducted at the vocational school. The study used a quantitative descriptive method with the open question to measure critical thinking skills. The indicators of critical thinking skills measured in this study are: formulating problems, providing simple answers, applying formulas and procedures, analyzing information, making conclusions, and synthesizing ideas. The results showed that there was a positive change in students’ critical thinking skills with the average value of N-Gain test is 0.59 and effect size test is 3.73. The critical thinking skills of students need to be trained more intensively using authentic problems in daily life.

Engineer Aviation Units in the Southwest Pacific Theater During World War II

DTIC Science & Technology

2005-06-17

of sorting and distributing cargoes, and a lack of port facilities, particularly in Brisbane, Sidney, and Auckland . 89 Finally, if engineer equipment... workforce provided the Army much needed labor at USASOS supply depots and the Australian Commonwealth provided many critical supplies to U.S. forces

A/C Interface: Workstations in the Laboratory: Part II.

ERIC Educational Resources Information Center

Dessy, Raymond E., Ed.

1985-01-01

Discusses the design philosophies of four different scientific workstations. Each workstation uses a different approach and addresses different needs. The intent is to provide material that, in conjunction with part I, can provide scientists with an ability to critically evaluate the numerous commercially available scientific workstations. (JN)

Building Type Basics for Elementary and Secondary Schools.

ERIC Educational Resources Information Center

Perkins, Bradford

This book provides the essential information architects need to fast-start a school design process and shares what leading architects have learned about elementary and secondary school design. It provides critical information on the process, potential problems, design concerns, and recent trends in school design, along with complete coverage of…

Evaluating Extension-Based Adult Education for Agricultural Labor Supervisors

ERIC Educational Resources Information Center

Morera, Maria C.; Monaghan, Paul F.; Galindo-Gonzalez, Sebastian; Tovar-Aguilar, J. Antonio; Roka, Fritz M.; Asuaje, Cesar

2014-01-01

Educating farm labor supervisors about the regulations that govern agricultural operations and employment is critical to reducing unintentional violations of workplace safety and labor laws. Cooperative Extension can provide the training needed to professionalize this vital and diverse workforce. One challenge to providing adult education to a…

A Needs Assessment of Brain Death Education in Pediatric Critical Care Medicine Fellowships.

PubMed

Ausmus, Andrew M; Simpson, Pippa M; Zhang, Liyun; Petersen, Tara L

2018-04-12

To assess the current training in brain death examination provided during pediatric critical care medicine fellowship. Internet-based survey. United States pediatric critical care medicine fellowship programs. Sixty-four pediatric critical care medicine fellowship program directors and 230 current pediatric critical care medicine fellows/recent graduates were invited to participate. Participants were asked demographic questions related to their fellowship programs, training currently provided at their fellowship programs, previous experience with brain death examinations (fellows/graduates), and perceptions regarding the adequacy of current training. Twenty-nine program directors (45%) and 91 current fellows/graduates (40%) responded. Third-year fellows reported having performed a median of five examinations (interquartile range, 3-6). On a five-point Likert scale, 93% of program directors responded they "agree" or "strongly agree" that their fellows receive enough instruction on performing brain death examinations compared with 67% of fellows and graduates (p = 0.007). The responses were similar when asked about opportunity to practice brain death examinations (90% vs 54%; p < 0.001). In a regression tree analysis, number of brain death examinations performed was the strongest predictor of trainee satisfaction. Both fellows and program directors preferred bedside demonstration or simulation as educational modalities to add to the fellowship curriculum. Pediatric critical care medicine fellows overall perform relatively few brain death examinations during their training. Pediatric critical care medicine fellows and program directors disagree in their perceptions of the current training in brain death examination, with fellows perceiving a need for increased training. Both program directors and fellows prefer additional training using bedside demonstration or simulation. Since clinical exposure to brain death examinations is variable, adding simulated brain death examinations to the pediatric critical care medicine fellowship curriculum could help standardize the experience.

Proceedings of the 2016 Clinical Nutrition Week Research Workshop-The Optimal Dose of Protein Provided to Critically Ill Patients.

PubMed

Heyland, Daren K; Rooyakers, Olav; Mourtzakis, Marina; Stapleton, Renee D

2017-02-01

Recent literature has created considerable confusion about the optimal amount of protein/amino acids that should be provided to the critically ill patient. In fact, the evidentiary basis that directly tries to answer this question is relatively small. As a clinical nutrition research community, there is an urgent need to develop the optimal methods to assess the impact of exogenous protein/amino acid administration in the intensive care unit setting. That assessment can be conducted at various levels: (1) impact on stress response pathways, (2) impact on muscle synthesis and protein balance, (3) impact on muscle mass and function, and (4) impact on the patient's recovery. The objective of this research workshop was to review current literature relating to protein/amino acid administration for the critically ill patient and clinical outcomes and to discuss the key measurement and methodological features of future studies that should be done to inform the optimal protein/amino acid dose provided to critically ill patients.

School Social Workers' Needs in Supporting Adolescents with Disabilities toward Dating and Sexual Health: A Qualitative Study

ERIC Educational Resources Information Center

Adams Rueda, Heidi; Linton, Kristen F.; Williams, Lela Rankin

2014-01-01

School social workers approach their direct practice from ecological systems and justice-oriented perspectives. As such, they may hold a critical role in providing needed sexual health and dating education and services to adolescents with disabilities. Thirteen high school social workers who work closely with adolescents with disabilities were…

Enhancing Learning Environments through Solution-based Knowledge Discovery Tools: Forecasting for Self-Perpetuating Systemic Reform.

ERIC Educational Resources Information Center

Tsantis, Linda; Castellani, John

2001-01-01

This article explores how knowledge-discovery applications can empower educators with the information they need to provide anticipatory guidance for teaching and learning, forecast school and district needs, and find critical markers for making the best program decisions for children and youth with disabilities. Data mining for schools is…

Transition Strategies for Adolescents and Young Adults Who Use AAC. AAC Series

ERIC Educational Resources Information Center

McNaughton, David B., Ed.; Beukelman, David R., Ed.

2010-01-01

To make a smooth transition to a fulfilling, self-determined adult life, young people who use Augmentative-Alternative Communication (AAC) need effective services that meet their individual needs and make the most of advances in technology. Professionals will provide these critical supports with the help of this book, the first complete guide to…

Performance Support Tools: Delivering Value when and where It Is Needed

ERIC Educational Resources Information Center

McManus, Paul; Rossett, Allison

2006-01-01

Some call them Electronic Performance Support Systems (EPSSs). Others prefer Performance Support Tools (PSTs) or decision support tools. One might call EPSSs or PSTs job aids on steroids, technological tools that provide critical information or advice needed to move forward at a particular moment in time. Characteristic advantages of an EPSS or a…

Why Do Children of the Caribbean Need Programmes of Early Childhood Education and Development?

ERIC Educational Resources Information Center

Williams, Sian

This paper examines the needs of young children in the Caribbean region with an emphasis on early childhood development programs in addition to early childhood education. The paper maintains that the first 3 years of life are critical for brain development; parents and caregivers should be enabled to provide appropriate experiences, and children…

Fight Like a Butterfly: Three Critical Elements for Taking the Sting out of Professional Development

ERIC Educational Resources Information Center

Pourreau, Leslie; Shields, Kathy D.; Wright, Judy A.

2012-01-01

This paper describes the need for developing, implementing and sustaining professional development (PD) designed to provide a network of coaching support for teachers, an element of independent online study and a collaborative network of peers. Leaders recognize the importance of school structure but need to further address the impact of…

EmPOWERing Children with Learning Disabilities: A Practitioner-Based Reflection

ERIC Educational Resources Information Center

Cass, Richard J.

2011-01-01

Recent reports indicate that the expressive writing needs of students who struggle have become a critical and life-influencing problem. This article provides an overview of current research on the writing needs of students with LD and a practitioner-based reflection on the Singer and Bashir EmPOWER approach, a resource that can help teachers meet…

Human spaceflight technology needs-a foundation for JSC's technology strategy

NASA Astrophysics Data System (ADS)

Stecklein, J. M.

Human space exploration has always been heavily influenced by goals to achieve a specific mission on a specific schedule. This approach drove rapid technology development, the rapidity of which added risks and became a major driver for costs and cost uncertainty. The National Aeronautics and Space Administration (NASA) is now approaching the extension of human presence throughout the solar system by balancing a proactive yet less schedule-driven development of technology with opportunistic scheduling of missions as the needed technologies are realized. This approach should provide cost effective, low risk technology development that will enable efficient and effective manned spaceflight missions. As a first step, the NASA Human Spaceflight Architecture Team (HAT) has identified a suite of critical technologies needed to support future manned missions across a range of destinations, including in cis-lunar space, near earth asteroid visits, lunar exploration, Mars moons, and Mars exploration. The challenge now is to develop a strategy and plan for technology development that efficiently enables these missions over a reasonable time period, without increasing technology development costs unnecessarily due to schedule pressure, and subsequently mitigating development and mission risks. NASA's Johnson Space Center (JSC), as the nation's primary center for human exploration, is addressing this challenge through an innovative approach in allocating Internal Research and Development funding to projects. The HAT Technology Needs (Tech Needs) Database has been developed to correlate across critical technologies and the NASA Office of Chief Technologist Technology Area Breakdown Structure (TABS). The TechNeeds Database illuminates that many critical technologies may support a single technical capability gap, that many HAT technology needs may map to a single TABS technology discipline, and that a single HAT technology need may map to multiple TABS technology disciplines. Th- TechNeeds Database greatly clarifies understanding of the complex relationships of critical technologies to mission and architecture element needs. Extensions to the core TechNeeds Database allow JSC to factor in and appropriately weight JSC core technology competencies, and considerations of commercialization potential and partnership potential. The inherent coupling among these, along with an appropriate importance weighting, has provided an initial prioritization for allocation of technology development research funding at JSc. The HAT Technology Needs Database, with a core of built-in reports, clarifies and communicates complex technology needs for cost effective human space exploration so that an organization seeking to assure that research prioritization supports human spaceflight of the future can be successful.

Auditing the needs of recovery room staff providing care for the child in an acute hospital.

PubMed

Nicholas-Holley, J

2016-05-01

This article examines the results of an audit into recovery nurse knowledge and understanding of paediatric care standards. It will critically analyse the availability of current standards for children's services in the recovery room and discuss the need for a national document specifically dedicated to standards of practise for the care of the child in the recovery room providing immediate post operative care. The article will also look at the development of such a document.

Supporting refugee Somali Bantu mothers with children with disabilities.

PubMed

Beatson, Jean E

2013-01-01

This study sought to understand how local Somali Bantu refugee mothers perceive education or health needs of their children with disabilities. Using a grounded theory qualitative design, the investigator interviewed five Somali Bantu mothers and one father in their homes. Four predominant categories emerged from the data: Native Healing, Unmet Needs, Ongoing Challenges, and Helpful Helping. Study findings demonstrate the need for nurses and other health care providers to understand the refugee experience in raising children with special needs in Vermont. Better communication between providers and families on critical topics, such as etiology and treatment of disabilities, negotiating systems of care, and managing health and safety issues at home, is needed. The small number of participants with limited interaction is the greatest limitation of this study.

A Case Study Using Modeling and Simulation to Predict Logistics Supply Chain Issues

NASA Technical Reports Server (NTRS)

Tucker, David A.

2007-01-01

Optimization of critical supply chains to deliver thousands of parts, materials, sub-assemblies, and vehicle structures as needed is vital to the success of the Constellation Program. Thorough analysis needs to be performed on the integrated supply chain processes to plan, source, make, deliver, and return critical items efficiently. Process modeling provides simulation technology-based, predictive solutions for supply chain problems which enable decision makers to reduce costs, accelerate cycle time and improve business performance. For example, United Space Alliance, LLC utilized this approach in late 2006 to build simulation models that recreated shuttle orbiter thruster failures and predicted the potential impact of thruster removals on logistics spare assets. The main objective was the early identification of possible problems in providing thruster spares for the remainder of the Shuttle Flight Manifest. After extensive analysis the model results were used to quantify potential problems and led to improvement actions in the supply chain. Similarly the proper modeling and analysis of Constellation parts, materials, operations, and information flows will help ensure the efficiency of the critical logistics supply chains and the overall success of the program.

The impact of aging physiology in critical care.

PubMed

Walker, Mandi; Spivak, Mark; Sebastian, Mary

2014-03-01

Aging physiology greatly impacts care delivery in the geriatric patient population. Consideration should be given to addressing the patient-specific needs regarding the systemic changes seen in the aging patient. Each major body system presents its own unique challenges to the critical care practitioner, and a comprehensive understanding of these changes is necessary to effectively care for this patient population. This article summarizes these changes and provides key points for the practitioner to consider when caring for the aging patient in the critical care arena. Copyright © 2014 Elsevier Inc. All rights reserved.

Training needs assessment of service providers: targeted intervention for HIV/AIDS in Jharkhand, India.

PubMed

Kumar, Anant; Kumar, Prakash

2013-01-01

Training needs assessments are pivotal for any capacity building program. Building capacity of service providers and staff involved in HIV/AIDS intervention programs is crucial because of the distinct nature of such programs. It requires specific knowledge, skills, and attitudes that are of utmost importance, influencing the reach of the program and its impact in halting and reversing the epidemic. This study was conducted to identify the training needs assessment of personnel involved in targeted intervention for high risk populations vulnerable to HIV infection in Jharkhand, India. Through the study the authors critically examine the existing training needs and gaps and suggest strategies to address them.

Perceived support at work after critical incidents and its relation to psychological distress: a survey among prehospital providers.

PubMed

Gouweloos-Trines, Juul; Tyler, Mark P; Giummarra, Melita J; Kassam-Adams, Nancy; Landolt, Markus A; Kleber, Rolf J; Alisic, Eva

2017-12-01

Prehospital providers are at increased risk for psychological distress. Support at work after critical incidents is believed to be important for providers, but current guidelines are in need of more scientific evidence. This study aimed to investigate: (1) to what extent prehospital providers experience support at work; (2) whether support at work is directly associated with lower distress and (3) whether availability of a formal peer support system is related to lower distress via perceived colleague support. This cross-sectional study surveyed prehospital providers from eight western industrialised countries between June and November 2014. A supportive work environment was operationalised as perceived management and colleague support (Job Content Questionnaire), availability of a formal peer support system and having enough time to recover after critical incidents. The outcome variable was psychological distress (Kessler 10). We conducted multiple linear regression analyses and mediation analysis. Of the 813 respondents, more than half (56.2%) were at moderate to high risk of psychological distress. Participants did not consistently report support at work (eg, 39.4% were not aware of formal peer support). Perceived management support (b (unstandardised regression coefficient)=-0.01, 95% CI -0.01 to 0.00), having enough time to recover after critical incidents (b=-0.07, 95% CI -0.09 to -0.04) and perceived colleague support (b=-0.01, 95% CI -0.01 to 0.00) were related to lower distress. Availability of formal peer support was indirectly related to lower distress via increased perceived colleague support (β=-0.04, 95% CI -0.02 to -0.01). Prehospital providers at risk of psychological distress may benefit from support from colleagues and management and from having time to recover after critical incidents. Formal peer support may assist providers by increasing their sense of support from colleagues. These findings need to be verified in a longitudinal design. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis.

PubMed

Lacson, Ronilda; O'Connor, Stacy D; Sahni, V Anik; Roy, Christopher; Dalal, Anuj; Desai, Sonali; Khorasani, Ramin

2016-07-01

Optimal critical test result communication is a Joint Commission national patient safety goal and requires documentation of closed-loop communication among care providers in the medical record. Electronic alert notification systems can facilitate an auditable process for creating alerts for transmission and acknowledgement of critical test results. We evaluated the impact of a patient safety initiative with an alert notification system on reducing critical results lacking documented communication, and assessed potential overuse of the alerting system for communicating results. We implemented an alert notification system-Alert Notification of Critical Results (ANCR)-in January 2010. We reviewed radiology reports finalised in 2009-2014 which lacked documented communication between the radiologist and another care provider, and assessed the impact of ANCR on the proportion of such reports with critical findings, using trend analysis over 10 semiannual time periods. To evaluate potential overuse of ANCR, we assessed the proportion of reports with non-critical results among provider-communicated reports. The proportion of reports with critical results among reports without documented communication decreased significantly over 4 years (2009-2014) from 0.19 to 0.05 (p<0.0001, Cochran-Armitage trend test). The proportion of provider-communicated reports with non-critical results remained unchanged over time before and after ANCR implementation (0.20 to 0.15, p=0.45, Cochran-Armitage trend test). A patient safety initiative with an alert notification system reduced the proportion of critical results among reports lacking documented communication between care providers. We observed no change in documented communication of non-critical results, suggesting the system did not promote overuse. Future studies are needed to evaluate whether such systems prevent subsequent patient harm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effective depth of soil compaction : [brief].

DOT National Transportation Integrated Search

2015-05-01

The Wisconsin Department of Transportation (WisDOT) spends approximately 10 percent of : its improvement project budget on embankment construction each year. A critical aspect of : embankment construction is stability. It is needed to provide an acce...

Effect of the essentials of critical care orientation (ECCO) program on the development of nurses' critical thinking skills.

PubMed

Kaddoura, Mahmoud A

2010-09-01

It is essential for nurses to develop critical thinking skills to ensure their ability to provide safe and effective care to patients with complex and variable needs in ever-changing clinical environments. To date, very few studies have been conducted to examine how nursing orientation programs develop the critical thinking skills of novice critical care nurses. Strikingly, no research studies could be found about the American Association of Critical Care Nurses Essentials of Critical Care Orientation (ECCO) program and specifically its effect on the development of nurses' critical thinking skills. This study explored the perceptions of new graduate nurses regarding factors that helped to develop their critical thinking skills throughout their 6-month orientation program in the intensive care unit. A convenient non-probability sample of eight new graduates was selected from a hospital that used the ECCO program. Data were collected with demographic questionnaires and semi-structured interviews. An exploratory qualitative research method with content analysis was used to analyze the data. The study findings showed that new graduate nurses perceived that they developed critical thinking skills that improved throughout the orientation period, although there were some challenges in the ECCO program. This study provides data that could influence the development and implementation of future nursing orientation programs. Copyright 2010, SLACK Incorporated.

Constructing Voices through Lived-Experiences: A Phenomenological Study of Novice Reading--Teachers' Personal Understanding of Pedagogical Ownership and Professional Identity

ERIC Educational Resources Information Center

Durham, Patricia Marie Gonzales

2012-01-01

It is in the best interest of the American educational system that novice reading teachers be provided with the opportunity for ownership of their pedagogy and be enabled to forge an identity that legitimatize them as an integral part of the educational arena. Nurturing a teacher's critical self and critical pedagogy will address the needs of the…

Review of battery powered embedded systems design for mission-critical low-power applications

NASA Astrophysics Data System (ADS)

Malewski, Matthew; Cowell, David M. J.; Freear, Steven

2018-06-01

The applications and uses of embedded systems is increasingly pervasive. Mission and safety critical systems relying on embedded systems pose specific challenges. Embedded systems is a multi-disciplinary domain, involving both hardware and software. Systems need to be designed in a holistic manner so that they are able to provide the desired reliability and minimise unnecessary complexity. The large problem landscape means that there is no one solution that fits all applications of embedded systems. With the primary focus of these mission and safety critical systems being functionality and reliability, there can be conflicts with business needs, and this can introduce pressures to reduce cost at the expense of reliability and functionality. This paper examines the challenges faced by battery powered systems, and then explores at more general problems, and several real-world embedded systems.

Educating Against Extremism: Towards a Critical Politicisation of Young People

NASA Astrophysics Data System (ADS)

Davies, Lynn

2009-05-01

This paper is based on a recently published book, Educating Against Extremism (Davies, Educating Against Extremism, 2008), which explores the potential role of schools in averting the more negative and violent forms of extremism in a country. It examines the nature of extremism; identity formation and radicalisation; religious belief, faith schools and the myth of equal value; justice, revenge and honour; and free speech, humour and satire. The paper argues that religious fundamentalism, as well as state terrorism, needs to be addressed in schools. The argument in the book is for a greater politicisation of young people through the forging of critical (dis)respect and the use of a secular basis of human rights. Specific forms of citizenship education are needed, which provide skills to analyse the media and political or religious messages, but also enable critical idealism to be fostered.

Evaluating clinical librarian services: a systematic review.

PubMed

Brettle, Alison; Maden-Jenkins, Michelle; Anderson, Lucy; McNally, Rosalind; Pratchett, Tracey; Tancock, Jenny; Thornton, Debra; Webb, Anne

2011-03-01

  Previous systematic reviews have indicated limited evidence and poor quality evaluations of clinical librarian (CL) services. Rigorous evaluations should demonstrate the value of CL services, but guidance is needed before this can be achieved.   To undertake a systematic review which examines models of CL services, quality, methods and perspectives of clinical librarian service evaluations.   Systematic review methodology and synthesis of evidence, undertaken collaboratively by a group of 8 librarians to develop research and critical appraisal skills.   There are four clear models of clinical library service provision. Clinical librarians are effective in saving health professionals time, providing relevant, useful information and high quality services. Clinical librarians have a positive effect on clinical decision making by contributing to better informed decisions, diagnosis and choice of drug or therapy. The quality of CL studies is improving, but more work is needed on reducing bias and providing evidence of specific impacts on patient care. The Critical Incident Technique as part of a mixed method approach appears to offer a useful approach to demonstrating impact.   This systematic review provides practical guidance regarding the evaluation of CL services. It also provides updated evidence regarding the effectiveness and impact of CL services. The approach used was successful in developing research and critical appraisal skills in a group of librarians. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

Film Music: Implications for Instructional Films and Television.

ERIC Educational Resources Information Center

Hlynka, D.

This paper provides a critical review of the behavioral research on film music, indicates that there is a visual bias in media attribute research which needs to be balanced, and provides media producers and instructional developers with a theoretical basis and practical guidelines for using music in audiovisual presentations. The question of film…

Online English Language Learning: Theory-Based Course Design and Pedagogy

ERIC Educational Resources Information Center

Andrade, Maureen Snow

2017-01-01

The demand for higher education is increasing worldwide. To meet this demand, and to provide increased access, flexible forms of delivery are needed. Although online courses are criticized for a lack of interaction, when intentionally designed, they can provide learners with opportunities for collaboration that supports the achievement of desired…

Integration of Mobile Health Technology in the Treatment of Chronic Pain: A Critical Review.

PubMed

Sundararaman, Lalitha V; Edwards, Robert R; Ross, Edgar L; Jamison, Robert N

This article provides a critical overview and best-evidence synthesis of the use of mobile health (mHealth) technology among persons with chronic pain and their health care providers and examines the future benefits and barriers of implementing mHealth technology in clinical care. We critically review articles about electronic pain diaries, pain assessment programs, text messaging, and smartphone pain apps for management of persons with pain. Also presented are findings on the utility of activity trackers and use of telehealth to deliver cognitive behavioral therapy. Finally, barriers, study gaps, and future challenges of incorporating mobile technology for chronic pain are discussed. Although the future of mHealth technology and telemedicine in clinical practice is promising, this critical review highlights the need for rigorous studies to establish an association of the use of mHealth technology with improved quality of life, functional autonomy, and decreased hospital use.

Development of an intensive care unit resource assessment survey for the care of critically ill patients in resource-limited settings.

PubMed

Leligdowicz, Aleksandra; Bhagwanjee, Satish; Diaz, Janet V; Xiong, Wei; Marshall, John C; Fowler, Robert A; Adhikari, Neill Kj

2017-04-01

Capacity to provide critical care in resource-limited settings is poorly understood because of lack of data about resources available to manage critically ill patients. Our objective was to develop a survey to address this issue. We developed and piloted a cross-sectional self-administered survey in 9 resource-limited countries. The survey consisted of 8 domains; specific items within domains were modified from previously developed survey tools. We distributed the survey by e-mail to a convenience sample of health care providers responsible for providing care to critically ill patients. We assessed clinical sensibility and test-retest reliability. Nine of 15 health care providers responded to the survey on 2 separate occasions, separated by 2 to 4 weeks. Clinical sensibility was high (3.9-4.9/5 on assessment tool). Test-retest reliability for questions related to resource availability was acceptable (intraclass correlation coefficient, 0.94; 95% confidence interval, 0.75-0.99; mean (SD) of weighted κ values = 0.67 [0.19]). The mean (SD) time for survey completion survey was 21 (16) minutes. A reliable cross-sectional survey of available resources to manage critically ill patients can be feasibly administered to health care providers in resource-limited settings. The survey will inform future research focusing on access to critical care where it is poorly described but urgently needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Professional Development, Capacity Building, and Research Needs: Critical Issues for Response to Intervention Implementation

ERIC Educational Resources Information Center

Danielson, Louis; Doolittle, Jennifer; Bradley, Renee

2007-01-01

The No Child Left Behind Act of 2001 in conjunction with the Individuals With Disabilities Education Act amendments of 2004 (IDEA) have created incentives to improve how K-12 instruction is provided and to improve the achievement of all students, including those with disabilities. To reach these goals, however, a thorough research base is needed,…

What Is Education For? A Discussion of Nussbaum's "Not for Profit: Why Democracy Needs the Humanities"

ERIC Educational Resources Information Center

Lin, Jing

2016-01-01

This article provides a discussion of the book, "Not for Profit: Why Democracy Needs the Humanities" by Martha C. Nussbaum from the perspective of a visiting scholar to the United States from China. It begins by addressing two critical topics discussed by Nussbaum: consequences of focusing only on economic growth and the importance of…

Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

PubMed

Moore, Bethany; Bone, Eric A

2017-01-01

The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

Radiopharmaceuticals drug interactions: a critical review.

PubMed

Santos-Oliveira, Ralph; Smith, Sheila W; Carneiro-Leão, Ana Maria A

2008-12-01

Radiopharmaceuticals play a critical role in modern medicine primarily for diagnostic purposes, but also for monitoring disease progression and response to treatment. As the use of image has been increased, so has the use of prescription medications. These trends increase the risk of interactions between medications and radiopharmaceuticals. These interactions which have an impact on image by competing with the radiopharmaceutical for binding sites for example can lead to false negative results. Drugs that accelerate the metabolism of the radiopharmaceutical can have a positive impact (i.e. speeding its clearance) or, if repeating image is needed, a negative impact. In some cases, for example in cardiac image among patients taking doxirubacin, these interactions may have a therapeutic benefit. The incidence of drug-radiopharmaceuticals adverse reactions is unknown, since they may not be reported or even recognized. Here,we compiled the medical literature, using the criteria of a systematic review established by the Cochrane Collaboration, on pharmaceutical-drug interactions to provide a summary of documented interactions by organ system and radiopharmaceuticals. The purpose is to provide a reference on drug interactions that could inform the nuclear medicine staff in their daily routine. Efforts to increase adverse event reporting, and ideally consolidate reports worldwide, can provide a critically needed resource for prevention of drug-radiopharmaceuticals interactions.

Critical care nurses' experiences of nursing mothers in an ICU after complicated childbirth.

PubMed

Engström, Asa; Lindberg, Inger

2013-09-01

Providing nursing care for a critically ill obstetric patient or a patient who has just become a mother after a complicated birth can be a challenging experience for critical care nurses (CCNs). These patients have special needs because of the significant alterations in their physiology and anatomy together with the need to consider such specifics as breastfeeding and mother-child bonding. The aim with this study was to describe CCNs' experience of nursing the new mother and her family after a complicated childbirth. The design of the study was qualitative. Data collection was carried out through focus group discussions with 13 CCNs in three focus groups during spring 2012. The data were subjected to qualitative content analysis. The analysis resulted in the formulation of four categories: the mother and her vital functions are prioritized; not being responsible for the child and the father; an environment unsuited to the new family and collaboration with staff in neonatal and maternity delivery wards. When nursing a mother after a complicated birth the CCNs give her and her vital signs high priority. The fathers of the children or partners of the mothers are expected to take on the responsibility of caring for the newborn child and of being the link with the neonatal ward. It is suggested that education about the needs of new families for nursing care would improve the situation and have clinical implications. Whether the intensive care unit is always the best place in which to provide care for mothers and new families is debatable. © 2013 British Association of Critical Care Nurses.

"Tuberculosis Case Management" Training.

ERIC Educational Resources Information Center

Knebel, Elisa; Kolodner, Jennifer

2001-01-01

The need to isolated health providers with critical knowledge in tuberculosis (TB) case management prompted the development of "Tuberculosis Case Management" CD-ROM. Features include "Learning Center,""Examination Room," and "Library." The combination of audio, video, and graphics allows participants to…

Spiritual Care in the Intensive Care Unit: A Narrative Review.

PubMed

Ho, Jim Q; Nguyen, Christopher D; Lopes, Richard; Ezeji-Okoye, Stephen C; Kuschner, Ware G

2018-05-01

Spiritual care is an important component of high-quality health care, especially for critically ill patients and their families. Despite evidence of benefits from spiritual care, physicians and other health-care providers commonly fail to assess and address their patients' spiritual care needs in the intensive care unit (ICU). In addition, it is common that spiritual care resources that can improve both patient outcomes and family member experiences are underutilized. In this review, we provide an overview of spiritual care and its role in the ICU. We review evidence demonstrating the benefits of, and persistent unmet needs for, spiritual care services, as well as the current state of spiritual care delivery in the ICU setting. Furthermore, we outline tools and strategies intensivists and other critical care medicine health-care professionals can employ to support the spiritual well-being of patients and families, with a special focus on chaplaincy services.

The need for a robust 24/7 subspecialty "clearing house" response for telementored trauma care.

PubMed

Kirkpatrick, Andrew W; Hamilton, Douglas; Beckett, Andrew; LaPorta, Anthony; Brien, Susan; Glassberg, Elon; Ball, Chad G; Roberts, Derek J; Tien, Homer

2015-06-01

Traumatic injury is increasing in importance in all settings and environments worldwide. Many preventable deaths are from conditions that are common and treatable. However, as potentially lethal injuries often induce progressive and frequently irreversible physiologic decline, the timing of interventions is critical. Invasive treatments may need to be offered by prehospital care providers who lack extensive training and practice. Telementoring allows experienced experts to guide less experienced providers remotely using information technology (IT). Early experience has shown that these techniques are practical and considered valuable. Their translation to regular practice, however, will require the immediate availability of appropriately trained remote experts willing to serve as mentors. Acute care trauma specialists are acclimatized to responding to out-of-hospital consultations and assuming overall responsibility for critical physiology and transport and may serve as the backbone of such a national/ international call response initiative.

Nuclear Data Activities in Support of the DOE Nuclear Criticality Safety Program

NASA Astrophysics Data System (ADS)

Westfall, R. M.; McKnight, R. D.

2005-05-01

The DOE Nuclear Criticality Safety Program (NCSP) provides the technical infrastructure maintenance for those technologies applied in the evaluation and performance of safe fissionable-material operations in the DOE complex. These technologies include an Analytical Methods element for neutron transport as well as the development of sensitivity/uncertainty methods, the performance of Critical Experiments, evaluation and qualification of experiments as Benchmarks, and a comprehensive Nuclear Data program coordinated by the NCSP Nuclear Data Advisory Group (NDAG). The NDAG gathers and evaluates differential and integral nuclear data, identifies deficiencies, and recommends priorities on meeting DOE criticality safety needs to the NCSP Criticality Safety Support Group (CSSG). Then the NDAG identifies the required resources and unique capabilities for meeting these needs, not only for performing measurements but also for data evaluation with nuclear model codes as well as for data processing for criticality safety applications. The NDAG coordinates effort with the leadership of the National Nuclear Data Center, the Cross Section Evaluation Working Group (CSEWG), and the Working Party on International Evaluation Cooperation (WPEC) of the OECD/NEA Nuclear Science Committee. The overall objective is to expedite the issuance of new data and methods to the DOE criticality safety user. This paper describes these activities in detail, with examples based upon special studies being performed in support of criticality safety for a variety of DOE operations.

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

Allcorn, Eric

Lithium-ion battery safety is a critical issue in the adoption of the chemistry to larger scale applications such as transportation and stationary storage. One of the critical components impacting the safety of lithium-ion batteries is their use of highly flammable organic electrolytes. In this work, brominated flame retardants (BFR’s) – an existing class of flame retardant materials – are incorporated as additives to lithium-ion battery electrolytes with the intention to reduce the electrolyte flammability and thereby improve safety. There are a few critical needs for a successful electrolyte additive: solubility in the electrolyte, electrochemical stability over the range of batterymore » operation, and minimal detrimental effects on battery performance. Those detrimental effects can take the form of electrolyte specific impacts, such as a reduction in conductivity, or electrode impacts, such as SEI-layer modification or chemical instability to the active material. In addition to these needs, the electrolyte additive also needs to achieve its intended purpose, which in this case is to reduce the flammability of the electrolyte. For the work conducted as part of this SPP agreement three separate BFR materials were provided by Albemarle to be tested by Sandia as additives in a traditional lithium-ion battery electrolyte. The provided BFR materials were tribromo-neopentyl alcohol, tetrabromo bisphenol A, and tribromoethylene. These materials were incorporated as separate 4 wt.% additives into a traditional lithium-ion battery electrolyte and compared to said traditional electrolyte, designated Gen2.« less

Searching for scientific literacy and critical pedagogy in socioscientific curricula: A critical discourse analysis

NASA Astrophysics Data System (ADS)

Cummings, Kristina M.

The omnipresence of science and technology in our society require the development of a critical and scientifically literate citizenry. However, the inclusion of socioscientific issues, which are open-ended controversial issues informed by both science and societal factors such as politics, economics, and ethics, do not guarantee the development of these skills. The purpose of this critical discourse analysis is to identify and analyze the discursive strategies used in intermediate science texts and curricula that address socioscientific topics and the extent to which the discourses are designed to promote or suppress the development of scientific literacy and a critical pedagogy. Three curricula that address the issue of energy and climate change were analyzed using Gee's (2011) building tasks and inquiry tools. The curricula were written by an education organization entitled PreSEES, a corporate-sponsored group called NEED, and a non-profit organization named Oxfam. The analysis found that the PreSEES and Oxfam curricula elevated the significance of climate change and the NEED curriculum deemphasized the issue. The PreSEES and Oxfam curricula promoted the development of scientific literacy while the NEED curricula suppressed its development. The PreSEES and Oxfam curricula both promoted the development of the critical pedagogy; however, only the Oxfam curricula provided authentic opportunities to enact sociopolitical change. The NEED curricula suppressed the development of critical pedagogy. From these findings, the following conclusions were drawn. When socioscientific issues are presented with the development of scientific literacy and critical pedagogy, the curricula allow students to develop fact-based opinions about the issue. However, curricula that address socioscientific issues without the inclusion of these skills minimize the significance of the issue and normalize the hegemonic worldview promoted by the curricula's authors. Based on these findings, additional research is necessary to confirm the connection between the way curricula address a socioscientific issue and develop or suppress scientific literacy. Additionally, further analysis is necessary to confirm the connection between corporate-sponsored curricula and the suppression of socioscientific issues, scientific literacy, and critical pedagogy. Finally, this study addressed only the intended results of the curricula. Further research is necessary to measure the actual impacts of these curricula on students.

Benefit cost models to support pavement management decisions.

DOT National Transportation Integrated Search

2012-06-01

A critical role of pavement management is to provide decision makers with estimates of the required budget level to achieve specific steady-state network conditions, and to recommend the best allocation of available budget among competing needs for m...

Fixture facilitates soldering operations

NASA Technical Reports Server (NTRS)

White, C. M.

1968-01-01

Soldering fixture, designed for printed circuit cards, is a basic bench-mounted, self-contained integral unit combining all soldering needs into a compact, readily available work station. All tools, materials, and accessories are available to provide an ideal station to perform critical soldering.

Exploratory Usability Testing of User Interface Options in LibGuides 2

ERIC Educational Resources Information Center

Thorngate, Sarah; Hoden, Allison

2017-01-01

Online research guides offer librarians a way to provide digital researchers with point-of-need support. If these guides are to support student learning well, it is critical that they provide an effective user experience. This article details the results of an exploratory comparison study that tested three key user interface options in LibGuides…

Triple Science GCSEs: Curriculum Planning and Design. GCSEs in Biology, Chemistry and Physics

ERIC Educational Resources Information Center

Morris, Pam; Quill, John

2007-01-01

This publication will provide managers and others with practical advice on how to plan, develop and model the Triple Science requirement, taking into account all the critical factors that need to be considered. This guidance concentrates on curriculum planning and design, including the use of the new (2006) specifications to provide Triple Science…

Overlooked and Understudied? A Survey of Current Trends in Research on Adult English Language Learners

ERIC Educational Resources Information Center

Mathews-Aydinli, Julie

2008-01-01

This article provides a synthesis and review of 41 recent research studies focusing on the population of adult English language learners (ELLs) studying in nonacademic contexts. It notes the unique qualities and importance of understanding the English-language needs of this population, provides a critical overview of the existing literature, and…

Offshore Wind Resource Characterization | Wind | NREL

Science.gov Websites

identify critical data needed. Remote Sensing and Modeling Photo of the SeaZephIR Prototype at sea. 2009 techniques such as remote sensing and modeling to provide data on design conditions. Research includes comparing the data provided by remote sensing devices and models to data collected by traditional methods

Models of Technology Management at the Community College: The Role of the Chief Information Officer

ERIC Educational Resources Information Center

Armstrong, Scott; Simer, Lauren; Spaniol, Lee

2011-01-01

Community colleges provide a wide range of educational services to very diverse groups of students. For that reason, the variety and flexibility of services provided can be critical. In addition, quickly changing needs result in quickly changing system requirements. In this chapter, community college CIOs speak to their roles, focusing on the…

Understanding and Using Fiscal Data: A Guide for Part C State Staff

ERIC Educational Resources Information Center

Greer, Maureen; Kilpatrick, Jamie; Nelson, Robin; Reid, Kellen

2014-01-01

This document provides an overview of the critical role of fiscal data in state Part C systems. This information is intended to help state Part C lead agency staff better understand strategic fiscal policy questions, the fiscal data elements needed to address those questions, and the benefits of using these data. Fiscal data provide powerful…

The European cooperative approach to securing critical information infrastructure.

PubMed

Purser, Steve

2011-10-01

This paper provides an overview of the EU approach to securing critical information infrastructure, as defined in the Action Plan contained in the Commission Communication of March 2009, entitled 'Protecting Europe from large-scale cyber-attacks and disruptions: enhancing preparedness, security and resilience' and further elaborated by the Communication of May 2011 on critical Information infrastructure protection 'Achievements and next steps: towards global cyber-security'. After explaining the need for pan-European cooperation in this area, the CIIP Action Plan is explained in detail. Finally, the current state of progress is summarised together with the proposed next steps.

Divine Interventions: Needs Analysis for Post-Graduate Academic Literacy and Curriculum Development, in a South African School of Theology

ERIC Educational Resources Information Center

Jackson, Fiona

2005-01-01

This paper provides a critical exploration of work in progress to develop a genre based academic support that promotes post-graduate academic literacies among new EIL and EAL Hons and Masters students in the School of Theology, University of Natal, Pietermaritzburg. It traces the path of an action research project, using an eclectic needs analysis…

Pattern Generator for Bench Test of Digital Boards

NASA Technical Reports Server (NTRS)

Berkun, Andrew C.; Chu, Anhua J.

2012-01-01

All efforts to develop electronic equipment reach a stage where they need a board test station for each board. The SMAP digital system consists of three board types that interact with each other using interfaces with critical timing. Each board needs to be tested individually before combining into the integrated digital electronics system. Each board needs critical timing signals from the others to be able to operate. A bench test system was developed to support test of each board. The test system produces all the outputs of the control and timing unit, and is delivered much earlier than the timing unit. Timing signals are treated as data. A large file is generated containing the state of every timing signal at any instant. This file is streamed out to an IO card, which is wired directly to the device-under-test (DUT) input pins. This provides a flexible test environment that can be adapted to any of the boards required to test in a standalone configuration. The problem of generating the critical timing signals is then transferred from a hardware problem to a software problem where it is more easily dealt with.

The failure of AHERF: 5 important lessons.

PubMed

Goldstein, Lisa

2008-08-01

Important lessons from AHERF's downfall: Strong governance and oversight of management are needed to ensure accountability; Disciplined growth strategies need to be supported by rigorous financial planning and feasibility analysis; Physician integration is critical to grow market share, but needs to be methodical and measured; Robust information systems are necessary to manage costs, maximize revenue, and provide differentiation in quality and clinical outcomes; Disclosure of the financial performance of all of a health system's operations creates greater transparency and builds credibility.

A systematic review of advance practice providers in acute care: options for a new model in a burn intensive care unit.

PubMed

Edkins, Renee E; Cairns, Bruce A; Hultman, C Scott

2014-03-01

Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges? We performed a systematic review of PubMed, CINAHL, Ovid, and Google Scholar, from 2002 to 2012, using the key words: nurse practitioner, physician assistant, critical care, and burn care. After applying inclusion/exclusion criteria, 18 relevant articles were selected for review. In addition, throughput and financial models were developed to examine provider staffing patterns. Advanced practice providers in critical care settings function in various models, both with and without residents, reporting to either an intensivist or an attending physician. When APPs participated, patient outcomes were similar or improved compared across provider models. Several studies reported considerable cost-savings due to decrease length of stay, decreased ventilator days, and fewer urinary tract infections when nurse practitioners were included in the provider mix. Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.

CELLULAR UPTAKE AND TOXICITY OF DENDRITIC NANOMATERIALS: AN INTEGRATED PHYSICOCHEMICAL AND TOXICOGENOMICS STUDY

EPA Science Inventory

The successful completion of this project is expected to provide industry with critical data and predictive tools needed to assess the health and environmental impact of dendritic nanomaterials such as EDA core PAMAM dendrimers.

Airborne multispectral detection of regrowth cotton fields

USDA-ARS?s Scientific Manuscript database

Regrowth of cotton, Gossypium hirsutum L., can provide boll weevils, Anthonomus grandis Boheman, with an extended opportunity to feed and reproduce beyond the production season. Effective methods for timely areawide detection of these potential host plants are critically needed to achieve eradicati...

Equality Matters: The Critical Implications of Precisely Defining Equality

ERIC Educational Resources Information Center

Faulkner, Valerie; Walkowiak, Temple; Cain, Chris; Lee, Carrie

2016-01-01

Equality is such an important concept for children to develop. In this article it is argued that a precise definition is needed to ensure that students are provided with a consistent "picture" of what it is that equality really means.

Muslim women's narratives about bodily change and care during critical illness: a qualitative study.

PubMed

Zeilani, Ruqayya; Seymour, Jane E

2012-03-01

To explore experiences of Jordanian Muslim women in relation to bodily change during critical illness. A longitudinal narrative approach was used. A purposive sample of 16 Jordanian women who had spent a minimum of 48 hr in intensive care participated in one to three interviews over a 6-month period. Three main categories emerged from the analysis: the dependent body reflects changes in the women's bodily strength and performance, as they moved from being care providers into those in need of care; this was associated with experiences of a sense of paralysis, shame, and burden. The social body reflects the essential contribution that family help or nurses' support (as a proxy for family) made to women's adjustment to bodily change and their ability to make sense of their illness. The cultural body reflects the effect of cultural norms and Islamic beliefs on the women's interpretation of their experiences and relates to the women's understandings of bodily modesty. This study illustrates, by in-depth focus on Muslim women's narratives, the complex interrelationship between religious beliefs, cultural norms, and the experiences and meanings of bodily changes during critical illness. This article provides insights into vital aspects of Muslim women's needs and preferences for nursing care. It highlights the importance of including an assessment of culture and spiritual aspects when nursing critically ill patients. © 2011 Sigma Theta Tau International.

CE: critical care recovery center: an innovative collaborative care model for ICU survivors.

PubMed

Khan, Babar A; Lasiter, Sue; Boustani, Malaz A

2015-03-01

Five million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed. To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post-critical illness morbidities and improving the ICU survivor's quality of life.

Auditory fitness for duty: a review.

PubMed

Tufts, Jennifer B; Vasil, Kristin A; Briggs, Sarah

2009-10-01

Auditory fitness for duty (AFFD) refers to the possession of hearing abilities sufficient for safe and effective job performance. In jobs such as law enforcement and piloting, where the ability to hear is critical to job performance and safety, hearing loss can decrease performance, even to the point of being hazardous to self and others. Tests of AFFD should provide an employer with a valid assessment of an employee's ability to perform the job safely, without discriminating against the employee purely on the basis of hearing loss. The purpose of this review is to provide a basic description of the functional hearing abilities required in hearing-critical occupations, and a summary of current practices in AFFD evaluation. In addition, we suggest directions for research and standardization to ensure best practices in the evaluation of AFFD in the future. We conducted a systematic review of the English-language peer-reviewed literature in AFFD. "Popular" search engines were consulted for governmental regulations and trade journal articles. We also contacted professionals with expertise in AFFD regarding research projects, unpublished material, and current standards. The literature review provided information regarding the functional hearing abilities required to perform hearing-critical tasks, the development of and characteristics of AFFD protocols, and the current implementation of AFFD protocols. This review paper provides evidence of the need to institute job-specific AFFD protocols, move beyond the pure-tone audiogram, and establish the validity of test protocols. These needs are arguably greater now than in times past.

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

Michael Schmitt; Juan Deaton; Curt Papke

In the event of large-scale natural or manmade catastrophic events, access to reliable and enduring commercial communication systems is critical. Hurricane Katrina provided a recent example of the need to ensure communications during a national emergency. To ensure that communication demands are met during these critical times, Idaho National Laboratory (INL) under the guidance of United States Strategic Command has studied infrastructure issues, concerns, and vulnerabilities associated with an airborne wireless communications capability. Such a capability could provide emergency wireless communications until public/commercial nodes can be systematically restored. This report focuses on the airborne cellular restoration concept; analyzing basic infrastructuremore » requirements; identifying related infrastructure issues, concerns, and vulnerabilities and offers recommended solutions.« less

Reflective thinking and medical students: some thoughtful distillations regarding John Dewey and Hannah Arendt.

PubMed

Papadimos, Thomas J

2009-04-16

Reflective thought (critical thinking) is essential to the medical student who hopes to become an effective physician. John Dewey, one of America's foremost educators in the early twentieth century, revolutionized critical thinking and its role in education. In the mid twentieth century Hannah Arendt provided profound insights into the problem of diminishing human agency and political freedom. Taken together, Dewey's insight regarding reflective thought, and Arendt's view of action, speech, and power in the public realm, provide mentors and teachers of medical students guidance in the training of thought and the need for its effective projection at the patient's bedside and in the community.

The link between national security and biometrics

NASA Astrophysics Data System (ADS)

Etter, Delores M.

2005-03-01

National security today requires identification of people, things and activities. Biometrics plays an important role in the identification of people, and indirectly, in the identification of things and activities. Therefore, the development of technology and systems that provide faster and more accurate biometric identification is critical to the defense of our country. In addition, the development of a broad range of biometrics is necessary to provide the range of options needed to address flexible and adaptive adversaries. This paper will discuss the importance of a number of critical areas in the development of an environment to support biometrics, including research and development, biometric education, standards, pilot projects, and privacy assurance.

Zika Virus: Critical Information for Emergency Providers.

PubMed

Shastry, Siri; Koenig, Kristi L; Hirshon, Jon Mark

2016-08-01

Zika virus is an arbovirus of the Flaviviridae family. It is primarily a minimally symptomatic mosquito-borne infection. However, with Zika's 2015 to 2016 introduction into the Western Hemisphere and its dramatic and rapid spread, it has become a public health concern, in large part due to congenital abnormalities associated with infection in pregnant women. In early 2016, the World Health Organization declared the microcephaly and other neurologic conditions associated with Zika virus infection a public health emergency of international concern. This article discusses the current epidemiologic and clinical understanding of Zika virus, focusing on critical information needed by emergency providers. Copyright © 2016 Elsevier Inc. All rights reserved.

Preparing for Human Exploration

NASA Technical Reports Server (NTRS)

Drake, Bret G.; Joosten, B. Kent

1998-01-01

NASA's Human Exploration and Development of Space (HEDS) Enterprise is defining architectures and requirements for human exploration that radically reduce the costs of such missions through the use of advanced technologies, commercial partnerships and innovative systems strategies. In addition, the HEDS Enterprise is collaborating with the Space Science Enterprise to acquire needed early knowledge about Mars and to demonstrate critical technologies via robotic missions. This paper provides an overview of the technological challenges facing NASA as it prepares for human exploration. Emphasis is placed on identifying the key technologies including those which will provide the most return in terms of reducing total mission cost and/or reducing potential risk to the mission crew. Top-level requirements are provided for those critical enabling technology options currently under consideration.

Comprehensive assessment of critical care needs in a community hospital*.

PubMed

Sarti, Aimee J; Sutherland, Stephanie; Landriault, Angèle; Fothergill-Bourbonnais, Frances; Bouali, Redouane; Willett, Timothy; Hamstra, Stanley J; Cardinal, Pierre

2014-04-01

To design and implement a needs assessment process that identifies gaps in caring for critically ill patients in a community hospital. This mixed-method study was conducted between June 2011 and February 2012. A conceptual framework, centered on the critically ill patient, guided the design and selection of the data collection instruments. Different perspectives sampled included regional leaders, healthcare professionals at the community hospital and its referral hospital, as well as family members of patients who had received care at the community ICU. Data sources included interviews (n = 22), walk-throughs (n = 5), focus groups (n = 31), database searches, context questionnaires (n = 8), family surveys (n = 16), and simulations (n = 13). None. Nine needs were identified. At the community hospital, needs identified included lack of access to human resources, gaps in expertise, poor patient flow and ICU bed use, communication, lack of educational opportunities, and gaps in end-of-life care and interprofessional teamwork. Needs were also identified in the interhospital interaction between the community and referral hospitals, which included an inadequate hospital network and gaps in transfer and repatriation of patients. The methodology uncovered the causes and widespread impact of each need and how they interacted with one another. Proposed solutions by the participants are presented including both organizational and educational/clinical solutions. This study captured needs in a complex, interprofessional, interhospital context, which can be targeted with tailored interventions to improve patient outcomes in a community hospital. Furthermore, this study provides a preliminary framework and rigorous methodology to performing a needs assessment in this setting.

Treating 'AIDS blindness': a critical pedagogical approach to HIV education at tertiary level.

PubMed

Wood, Lesley; Rens, Julialet

2014-01-01

HIV and AIDS affect all South Africans, irrespective of gender, race, age and economic status. Teachers should therefore be able to meaningfully integrate HIV content into the school curriculum. However, pre-service teacher education programmes still do not pay adequate attention to HIV education, particularly in institutions where students are being prepared to work in environments that are perceived to be unaffected by the consequences of the pandemic. This article advocates that HIV education should be integrated into contexts of privilege and presents evidence of the influence that a critical pedagogical approach can have on changing student perceptions of the need to address HIV in and through their teaching. We led 109 Post-graduate Certificate of Education students through a series of activities that required them to critically reflect on their feelings, attitudes and perceived skills with regard to HIV and AIDS education; to identify potential areas of personal change; and to begin to imagine alternative professional possibilities. We generated qualitative data through drawings, group discussions, individual written reflections, and a voluntary focus group. A content analysis of the data revealed that the participating students initially felt incompetent to incorporate HIV and related issues into their teaching, and felt hesitant and uncomfortable at the prospect. However, a critical reflection on their thinking, both individually and in a group setting, served to shift them towards a more holistic, critical and humanising understanding of the pandemic and the role they could play as future teachers in helping to mitigate its impact. The findings provide evidence that a critical pedagogical approach - particularly with groups who believe that HIV and AIDS is not something that concerns them - can provide an effective way to mediate the knowledge, skills and attitudes that competent teachers need in today's world.

Critical success factor (CSF) service delivery for tahfiz institution teaching & learning environment

NASA Astrophysics Data System (ADS)

Ridza, B. H.; Jalil, R. A.; Sipan, I.; Nukman, Y.

2017-11-01

The exceptional existence of tahfiz institutions (TI) by a government and the private sector in Malaysia indicates that tahfiz education at par to fill mainstream education. Nevertheless, the level of TI facilities management (FM) provided is unstandardized since its infrastructure and establishment is initiated by the varied background of TI organizer. Thus, the effectiveness of TI education system is immeasurable. The significance of this research is to explore the critical success factor (CSF) of service delivery for TI teaching and learning environment. This research adopts both qualitative and quantitative method through survey instrument in order to review and analyze to achieve the research goal. The findings showed several important criteria for a transformation of TI education teaching and learning environment such top management of TI needs to be more responsible in providing better FM practice to achieve efficiency of manpower in providing a conducive learning environment for students for producing excellent huffaz. Thus, TI education system needs to have clear standard guidelines in operating their activities in producing huffaz that capable implement Islamic knowledge to the development of the country.

The Need for V&V in Reuse-Based Software Engineering

NASA Technical Reports Server (NTRS)

Addy, Edward A.

1997-01-01

V&V is currently performed during application development for many systems, especially safety-critical and mission-critical systems. The V&V process is intended to discover errors, especially errors related to entire' domain or product line rather than a critical processing, as early as possible during the development process. The system application provides the context under which the software artifacts are validated. engineering. This paper describes a framework that extends V&V from an individual application system to a product line of systems that are developed within an architecture-based software engineering environment. This framework includes the activities of traditional application-level V&V, and extends these activities into the transition between domain engineering and application engineering. The framework includes descriptions of the types of activities to be performed during each of the life-cycle phases, and provides motivation for activities.

Promotional literature: how do we critically appraise?

PubMed

Shetty, V V; Karve, A V

2008-01-01

There has been a tremendous increase in the number of new and generic drugs coming into the market. The busy practitioner obtains the information from various sources, of which promotional literature forms an important source. The promotional literature provided by the pharmaceutical companies cannot be entirely relied upon; moreover, very few physicians are equipped with the skills of critically appraising it. The new drug should be relevant to the clinician's practice in terms of population studied, the disease and the need for new treatment. The methodology of the study should be carefully judged to determine the authenticity of the evidence. The new drug should be preferred over the existing one if it offers clear advantages in terms of safety, tolerability, efficacy and price. Critical appraisal of promotional literature can provide valuable information to the busy physician to practice evidence-based medicine.

Online Dutch L2 Learning in Adult Education: Educators' and Providers' Viewpoints on Needs, Advantages and Disadvantages

ERIC Educational Resources Information Center

De Paepe, Liesbeth; Zhu, Chang; Depryck, Koen

2018-01-01

This study critically addresses the assumptions made by educators and providers in the field of Dutch second language (L2) acquisition about the online learning of Dutch L2. These include assumptions about advantages and disadvantages of online language learning, such as flexibility, learner autonomy, enhanced opportunities for remediation and…

Providers’ Perceptions of and Receptivity toward Evidence-Based HIV Prevention Interventions

PubMed Central

Owczarzak, Jill; Dickson-Gomez, Julia

2014-01-01

Since 1999, the Centers for Disease Control have trained over 10,000 service providers from more than 5,000 agencies to implement evidence-based HIV prevention interventions through its Diffusion of Effective Behavioral Interventions (DEBI) program. Based on in-depth, semi-structured interviews with a convenience sample of 22 HIV prevention service providers from 8 agencies in Wisconsin who participated in DEBI training, this article explores providers’ motivations for attending DEBI training, perceptions of the utility and value of the DEBI program, and criticisms of the program. Providers indicated that they attended training as part of general skill-building efforts, as a way to improve services through the adoption of evidence-based interventions, and to better meet client needs. DEBI training participants were critical of the program's “top down” approach, perceived lack of fit between the DEBI and their target populations, and what they perceived as a lack of evidence that the interventions would work with their particular populations. These results suggest that in order for the DEBI program to be more widely accepted, the experiences and expertise of providers need to be more fully integrated into the processes of developing, disseminating, and adapting evidence-based HIV prevention interventions. PMID:21517660

Army Sustainment. Volume 43, Issue 5, September-October 2011

DTIC Science & Technology

2011-10-01

provides the critical insights that CASCOM needs to effectively support the Guard and Reserve. The knowledge and understanding possessed by its...pump the information it needs in order to function as a healthy and effective system. The Army Materiel Command’s Logistics Support Ac- tivity...and analysis for its customers worldwide. Logisticians must continually focus on the effect of the operational environment on the Soldier. Having a

Educating the Future of Agriculture: A Focus Group Analysis of the Programming Needs and Preferences of Montana Young and Beginning Farmers and Ranchers

ERIC Educational Resources Information Center

Bailey, Nikki E.; Arnold, Shannon K.; Igo, Carl G.

2014-01-01

The average age of farmers and ranchers is rising and each year, there are fewer young and beginning farmers and ranchers (YBFR). Therefore, it is critical that agricultural educators and programmers provide learning opportunities that develop the knowledge and competencies YBFR need to be successful. The purpose of this study was to develop a…

The United States digital recording industry

NASA Technical Reports Server (NTRS)

Simonds, John L.

1993-01-01

The recording industry resembles the semiconductor industry in several aspects. Both are large (greater than $60 Billion/year revenues); both are considered critical technologies supporting national objectives; both are experiencing increased competition from foreign suppliers; they recognize significant opportunities for both technological and market growth in the decade to come; and both realize that a key to this future growth lies in alliances among industry, academia, and government. The semiconductor industry has made significant investments in alliances relating to manufacturing technologies (SEMATECH) and to joint long-term technology research centered in universities (SRC). The federal government has provided funding support of these efforts in recognition of the critical roles semiconductor technologies play in national interests. The recording industry is now also forming critical alliances, but has been slower in starting and in gaining broad recognition by government agencies and legislators that the industry needs federal support. Traditionally, the recording industry has been viewed as mature, stable, and, while critical to national interests, able to chart and fund its own course toward future national needs. That perception is fortunately changing.

Pediatricians Transitioning Practices, Youth With Special Health Care Needs in New York State.

PubMed

Davidson, Lynn F; Chhabra, Rosy; Cohen, Hillel W; Lechuga, Claudia; Diaz, Patricia; Racine, Andrew

2015-10-01

To assess current practices of New York State pediatricians as they transition youth with special health care needs to adult-oriented medical care. A survey of New York State pediatricians included 6 critical steps from 2002 consensus statement, 11 essential steps adapted from recent literature, and questions targeting age of starting transition and availability of transition policy. Of 181 respondents, only 11% have a transition policy. Most assist patients in transition process; identify an adult provider (92%); and create portable medical summary (57%). Only 3% start planning process at recommended age. No respondents are compliant with all 6 critical steps; subspecialists were more likely to report compliance to more than 4 steps. Participating pediatricians are making gains, yet effort is needed, to incorporate the essential steps into practice for transitioning youth with special health care needs. Recognition of barriers, use of electronic tools, and clarifying subspecialist's approach, may improve compliance with transition recommendations. © The Author(s) 2015.

The education of health practitioners supporting breastfeeding women: time for critical reflection.

PubMed

Dykes, Fiona

2006-10-01

The protection, promotion and support of breastfeeding has now become a major international priority as emphasized in the Global Strategy for Infant and Young Child Feeding. Health practitioners, such as midwives, nurses and doctors, have a key role to play in providing support to breastfeeding women. This paper provides a critical discussion of educational requirements of health practitioners to equip them for their supportive role. The effective integration of embodied, vicarious, practice-based and theoretical knowledge requires opportunities for deep critical reflection. This approach should facilitate personal reflection and critical engagement with broader socio-political issues, thus allowing for collective understandings and change. Practitioners also need to understand breastfeeding as a biopsychosocial process that is dynamic, relational and changes over time. Recommendations are outlined with regards to multidisciplinary undergraduate education; mentorship schemes with knowledgeable role models supporting student practitioners; involvement of voluntary and peer supporters; post-registration education; setting of national standards for breastfeeding education; tailored education for specific groups; designated funding; and involvement of breastfeeding specialists.

The United States Total DEPosition (TDEP) Project for Sulfur and Nitrogen

EPA Science Inventory

Estimates of total sulfur and nitrogen deposition are needed for use in critical loads and other ecosystem assessments. Measurements are available for some chemical species at individual locations for air concentration and wet deposition, but not dry deposition. Modeling provid...

Genomics for the identification of novel antimicrobials

USDA-ARS?s Scientific Manuscript database

There is a critical need in animal agriculture for developing novel antimicrobials and alternative strategies to reduce the use of antibiotics and address the challenges of antimicrobial resistance. High-throughput gene expression analysis is providing new tools that are enabling the discovery of h...

Preparing Twice Exceptional Students for Adult Lives: A Critical Need.

ERIC Educational Resources Information Center

Hua, C. Bruce; Coleman, Mary Ruth

2002-01-01

Six necessary program components to prepare gifted students with disabilities for productive adult lives are identified: provide challenging educational experiences along with supports, facilitate passion learning through enrichment activities, empower students through student-centered planning, develop self-advocacy, enhance positive social…

Understanding the information needs of public health practitioners: a literature review to inform design of an interactive digital knowledge management system.

PubMed

Revere, Debra; Turner, Anne M; Madhavan, Ann; Rambo, Neil; Bugni, Paul F; Kimball, AnnMarie; Fuller, Sherrilynne S

2007-08-01

The need for rapid access to information to support critical decisions in public health cannot be disputed; however, development of such systems requires an understanding of the actual information needs of public health professionals. This paper reports the results of a literature review focused on the information needs of public health professionals. The authors reviewed the public health literature to answer the following questions: (1) What are the information needs of public health professionals? (2) In what ways are those needs being met? (3) What are the barriers to meeting those needs? (4) What is the role of the Internet in meeting information needs? The review was undertaken in order to develop system requirements to inform the design and development of an interactive digital knowledge management system. The goal of the system is to support the collection, management, and retrieval of public health documents, data, learning objects, and tools. The search method extended beyond traditional information resources, such as bibliographic databases, tables of contents (TOC), and bibliographies, to include information resources public health practitioners routinely use or have need to use--for example, grey literature, government reports, Internet-based publications, and meeting abstracts. Although few formal studies of information needs and information-seeking behaviors of public health professionals have been reported, the literature consistently indicated a critical need for comprehensive, coordinated, and accessible information to meet the needs of the public health workforce. Major barriers to information access include time, resource reliability, trustworthiness/credibility of information, and "information overload". Utilizing a novel search method that included the diversity of information resources public health practitioners use, has produced a richer and more useful picture of the information needs of the public health workforce than other literature reviews. There is a critical need for public health digital knowledge management systems designed to reflect the diversity of public health activities, to enable human communications, and to provide multiple access points to critical information resources. Public health librarians and other information specialists can serve a significant role in helping public health professionals meet their information needs through the development of evidence-based decision support systems, human-mediated expert searching and training in the use information retrieval systems.

Structural barriers to South African volunteer home-based caregivers providing quality care: the need for a policy for caregivers not affiliated to primary healthcare clinics.

PubMed

Morton, David; Mayekiso, Thoko; Cunningham, Peter

2018-03-01

Community home-based care (CHBC) is a critical component of non-formal care in communities in Africa that have a high prevalence of HIV and tuberculosis (TB). Community carers consisting primarily of volunteers are critical role players in African healthcare systems and particularly in South Africa's strategy to fight HIV and AIDS. This paper explores the structural barriers volunteer caregivers need to overcome to provide quality CHBC. The researchers used two focus group discussions with key informants (each with four participants), and semi-structured interviews with six key informants to collect data relating to the meaning of quality CHBC. The data were coded using Tesch's data analysis technique. A major theme that emerged from the results was "Addressing structural challenges to improve the quality of CHBC". Subthemes underpinning this theme were: 1) lack of standardised training of volunteer caregivers; 2) the need for a scope of practice, parameters and legal boundaries; 3) lack of monitoring and evaluation (M&E) of CHBC; and 4) the importance of mentoring and supervision in CHBC. CHBC policy should address the need for standardised training programmes for caregivers, so that they are equipped with multiple skills. Furthermore CHBC policy must emphasise mentoring as well as M&E to encourage quality care. Finally, the policy should provide a clear scope of practice for caregivers to regulate their competencies and boundaries.

Information needs assessment of medical equipment offices based on Critical Success Factors (CSF) and Business System Planning (BSP) methods.

PubMed

Khorrami, F; Ahmadi, M; Alizadeh, A; Roozbeh, N; Mohseni, S

2015-01-01

Introduction: Given the ever-increasing importance and value of information, providing the management with a reliable information system, which can facilitate decision-making regarding planning, organization and control, is vitally important. This study aimed to analyze and evaluate the information needs of medical equipment offices. Methods: This descriptive applied cross-sectional study was carried out in 2010. The population of the study included the managers of statistic and medical records at the offices of vice-chancellor for treatment in 39 medical universities in Iran. Data were collected by using structured questioners. With regard to different kinds of designing information systems, sampling was done by two methods, BSP (based on processes of job description) and CSF method (based on critical success factors). The data were analyzed by SPSS-16. Results: Our study showed that 41% of information needs were found to be critical success factors of managers of office. The first priority of managers was "the number of bed and bed occupancy in hospitals". Of 29 identified information needs, 62% were initial information needs of managers (from the viewpoints of managers). Of all, 4% of the information needs were obtained through the form, 14% through both the form and database, 11% through the web site, and 71% had no sources (forms, databases, web site). Conclusion: Since 71% of the information needs of medical equipment offices managers had no information sources, the development of information system in these offices seems to be necessary. Despite the important role of users in designing the information systems (identifying 62% of information needs), other scientific methods is also needed to be utilized in designing the information systems.

Information needs assessment of medical equipment offices based on Critical Success Factors (CSF) and Business System Planning (BSP) methods

PubMed Central

Khorrami, F; Ahmadi, M; Alizadeh, A; Roozbeh, N; Mohseni, S

2015-01-01

Introduction: Given the ever-increasing importance and value of information, providing the management with a reliable information system, which can facilitate decision-making regarding planning, organization and control, is vitally important. This study aimed to analyze and evaluate the information needs of medical equipment offices. Methods: This descriptive applied cross-sectional study was carried out in 2010. The population of the study included the managers of statistic and medical records at the offices of vice-chancellor for treatment in 39 medical universities in Iran. Data were collected by using structured questioners. With regard to different kinds of designing information systems, sampling was done by two methods, BSP (based on processes of job description) and CSF method (based on critical success factors). The data were analyzed by SPSS-16. Results: Our study showed that 41% of information needs were found to be critical success factors of managers of office. The first priority of managers was “the number of bed and bed occupancy in hospitals”. Of 29 identified information needs, 62% were initial information needs of managers (from the viewpoints of managers). Of all, 4% of the information needs were obtained through the form, 14% through both the form and database, 11% through the web site, and 71% had no sources (forms, databases, web site). Conclusion: Since 71% of the information needs of medical equipment offices managers had no information sources, the development of information system in these offices seems to be necessary. Despite the important role of users in designing the information systems (identifying 62% of information needs), other scientific methods is also needed to be utilized in designing the information systems. PMID:28255389

What makes staff consider leaving the health service in Malawi?

PubMed

Chimwaza, Wanangwa; Chipeta, Effie; Ngwira, Andrew; Kamwendo, Francis; Taulo, Frank; Bradley, Susan; McAuliffe, Eilish

2014-03-19

Malawi faces a severe shortage of health workers, a factor that has contributed greatly to high maternal mortality in the country. Most clinical care is performed by mid-level providers (MLPs). While utilization of these cadres in providing health care is a solution to the current shortages, demotivating factors within the Malawian health system are pushing them into private, non-governmental, and other non-health related positions. This study aims to highlight these demotivating factors by exploring the critical aspects that influence MLPs' intention to leave their jobs. This descriptive qualitative study formed part of the larger Health Systems Strengthening for Equity (HSSE) study. Data presented in this paper were collected in Malawi using the Critical Incident Analysis tool. Participants were asked to narrate an incident that had happened during the past three months which had made them seriously consider leaving their job. Data were subjected to thematic analysis using NVivo 8 software. Of the 84 respondents who participated in a Critical Incident Analysis interview, 58 respondents (69%) indicated they had experienced a demotivating incident in the previous three months that had made them seriously consider leaving their job. The most commonly cited critical factors were being treated unfairly or with disrespect, lack of recognition of their efforts, delays and inconsistencies in salary payments, lack of transparent processes and criteria for upgrading or promotion, and death of patients. Staff motivation and an enabling environment are crucial factors for retaining MLPs in the Malawian health system. This study revealed key 'tipping points' that drive staff to seriously consider leaving their jobs. Many of the factors underlying these critical incidents can be addressed by improved management practices and the introduction of fair and transparent policies. Managers need to be trained and equipped with effective managerial skills and staff should have access to equal opportunities for upgrading and promotion. There is need for continuous effort to mobilize the resources needed to fill gaps in basic equipment, supplies, and medicine, as these are critical in creating an enabling environment for MLPs.

What makes staff consider leaving the health service in Malawi?

PubMed Central

2014-01-01

Background Malawi faces a severe shortage of health workers, a factor that has contributed greatly to high maternal mortality in the country. Most clinical care is performed by mid-level providers (MLPs). While utilization of these cadres in providing health care is a solution to the current shortages, demotivating factors within the Malawian health system are pushing them into private, non-governmental, and other non-health related positions. This study aims to highlight these demotivating factors by exploring the critical aspects that influence MLPs’ intention to leave their jobs. Methods This descriptive qualitative study formed part of the larger Health Systems Strengthening for Equity (HSSE) study. Data presented in this paper were collected in Malawi using the Critical Incident Analysis tool. Participants were asked to narrate an incident that had happened during the past three months which had made them seriously consider leaving their job. Data were subjected to thematic analysis using NVivo 8 software. Results Of the 84 respondents who participated in a Critical Incident Analysis interview, 58 respondents (69%) indicated they had experienced a demotivating incident in the previous three months that had made them seriously consider leaving their job. The most commonly cited critical factors were being treated unfairly or with disrespect, lack of recognition of their efforts, delays and inconsistencies in salary payments, lack of transparent processes and criteria for upgrading or promotion, and death of patients. Conclusion Staff motivation and an enabling environment are crucial factors for retaining MLPs in the Malawian health system. This study revealed key ‘tipping points’ that drive staff to seriously consider leaving their jobs. Many of the factors underlying these critical incidents can be addressed by improved management practices and the introduction of fair and transparent policies. Managers need to be trained and equipped with effective managerial skills and staff should have access to equal opportunities for upgrading and promotion. There is need for continuous effort to mobilize the resources needed to fill gaps in basic equipment, supplies, and medicine, as these are critical in creating an enabling environment for MLPs. PMID:24641840

Children visiting family and friends on adult intensive care units: the nurses' perspective.

PubMed

Clarke, C M

2000-02-01

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.

A systematic review of selected evidence on developing nursing students' critical thinking through problem-based learning.

PubMed

Yuan, Haobin; Williams, Beverly A; Fan, Lin

2008-08-01

Rapidly changing developments and expanding roles in healthcare environment requires professional nurses to develop critical thinking. Nursing education strives to facilitate students' critical thinking through the appropriate instructional approaches. Problem-based learning (PBL) is a student-centered approach to learning which enables the students to work cooperatively in small groups for seeking solutions to situations/problems. The systematic review was conducted to provide the available evidence on developing nursing students' critical thinking through PBL. The computerized searches from 1990-2006 in CINAHL, Proquest, Cochrane library, Pubmed etc were performed. All studies which addressed the differences in critical thinking among nursing students in PBL were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. As a result, only ten studies were retrieved, they were: one RCT with a Jadad quality score of 3, one nonrandomized control study, two quasi-experimental studies with non-controlled pretest-posttest design, and six descriptive studies. The available evidence in this review did not provide supportive evidence on developing nursing students' critical thinking through PBL. Clearly, there is a need for additional research with larger sample size and high quality to clarify the effects of PBL on critical thinking development within nursing educational context.

Theory underlying CRM training: Psychological issues in flight crew performance and crew coordination

NASA Technical Reports Server (NTRS)

Helmreich, Robert L.

1987-01-01

What psychological theory and research can reveal about training in Cockpit Resource Management (CRM) is summarized. A framework is provided for the critical analysis of current approaches to CRM training. Background factors and definitions critical to evaluating CRM are reviewed, followed by a discussion of issues directly related to CRM training effectiveness. Some of the things not known about the optimization of crew performance and the research needed to make these efforts as effective as possible are described.

Advances in Machine Technology.

PubMed

Clark, William R; Villa, Gianluca; Neri, Mauro; Ronco, Claudio

2018-01-01

Continuous renal replacement therapy (CRRT) machines have evolved into devices specifically designed for critically ill over the past 40 years. In this chapter, a brief history of this evolution is first provided, with emphasis on the manner in which changes have been made to address the specific needs of the critically ill patient with acute kidney injury. Subsequently, specific examples of technology developments for CRRT machines are discussed, including the user interface, pumps, pressure monitoring, safety features, and anticoagulation capabilities. © 2018 S. Karger AG, Basel.

Process analytical technologies (PAT) in freeze-drying of parenteral products.

PubMed

Patel, Sajal Manubhai; Pikal, Michael

2009-01-01

Quality by Design (QbD), aims at assuring quality by proper design and control, utilizing appropriate Process Analytical Technologies (PAT) to monitor critical process parameters during processing to ensure that the product meets the desired quality attributes. This review provides a comprehensive list of process monitoring devices that can be used to monitor critical process parameters and will focus on a critical review of the viability of the PAT schemes proposed. R&D needs in PAT for freeze-drying have also been addressed with particular emphasis on batch techniques that can be used on all the dryers independent of the dryer scale.

Keeping the exotic pet mentally healthy.

PubMed

Clayton, Leigh Ann; Tynes, Valarie V

2015-05-01

When basic needs are not met, captive animal health and welfare will be compromised by physical and psychological stressors. These basic needs include more than just appropriate food, water, and shelter; they should include environments that provide the animal with opportunities to thrive. These opportunities to thrive can be categorized as opportunity for a well-balanced diet (including how it is provided), to self-maintain, for optimal health, to express species-specific behaviors, and for choice and control. Adequate planning and knowledge are critical to creating environments in which animals can thrive. Copyright © 2015 Elsevier Inc. All rights reserved.

Case Studies in Cardiac Dysfunction After Acute Aneurysmal Subarachnoid Hemorrhage

PubMed Central

Hamilton, Jason C.; Korn-Naveh, Lauren; Crago, Elizabeth A.

2015-01-01

Patients with acute aneurysmal subarachnoid hemorrhage (SAH) often present with more than just neurological compromise. A wide spectrum of complicating cardiopulmonary abnormalities have been documented in patients with acute SAH, presenting additional challenges to the healthcare providers who attempt to treat and stabilize these patients. The patients described in this article presented with both acute aneurysmal SAH and cardiopulmonary compromise. Education and further research on this connection is needed to provide optimal care and outcomes for this vulnerable population. Nurses play a key role in balancing the critical and diverse needs of patients presenting with these symptoms. PMID:18856247

Analysis of family satisfaction in intensive care unit.

PubMed

Neves, Flávia Branco Cerqueira Serra; Dantas, Maíra Pereira; Bitencourt, Almir Galvão Vieira; Vieira, Patrícia Sena; Magalhães, Lis Thomazini; Teles, José Mário Meira; Farias, Augusto Manoel de Carvalho; Messeder, Octávio Henrique Coelho

2009-03-01

To know the needs and level of family members' satisfaction is an essential part of the care provided to critically ill patients in intensive care units. The objective of this study was to identify the level of family members' satisfaction in an intensive care unit. A descriptive survey was carried out in the general adult intensive care unit of the Hospital Português (Salvador - BA) from November 2007 to January 2008. Jonhson's 14-question modified version of the Critical Care Family Needs Inventory was used to evaluate satisfaction of family members. Fifty three family members were included, mean age was 44 years and 68% were female. The median of family members satisfaction level was 11 (IQI = 9-13). Critical Care Family Need Inventory, questions with higher percentiles of satisfaction were those stating that family members felt that the patient was receiving the best possible care (96%) and that the information provided was honest (96%). The questions with lower percentiles of satisfaction were those stating that family members believed that someone in the intensive care unit had shown interest in their feelings (45%) and that a healthcare professional had explained how the intensive care unit equipment was used (41%). Most family members positively evaluated the intensive care unit professionals in the questions related to communication, attitude and patient care. However, there was a lower level of satisfaction in the questions related to the intensive care unit professionals' ability to comfort family members.

Specialty-care access for community health clinic patients: processes and barriers.

PubMed

Ezeonwu, Mabel C

2018-01-01

Community health clinics/centers (CHCs) comprise the US's core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients' access to specialty care. Analysis of data was done using content analysis. The process of coordinating care referrals for CHC patients is complex and begins with a provider's order for consultation and ends when the referring provider receives the specialist's note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic-hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care.

Short- and long-term impact of critical illness on relatives: literature review.

PubMed

Paul, Fiona; Rattray, Janice

2008-05-01

This paper is a report of a literature review undertaken to identify the short- and long-term impact of critical illness on relatives. Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after intensive care. The following databases were searched for the period 1950-2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews--Cochrane Central Register of Clinical Trials. Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 'interventions', 'satisfaction', 'psychological outcomes' and 'coping'. Studies have mainly identified relatives' immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives' needs and the short- and long-term effects of critical illness on relatives. Despite widespread use of the Critical Care Family Needs Inventory, factors such as local or cultural differences may influence relatives' needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives' needs and the effects of critical illness on their well-being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the illness.

Does artificial nutrition improve outcome of critical illness? An alternative viewpoint!

PubMed

Heyland, Daren K; Wischmeyer, Paul E

2013-08-27

Recent studies challenge the beneficial role of artificial nutrition provided to critically ill patients and point out the limitations of existing studies in this area. We take a differing view of the existing data and refute many of the arguments put forward by previous authors. We review the mechanistic, observational, and experimental data supporting a role for early enteral nutrition in the critically ill patient. We conclude without question that more, high-quality research is needed to better define the role of artificial nutrition in the critical care setting, but until then early and adequate delivery of enteral nutrition is a legitimate, evidence-based treatment recommendation and we see no evidence-based role for restricting enteral nutrition in critically ill patients. The role of early supplemental parenteral nutrition continues to be defined as new data emerge.

Emergency and crisis management: critical incident stress management for first responders and business organisations.

PubMed

Guenthner, Daniel H

2012-01-01

A literature review was performed on critical incident stress after September 11th, 2001 (9/11), and Hurricanes Katrina and Rita, which focused on the need to implement a holistic critical incident stress management programme for first responders and business organisations. Critical incident stress management is required to handle acute stress and other distress in the face of natural or man-made disasters, including terrorist attacks. A holistic approach to community resilience through a well-planned and implemented critical incident stress management programme has been shown in the literature to promote self-help and self-efficacy of individuals and organisations. The interventions and programme elements defined clearly show how a number of different intervention and prevention strategies will promote business and community resilience and also self-efficacy in a culturally-diverse community and organisation. Implementing a critical incident stress management programme within a responding business organisation is critical because of the fact that first responders are the most susceptible every day to exposure to critical incidents that will affect their mental health; and business employees will suffer some of the same maladies as first responders in the event of a disaster or crisis. Utilising the framework provided, a holistic critical incident stress management programme can be implemented to help reduce the effects of burnout, absenteeism, acute stress, post-traumatic stress, substance use and traumatic stress, and to work to promote community resilience and toughen individuals against the effects of stress. Taking care of the needs of the employees of a business organisation, and of those of first responders, is clearly required.

The optimal blood glucose level for critically ill adult patients.

PubMed

Lv, Shaoning; Ross, Paul; Tori, Kathleen

2017-09-01

Glycaemic control is recognized as one of the important aspects in managing critically ill patients. Both hyperglycaemia and hypoglycaemia independently increase the risk of patient mortality. Hence, the identification of optimal glycaemic control is of paramount importance in the management of critically ill patients. The aim of this literature review is to examine the current status of glycaemic control in critically ill adult patients. This literature review will focus on randomized controlled trials comparing intensive insulin therapy to conventional insulin therapy, with an objective to identify optimal blood glucose level targets for critically ill adult patients. A literature review was conducted to identify large randomized controlled trials for the optimal targeted blood glucose level for critically ill adult patients published since 2000. A total of eight studies fulfilled the selection criteria of this review. With current human and technology resources, the results of the studies support commencing glycaemic control once the blood glucose level of critically ill patients reaches 10 mmol/L and maintaining this level between 8 mmol/L and 10 mmol/L. This literature review provides a recommendation for targeting the optimal blood glucose level for critically ill patients within moderate blood glucose level target range (8-10 mmol/L). The need for uniformed glucometrics for unbiased reporting and further research for optimal blood glucose target is required, especially in light of new technological advancements in closed-loop insulin delivery and monitoring devices. This literature review has revealed a need to call for consensus in the measurement and reporting of glycaemic control using standardized glucometrics. © 2017 British Association of Critical Care Nurses.

Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses.

PubMed

Secker, Barbara; Goldenberg, Maya J; Gibson, Barbara E; Wagner, Frank; Parke, Bob; Breslin, Jonathan; Thompson, Alison; Lear, Jonathan R; Singer, Peter A

2006-08-29

Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs - equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care - and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of - or revisions to - a regionalised health care strategy.

Managing Field Evacuations.

ERIC Educational Resources Information Center

Satz, Jay A.; McEvoy, David; Merrill, Kurt

In the event of a debilitating injury or illness, outdoor leaders should consider four critical phases in successfully managing backcountry field evaluations. The first phase, managing the immediate scene, involves assuring scene safety, medical care of the patient, instituting the emergency response plan, and providing for the needs of uninjured…

Evaluation of Gene Expression Endpoints in the Context of a Xenopus laevis Metamorphosis-based Bioassay to Detect Thyroid Hormone Disruptors

EPA Science Inventory

This study accentuates the need to examine multiple tissues and provides critical information required for optimization of exposure regimens and endpoint assessments that focus on the detection of disruption in TH-regulatory systems.

Who needs environmental monitoring?

Treesearch

Gary M. Lovett; Douglas A. Burns; Charles T. Driscoll; Jennifer C. Jenkins; Myron J. Mitchell; Lindsey Rustad; James B. Shanley; Gene E. Likens; Richard Haeuber

2007-01-01

Environmental monitoring is often criticized as being unscientific, too expensive, and wasteful. While some monitoring studies do suffer from these problems, there are also many highly successful long-term monitoring programs that have provided important scientific advances and crucial information for environmental policy. Here, we discuss the characteristics of...

Teaching about Indians? Use the Real Stuff!

ERIC Educational Resources Information Center

Feldkamp-Price, Betsy; Smith, David Lee

1994-01-01

Provides suggestions for teaching students about American Indians. Teachers need to learn more about Indians; confront misconceptions and stereotypes; have students make Indian crafts and foods; play Indian games; learn about contemporary Indian culture; be critical of resources; and contact local Indian or cultural groups. (MDM)

Implementing PCRP: Fact or Fiction? Communication Skills.

ERIC Educational Resources Information Center

Rosecky, Marion

The Pennsylvania Comprehensive Reading/Communication Arts Plan (PCRP) is a language arts curriculum providing four critical experiences that all students need in order to become competent in reading, writing, listening, and speaking: responding to literature, sustained silent reading, oral and written composing, and investigating and mastering…

Exploring the Relevant Antecedents of Superintendent Leadership Skills

ERIC Educational Resources Information Center

Hartley, Lloyd

2012-01-01

Understanding antecedents to superintendent leadership development is crucial for the continued improvement of schools. This qualitative study seeks to identify skills superintendents consider critical to their position, antecedents that developed those skills, and provide an increased understanding of the methods needed for developing current and…

The impact of chemical pollution on biodiversity and ecosystem services: the need for an improved understanding

EPA Science Inventory

The Millennium Ecosystem Assessment (2005) provided a framework that acknowledges biodiversity as one key factor for ensuring the continuous supply of ecosystem services, facilitating ecosystem stability and consequently as a critical basis for sustainable development. The close...

A Response to Critics.

ERIC Educational Resources Information Center

Hawley, Willis D.

1987-01-01

Provides a rejoinder to comments published in the February issue rebutting author's article on the risks and promises of extended teacher-preparation programs. Covers issues surrounding costs and benefits, the need for evaluative research before investment in programs, the differences between types of programs, and their objectives and possible…

Joining Forces

ERIC Educational Resources Information Center

Kennedy, Mike

2006-01-01

As education institutions more readily pursue stronger connections with the entire community, joint-use programs allow them to forge those bonds more effectively--providing entire communities with more access to facilities and services, often critically needed in some areas, and more efficient use of tax funds. Through joint-use agreements,…

The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review.

PubMed

Kynoch, Kate; Chang, Anne M; Coyer, Fiona

Background Attending to the needs of family members of critically ill patients is an important and necessary step in providing appropriate care for both the patient and the family. An initial search of the Cochrane and Joanna Briggs Institute Libraries did not reveal any published systematic reviews recommending effective interventions for addressing family needs of critically ill patients in an acute intensive care unit.Objectives This systematic review aims to establish best practice in addressing the needs of family members with a relative admitted to an adult critical care unit.Search strategy An extensive search of the major databases was conducted. Databases searched included: MEDLINE, CINAHL, psycINFO, Health source, Web of science, EMBASE, the Cochrane library and Database of abstracts of reviews of effects (DARE) as well as Pubmed. The search included published and unpublished studies and papers in English from 1980-2010.Selection criteria This review considered any randomised controlled trials that evaluated the effectiveness of interventions in addressing family needs of critically ill patients in an adult intensive care unit. In the absence of randomised controlled trials, other research designs such as quasi-experimental as well as before and after studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for addressing family needs of critically ill patients.Assessment of quality Each included study was assessed by two independent reviewers using the appropriate appraisal checklist developed by the Joanna Briggs Institute.Data collection and analysis Data was extracted from the papers included in this review using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented in narrative form.Results Fourteen studies and one dissertation met the inclusion criteria and were included in the review. There were 12 quasi-experimental studies identified including 8 two or three group, pre-test/post-test studies; 1 one-way between subjects design; 1 interrupted time series and 1 two-group comparative design study. The dissertation was a quasi-experimental three group pre-test/post-test design. There were 3 prospective randomised trials included. The evidence identified includes: the use of support groups for family members of patients admitted to an intensive care unit, structured communication and/or education programs for family members, the use of leaflets or brochures to meet family information needs and open or more flexible visiting hours.Conclusion/Recommendations This review makes several recommendations for clinical practice to address family needs of patients admitted to a critical care unit, however this review highlights the need for significant further research in this area. Future intervention studies focusing on family needs could include: the use of technology such as DVD's and SMS for informing families and interventions specifically designed to improve family comfort.

Pharmacists need recognition as providers to enhance patient care.

PubMed

White, C Michael

2014-02-01

To demonstrate that pharmacists are vital but currently underutilized direct care providers and that full provider status and inclusion into advanced multidisciplinary team models is needed. Literature was accessed through Ovid MEDLINE from 1990 to the present using the terms pharmacy care, pharmacist care, medication therapy management, and pharmaceutical care. Web-based searching and backward citation tracking was conducted for context and additional citations. There is strong data showing that pharmacists in patient care roles contribute to intermediate and final health outcomes improvements and cost-effectiveness. The general perception of pharmacists from prominent people in the Federal Government, some medical societies, and from physicians and nurses who work with pharmacists most closely is overwhelmingly positive. However, the penetration of pharmacists into complementary patient care roles is minimized by an antiquated reimbursement structure that needs to change. There are critical future primary care provider shortages that will be exacerbated under health care reform, and pharmacists can be a part of the solution if the reimbursement environment was altered. For all the data and support for expanded direct patient care pharmacist services, pharmacists are marginalized by an antiquated reimbursement structure. Pharmacists need to be granted Medicare provider status, and new models of primary care need to include pharmacists in patient care roles in order to more fully meet the needs of patients.

The Northern Forest Futures Project: A forward look at forest conditions in the northern United States

Treesearch

W. Keith Moser; Stephen R. Shifley

2012-01-01

Forests and forest ecosystems provide a critical array of benefits, from clean air and water to commercial products to open space. The forests and their ability to provide desired benefi ts constantly change in response to natural forces, human decisions, and human needs. The complexity and rate of change demand a rigorous evaluation of existing and emerging natural...

Entering Adulthood: Balancing Stress for Success. A Curriculum for Grades 9-12. Contemporary Health Series. [Teacher's Guide and] Student Workbook.

ERIC Educational Resources Information Center

Hart, Susan J.

This curriculum guide provides high school students with specific tools to develop insights, attitudes and life skills they need to meet life's challenges and covers critical health and family life topics. It is part of a series designed to provide educators with the curricular tools necessary to challenge students to take personal responsibility…

A consistent professional brand for pharmacy-the need and a path forward.

PubMed

Speedie, Marilyn K; Anderson, Lowell J

The authors draw on their broad experiences in the profession to put forth their assessment of the critical need for all elements of the pharmacy profession to agree upon its core services, and to deliver those services in all pharmacies. And also the need to promote the value of those services to patients, payers, and other providers. Since the advent of pharmaceutical care, the profession has changed its curricula and its regulations to reflect the value of direct patient care. For many reasons, the practice has not been unified in delivering these services-lack of definition of what constitutes the service, principally. This has led to the "tower of babel" that exists because of the many names given to these patient-care services by various professional organizations, colleges, payers, and government agencies. Lack of inclusion in benefit design with value-based compensation is also recognized as an important barrier for a pharmacist wishing to provide direct patient-care services. The authors believe this issue to be critical for the profession, and appeal to JCPP and its member organizations to provide leadership to the various pharmacy associations and colleges to put immediate energy and resources into the definitions, labels, and branding of pharmacy practice. This leadership is essential if the profession's organizations and colleges are to promote the whole of practice and payment for the entirety of services pharmacists provide. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Reflective thinking and medical students: some thoughtful distillations regarding John Dewey and Hannah Arendt

PubMed Central

Papadimos, Thomas J

2009-01-01

Reflective thought (critical thinking) is essential to the medical student who hopes to become an effective physician. John Dewey, one of America's foremost educators in the early twentieth century, revolutionized critical thinking and its role in education. In the mid twentieth century Hannah Arendt provided profound insights into the problem of diminishing human agency and political freedom. Taken together, Dewey's insight regarding reflective thought, and Arendt's view of action, speech, and power in the public realm, provide mentors and teachers of medical students guidance in the training of thought and the need for its effective projection at the patient's bedside and in the community. PMID:19368737

Biophysical Technologies for Management of Wound Bioburden

PubMed Central

Korzendorfer, Holly; Hettrick, Heather

2014-01-01

Significance: Chronic wounds commonly have high levels of bioburden and antibiotic-resistant pathogens. This review article focuses on findings from current literature related to four biophysical technologies (ultrasound, electrical stimulation, phototherapy, and negative pressure wound therapy) believed to be beneficial for managing wound bioburden and support healing. Recent Advances and Critical Issues: Recent advances for each modality are provided as a basic synopsis of the technology followed by brief overviews of the most recent literature addressing its effectiveness for managing wound bioburden, and critical issues for each modality are provided as conclusions. Future Directions: This review highlights the need for further clinically relevant studies examining bacterial levels in addition to healing progression for each technology. PMID:25493207

Charting the future course of rural health and remote health in Australia: Why we need theory.

PubMed

Bourke, Lisa; Humphreys, John S; Wakerman, John; Taylor, Judy

2010-04-01

This paper argues that rural and remote health is in need of theoretical development. Based on the authors' discussions, reflections and critical analyses of literature, this paper proposes key reasons why rural and remote health warrants the development of theoretical frameworks. The paper cites five reasons why theory is needed: (i) theory provides an approach for how a topic is studied; (ii) theory articulates key assumptions in knowledge development; (iii) theory systematises knowledge, enabling it to be transferable; (iv) theory provides predictability; and (v) theory enables comprehensive understanding. This paper concludes with a call for theoretical development in both rural and remote health to expand its knowledge and be more relevant to improving health care for rural Australians.

Veteran family reintegration, primary care needs, and the benefit of the patient-centered medical home model.

PubMed

Hinojosa, Ramon; Hinojosa, Melanie Sberna; Nelson, Karen; Nelson, David

2010-01-01

Men and women returning from the wars in Afghanistan and Iraq face a multitude of difficulties while integrating back into civilian life, but the importance of their veteran status is often overlooked in primary care settings. Family physicians have the potential to be the first line of defense to ensure the well-being of veterans and their families because many will turn to nonmilitary and non-Veterans Affairs providers for health care needs. An awareness of the unique challenges faced by this population is critical to providing care. A patient-centered medical home orientation can help the family physician provide veterans and their families the care they need. Specific recommendations for family physicians include screening their patient population; providing timely care; treating the whole family; and integrating care from multiple disciplines and specialties, providing veterans and families with "one-stop shopping" care. An awareness of the unique challenges faced by veterans and their families translates into better overall outcomes for this population.

Understanding the essential elements of work-based learning and its relevance to everyday clinical practice.

PubMed

Williams, Caroline

2010-09-01

To critically review the work-based learning literature and explore the implications of the findings for the development of work-based learning programmes. With NHS budgets under increasing pressure, and challenges to the impact of classroom-based learning on patient outcomes, work-based learning is likely to come under increased scrutiny as a potential solution. Evidence from higher education institutions suggests that work-based learning can improve practice, but in many cases it is perceived as little more than on-the-job training to perform tasks. The CINAHL database was searched using the keywords work-based learning, work-place learning and practice-based learning. Those articles that had a focus on post-registration nursing were selected and critically reviewed. Using the review of the literature, three key issues were explored. Work-based learning has the potential to change practice. Learning how to learn and critical reflection are key features. For effective work-based learning nurses need to take control of their own learning, receive support to critically reflect on their practice and be empowered to make changes to that practice. A critical review of the literature has identified essential considerations for the implementation of work-based learning. A change in culture from classroom to work-based learning requires careful planning and consideration of learning cultures. To enable effective work-based learning, nurse managers need to develop a learning culture in their workplace. They should ensure that skilled facilitation is provided to support staff with critical reflection and effecting changes in practice. CONTRIBUTION TO NEW KNOWLEDGE: This paper has identified three key issues that need to be considered in the development of work-based learning programmes. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Strategies of organization and service for the critical-care laboratory.

PubMed

Fleisher, M; Schwartz, M K

1990-08-01

Critical-care medicine requires rapidity of treatment decisions and clinical management. To meet the objectives of critical-care medicine, the critical-care laboratory must consider four major aspects of laboratory organization in addition to analytical responsibilities: specimen collection and delivery, training of technologists, selection of reliable instrumentation, and efficient data dissemination. One must also consider the advantages and disadvantages of centralization vs decentralization, the influence of such a laboratory on patient care and personnel needs, and the space required for optimal operation. Centralization may lead to workflow interruption and increased turnaround time (TAT); decentralization requires redundancy of instrumentation and staff but may shorten TAT. Minimal TAT is the hallmark of efficient laboratory service. We surveyed 55 laboratories in 33 hospitals and found that virtually all hospitals with 200 or more beds had a critical-care laboratory operating as a satellite of the main laboratory. We present data on actual TAT, although these were available in only eight of the 15 routine laboratories that provided emergency service and in eight of the 40 critical-care laboratories. In meeting the challenges of an increasing workload, a reduced clinical laboratory work force, and the need to reduce TAT, changes in traditional laboratory practice are mandatory. An increased reliance on whole-blood analysis, for example, should eliminate delays associated with sample preparation, reduce the potential hazards associated with centrifugation, and eliminate excess specimen handling.

A need for the standardization of the pharmaceutical sector in Libya

PubMed Central

Mustafa, Asma Abubakr; Kowalski, Stefan Robert

2010-01-01

Medicines are health technologies that can translate into tangible benefits for numerous acute as well as chronic health conditions. A nation's pharmaceutical sector needs to be appropriately structured and managed in order to ensure a safe, effective and quality supply of medicines to society. The process of medicines management involves the sequential management of five critical activity areas; namely; registration, selection, procurement, distribution and use. Formalized and standardized management of all five critical activity areas positively influences the availability, quality and affordability of medicines and ultimately increases the reliability and quality of the national healthcare system. Aim The aim of this review is to examine the current structure and operation of medicines management (i.e. the pharmaceutical sector) in Libya. Conclusion In the Libyan healthcare system all five critical activity areas are compromised. Restructuring of the pharmaceutical sector in Libya is required in order to provide and sustain sound pharmaceutical services for Libyan society and improve the national public health outcomes. PMID:21483563

Secondary Traumatic Stress in NICU Nurses: A Mixed-Methods Study.

PubMed

Beck, Cheryl Tatano; Cusson, Regina M; Gable, Robert K

2017-12-01

Secondary traumatic stress is an occupational hazard for healthcare providers who care for patients who have been traumatized. This type of stress has been reported in various specialties of nursing, but no study to date had specifically focused on neonatal intensive care unit (NICU) nurses. (1) To determine the prevalence and severity of secondary traumatic stress in NICU nurses and (2) to explore those quantitative findings in more depth through nurses' qualitative descriptions of their traumatic experiences caring for critically ill infants in the NICU. Members of NANN were sent e-mails with a link to the electronic survey. In this mixed-methods study, a convergent parallel design was used. Neonatal nurses completed the Secondary Traumatic Stress Scale (STSS) and then described their traumatic experiences caring for critically ill infants in the NICU. SPSS version 24 and content analysis were used to analyze the quantitative and qualitative data, respectively. In this sample of 175 NICU nurses, 49% of the nurses' scores on the STSS indicated moderate to severe secondary traumatic stress. Analysis of the qualitative data revealed 5 themes that described NICU nurses' traumatic experiences caring for critically ill infants. NICU nurses need to know the signs of secondary traumatic stress that they may experience caring for their critically ill infants. Avenues for dealing with the stress should be provided. Future research with a higher response rate to increase the external validity of the findings to the population of neonatal nurses is needed.

Patients' Perceptions of an Exercise Program Delivered Following Discharge From Hospital After Critical Illness (the Revive Trial).

PubMed

Ferguson, Kathryn; Bradley, Judy M; McAuley, Daniel F; Blackwood, Bronagh; O'Neill, Brenda

2017-01-01

The REVIVE randomized controlled trial (RCT) investigated the effectiveness of an individually tailored (personalized) exercise program for patients discharged from hospital after critical illness. By including qualitative methods, we aimed to explore patients' perceptions of engaging in the exercise program. Patients were recruited from general intensive care units in 6 hospitals in Northern Ireland. Patients allocated to the exercise intervention group were invited to participate in this qualitative study. Independent semistructured interviews were conducted at 6 months after randomization. Interviews were audio-recorded, transcribed, and content analysis used to explore themes arising from the data. Of 30 patients allocated to the exercise group, 21 completed the interviews. Patients provided insight into the physical and mental sequelae they experienced following critical illness. There was a strong sense of patients' need for the exercise program and its importance for their recovery following discharge home. Key facilitators of the intervention included supervision, tailoring of the exercises to personal needs, and the exercise manual. Barriers included poor mental health, existing physical limitations, and lack of motivation. Patients' views of outcome measures in the REVIVE RCT varied. Many patients were unsure about what would be the best way of measuring how the program affected their health. This qualitative study adds an important perspective on patients' attitude to an exercise intervention following recovery from critical illness, and provides insight into the potential facilitators and barriers to delivery of the program and how programs should be evolved for future trials.

Integrating topics of sex and gender into medical curricula-lessons from the international community.

PubMed

Miller, Virginia M; Kararigas, Georgios; Seeland, Ute; Regitz-Zagrosek, Vera; Kublickiene, Karolina; Einstein, Gillian; Casanova, Robert; Legato, Marianne J

2016-01-01

In the era of individualized medicine, training future scientists and health-care providers in the principles of sex- and gender-based differences in health and disease is critical in order to optimize patient care. International successes to incorporate these concepts into medical curricula can provide a template for others to follow. Methodologies and resources are provided that can be adopted and adapted to specific needs of other institutions and learning situations.

Balancing energy, conservation, and soil health requirements for plant biomass

USDA-ARS?s Scientific Manuscript database

The importance of crop residue for mitigating water and wind erosion, sustaining soil organic carbon (SOC) levels, and providing animal feed and bedding is well recognized around the world. But, those critical needs are no longer the only factors influencing crop residue management decisions. Global...

Using Mobile Devices in Field Science

ERIC Educational Resources Information Center

Huffling, Lacey; Tomasek, Terry; Matthews, Catherine; Benavides, Aerin; Carlone, Heidi; Hegedus, Tess

2014-01-01

Students today need advanced tools and competencies to succeed in the global economy. Technology can provide students with critical learning experiences but is often affordable only to affluent students. All students, regardless of socioeconomic status, deserve to use technology to create and innovate, communicate and collaborate, and gain the…

Psychology and Adult Learning. Second Edition.

ERIC Educational Resources Information Center

Tennant, Mark

This book provides a critical account of the psychological theories that have informed contemporary adult education theory and practice. Chapter 1 discusses the importance of balancing description, critique, and comments on each theory's influence on adult education and the need to understand psychological development throughout the life span. The…

Genetically Modified (GM) Foods & Teaching Critical Thinking.

ERIC Educational Resources Information Center

Flores, Vanessa S.; Tobin, Allan J.

2003-01-01

Describes instructional materials developed to address two major needs in biology education--how to form scientific opinions and providing a link between students and literature. Presents two essays, rats and potatoes and butterflies and corn, introduces students to article searching, reading peer-reviewed scientific studies, writing, critical…

45 CFR 2553.62 - What are the responsibilities of a volunteer station?

Code of Federal Regulations, 2010 CFR

2010-10-01

... that impact critical human and social needs, and regularly assess those assignments for continued...) Comply with all applicable civil rights laws and regulations including reasonable accommodation for RSVP volunteers with disabilities; and (f) Provide assigned RSVP volunteers the following support: (1) Orientation...

A Critical Review of Videoconferencing Software to Support School Consultation

ERIC Educational Resources Information Center

Fischer, Aaron J.; Schultz, Brandon K.; Collier-Meek, Melissa A.; Zoder-Martell, Kimberly A.; Erchul, William P.

2018-01-01

With recent advances in technology, several viable options now exist for school consultants to communicate with teachers via synchronous online videoconferencing (VC) without the need for specialized equipment. Unfortunately, few studies have evaluated the effectiveness of school consultation through VC, so practitioners are provided little…

FORMATION MECHANISMS FOR SECONDARY ORGANIC AEROSOL IN AMBIENT AIR

EPA Science Inventory

An laboratory and field research program is underway at the NERL to characterize secondary organic carbon in PM_2.5 which is formed through chemical reactions in the atmosphere. Information from this study will provide critical data needed to improve the treatment of SO...

Purchasing and Selling Evaluation: A Contract Negotiation Process.

ERIC Educational Resources Information Center

Sieber, Joan E.

1981-01-01

Responsible scientists/evaluators must be assertive contract negotiators who understand and respect the legitimate needs and obligations of all pertinent parties to the contract. Evaluators should not work under conditions that prevent them from providing an appropriately comprehensive and critical evaluation, nor that prevent useful secondary…

Concise Review: Mesenchymal Stem (Stromal) Cells: Biology and Preclinical Evidence for Therapeutic Potential for Organ Dysfunction Following Trauma or Sepsis.

PubMed

Matthay, Michael A; Pati, Shibani; Lee, Jae-Woo

2017-02-01

Several experimental studies have provided evidence that bone-marrow derived mesenchymal stem (stromal) cells (MSC) may be effective in treating critically ill surgical patients who develop traumatic brain injury, acute renal failure, or the acute respiratory distress syndrome. There is also preclinical evidence that MSC may be effective in treating sepsis-induced organ failure, including evidence that MSC have antimicrobial properties. This review considers preclinical studies with direct relevance to organ failure following trauma, sepsis or major infections that apply to critically ill patients. Progress has been made in understanding the mechanisms of benefit, including MSC release of paracrine factors, transfer of mitochondria, and elaboration of exosomes and microvesicles. Regardless of how well they are designed, preclinical studies have limitations in modeling the complexity of clinical syndromes, especially in patients who are critically ill. In order to facilitate translation of the preclinical studies of MSC to critically ill patients, there will need to be more standardization regarding MSC production with a focus on culture methods and cell characterization. Finally, well designed clinical trials will be needed in critically ill patient to assess safety and efficacy. Stem Cells 2017;35:316-324. © 2016 AlphaMed Press.

Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: Critical review.

PubMed

Toss, M; Miligy, I; Thompson, A M; Khout, H; Green, A R; Ellis, I O; Rakha, E A

2017-10-01

The high proportion of ductal carcinoma in situ (DCIS) presented in mammographic screening and the relatively low risk of progression to invasive disease have raised questions related to overtreatment. Following a review of current DCIS management protocols a more conservative approach has been suggested. Clinical trials have been introduced to evaluate the option of avoiding surgical intervention in a proportion of patients with DCIS defined as "low-risk" using certain clinicopathological criteria. These trials can potentially provide evidence-based models of active surveillance (with or without endocrine therapy) as a future management approach. Despite the undisputable fact of our need to address the obvious overtreatment of screen-detected DCIS, some important questions need to be considered regarding these trials including the eligibility criteria and definition of risk, the proportion of patient eligible for inclusion, and the length of time required for proper analysis of the trials' outcome in view of the long-term natural history of DCIS progression particularly the low-risk group. These factors can potentially affect the practicality and future impact of such trials. This review provides critical analysis of current DCIS management trials and highlights critical issues related to their practicality and the expected outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

Critical Infrastructure Interdependencies Assessment

DOE PAGES

Petit, Frederic; Verner, Duane

2016-11-01

Throughout the world there is strong recognition that critical infrastructure security and resilience needs to be improved. In the United States, the National Infrastructure Protection Plan (NIPP) provides the strategic vision to guide the national effort to manage risk to the Nation’s critical infrastructure.”1 The achievement of this vision is challenged by the complexity of critical infrastructure systems and their inherent interdependencies. The update to the NIPP presents an opportunity to advance the nation’s efforts to further understand and analyze interdependencies. Such an important undertaking requires the involvement of public and private sector stakeholders and the reinforcement of existing partnershipsmore » and collaborations within the U.S. Department of Homeland Security (DHS) and other Federal agencies, including national laboratories; State, local, tribal, and territorial governments; and nongovernmental organizations.« less

Evaluation of Critical Care Monitor Technology During the US Navy Strong Angel Exercise

NASA Technical Reports Server (NTRS)

Johannesen, John; Rasbury, Jack

2003-01-01

The NASA critical path road map identifies "trauma and acute medical problems" as a clinical capability risk category (http://criticalDath.isc.nasa.gov). Specific risks include major trauma, organ laceration or contusion, hemoperitoneum, pulmonary failure, pneumo- and hemothorax, burn, open bone fracture, blunt head trauma, and penetrating injury. Mitigation of these risks includes the capability for critical care monitoring. Currently, the International Space Station (ISS) Crew Health Care System (CHeCS) does not provide such a capability. The Clinical Space Medicine Strategic Planning Forum (4/8/97), sponsored by NASA Medical Operations, identified the development of trauma care capabilities as one of the top priorities for space medicine. The Clinical Care Capability Development Project (CCCDP) subsequently undertook the task to address this need.

Use of virtual reality gaming systems for children who are critically ill.

PubMed

Salem, Yasser; Elokda, Ahmed

2014-01-01

Children who are critically ill are frequently viewed as "too sick" to tolerate physical activity. As a result, these children often fail to develop strength or cardiovascular endurance as compared to typically developing children. Previous reports have shown that early participation in physical activity in is safe and feasible for patients who are critically ill and may result in a shorter length of stay and improved functional outcomes. The use of the virtual reality gaming systems has become a popular form of therapy for children with disabilities and has been supported by a growing body of evidence substantiating its effectiveness with this population. The use of the virtual reality gaming systems in pediatric rehabilitation provides the children with opportunity to participate in an exercise program that is fun, enjoyable, playful, and at the same time beneficial. The integration of those systems in rehabilitation of children who are critically ill is appealing and has the potential to offer the possibility of enhancing physical activities. The lack of training studies involving children who are critically ill makes it difficult to set guidelines on the recommended physical activities and virtual reality gaming systems that is needed to confer health benefits. Several considerations should be taken into account before recommended virtual reality gaming systems as a training program for children who are critically ill. This article highlighted guidelines, limitations and challenges that need to be considered when designing exercise program using virtual reality gaming systems for critically ill children. This information is helpful given the popular use of virtual reality gaming systems in rehabilitation, particularly in children who are critically ill.

Preparing for Mars: The Evolvable Mars Campaign 'Proving Ground' Approach

NASA Technical Reports Server (NTRS)

Bobskill, Marianne R.; Lupisella, Mark L.; Mueller, Rob P.; Sibille, Laurent; Vangen, Scott; Williams-Byrd, Julie

2015-01-01

As the National Aeronautics and Space Administration (NASA) prepares to extend human presence beyond Low Earth Orbit, we are in the early stages of planning missions within the framework of an Evolvable Mars Campaign. Initial missions would be conducted in near-Earth cis-lunar space and would eventually culminate in extended duration crewed missions on the surface of Mars. To enable such exploration missions, critical technologies and capabilities must be identified, developed, and tested. NASA has followed a principled approach to identify critical capabilities and a "Proving Ground" approach is emerging to address testing needs. The Proving Ground is a period subsequent to current International Space Station activities wherein exploration-enabling capabilities and technologies are developed and the foundation is laid for sustained human presence in space. The Proving Ground domain essentially includes missions beyond Low Earth Orbit that will provide increasing mission capability while reducing technical risks. Proving Ground missions also provide valuable experience with deep space operations and support the transition from "Earth-dependence" to "Earth-independence" required for sustainable space exploration. A Technology Development Assessment Team identified a suite of critical technologies needed to support the cadence of exploration missions. Discussions among mission planners, vehicle developers, subject-matter-experts, and technologists were used to identify a minimum but sufficient set of required technologies and capabilities. Within System Maturation Teams, known challenges were identified and expressed as specific performance gaps in critical capabilities, which were then refined and activities required to close these critical gaps were identified. Analysis was performed to identify test and demonstration opportunities for critical technical capabilities across the Proving Ground spectrum of missions. This suite of critical capabilities is expected to provide the foundation required to enable a variety of possible destinations and missions consistent with the Evolvable Mars Campaign.. The International Space Station will be used to the greatest extent possible for exploration capability and technology development. Beyond this, NASA is evaluating a number of options for Proving Ground missions. An "Asteroid Redirect Mission" will demonstrate needed capabilities (e.g., Solar Electric Propulsion) and transportation systems for the crew (i.e., Space Launch System and Orion) and for cargo (i.e., Asteroid Redirect Vehicle). The Mars 2020 mission and follow-on robotic precursor missions will gather Mars surface environment information and will mature technologies. NASA is considering emplacing a small pressurized module in cis-lunar space to support crewed operations of increasing duration and to serve as a platform for critical exploration capabilities testing (e.g., radiation mitigation; extended duration deep space habitation). In addition, "opportunistic mission operations" could demonstrate capabilities not on the Mars critical path that may, nonetheless, enhance exploration operations (e.g., teleoperations, crew assisted Mars sample return). The Proving Ground may also include "pathfinder" missions to test and demonstrate specific capabilities at Mars (e.g., entry, descent, and landing). This paper describes the (1) process used to conduct an architecture-driven technology development assessment, (2) exploration mission critical and supporting capabilities, and (3) approach for addressing test and demonstration opportunities encompassing the spectrum of flight elements and destinations consistent with the Evolvable Mars Campaign.

Supplier's Status for Critical Solid Propellants, Explosive, and Pyrotechnic Ingredients

NASA Technical Reports Server (NTRS)

Sims, B. L.; Painter, C. R.; Nauflett, G. W.; Cramer, R. J.; Mulder, E. J.

2000-01-01

In the early 1970's a program was initiated at the Naval Surface Warfare Center/Indian Head Division (NSWC/IHDIV) to address the well-known problems associated with availability and suppliers of critical ingredients. These critical ingredients are necessary for preparation of solid propellants and explosives manufactured by the Navy. The objective of the program was to identify primary and secondary (or back-up) vendor information for these critical ingredients, and to develop suitable alternative materials if an ingredient is unavailable. In 1992 NSWC/IHDIV funded Chemical Propulsion Information Agency (CPIA) under a Technical Area Task (TAT) to expedite the task of creating a database listing critical ingredients used to manufacture Navy propellant and explosives based on known formulation quantities. Under this task CPIA provided employees that were 100 percent dedicated to the task of obtaining critical ingredient suppliers information, selecting the software and designing the interface between the computer program and the database users. TAT objectives included creating the Explosive Ingredients Source Database (EISD) for Propellant, Explosive and Pyrotechnic (PEP) critical elements. The goal was to create a readily accessible database, to provide users a quick-view summary of critical ingredient supplier's information and create a centralized archive that CPIA would update and distribute. EISD funding ended in 1996. At that time, the database entries included 53 formulations and 108 critical used to manufacture Navy propellant and explosives. CPIA turned the database tasking back over to NSWC/IHDIV to maintain and distribute at their discretion. Due to significant interest in propellant/explosives critical ingredients suppliers' status, the Propellant Development and Characterization Subcommittee (PDCS) approached the JANNAF Executive committee (EC) for authorization to continue the critical ingredient database work. In 1999, JANNAF EC approved the PDCS panel task. This paper is designed to emphasize the necessity of maintaining a JANNAF community supported database, which monitors PEP critical ingredient suppliers' status. The final product of this task is a user friendly, searchable database that provides a quick-view summary of critical ingredient supplier's information. This database must be designed to serve the needs of JANNAF and the propellant and energetic commercial manufacturing community as well. This paper provides a summary of the type of information to archive each critical ingredient.

Critical Questions for Space Human Factors

NASA Technical Reports Server (NTRS)

Woolford, Barbara; Bagian, Tandi

2000-01-01

Traditional human factors contributions to NASA's crewed space programs have been rooted in the classic approaches to quantifying human physical and cognitive capabilities and limitations in the environment of interest, and producing recommendations and standards for the selection or design of mission equipment. Crews then evaluate the interfaces, displays, or equipment, and with the assistance of human factors experts, improvements are made as funds, time, control documentation, and weight allow. We have come a long way from the early spaceflight days, where men with the ' right stuff were the solution to operating whatever equipment was given to them. The large and diverse Shuttle astronaut corps has impacted mission designs to accommodate a wide range of human capabilities and preferences. Yet with existing long duration experience, we have seen the need to address a different set of dynamics when designing for optimal crew performance: critical equipment and mission situations degrade, and human function changes with mission environment, situation, and duration. Strategies for quantifying the critical nature of human factors requirements are being worked by NASA. Any exploration-class mission will place new responsibilities on mission designers to provide the crew with the information and resources to accomplish the mission. The current duties of a Mission Control Center to monitor system status, detect degradation or malfunction, and provide a proven solution, will need to be incorporated into on-board systems to allow the crew autonomous decision-making. The current option to resupply and replace mission systems and resources, including both vehicle equipment and human operators, will be removed, so considerations of maintenance, onboard training, and proficiency assessment are critical to providing a self-sufficient crew. As we 'move in' to the International Space Station, there are tremendous opportunities to investigate our ability to design for autonomous crews. Yet prioritizing the research that can and should be done by NASA will be based on the critical nature of the issues, and the impact of the individual research questions on mission design. The risks to crew health and safety associated with answering critical human factors issues must be properly included and communicated in order to support the Agency's decisions regarding future space programs.

Automatic Analysis of Critical Incident Reports: Requirements and Use Cases.

PubMed

Denecke, Kerstin

2016-01-01

Increasingly, critical incident reports are used as a means to increase patient safety and quality of care. The entire potential of these sources of experiential knowledge remains often unconsidered since retrieval and analysis is difficult and time-consuming, and the reporting systems often do not provide support for these tasks. The objective of this paper is to identify potential use cases for automatic methods that analyse critical incident reports. In more detail, we will describe how faceted search could offer an intuitive retrieval of critical incident reports and how text mining could support in analysing relations among events. To realise an automated analysis, natural language processing needs to be applied. Therefore, we analyse the language of critical incident reports and derive requirements towards automatic processing methods. We learned that there is a huge potential for an automatic analysis of incident reports, but there are still challenges to be solved.

Respiratory assessment in critical care units.

PubMed

Cox, C L; McGrath, A

1999-08-01

As healthcare delivery changes in critical care, nursing continues to extend its practice base. Nursing practice is expanding to incorporate skills once seen as the remit of the medical profession. Critical care nurses are equipping themselves with evidence-based knowledge and skills that can enhance the care they provide to their patients. Assessment of patients is a major role in nursing and, by expanding assessment techniques, nurses can ensure patients receive the care most appropriate to their needs. Nurses in critical care are well placed to perform a more detailed assessment which can help to focus nursing care. This article describes the step-by-step process of undertaking a full and comprehensive respiratory assessment in critical care settings. It identifies many of the problems that patients may have and the signs and symptoms that a nurse may not whilst undertaking the assessment and preparing to prescribe care.

Understanding health economic analysis in critical care: insights from recent randomized controlled trials.

PubMed

Sud, Sachin; Cuthbertson, Brian H

2011-10-01

The article reviews the methods of health economic analysis (HEA) in clinical trials of critically ill patients. Emphasis is placed on the usefulness of HEA in the context of positive and 'no effect' studies, with recent examples. The need to control costs and promote effective spending in caring for the critically ill has garnered considerable attention due to the high cost of critical illness. Many clinical trials focus on short-term mortality, ignoring costs and quality of life, and fail to change clinical practice or promote efficient use of resources. Incorporating HEA into clinical trials is a possible solution. Such studies have shown some interventions, although expensive, provide good value, whereas others should be withdrawn from clinical practice. Incorporating HEA into randomized controlled trials (RCTs) requires careful attention to collect all relevant costs. Decision trees, modeling assumptions and methods for collecting costs and measuring outcomes should be planned and published beforehand to minimize bias. Costs and cost-effectiveness are potentially useful outcomes in RCTs of critically ill patients. Future RCTs should incorporate parallel HEA to provide both economic outcomes, which are important to the community, alongside patient-centered outcomes, which are important to individuals.

Dynamic systems approaches and levels of analysis in the nervous system

PubMed Central

Parker, David; Srivastava, Vipin

2013-01-01

Various analyses are applied to physiological signals. While epistemological diversity is necessary to address effects at different levels, there is often a sense of competition between analyses rather than integration. This is evidenced by the differences in the criteria needed to claim understanding in different approaches. In the nervous system, neuronal analyses that attempt to explain network outputs in cellular and synaptic terms are rightly criticized as being insufficient to explain global effects, emergent or otherwise, while higher-level statistical and mathematical analyses can provide quantitative descriptions of outputs but can only hypothesize on their underlying mechanisms. The major gap in neuroscience is arguably our inability to translate what should be seen as complementary effects between levels. We thus ultimately need approaches that allow us to bridge between different spatial and temporal levels. Analytical approaches derived from critical phenomena in the physical sciences are increasingly being applied to physiological systems, including the nervous system, and claim to provide novel insight into physiological mechanisms and opportunities for their control. Analyses of criticality have suggested several important insights that should be considered in cellular analyses. However, there is a mismatch between lower-level neurophysiological approaches and statistical phenomenological analyses that assume that lower-level effects can be abstracted away, which means that these effects are unknown or inaccessible to experimentalists. As a result experimental designs often generate data that is insufficient for analyses of criticality. This review considers the relevance of insights from analyses of criticality to neuronal network analyses, and highlights that to move the analyses forward and close the gap between the theoretical and neurobiological levels, it is necessary to consider that effects at each level are complementary rather than in competition. PMID:23386835

Whats the story? Information needs of trauma teams.

PubMed

Sarcevic, Aleksandra; Burd, Randall S

2008-11-06

This paper reports on information needs of trauma teams based on an ethnographic study in an urban teaching hospital. We focus on questions posed by trauma team members during ten trauma events. We identify major categories of questions, as well as information seekers and providers. In addition to categories known from other critical care settings, we found categories unique to trauma settings. Based on these findings, we discuss implications for information technology support for trauma teams.

School-Based Health Centers Make Sense: Ensuring All Kids Have Access to the Health Care They Need to Be Healthy and Safe, and to Do Their Best in School. Issue Brief

ERIC Educational Resources Information Center

Children Now, 2014

2014-01-01

School-based health centers (SBHCs) are an innovative and effective way to address California's severe health care access problem among children. By providing critical health care services to kids in school, SBHCs ensure children get the medical, mental health, and dental care they need to be healthy and safe, and to support their ability to…

Application of a robot for critical care rounding in small rural hospitals.

PubMed

Murray, Cindy; Ortiz, Elizabeth; Kubin, Cay

2014-12-01

The purpose of this article is to present an option for a model of care that allows small rural hospitals to be able to provide specialty physicians for critical care patient needs in lieu of on-site critical care physician coverage. A real-time, 2-way audio and video remote presence robot is used to bring a specialist to the bedside to interact with patients. This article discusses improvements in quality and finance outcomes as well as care team and patient satisfaction associated with this model. Discussion also includes expansion of the care model to the emergency department for acute stroke care. Copyright © 2014 Elsevier Inc. All rights reserved.

Working to End Family Homelessness. Annual Report

ERIC Educational Resources Information Center

National Center on Family Homelessness (NJ1), 2012

2012-01-01

The National Center on Family Homelessness is determined to end family homelessness. Sheltering families provides a temporary safe haven. Connecting families to permanent housing, essential services, and critical supports can change their lives forever. Through research the Center learns what families need to rebound from the housing, economic,…

Preparing Urban Special Education Leaders: What Works

ERIC Educational Resources Information Center

Martin, Suzanne M.; Little, Joyce; Miller, Katie; Gourwitz, Jillian

2014-01-01

Special education administrators play a critical role in the implementation of successful inclusion in diverse, standards-based environments. They provide the vision and leadership necessary to guide educators in both general and special education as they deliver instructional programs to meet the needs of diverse students with disabilities.…

Intentional Learning Partnerships: The Global Studies Model at the University of Illinois

ERIC Educational Resources Information Center

Bartolomei, Mercedes Ramirez

2013-01-01

Higher education institutions are well positioned to provide students with meaningful educational opportunities, to prepare them for lives of impact and service to their communities by investing their acquired knowledge to address critical societal needs. Furthermore, a sound college education is particularly important to students' personal,…

Branding and Positioning to Satisfy the Customer's Appetite: An Educational Case Study

ERIC Educational Resources Information Center

Ham, Tim

2010-01-01

Rebranding and positioning a school district has become critical to satisfy the "customer's" appetite, enhance public relations, and advance consumer perceptions. A service design model provides a district with the framework to advance its position by identifying attributes and prompts to satisfy customer needs and increase student…

Core Values and Major Issues in Student Affairs Practice: What Really Matters?

ERIC Educational Resources Information Center

Helfgot, Steven R.

2005-01-01

In a professional world characterized by change, uncertainty, and increased pressure to demonstrate that what they do really matters, community college student affairs professionals need clear definitions, a shared understanding of critical professional issues, and professional values that are consistent and congruent. This chapter provides those…

Kaupapa Maori, Philosophy and Schools

ERIC Educational Resources Information Center

Stewart, Georgina

2014-01-01

Goals for adding philosophy to the school curriculum centre on the perceived need to improve the general quality of critical thinking found in society. School philosophy also provides a means for asking questions of value and purpose about curriculum content across and between subjects, and, furthermore, it affirms the capability of children to…

Using Intelligent Tutor Technology to Implement Adaptive Support for Student Collaboration

ERIC Educational Resources Information Center

Diziol, Dejana; Walker, Erin; Rummel, Nikol; Koedinger, Kenneth R.

2010-01-01

Research on computer-supported collaborative learning has shown that students need support to benefit from collaborative activities. While classical collaboration scripts have been effective in providing such support, they have also been criticized for being coercive and not allowing students to self-regulate their learning. Adaptive collaboration…

Study Abroad Information in the New Media

ERIC Educational Resources Information Center

Teng, Shasha; Khong, Kok Wei; Chong, Alain Yee Loong

2015-01-01

Few studies have been conducted to identify what kinds of online information are provided by institutions and needed by international students in social media. This study aims to identify critical constructs of study abroad information (SAI) that can generate positive attitudes toward the university. Specifically, this study attempts to…

Adventure Therapy with Youth

ERIC Educational Resources Information Center

Norton, Christine Lynn; Tucker, Anita; Russell, Keith C.; Bettmann, Joanna E.; Gass, Michael A.; Gillis, H. L.; Behrens, Ellen

2014-01-01

This state of knowledge article provides an overview of Adventure Therapy (AT) as it is practiced with adolescents in North America, presenting (a) current findings in AT research with adolescents, (b) critical issues in AT, (c) the need for training and professional development in AT, and (d) professionalization in AT. Implications of current…

NETL- High-Pressure Combustion Research Facility

ScienceCinema

None

2018-02-14

NETL's High-Pressure Combustion Facility is a unique resource within the National Laboratories system. It provides the test capabilities needed to evaluate new combustion concepts for high-pressure, high-temperature hydrogen and natural gas turbines. These concepts will be critical for the next generation of ultra clean, ultra efficient power systems.

Reproductive behaviors of Anoplophora glabripennis (Coleoptera: Cerambycidae) in the laboratory

Treesearch

Melody A. Keena; Vicente Sanchez

2007-01-01

There is a critical need for information on the reproductive behavior of Anoplophora glabripennis (Motschulsky) to provide the biological basis for predicting population dynamics, especially as the population size declines due to eradication efforts. To document the reproductive behaviors (both mating and oviposition) five males each from the Chicago...

Identifying critical life stage transitions for biological control of long-lived perennial Vincetoxicum species

USDA-ARS?s Scientific Manuscript database

Demographic matrix modeling of invasive plant populations can be a powerful tool to identify key life stage transitions for targeted disruption in order to cause population decline. This approach can provide quantitative estimates of reductions in select vital rates needed to reduce population growt...

Employer Perceptions of Student Informational Interviewing Skills and Behaviors

ERIC Educational Resources Information Center

Orr, Claudia; Sherony, Bruce; Steinhaus, Carol

2011-01-01

Employers continue to report that soft skills are critically important in obtaining employment and achieving long-term career success. Given the challenging job market for college graduates, business school faculty need to provide practical opportunities for students to develop their soft skills in professional settings. A longitudinal study was…

IFSP Outcome Statements Made Simple

ERIC Educational Resources Information Center

Shelden, M'Lisa L.; Rush, Dathan D.

2014-01-01

A critical component for implementing evidence-based early intervention supports and services is the ability to write family-centered, functional, participation-based outcomes. Participation-based outcome statements that are family-focused center on the desires and needs of the parents or other care providers and are based on their interest in…

Making Sense of Sensory Systems

ERIC Educational Resources Information Center

Hendrix, Marie

2010-01-01

The role of caregivers requires that they continuously assess the needs and performance of children and provide the support necessary for them to achieve their potential. A thorough understanding of child development, including the role and impact of sensory development, is critical for caregivers to properly evaluate and assist these children.…

Native plant development and deployment [Section VII

Treesearch

Jessica Wright; Kas Dumroese; Amy Symstad; Theresa Pitts-Singer; Jim Cane; Gary Krupnick; Peggy Olwell; Byron Love; Elizabeth Sellers; John Englert; Troy Wood

2015-01-01

Native plant materials are needed to create, enhance, or restore pollinator habitat. They provide critical foraging and breeding areas for wild and managed pollinator species, including transnational migratory species such as hummingbirds and monarch butterflies. Although many pollinators and plants are generalists, some have limited, obligate relationships (i.e., one...

The Healthy Relationships Program: Preventing Sexual Assault of Youth.

ERIC Educational Resources Information Center

Lutzer, Victoria D.; Day-Vines, Norma

2001-01-01

This article describes an innovative model for supporting high-risk teens, including those in special education, who need social skills to protect them from sexual assault. Suggestions are made for prevention activities and involvement of community agencies with expertise for providing critical transition services to at-risk adolescents. (Author)

The Critical Link: Community Colleges and the Workforce.

ERIC Educational Resources Information Center

Falcone, Lisa, Ed.

In 1993, the American Association of Community Colleges (AACC) sponsored five activities designed to build the capacity of community colleges to respond to workforce development needs of employers and employees through contract training services. Three of these activities targeted community college-based business/industry liaisons, who provide a…

14 CFR 25.147 - Directional and lateral control.

Code of Federal Regulations, 2011 CFR

2011-01-01

... one engine inoperative, to provide a roll rate necessary for safety without excessive control forces... peak roll rate necessary for safety, without excessive control forces or travel. [Doc. No. 5066, 29 FR... force is 150 pounds need not be exceeded), and with— (1) The critical engine inoperative and its...

14 CFR 25.147 - Directional and lateral control.

Code of Federal Regulations, 2014 CFR

2014-01-01

... one engine inoperative, to provide a roll rate necessary for safety without excessive control forces... peak roll rate necessary for safety, without excessive control forces or travel. [Doc. No. 5066, 29 FR... force is 150 pounds need not be exceeded), and with— (1) The critical engine inoperative and its...

14 CFR 25.147 - Directional and lateral control.

Code of Federal Regulations, 2012 CFR

2012-01-01

... one engine inoperative, to provide a roll rate necessary for safety without excessive control forces... peak roll rate necessary for safety, without excessive control forces or travel. [Doc. No. 5066, 29 FR... force is 150 pounds need not be exceeded), and with— (1) The critical engine inoperative and its...

14 CFR 25.147 - Directional and lateral control.

Code of Federal Regulations, 2013 CFR

2013-01-01

... one engine inoperative, to provide a roll rate necessary for safety without excessive control forces... peak roll rate necessary for safety, without excessive control forces or travel. [Doc. No. 5066, 29 FR... force is 150 pounds need not be exceeded), and with— (1) The critical engine inoperative and its...

14 CFR 25.147 - Directional and lateral control.

Code of Federal Regulations, 2010 CFR

2010-01-01

... one engine inoperative, to provide a roll rate necessary for safety without excessive control forces... peak roll rate necessary for safety, without excessive control forces or travel. [Doc. No. 5066, 29 FR... force is 150 pounds need not be exceeded), and with— (1) The critical engine inoperative and its...

THE TRANSCULTURAL RESEARCH AND TRAINING INSTITUTE (TCI).

ERIC Educational Resources Information Center

LOUBERT, J. DANIEL

MANY AMERICANS EMPLOYED OVERSEAS, ESPECIALLY NAVY AND MARINE PERSONNEL, NEED KNOWLEDGE OF THE CULTURES IN WHICH THEY LIVE. THERE IS CRITICISM OF TRADITIONAL WAYS OF SELECTING PERSONS AND TRAINING THEM. A NUMBER OF NEW TECHNIQUES, BASED ON EXPERIMENTAL TRAINING IN SIMULATION OF FOREIGN SOCIETIES, SEEM TO PROVIDE FOR OVERCOMING INTERNALIZATION…

A systems approach to restoring degraded drylands

Treesearch

Jeremy J. James; Roger L. Sheley; Todd Erickson; Kimberly S. Rollins; Michael H. Taylor; Kingsley W. Dixon

2013-01-01

Drylands support over 2 billion people and are major providers of critical ecosystem goods and services across the globe. Drylands, however, are one of the most susceptible biomes to degradation. International programmes widely recognize dryland restoration as key to combating global dryland degradation and ensuring future global sustainability. While the need to...

Tackling Climate Change in the Science Classroom

ERIC Educational Resources Information Center

Johnson, Roberta

2013-01-01

Despite the pressures on education and educators today -- seemingly from all sides -- science teachers provide critically important opportunities for students to develop the scientific knowledge and skills they will need as adults. This preparation empowers them to make well-informed decisions as citizens, as well as to use this knowledge as a…

Chiral Pesticides in Chiral Biological Enciroments: Do We Need to Move Beyond our Achiral Perspective.

EPA Science Inventory

When a chemical stressor crosses the body barrier it becomes an internal dose. In the context of risk assessment, this internal dose provides a critical linkage between exposure and effects. Pharmacokinetic processes (i.e., what the body does to the chemical) such as absorption, ...

76 FR 76120 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

... ERS is to provide timely research and analysis to public and private decision makers on topics related... Supplemental Nutrition Assistance Program (SNAP) in delivering nutrition-related benefits. Need and Use of the... above information as it relates to low-income households. It is critical for USDA to better understand...

Early Childhood Special Music Education

ERIC Educational Resources Information Center

Darrow, Alice-Ann

2011-01-01

The process of early intervention is a critical component of Early Childhood Special Music Education. Early intervention is the process of providing services, education, and support to young children who have disabilities or to children who are at-risk of developing needs that may affect their physical, cognitive, or emotional development. The…

Talking about Youth Development: Helping Campers Grow into Successful Adults.

ERIC Educational Resources Information Center

Camping Magazine, 2001

2001-01-01

Youth development moves beyond risk reduction by turning a narrow negative focus on at-risk factors into positive action strategies. Critical components of youth development are providing positive ways for young people to meet their needs and building competencies. Physical, social, cognitive, vocational, and moral competence are described, and…

Critical thinking ability of new graduate and experienced nurses.

PubMed

Fero, Laura J; Witsberger, Catherine M; Wesmiller, Susan W; Zullo, Thomas G; Hoffman, Leslie A

2009-01-01

This paper is a report of a study to identify critical thinking learning needs of new and experienced nurses. Concern for patient safety has grown worldwide as high rates of error and injury continue to be reported. In order to improve patient safety, nurses must be able to recognize changes in patient condition, perform independent nursing interventions, anticipate orders and prioritize. In 2004-2006, a consecutive sample of 2144 newly hired nurses in a university-affiliated healthcare system completed the Performance Based Development System Assessment consisting of 10 videotaped vignettes depicting change in patient status. Results were reported as meeting or not meeting expectations. For nurses not meeting expectations, learning needs were identified in one of six subcategories. Overall, 74.9% met assessment expectations. Learning needs identified for nurses not meeting expectations included initiating independent nursing interventions (97.2%), differentiation of urgency (67%), reporting essential clinical data (65.4%), anticipating relevant medical orders (62.8%), providing relevant rationale to support decisions (62.6%) and problem recognition (57.1%). Controlling for level of preparation, associate (P=0.007) and baccalaureate (P<0.0001) nurses were more likely to meet expectations as years of experience increased; a similar trend was not seen for diploma nurses (P=0.10). Controlling for years of experience, new graduates were less likely to meet expectations compared with nurses with >or=10 years experience (P=0.046). Patient safety may be compromised if a nurse cannot provide clinically competent care. Assessments such as the Performance Based Development System can provide information about learning needs and facilitate individualized orientation targeted to increase performance level.

Year 2000 Computing Challenge: Education Taking Needed Actions but Work Remains. Testimony before the Subcommittee on Oversight and Investigations, Committee on Education and the Workforce, House of Representatives.

ERIC Educational Resources Information Center

Willemssen, Joel C.

This document provides testimony on the U.S. Department of Education's efforts to ensure that its computer systems supporting critical student financial aid activities will be able to process information reliably through the turn of the century. After providing some background information, the statement recaps prior findings and the actions that…

STEADI: CDC's approach to make older adult fall prevention part of every primary care practice.

PubMed

Sarmiento, Kelly; Lee, Robin

2017-12-01

Primary care providers play a critical role in protecting older adult patients from one of the biggest threats to their health and independence-falls. A fall among an older adult patient cannot only be fatal or cause a devastating injury, but can also lead to problems that can effect a patient's overall quality of life. In response, the Centers for Disease Control and Prevention (CDC) developed the STEADI initiative to give health care providers the tools they need to help reduce their older adult patient's risk of a fall. CDC's STEADI resources have been distributed widely and include practical materials and tools for health care providers and their patients that are designed to be integrated into every primary care practice. As the population ages, the need for fall prevention efforts, such as CDC's STEADI, will become increasingly critical to safeguard the health of Americans. STEADI's electronic health records (EHRs), online trainings, assessment tools, and patient education materials are available at no-cost and can be downloaded online at www.cdc.gov/STEADI. Health care providers should look for opportunities to integrate STEADI materials into their practice, using a team-based approach, to help protect their older patients. Published by Elsevier Ltd.

INSPECTION SHOP: PLAN TO PROVIDE UNCERTAINTY ANALYSIS WITH MEASUREMENTS

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

Nederbragt, W W

The LLNL inspection shop is chartered to make dimensional measurements of components for critical programmatic experiments. These measurements ensure that components are within tolerance and provide geometric details that can be used to further refine simulations. For these measurements to be useful, they must be significantly more accurate than the tolerances that are being checked. For example, if a part has a specified dimension of 100 millimeters and a tolerance of 1 millimeter, then the precision and/or accuracy of the measurement should be less than 1 millimeter. Using the ''10-to-1 gaugemaker's rule of thumb'', the desired precision of the measurementmore » should be less than 100 micrometers. Currently, the process for associating measurement uncertainty with data is not standardized, nor is the uncertainty based on a thorough uncertainty analysis. The goal of this project is to begin providing measurement uncertainty statements with critical measurements performed in the inspection shop. To accomplish this task, comprehensive knowledge about the underlying sources of uncertainty for measurement instruments need to be understood and quantified. Moreover, measurements of elemental uncertainties for each physical source need to be combined in a meaningful way to obtain an overall measurement uncertainty.« less

Aviation Weather Information Communications Study (AWIN). Phase 1 and 2

NASA Technical Reports Server (NTRS)

Ball, J. W.; Herron, R. G.; Nozawa, E. T.; Thomas, E. A.; Witchey, R. D.

2000-01-01

This two part study examines the communication requirements to provide weather information in the cockpit as well as public and private communication systems available to address the requirements. Ongoing research projects combined with user needs for weather related information are used to identify and describe potential weather products that address decision support in three time frames: Far-Term Strategic, Near-Term Strategic and Tactical. Data requirements of these future products are identified and quantified. Communications systems and technologies available in the public as well as private sector are analyzed to identify potential solutions. Recommendations for further research identify cost, performance, and safety benefits to justify the investment. The study concludes that not all weather information has the same level of urgency to safety-of-flight and some information is more critical to one category of flight than another. Specific weather products need to be matched with communication systems with appropriate levels of reliability to support the criticality of the information. Available bandwidth for highly critical information should be preserved and dedicated to safety. Meanwhile, systems designed for in-flight-entertainment and other passenger/crew services could be used to support less critical information that is used only for planning and economic decision support.

A Critical Realist Orientation to Learner Needs

ERIC Educational Resources Information Center

Ayers, David F.

2011-01-01

The objective of this essay is to propose critical realism as a philosophical middle way between two sets of ontological, epistemological, and methodological assumptions regarding learner needs. Key concepts of critical realism, a tradition in the philosophy of science, are introduced and applied toward an analysis of learner needs, resulting in…

Geriatric Oncology Program Development and Gero-Oncology Nursing.

PubMed

Lynch, Mary Pat; DeDonato, Dana Marcone; Kutney-Lee, Ann

2016-02-01

To provide a critical analysis of current approaches to the care of older adults with cancer, outline priority areas for geriatric oncology program development, and recommend strategies for improvement. Published articles and reports between 1999 and 2015. Providing an interdisciplinary model that incorporates a holistic geriatric assessment will ensure the delivery of patient-centered care that is responsive to the comprehensive needs of older patients. Nursing administrators and leaders have both an opportunity and responsibility to shape the future of geriatric oncology. Preparations include workforce development and the creation of programs that are designed to meet the complex needs of this population. Copyright © 2015 Elsevier Inc. All rights reserved.

Convenience Sampling of Children Presenting to Hospital-Based Outpatient Clinics to Estimate Childhood Obesity Levels in Local Surroundings.

PubMed

Gilliland, Jason; Clark, Andrew F; Kobrzynski, Marta; Filler, Guido

2015-07-01

Childhood obesity is a critical public health matter associated with numerous pediatric comorbidities. Local-level data are required to monitor obesity and to help administer prevention efforts when and where they are most needed. We hypothesized that samples of children visiting hospital clinics could provide representative local population estimates of childhood obesity using data from 2007 to 2013. Such data might provide more accurate, timely, and cost-effective obesity estimates than national surveys. Results revealed that our hospital-based sample could not serve as a population surrogate. Further research is needed to confirm this finding.

Evidence for structural plasticity in humans: comment on Thomas and Baker (2012).

PubMed

Erickson, Kirk I

2013-06-01

Thomas and Baker (2012) have provided a balanced and critical review of the scientific evidence claiming that training interventions have the capacity to alter the structural morphology of the brain. Here I provide some additional considerations when reading and interpreting both the review and the original empirical articles. Research proposing to examine the capacity for structural brain plasticity needs to contemplate methodological issues and factors that could moderate or mask potentially interesting effects. Overall, although this area of research is in need of circumspection, it also could have transformative implications if structural brain plasticity in humans is possible. Copyright © 2012 Elsevier Inc. All rights reserved.

The Top Ten Websites in Critical Care Medicine Education Today.

PubMed

Wolbrink, Traci A; Rubin, Lucy; Burns, Jeffrey P; Markovitz, Barry

2018-01-01

The number of websites for the critical care provider is rapidly growing, including websites that are part of the Free Open Access Med(ical ed)ucation (FOAM) movement. With this rapidly expanding number of websites, critical appraisal is needed to identify quality websites. The last major review of critical care websites was published in 2011, and thus a new review of the websites relevant to the critical care clinician is necessary. A new assessment tool for evaluating critical care medicine education websites, the Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET), was modified from existing tools. A PubMed and Startpage search from 2007 to 2017 was conducted to identify websites relevant to critical care medicine education. These websites were scored based on the CCMEWQET. Ninety-seven websites relevant for critical care medicine education were identified and scored, and the top ten websites were described in detail. Common types of resources available on these websites included blog posts, podcasts, videos, online journal clubs, and interactive components such as quizzes. Almost one quarter of websites (n = 22) classified themselves as FOAM websites. The top ten websites most often included an editorial process, high-quality and appropriately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included opportunities for interactive learning. Many excellent online resources for critical care medicine education currently exist, and the number is likely to continue to increase. Opportunities for improvement in many websites include more active engagement of learners, upgrading navigation abilities, incorporating an editorial process, and providing appropriate attribution for graphics and media.

e-Healthcare in India: critical success factors for sustainable health systems.

PubMed

Taneja, Udita; Sushil

2007-01-01

As healthcare enterprises seek to move towards an integrated, sustainable healthcare delivery model an IT-enabled or e-Healthcare strategy is being increasingly adopted. In this study we identified the critical success factors influencing the effectiveness of an e-Healthcare strategy in India. The performance assessment criteria used to measure effectiveness were increasing reach and reducing cost of healthcare delivery. A survey of healthcare providers was conducted. Analytic Hierarchy Process (AHP) and Interpretive Structural Modeling (ISM) were the analytical tools used to determine the relative importance of the critical success factors in influencing effectiveness of e-Healthcare and their interplay with each other. To succeed in e-Healthcare initiatives the critical success factors that need to be in place are appropriate government policies, literacy levels, and telecommunications and power infrastructure in the country. The focus should not be on the IT tools and biomedical engineering technologies as is most often the case. Instead the nontechnology factors such as healthcare provider and consumer mindsets should be addressed to increase acceptance of, and enhance the effectiveness of, sustainable e-Healthcare services.

Powerless positions, silenced voices? - critical views on health and social care management.

PubMed

Hujala, Anneli; Laulainen, Sanna; Lindberg, Kajsa

2014-01-01

The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management. Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue. In order to identify the wicked problems and darker sides of the care field, there is a need to study things in alternative ways through critical lenses. Giving a voice to those in less powerful positions may result in redefinition and redesign of conventional roles and agency of patients, volunteers and professionals and call into question the taken-for-granted understanding of health and social care management. The special issue as a whole was designed to enhance critical approaches to the discussion in the field of health and social care. This editorial hopefully raises awareness of CMS and serves as an opening for further discussion on critical views in the research on management and organization in this field.

Nontraditional teaching techniques and critical thinking in an introductory postsecondary environmental science course

NASA Astrophysics Data System (ADS)

Buerdsell, Sherri Lynn

2009-12-01

As an institution of higher education and as a Hispanic-serving institution, New Mexico State University has a responsibility to its students to provide the skills and experiences necessary for each and every student to become a responsible, reflective citizen, capable of making informed decisions. Postsecondary science has traditionally been taught through lectures. Traditional lecture classes simply do not meet the needs of diverse groups of students in the modern multicultural student body like New Mexico State University's. However, the implementation of nontraditional pedagogy without evaluation of the results is useless as a step to reform; it is necessary to evaluate the results of in situ nontraditional pedagogy to determine its worth. The purpose of this research is to analyze the development and change in students' critical thinking skills, and critical thinking dispositions in single semester in an introductory Environmental Science course. This study utilized a mixed methods approach. The California Critical Thinking Skills Test and the California Critical Thinking Disposition Inventory were administered in the beginning and at the end of the semester. The pretest was used to provide a baseline for each participant against which the posttest score was compared. In addition, student interviews, field notes, and a survey provided qualitative data, which generated themes regarding the development of student critical thinking in this course. The results indicated there were no significant differences in the critical thinking test scores. However, qualitative analysis indicated that students experienced significant changes in critical thinking. Three themes emerged from the qualitative analysis pertaining to the amount of influence on student learning. These themes are active thinking and learning, dialogue, and professor's influence. Due to the conflict between the quantitative and the qualitative results, it is suggested that the critical thinking tests are not sensitive enough to identify minute but important changes in student critical thinking.

The development of an internet-based knowledge exchange platform for pediatric critical care clinicians worldwide*.

PubMed

Wolbrink, Traci A; Kissoon, Niranjan; Burns, Jeffrey P

2014-03-01

Advances in Internet technology now enable unprecedented global collaboration and collective knowledge exchange. Up to this time, there have been limited efforts to use these technologies to actively promote knowledge exchange across the global pediatric critical care community. To develop an open-access, peer-reviewed, not-for-profit Internet-based learning application, OPENPediatrics, a collaborative effort with the World Federation of Pediatric Intensive and Critical Care Societies, was designed to promote postgraduate educational knowledge exchange for physicians, nurses, and others caring for critically ill children worldwide. Description of program development. International multicenter tertiary pediatric critical care units across six continents. Multidisciplinary pediatric critical care providers. A software application, providing information on demand, curricular pathways, and videoconferencing, downloaded to a local computer. In 2010, a survey assessing postgraduate educational needs was distributed through World Federation of Pediatric Intensive and Critical Care Societies to constituent societies. Four hundred and twenty-nine critical care providers from 49 countries responded to the single e-mail survey request. Respondents included 68% physicians and 28% nurses who care for critically ill children. Fifty-two percent of respondents reported accessing the Internet at least weekly to obtain professional educational information. The five highest requests were for educational content on respiratory care [mechanical ventilation] (48% [38%]), sepsis (28%), neurology (25%), cardiology (14%), extracorporeal membrane oxygenation (10%), and ethics (8%). Based on these findings, and in collaboration with researchers in adult learning and online courseware, an application was developed and is currently being used by 770 registered users in 60 countries. We describe here the development and implementation of an Internet-based application which is among the first efforts designed to promote global knowledge exchange for physicians and nurses caring for critically ill children. This application has the potential to evolve new methods in postgraduate education. Ongoing assessment of the efficacy of Internet-based learning platforms will be necessary.

Microgrid Controllers : Expanding Their Role and Evaluating Their Performance

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

Maitra, Arindam; Pratt, Annabelle; Hubert, Tanguy

Microgrids have long been deployed to provide power to customers in remote areas as well as critical industrial and military loads. Today, they are also being proposed as grid-interactive solutions for energy-resilient communities. Such microgrids will spend most of the time operating while synchronized with the surrounding utility grid but will also be capable of separating during contingency periods due to storms or temporary disturbances such as local grid faults. Properly designed and grid-integrated microgrids can provide the flexibility, reliability, and resiliency needs of both the future grid and critical customers. These systems can be an integral part of futuremore » power system designs that optimize investments to achieve operational goals, improved reliability, and diversification of energy sources.« less

Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children.

PubMed

Peckover, Sue; Aston, Megan

2018-01-01

To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance. Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power. Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families. © 2017 John Wiley & Sons Ltd.

Long-Term Soil Experiments: A Key to Managing Earth's Rapidly Changing Critical Zones

NASA Astrophysics Data System (ADS)

Richter, D., Jr.

2014-12-01

In a few decades, managers of Earth's Critical Zones (biota, humans, land, and water) will be challenged to double food and fiber production and diminish adverse effects of management on the wider environment. To meet these challenges, an array of scientific approaches is being used to increase understanding of Critical Zone functioning and evolution, and one amongst these approaches needs to be long-term soil field studies to move us beyond black boxing the belowground Critical Zone, i.e., to further understanding of processes driving changes in the soil environment. Long-term soil experiments (LTSEs) provide direct observations of soil change and functioning across time scales of decades, data critical for biological, biogeochemical, and environmental assessments of sustainability; for predictions of soil fertility, productivity, and soil-environment interactions; and for developing models at a wide range of temporal and spatial scales. Unfortunately, LTSEs globally are not in a good state, and they take years to mature, are vulnerable to loss, and even today remain to be fully inventoried. Of the 250 LTSEs in a web-based network, results demonstrate that soils and belowground Critical Zones are highly dynamic and responsive to human management. The objective of this study is to review the contemporary state of LTSEs and consider how they contribute to three open questions: (1) can soils sustain a doubling of food production in the coming decades without further impinging on the wider environment, (2) how do soils interact with the global C cycle, and (3) how can soil management establish greater control over nutrient cycling. While LTSEs produce significant data and perspectives for all three questions, there is on-going need and opportunity for reviews of the long-term soil-research base, for establishment of an efficiently run network of LTSEs aimed at sustainability and improving management control over C and nutrient cycling, and for research teams that provide for generation to generation transfer of new and historic LTSEs.

[Emergency and disaster response in critical care unit in the Mexican Social Security Institute: triage and evacuation].

PubMed

Echevarría-Zuno, Santiago; Cruz-Vega, Felipe; Elizondo-Argueta, Sandra; Martínez Valdés, Everardo; Franco-Bey, Rubén; Méndez-Sánchez, Luis Miguel

2013-01-01

Providing medical assistance in emergencies and disaster in advance makes the need to maintain Medical Units functional despite the disturbing phenomenon that confronts the community, but conflict occurs when the Medical Unit needs support and needs to be evacuated, especially when the evacuation of patients in a Critical Care Unit is required. In world literature there is little on this topic, and what is there usually focuses on the conversion of areas and increased ability to care for mass casualties, but not about how to evacuate if necessary, and when a wrong decision can have fatal consequences. That is why the Mexican Social Security Institute gave the task of examining these problems to a working group composed of specialists of the Institute. The purpose was to evaluate and establish a method for performing a protocol in the removal of patients and considering always to safeguard both staff and patients and maintain the quality of care.

What Community-Based HIV Prevention Organizations Say About Their Role in Biomedical HIV Prevention.

PubMed

Smith, Dawn K; Maier, Emily; Betts, Joshua; Gray, Simone; Kolodziejski, Brian; Hoover, Karen W

2016-10-01

Community-based organizations (CBOs) are critical to delivery of effective HIV prevention because of their reach to key populations. This online survey of a national sample of CBOs assessed their awareness of, interest in, and resources needed to provide nonoccupational postexposure prophylaxis (nPEP), preexposure prophylaxis (PrEP), and HIV treatment as prevention (TasP). One hundred seventy-five CBOs participated: 87 clinical and 88 nonclinical CBOs. For nPEP, PrEP, and TasP, program managers reported that awareness was high (94%, 90%, 85%), meeting current client need was low (20%, 13%, 18%), and the likelihood of increasing their current provision with additional resources was somewhat high (62%, 64%, 62%). Clinical CBOs were more prepared to support expansion of these biomedical interventions than nonclinical CBOs. Meeting the information, training, and resource needs of CBOs is critical for effective collaboration to reduce the number of new HIV infections through expanded delivery of PrEP, nPEP, and TasP.

A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations.

PubMed

Lee, Joy L; Matthias, Marianne S; Menachemi, Nir; Frankel, Richard M; Weiner, Michael

2018-04-01

Patient-provider electronic communication has proliferated in recent years, yet there is a dearth of published research either leading to, or including, recommendations that improve clinical care and prevent unintended negative consequences. We critically appraise published guidelines and suggest an agenda for future work in this area. To understand how existing guidelines align with current practice, evidence, and technology. We performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers, searching Ovid MEDLINE, Embase, and PubMed databases using relevant terms. We limited the search to articles published in English, and manually searched the citations of relevant articles. For each article, we identified and evaluated the suggested practices. Across 11 identified guidelines, the primary focus was on technical and administrative concerns, rather than on relational communication. Some of the security practices recommended by the guidelines are no longer needed because of shifts in technology. It is unclear the extent to which the recommendations that are still relevant are being followed. Moreover, there is no guideline-cited evidence of the effectiveness of the practices that have been proposed. Our analysis revealed major weaknesses in current guidelines for electronic communication between patients and providers: the guidelines appear to be based on minimal evidence and offer little guidance on how best to use electronic tools to communicate effectively. Further work is needed to systematically evaluate and identify effective practices, create a framework to evaluate quality of communication, and assess the relationship between electronic communication and quality of care.

“What’s the Story?” Information Needs of Trauma Teams

PubMed Central

Sarcevic, Aleksandra; Burd, Randall S.

2008-01-01

This paper reports on information needs of trauma teams based on an ethnographic study in an urban teaching hospital. We focus on questions posed by trauma team members during ten trauma events. We identify major categories of questions, as well as information seekers and providers. In addition to categories known from other critical care settings, we found categories unique to trauma settings. Based on these findings, we discuss implications for information technology support for trauma teams. PMID:18999288

Some aspects of dust-plasma interactions in the cosmic environment

NASA Technical Reports Server (NTRS)

Mendis, D. A.; Rosenberg, Marlene

1992-01-01

In this paper we present a brief, critical review of dust-plasma interactions in the cosmic environment, with emphasis on certain recent results. Both single-particle (e.g. gravitoelectrodynamics) and collective effects (e.g. appearance of new wave modes) are discussed and some areas in which further research is needed are pointed out. Finally the pressing need for laboratory studies, both to provide the necessary data for the theoretical studies and to test the predictions of these theories, is emphasized.

ITOHealth: a multimodal middleware-oriented integrated architecture for discovering medical entities.

PubMed

Alor-Hernández, Giner; Sánchez-Cervantes, José Luis; Juárez-Martínez, Ulises; Posada-Gómez, Rubén; Cortes-Robles, Guillermo; Aguilar-Laserre, Alberto

2012-03-01

Emergency healthcare is one of the emerging application domains for information services, which requires highly multimodal information services. The time of consuming pre-hospital emergency process is critical. Therefore, the minimization of required time for providing primary care and consultation to patients is one of the crucial factors when trying to improve the healthcare delivery in emergency situations. In this sense, dynamic location of medical entities is a complex process that needs time and it can be critical when a person requires medical attention. This work presents a multimodal location-based system for locating and assigning medical entities called ITOHealth. ITOHealth provides a multimodal middleware-oriented integrated architecture using a service-oriented architecture in order to provide information of medical entities in mobile devices and web browsers with enriched interfaces providing multimodality support. ITOHealth's multimodality is based on the use of Microsoft Agent Characters, the integration of natural language voice to the characters, and multi-language and multi-characters support providing an advantage for users with visual impairments.

The needs of the relatives in the adult intensive care unit: Cultural adaptation and psychometric properties of the Chilean-Spanish version of the Critical Care Family Needs Inventory.

PubMed

Rojas Silva, Noelia; Padilla Fortunatti, Cristobal; Molina Muñoz, Yerko; Amthauer Rojas, Macarena

2017-12-01

The admission of a patient to an intensive care unit is an extraordinary event for their family. Although the Critical Care Family Needs Inventory is the most commonly used questionnaire for understanding the needs of relatives of critically ill patients, no Spanish-language version is available. The aim of this study was to culturally adapt and validate theCritical Care Family Needs Inventory in a sample of Chilean relatives of intensive care patients. The back-translated version of the inventory was culturally adapted following input from 12 intensive care and family experts. Then, it was evaluated by 10 relatives of recently transferred ICU patients and pre-tested in 10 relatives of patients that were in the intensive care unit. Psychometric properties were assessed through exploratory factor analysis and Cronbach's α in a sample of 251 relatives of critically ill patients. The Chilean-Spanish version of the Critical Care Family Needs Inventoryhad minimal semantic modifications and no items were deleted. A two factor solution explained the 31% of the total instrument variance. Reliability of the scale was good (α=0.93), as were both factors (α=0.87; α=0.93). The Chilean-Spanish version of theCritical Care Family Needs Inventory was found valid and reliable for understanding the needs of relatives of patients in acute care settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

A leadership programme for critical care.

PubMed

Crofts, Linda

2006-08-01

This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management.

Keeping Pace with Climate Change: Habitat Protection in the Face of Uncertainty

NASA Astrophysics Data System (ADS)

Flitcroft, R. L.; Burnett, K.; Giannico, G.

2014-12-01

Estuaries provide critical habitat for many economically and culturally important species. In the Pacific Northwest, intertidal and subtidal areas provide critical habitat for production of native and commercial oysters (Olympia oyster Ostrea lurida and Pacific oyster Crassostrea gigas, respectively) that in turn provide refuge and rearing habitat for Dungeness Crab, Metacarcinus magister. Environments ranging from subtidal through freshwater zones provide nursery areas for juvenile salmonids at different development stages in their life history. Most Oregon estuaries have been significantly altered by humans over the past century, reducing the quantity and diversity of available habitats. Management agencies have responded with projects to restore and enhance estuarine habitats. Unfortunately, future climate change and sea-level rise could render many current restoration projects ineffective over time. Planning for habitat restoration that keeps pace with climate change will be critical to the sustainable production of seafood and maintenance of ecosystem function. However, land managers and citizens lack the spatially-explicit data needed to incorporate the potential effects of climate change and sea-level rise into planning for habitat improvement projects in estuarine areas. To meet this need, we developed simple models using LiDAR to characterize the geomorphologies of multiple Oregon estuaries. We were able to map the margin of current mean high tide, and contour intervals associated with different potential increases in mean high tide. Because our analysis relied on digital data, we compared three types of digital data in one estuary to assess the utility of different data sets in predicting changes in estuary shape. For each estuary, we assessed changes in the amount and complexity of edge habitats. The simple modeling approach we applied can also be used to identify areas that may be most amenable to pre-emptive restoration actions to mitigate or enhance habitats under future climatic conditions.

Challenges faced by nurses in managing pain in a critical care setting.

PubMed

Subramanian, Pathmawathi; Allcock, Nick; James, Veronica; Lathlean, Judith

2012-05-01

To explore nurses' challenges in managing pain among ill patients in critical care. Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill. Qualitative prospective exploratory design. This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses. Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself. Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience. There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines. © 2011 Blackwell Publishing Ltd.

Critical care capacity in Canada: results of a national cross-sectional study.

PubMed

Fowler, Robert A; Abdelmalik, Philip; Wood, Gordon; Foster, Denise; Gibney, Noel; Bandrauk, Natalie; Turgeon, Alexis F; Lamontagne, François; Kumar, Anand; Zarychanski, Ryan; Green, Rob; Bagshaw, Sean M; Stelfox, Henry T; Foster, Ryan; Dodek, Peter; Shaw, Susan; Granton, John; Lawless, Bernard; Hill, Andrea; Rose, Louise; Adhikari, Neill K; Scales, Damon C; Cook, Deborah J; Marshall, John C; Martin, Claudio; Jouvet, Philippe

2015-04-01

Intensive Care Units (ICUs) provide life-supporting treatment; however, resources are limited, so demand may exceed supply in the event of pandemics, environmental disasters, or in the context of an aging population. We hypothesized that comprehensive national data on ICU resources would permit a better understanding of regional differences in system capacity. After the 2009-2010 Influenza A (H1N1) pandemic, the Canadian Critical Care Trials Group surveyed all acute care hospitals in Canada to assess ICU capacity. Using a structured survey tool administered to physicians, respiratory therapists and nurses, we determined the number of ICU beds, ventilators, and the ability to provide specialized support for respiratory failure. We identified 286 hospitals with 3170 ICU beds and 4982 mechanical ventilators for critically ill patients. Twenty-two hospitals had an ICU that routinely cared for children; 15 had dedicated pediatric ICUs. Per 100,000 population, there was substantial variability in provincial capacity, with a mean of 0.9 hospitals with ICUs (provincial range 0.4-2.8), 10 ICU beds capable of providing mechanical ventilation (provincial range 6-19), and 15 invasive mechanical ventilators (provincial range 10-24). There was only moderate correlation between ventilation capacity and population size (coefficient of determination (R(2)) = 0.771). ICU resources vary widely across Canadian provinces, and during times of increased demand, may result in geographic differences in the ability to care for critically ill patients. These results highlight the need to evolve inter-jurisdictional resource sharing during periods of substantial increase in demand, and provide background data for the development of appropriate critical care capacity benchmarks.

Recruiting and Selecting a Superintendent.

ERIC Educational Resources Information Center

Lueders, Wayne J.

This manual is a resource document and guide for school boards to use in recruiting and selecting a superintendent. The material provides a basis to first identify the critical decisions that need to be made and, second, to consider alternatives or options to each of the major decision areas. The following factors are discussed: (1) the board's…

Human influences on forest ecosystems: the southern wildland-urban interface assessment

Treesearch

Edward A. Macie; L. Annie Hermansen; [Editors

2002-01-01

This publication provides a review of critical wildland-urban interface issues, challenges, and needs for the Southern United States. Chapter topics include population and demographic trends; economic and tax issues; land use planning and policy; urban effects on forest ecosystems; challenges for forest resource management and conservation; social consequences of...

Promoting Social and Emotional Well-Being in Schools

ERIC Educational Resources Information Center

Barry, Margaret M.; Clarke, Aleisha Mary; Dowling, Katherine

2017-01-01

Purpose: The purpose of this paper is to provide a critical perspective on the international evidence on promoting young people's social and emotional well-being in schools. The challenges of integrating evidence-based interventions within schools are discussed and the need for innovative approaches to research and practice are considered in order…

Empowering Hispanic Families: A Critical Issue for the '90s.

ERIC Educational Resources Information Center

Sotomayor, Marta, Ed.

The chapters of this book will guide discourse about the service needs of the Hispanic population and provide a significant knowledge base for understanding the strengths of Hispanics, for whom the family is central and crucial. Following an introduction by M. Sotomayor, the following chapters are presented: (1) "Hispanics in the Past Two…

Mathematics in Early Childhood: Research-Based Rationale and Practical Strategies

ERIC Educational Resources Information Center

Linder, Sandra M.; Powers-Costello, Beth; Stegelin, Dolores A.

2011-01-01

Mathematics education is a critical part of the curriculum for students worldwide. The foundation for understanding mathematical concepts related to number sense begins early in life, and early childhood classrooms can provide the seeds for mathematical skills that will be needed later in life. In this article, the authors make a case for…

Sustainability and productivity of southern pine ecosystems

Treesearch

Jim Barnett; Rod Busby; Floyd Bridgwater; Don English; Jim Hanula; Nancy Herbert; Kurt Johnsen; Brad Kard; Kier Klepzig; Charlie McMahon; Jeff Prestemon; Tim Rials; Bob Rummer; Mike Shelton; Ron Thill; Tom Waldrop; Joan Walker; Nancy Walters

2000-01-01

Scientist at the Southern Research Station (SRS) have developed a means to address critical forest resource needs in the 21st century. Throughout the South, we are working with public and private land owners to face unprecedented natural resource challenges (United States Department of Agriculture, forest Service 1997). By providing access to research results and...

Cognitive Potential: How Different Are Agriculture Students?

ERIC Educational Resources Information Center

Rhoades, Emily B.; Ricketts, John; Friedel, Curt

2009-01-01

Given the interest, research, and effort extended to help faculty in colleges of agriculture provide educational discourse at higher cognitive levels over the last few years, one would expect that students enrolled in colleges of agriculture would exhibit higher levels of critical thinking and need for cognition. This study thus aimed to discover…

Caring for Infants and Toddlers in Groups: Developmentally Appropriate Practice.

ERIC Educational Resources Information Center

Lally, J. Ronald; Griffin, Abbey; Fenichel, Emily; Segal, Marilyn; Szanton, Eleanor; Weissbourd, Bernice

Noting that high quality group care for infants and toddlers can enrich children's early experience and provide critical support to their families, this guide is designed to help caregivers and other interested parties in early care and education recognize and communicate the skills and knowledge needed to offer nurturing group care that supports…

Critical Factors in Mental Health Programming for Juveniles in Corrections Facilities

ERIC Educational Resources Information Center

Underwood, Lee A.; Phillips, Annie; von Dresner, Kara; Knight, Pamela D.

2006-01-01

Juveniles with mental health and other specialized needs are overrepresented in the juvenile justice system, and while juvenile corrections have not historically provided standardized and evidence-based mental health services for its incarcerated youth, the demand is evident. The reality is that juveniles with serious mental illness are committed…

Visual Search Asymmetries within Color-Coded and Intensity-Coded Displays

ERIC Educational Resources Information Center

Yamani, Yusuke; McCarley, Jason S.

2010-01-01

Color and intensity coding provide perceptual cues to segregate categories of objects within a visual display, allowing operators to search more efficiently for needed information. Even within a perceptually distinct subset of display elements, however, it may often be useful to prioritize items representing urgent or task-critical information.…

Not Hoovervilles, but Hooch: Gertrude Chandler Warner's "The Boxcar Children" and the Roaring Twenties

ERIC Educational Resources Information Center

Abate, Michelle Ann

2016-01-01

This essay provides much-needed critical attention and historical context to the long-neglected 1924 edition of Gertrude Chandler Warner's "The Box-Car Children." Commonly overshadowed by its more recent and more popular 1942 version--known as "The Boxcar Children"--this earlier edition calls attention to the original cultural…

Digital and Media Literacy: Connecting Culture and Classroom

ERIC Educational Resources Information Center

Hobbs, Renee

2011-01-01

Today's students tweet, text, and navigate apps up to 12 hours each day, but they may not know how to effectively analyze a TV show or website. Award-winning author Renee Hobbs demonstrates how to incorporate media literacy into the secondary classroom, providing the tools teachers need to: (1) Effectively foster students' critical thinking,…

Rethinking edTPA: The Use of InTASC Principles and Standards

ERIC Educational Resources Information Center

Kuo, Nai-Cheng

2018-01-01

The Interstate Teacher Assessment and Support Consortium (InTASC) Model Core Teaching Standards and Learning Progressions for Teachers 1.0, developed by the Council of Chief State School Officers (CCSSO, 2013) in the United States, provide a set of expectations for essential knowledge, critical disposition, and performance needed for high-quality…

The Relationship of the World Wide Web to Thinking Skills.

ERIC Educational Resources Information Center

Bradshaw, Amy C.; Bishop, Jeanne L.; Gens, Linda S.; Miller, Sharla L.; Rogers, Martha A.

2002-01-01

Discusses use of the World Wide Web in education and its possibilities for developing higher order critical thinking skills to successfully deal with the demands of the future information society. Suggests that teachers need to provide learning environments that are learner-centered, authentic, problem-based, and collaborative. (Contains 61…

In Search of Common Ground. A Briefing Paper on School Reform & the Religious Right.

ERIC Educational Resources Information Center

Averitt, Debbie Lee

This document provides a background for understanding the conflicts surrounding educational reform and the reactions of the religious right, and it outlines critical implications for policymakers, educators, business leaders, and other interested citizens in North Carolina. Both educational reformers and the religious right agree on the need to…

Developing a Multi-Dimensional Early Elementary Mathematics Screener and Diagnostic Tool: The Primary Mathematics Assessment

ERIC Educational Resources Information Center

Brendefur, Jonathan L.; Johnson, Evelyn S.; Thiede, Keith W.; Strother, Sam; Severson, Herb H.

2018-01-01

There is a critical need to identify primary level students experiencing difficulties in mathematics to provide immediate and targeted instruction that remediates their deficits. However, most early math screening instruments focus only on the concept of number, resulting in inadequate and incomplete information for teachers to design intervention…

76 FR 48485 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-08

... order below: ABN Advance Beneficiary Notice AIDS Acquired Immune Deficiency Syndrome ARD Assessment... Survey Certification and Reporting System PAC-PRD Post Acute Care Payment Reform Demonstration PECOS... which the hospital can use its beds to provide either acute or SNF care, as needed. For critical [[Page...

Building and Strengthening Policy Research Capacity: Key Issues in Canadian Higher Education

ERIC Educational Resources Information Center

Jones, Glen A.

2014-01-01

Given the importance of higher education in social and economic development, governments need to build a strong higher education data and policy research infrastructure to support informed decision-making, provide policy advice, and offer a critical assessment of key trends and issues. The author discusses the decline of higher education policy…

75 FR 25288 - Notice of Availability of the Proposed Resource Management Plan and Final Environmental Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-07

... date that the Environmental Protection Agency publishes its Notice of Availability in the Federal... level of protection, restoration, and enhancement to meet the overall needs of the resources, use... Petticoat Peak Area of Critical Environmental Concern (ACEC) to provide protection to unique native plants...

An Evaluation of Semi-Automated, Collaborative Marking and Feedback Systems: Academic Staff Perspectives

ERIC Educational Resources Information Center

Burrows, Steven; Shortis, Mark

2011-01-01

Online marking and feedback systems are critical for providing timely and accurate feedback to students and maintaining the integrity of results in large class teaching. Previous investigations have involved much in-house development and more consideration is needed for deploying or customising off the shelf solutions. Furthermore, keeping up to…

Professional Development in an Online Context: Opportunities and Challenges from the Voices of College Faculty

ERIC Educational Resources Information Center

Wynants, Shelli; Dennis, Jessica

2018-01-01

Given the variety of learning and engagement needs of the increasingly diverse student population in higher education, flexible approaches to teaching are critical for improving student success. Professional development that provides faculty exposure to effective, evidence-based instructional strategies in an online context may enhance their…

Advancing Social Work Curriculum in Psychopharmacology and Medication Management

ERIC Educational Resources Information Center

Farmer, Rosemary L.; Bentley, Kia J.; Walsh, Joseph

2006-01-01

The authors reviewed current literature and curriculum resources on psychopharmacology and social work. They argue that baccalaureate and master of social work courses need to routinely include more in-depth knowledge on psychopharmacology and provide a more critical social work-focused approach to this content due to the increasing complexity of…

Meeting Needs of Young Children at Risk for or Having a Disability

ERIC Educational Resources Information Center

Peterson, Carla A.; Mayer, Lynn Milgram; Summers, Jean Ann; Luze, Gayle J.

2010-01-01

Poverty-related factors place children at higher risk for disabilities and also serve as barriers to families accessing services for their children and themselves. Early childhood practitioners can play a critical role in supporting families by providing services to overcome these obstacles and by working in partnership with specialized early…

Fostering Cross-Cultural Learning and Advocacy for Social Justice through an Immersion Experience in Puerto Rico

ERIC Educational Resources Information Center

Cordero, Antonia; Rodriguez, Lirio Negroni

2009-01-01

Our country's increasing social diversity, the richness and complexity of cultures, diversity of self-defined individual identities, and complexity of cross-cultural interactions make effective diversity teaching a challenging but critical need. In addition, for services to be provided in culturally competent manner educators must prepare social…

Comparative Performance Data for Critical Access Hospitals

ERIC Educational Resources Information Center

Pink, George H.; Slifkin, Rebecca T.; Coburn, Andrew F.; Gale, John A.

2004-01-01

Context: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations.…

Rethinking Education in Botswana: A Need to Overhaul the Botswana Education System

ERIC Educational Resources Information Center

Makwinja, Veronica Margaret

2017-01-01

Botswana through its two educational reform philosophies of 1977 and 1994 envisioned a developing education system that is on par with international standards. According to Tabulawa (2009), the education system was developed to produce critical thinkers, problem solvers, and innovative learners. The system was designed to provide opportunities for…

University English and Audit Firms in the Philippines: Meeting Needs, Merging Deeds

ERIC Educational Resources Information Center

Tenedero, Pia Patricia P.; Vizconde, Camilla J.

2015-01-01

With increasing demand for accounting professionals, audit firms are banking on universities to provide graduates equipped with technical know-how and critical English skills. This explains heightened employer concern over the business English skills of new hires, prompting questions on adequacy and relevance of English taught in universities.…

Using Five-Frames in Preschool Mathematics Instruction

ERIC Educational Resources Information Center

Rizer, Jennifer

2017-01-01

Mathematics education is a critical part of instruction for students around the globe. The foundation for understanding basic mathematical concepts begins early in life. Preschool classrooms can provide the early skills in mathematical reasoning that will be needed later in life. In this study, the author sought to determine if the use of…

Examining the Effectiveness of the Remote Observation of Graduate Interns

ERIC Educational Resources Information Center

Hartshorne, Richard; Heafner, Tina; Petty, Teresa

2011-01-01

With teacher shortages in both general and critical needs areas and constricting operating budgets, it is important for Colleges of Education to develop methods of providing alternative certification programs to reach larger segments of the population. One method of increasing the scope of potential preservice teachers is through the development…

76 FR 67250 - Information Collection Available for Public Comments and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-31

... transportation service providers to identify their specific plans, investment strategies, and perspectives concerning market trends, which are a critical part of the subject of the Study. Finally, MARAD's on- line... on their costs and routing strategies as a result of the Panama Canal Expansion. Need and Use of the...

Water Resources Management in the Lerma-Chapala Basin, Mexico: A Case Study

ERIC Educational Resources Information Center

Villamagna, Amy M.; Murphy, Brian R.

2008-01-01

Water resources have become an increasingly important topic of discussion in natural resources and environmental management courses. To address the need for more critical thinking in the classroom and to provide an active learning experience for undergraduate students, we present a case study based on water competition and management in the…

Leading Personalized and Digital Learning: A Framework for Implementing School Change

ERIC Educational Resources Information Center

Wolf, Mary Ann; Bobst, Elizabeth; Mangum, Nancy

2017-01-01

"Leading Personalized and Digital Learning" provides needed guidance for principals, aspiring principals, and other school leaders at a critical time when educators are looking to put the power of technology to work for student-centered learning. The authors identify eight leadership essentials that school leaders must attend to if they…

Learning and Teaching with Loss: Meeting the Needs of Refugee Children through Narrative Inquiry

ERIC Educational Resources Information Center

Kovinthan, Thursica

2016-01-01

Providing refugee students with a safe and welcoming classroom environment is critical for school success but largely dependent on teachers' knowledge, values, practices, and attitudes. This qualitative study juxtaposes the experience of one refugee students' experience in the school system and one beginning teachers' experience in working with…

Effects of temperature on the life history parameters of Anoplophora Glabripennis (Coleoptera: Cerambycidae)

Treesearch

Melody A. Keena; Paul M. Moore; Steve M. Ulanecki

2003-01-01

There is a critical need for information on the basic biology of the Asian longhorned beetle, Anoplophora glabripennis (Motschulsky), to provide the biological basis for predicting developmental phenology in order to optimize the timing of exclusion and eradication treatments and to predict attack rates under different environmental conditions. In...

The Effects of Victim-Related Contextual Factors on the Criminal Justice System

ERIC Educational Resources Information Center

Haynes, Stacy Hoskins

2011-01-01

Despite numerous reforms designed to integrate the needs and concerns of crime victims into the criminal justice system, which include expanding programs for compensation and restitution, providing counseling and other services to victims, and increasing victims' involvement in the criminal justice process, critics have argued that these reforms…

They're Why I'm Dead.

ERIC Educational Resources Information Center

Cross, William C.

This tongue-in-cheek paper represents that ideal and fictitious being, "Joe Personnel", as envisioned by critics of regularly-organized student personnel services. They contend that, since people have, for centuries, handled their own problems, they should be capable of doing so today, and that any assistance needed can be provided by a single…

Teachers Developing Exemplary Inquiry Practices: Three Longitudinal Case Studies

ERIC Educational Resources Information Center

Sweetman, Sara Berry

2013-01-01

If students are to be successful in the ever-changing scientific world they need to be taught how to think critically, to manipulate materials, and to gather evidence to build knowledge. Most teachers fall short in providing students the inquiry instruction described in the Next Generation Science Frameworks (National Research Council, 2011). This…

Comal County, Texas: Preparing for Life after High School

ERIC Educational Resources Information Center

Walter, Frank

2018-01-01

Comal County, Texas, may be rural but its students face many of the same challenges as students in urban districts. Communities In Schools of South Central Texas works with the local school district to identify student needs and provide critical supports to help young people prepare for life after high school.

EVERGLADES ECOSYSTEM ASSESSMENT: WATER MANAGEMENT AND QUALITY, EUTROPHICATION, MERCURY CONTAMINATION, SOILS AND HABITAT: MONITORING FOR ADAPTIVE MANAGEMENT: A R-EMAP STATUS REPORT

EPA Science Inventory

The United States Environmental Protection Agency’s Everglades Ecosystem Assessment Program is a long-term research, monitoring and assessment effort. Its goal is to provide critical, timely, scientific information needed for management decisions on the Everglades ecosystem and i...

A Critical Study of Vocational-Industrial Education in Taiwan.

ERIC Educational Resources Information Center

Koo, Po-Ken

This study was concerned with determining the kind of vocational-industrial educational programs that would best suit the needs of Taiwan. The general conditions and provisions of 27 existing vocational-industrial programs were studied to determine their strengths and weaknesses and to provide a set of principles that would serve as guideposts for…

Measuring Student Engagement in the Online Course: The Online Student Engagement Scale (OSE)

ERIC Educational Resources Information Center

Dixson, Marcia D.

2015-01-01

Student engagement is critical to student learning, especially in the online environment, where students can often feel isolated and disconnected. Therefore, teachers and researchers need to be able to measure student engagement. This study provides validation of the Online Student Engagement scale (OSE) by correlating student self-reports of…

Brain Matters: Translating Research into Classroom Practice.

ERIC Educational Resources Information Center

Wolfe, Patricia

Maintaining that educators need a functional understanding of the brain and how it operates in order to teach effectively and to critically analyze the vast amount of neuroscientific information being published, this book provides information on brain-imaging techniques and the anatomy and physiology of the brain. The book also introduces a model…

Models, measurement, and strategies in developing critical-thinking skills.

PubMed

Brunt, Barbara A

2005-01-01

Health care professionals must use critical-thinking skills to solve increasingly complex problems. Educators need to help nurses develop their critical-thinking skills to maintain and enhance their competence. This article reviews various models of critical thinking, as well as methods used to evaluate critical thinking. Specific educational strategies to develop nurses' critical-thinking skills are discussed. Additional research studies are needed to determine how the process of nursing practice can nurture and develop critical-thinking skills, and which strategies are most effective in developing and evaluating critical thinking.

Implementing an educational program to improve critical care nurses' enteral nutritional support.

PubMed

Kim, Hyunjung; Chang, Sun Ju

2018-05-11

Although international nutrition societies recommend enteral nutrition guidelines for patients in intensive care units (ICUs), large gaps exist between these recommendations and actual clinical practice. Education programs designed to improve nurses' knowledge about enteral nutrition are therefore required. In Korea, there are no educational intervention studies about evidence-based guidelines of enteral nutrition for critically ill patients. We aimed to evaluate the effects of an education program to improve critical care nurses' perceptions, knowledge, and practices towards providing enteral nutritional support for ICU patients. A quasi-experimental, one-group study with a pre- and post-test design was conducted from March to April 2015. Nurses (N = 205) were recruited from nine ICUs from four tertiary hospitals in South Korea. The education program comprised two sessions of didactic lectures. Data were collected before (pre-test) and 1 month after (post-test) the education program using questionnaires that addressed nurses' perceptions, knowledge, and practices relating to providing enteral nutritional support for ICU patients. After the program, nurses showed a significant improvement in their perceptions and knowledge of enteral nutrition for ICU patients. There was a significant improvement in inspecting nostrils daily, flushing the feeding tube before administration, providing medication that needs to be crushed correctly, changing feeding sets, and adjusting feeding schedules. The findings indicate that an enteral nutrition education program could be an effective strategy to increase critical care nurses' support for the critically ill. This education program can be incorporated into hospital education or in-service training for critical care nurses to strengthen their perceptions and knowledge of nutritional support in the ICU. This may improve the clinical outcomes of ICU patients. Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

On the Edge of Research and Technological Application: A Critical Review of Electromethanogenesis

PubMed Central

Blasco-Gómez, Ramiro; Batlle-Vilanova, Pau; Villano, Marianna; Balaguer, Maria Dolors; Colprim, Jesús; Puig, Sebastià

2017-01-01

The conversion of electrical current into methane (electromethanogenesis) by microbes represents one of the most promising applications of bioelectrochemical systems (BES). Electromethanogenesis provides a novel approach to waste treatment, carbon dioxide fixation and renewable energy storage into a chemically stable compound, such as methane. This has become an important area of research since it was first described, attracting different research groups worldwide. Basics of the process such as microorganisms involved and main reactions are now much better understood, and recent advances in BES configuration and electrode materials in lab-scale enhance the interest in this technology. However, there are still some gaps that need to be filled to move towards its application. Side reactions or scaling-up issues are clearly among the main challenges that need to be overcome to its further development. This review summarizes the recent advances made in the field of electromethanogenesis to address the main future challenges and opportunities of this novel process. In addition, the present fundamental knowledge is critically reviewed and some insights are provided to identify potential niche applications and help researchers to overcome current technological boundaries. PMID:28425974

Tank Pressure Control Experiment on the Space Shuttle

NASA Technical Reports Server (NTRS)

1989-01-01

The tank pressure control experiment is a demonstration of NASA intent to develop new technology for low-gravity management of the cryogenic fluids that will be required for future space systems. The experiment will use freon as the test fluid to measure the effects of jet-induced fluid mixing on storage tank pressure and will produce data on low-gravity mixing processes critical to the design of on-orbit cryogenic storage and resupply systems. Basic data on fluid motion and thermodynamics in low gravity is limited, but such data is critical to the development of space transfer vehicles and spacecraft resupply facilities. An in-space experiment is needed to obtain reliable data on fluid mixing and pressure control because none of the available microgravity test facilities provide a low enough gravity level for a sufficient duration to duplicate in-space flow patterns and thermal processes. Normal gravity tests do not represent the fluid behavior properly; drop-tower tests are limited in length of time available; aircraft low-gravity tests cannot provide the steady near-zero gravity level and long duration needed to study the subtle processes expected in space.

On the Edge of Research and Technological Application: A Critical Review of Electromethanogenesis.

PubMed

Blasco-Gómez, Ramiro; Batlle-Vilanova, Pau; Villano, Marianna; Balaguer, Maria Dolors; Colprim, Jesús; Puig, Sebastià

2017-04-20

The conversion of electrical current into methane (electromethanogenesis) by microbes represents one of the most promising applications of bioelectrochemical systems (BES). Electromethanogenesis provides a novel approach to waste treatment, carbon dioxide fixation and renewable energy storage into a chemically stable compound, such as methane. This has become an important area of research since it was first described, attracting different research groups worldwide. Basics of the process such as microorganisms involved and main reactions are now much better understood, and recent advances in BES configuration and electrode materials in lab-scale enhance the interest in this technology. However, there are still some gaps that need to be filled to move towards its application. Side reactions or scaling-up issues are clearly among the main challenges that need to be overcome to its further development. This review summarizes the recent advances made in the field of electromethanogenesis to address the main future challenges and opportunities of this novel process. In addition, the present fundamental knowledge is critically reviewed and some insights are provided to identify potential niche applications and help researchers to overcome current technological boundaries.

Are consumer surveys valuable as a service improvement tool in health services? A critical appraisal.

PubMed

Patwardhan, Anjali; Patwardhan, Prakash

2009-01-01

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be elicited with accepted validity and reliability only by strict methodological control, customerisation of the questionnaire and skilled interpretation. To construct, conduct, interpret and implement improved service provision, requires a trained work force and infrastructure. This article aims to appraise various aspects of consumer surveys and to assess their value as effective service improvement tools. The customer is the sole reason organisations exist. Consumer surveys are used worldwide as service and quality of care improvement tools by all types of service providers including health service providers. The article critically appraises the value of consumer surveys as service improvement tools in health services tool and its future applications. No one type of survey is the best or ideal. The key is the selection of the correct survey methodology, unique and customised for the particular type/aspect of care being evaluated. The method used should reflect the importance of the information required. Methodological rigor is essential for the effectiveness of consumer surveys as service improvement tools. Unfortunately so far there is no universal consensus on superiority of one particular methodology over another or any benefit of one specific methodology in a given situation. More training and some dedicated resource allocation is required to develop consumer surveys. More research is needed to develop specific survey methodology and evaluation techniques for improved validity and reliability of the surveys as service improvement tools. Measurement of consumer preferences/priorities, evaluation of services and key performance scores, is not easy. Consumer surveys seem impressive tools as they provide the customer a voice for change or modification. However, from a scientific point-of-view their credibility in service improvement in terms of reproducibility, reliability and validity, has remained debatable. This artcile is a critical appraisal of the value of consumer surveys as a service improvement tool in health services--a lesson which needs to be learnt.

Tobacco control in the 21st century: a critical issue for the nursing profession.

PubMed

Sarna, Linda; Bialous, Stella

2005-01-01

Tobacco control is central to reducing death and disability and improving quality of life worldwide and nursing action is imperative. This article addresses tobacco as a global health issue with implications for nursing practice, education, research, and policy development. The lack of knowledge and skills, lack of expectation for clinical intervention, limited research, an absence of professional policies, and minimal nursing leadership have diminished the critical role that nurses can play in confronting this epidemic. Swift action is needed to ensure that all nurses are prepared to effectively engage in activities to prevent tobacco use, provide evidence-based cessation interventions, and support efforts to prevent exposure to secondhand smoke. Increased opportunities are needed to support creative nursing research efforts that test interventions and strategies to reduce barriers to tobacco control within different cultures, subcultures, and countries.

Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties.

PubMed

van den Broek, Janneke M; Brunsveld-Reinders, Anja H; Zedlitz, Aglaia M E E; Girbes, Armand R J; de Jonge, Evert; Arbous, M Sesmu

2015-08-01

To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties. We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013. Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility. Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies. The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce. Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.

Wind Energy Applications for Municipal Water Services: Opportunities, Situation Analyses, and Case Studies; Preprint

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

Flowers, L.; Miner-Nordstrom, L.

2006-01-01

As communities grow, greater demands are placed on water supplies, wastewater services, and the electricity needed to power the growing water services infrastructure. Water is also a critical resource for thermoelectric power plants. Future population growth in the United States is therefore expected to heighten competition for water resources. Many parts of the United States with increasing water stresses also have significant wind energy resources. Wind power is the fastest-growing electric generation source in the United States and is decreasing in cost to be competitive with thermoelectric generation. Wind energy can offer communities in water-stressed areas the option of economicallymore » meeting increasing energy needs without increasing demands on valuable water resources. Wind energy can also provide targeted energy production to serve critical local water-system needs. The research presented in this report describes a systematic assessment of the potential for wind power to support water utility operation, with the objective to identify promising technical applications and water utility case study opportunities. The first section describes the current situation that municipal providers face with respect to energy and water. The second section describes the progress that wind technologies have made in recent years to become a cost-effective electricity source. The third section describes the analysis employed to assess potential for wind power in support of water service providers, as well as two case studies. The report concludes with results and recommendations.« less

Eight critical factors in creating and implementing a successful simulation program.

PubMed

Lazzara, Elizabeth H; Benishek, Lauren E; Dietz, Aaron S; Salas, Eduardo; Adriansen, David J

2014-01-01

Recognizing the need to minimize human error and adverse events, clinicians, researchers, administrators, and educators have strived to enhance clinicians' knowledge, skills, and attitudes through training. Given the risks inherent in learning new skills or advancing underdeveloped skills on actual patients, simulation-based training (SBT) has become an invaluable tool across the medical education spectrum. The large simulation, training, and learning literature was used to provide a synthesized yet innovative and "memorable" heuristic of the important facets of simulation program creation and implementation, as represented by eight critical "S" factors-science, staff, supplies, space, support, systems, success, and sustainability. These critical factors advance earlier work that primarily focused on the science of SBT success, to also include more practical, perhaps even seemingly obvious but significantly challenging components of SBT, such as resources, space, and supplies. SYSTEMS: One of the eight critical factors-systems-refers to the need to match fidelity requirements to training needs and ensure that technological infrastructure is in place. The type of learning objectives that the training is intended to address should determine these requirements. For example, some simulators emphasize physical fidelity to enable clinicians to practice technical and nontechnical skills in a safe environment that mirrors real-world conditions. Such simulators are most appropriate when trainees are learning how to use specific equipment or conduct specific procedures. The eight factors-science, staff, supplies, space, support, systems, success, and sustainability-represent a synthesis of the most critical elements necessary for successful simulation programs. The order of the factors does not represent a deliberate prioritization or sequence, and the factors' relative importance may change as the program evolves.

Beyond adaptive-critic creative learning for intelligent mobile robots

NASA Astrophysics Data System (ADS)

Liao, Xiaoqun; Cao, Ming; Hall, Ernest L.

2001-10-01

Intelligent industrial and mobile robots may be considered proven technology in structured environments. Teach programming and supervised learning methods permit solutions to a variety of applications. However, we believe that to extend the operation of these machines to more unstructured environments requires a new learning method. Both unsupervised learning and reinforcement learning are potential candidates for these new tasks. The adaptive critic method has been shown to provide useful approximations or even optimal control policies to non-linear systems. The purpose of this paper is to explore the use of new learning methods that goes beyond the adaptive critic method for unstructured environments. The adaptive critic is a form of reinforcement learning. A critic element provides only high level grading corrections to a cognition module that controls the action module. In the proposed system the critic's grades are modeled and forecasted, so that an anticipated set of sub-grades are available to the cognition model. The forecasting grades are interpolated and are available on the time scale needed by the action model. The success of the system is highly dependent on the accuracy of the forecasted grades and adaptability of the action module. Examples from the guidance of a mobile robot are provided to illustrate the method for simple line following and for the more complex navigation and control in an unstructured environment. The theory presented that is beyond the adaptive critic may be called creative theory. Creative theory is a form of learning that models the highest level of human learning - imagination. The application of the creative theory appears to not only be to mobile robots but also to many other forms of human endeavor such as educational learning and business forecasting. Reinforcement learning such as the adaptive critic may be applied to known problems to aid in the discovery of their solutions. The significance of creative theory is that it permits the discovery of the unknown problems, ones that are not yet recognized but may be critical to survival or success.

Critical Review of NOAA's Observation Requirements Process

NASA Astrophysics Data System (ADS)

LaJoie, M.; Yapur, M.; Vo, T.; Templeton, A.; Bludis, D.

2017-12-01

NOAA's Observing Systems Council (NOSC) maintains a comprehensive database of user observation requirements. The requirements collection process engages NOAA subject matter experts to document and effectively communicate the specific environmental observation measurements (parameters and attributes) needed to produce operational products and pursue research objectives. User observation requirements documented using a structured and standardized manner and framework enables NOAA to assess its needs across organizational lines in an impartial, objective, and transparent manner. This structure provides the foundation for: selecting, designing, developing, acquiring observing technologies, systems and architectures; budget and contract formulation and decision-making; and assessing in a repeatable fashion the productivity, efficiency and optimization of NOAA's observing system enterprise. User observation requirements are captured independently from observing technologies. Therefore, they can be addressed by a variety of current or expected observing capabilities and allow flexibility to be remapped to new and evolving technologies. NOAA's current inventory of user observation requirements were collected over a ten-year period, and there have been many changes in policies, mission priorities, and funding levels during this time. In light of these changes, the NOSC initiated a critical, in-depth review to examine all aspects of user observation requirements and associated processes during 2017. This presentation provides background on the NOAA requirements process, major milestones and outcomes of the critical review, and plans for evolving and connecting observing requirements processes in the next year.

Activation of a critical attitude in prospective teachers: From research investigations to guidelines for teacher education

NASA Astrophysics Data System (ADS)

Viennot, Laurence; Décamp, Nicolas

2018-06-01

This paper is inspired by the widely accepted need to develop critical thinking in physics students and teachers. More specifically, it is focused on the development of a critical attitude in prospective physics teachers. The question of a possible interplay between the development of conceptual comprehension and that of a critical attitude prompted us to conduct a series of investigations with teachers at the end of their preparation. The goal of this paper is to provide a synthesis of five previously published papers on this topic in order to inform discussion about teacher preparation. Each investigation is centered on a particular aspect of physics, and all are based on in-depth interviews with different participants. We focus on prospective teachers' "intellectual dynamics," that is, the way their comprehension of nonobvious topics and their critical attitudes evolve during these interviews, taking into account metacognitive and affective aspects such as intellectual satisfaction and self-esteem. We characterize several types of intellectual dynamics: "early critique," "delayed critique," "unstable critique," and "expert anesthesia" and provide information on their frequency. An overall conclusion is that in this type of context, that is, a guided intellectual pathway of about an hour, the development of conceptual comprehension and critical attitude are most often deeply entangled. We discuss the implications of these results for future research and we advocate new objectives and strategies for physics teachers' preparation.

Effects of ethics education on moral sensitivity of nursing students.

PubMed

Yeom, Hye-A; Ahn, Sung-Hee; Kim, Su-Jeong

2017-09-01

While nursing ethics education is commonly provided for undergraduate nursing students in most nursing colleges, consensus on the content and teaching modules for these ethics courses have still not been established. This study aimed to examine the effects of nursing ethics education on the moral sensitivity and critical thinking disposition of nursing students in Korea. A one-group pre- and post-test design was used. Moral sensitivity was measured using the Korean version of the Moral Sensitivity Questionnaire. Critical thinking disposition was measured using the Critical Thinking Disposition Questionnaire. Participants and research context: Participants were 70 undergraduate nursing students who were attending a university located in Seoul, Korea. The nursing ethics education was provided 7 times, from September to December 2010, and comprised 90-min sessions each week. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines. After the education, the levels for the patient-oriented care, a sub-domain of moral sensitivity, and inquisitiveness, a sub-domain of critical thinking disposition, significantly improved. There were no changes in overall scores for moral sensitivity and critical thinking disposition. There were significant positive correlations between moral sensitivity and critical thinking disposition both pre- and post-intervention. These results reflect the need for ongoing efforts to develop innovative content, structure, and instructional methods for undergraduate nursing ethics education programs.

Emergency Telemedicine: Achieving and Maintaining Compliance with the Emergency Medical Treatment and Labor Act.

PubMed

Rockwell, Kimberly Lovett; Gilroy, Alexis

2018-03-12

Telemedicine is a growing and important platform for medical delivery in the emergency department. Emergency telemedicine outlays often confront and conflict with important federal healthcare regulations. Because of this, academic medical centers, critical access hospitals, and other providers interested in implementing emergency telemedicine have often delayed or forgone such services due to reasonable fears of falling out of compliance with regulatory restrictions imposed by the Emergency Medical Treatment and Labor Act ("EMTALA"). This article offers insights into methods for implementing emergency telemedicine services while maintaining EMTALA compliance. Critical analysis of EMTALA and its attendant regulations. The primary means of ensuring EMTALA compliance while implementing emergency telemedicine programs include incorporating critical clinical details into the services contracts and implementing robust written policies that anticipate division of labor issues, the need for backup coverage, triaging, patient transfer protocols, and credentialing issues. With adequate up-front due diligence and meaningful contracting, hospitals and telemedicine providers can avoid common EMTALA liability pitfalls.

Service-Learning in Undergraduate Nursing Education: Where is the Reflection?

PubMed

Brown, Janet M; Schmidt, Nola A

2016-01-01

Service-Learning is recognized as a valuable pedagogy that involves experiential learning, reflection, and reciprocal learning. Reflection is a critical component because it assists students to develop critical thinking and social awareness as they reflect upon their experiential learning with community partners. Although there is a proliferation of literature about service-learning, upon closer examination, it is apparent that some authors do not place emphasis on reflection when reporting on service-learning projects. This begs the question, "Where is the reflection?" The purpose of this article is to provide an overview and describe misrepresentations and exemplars of service-learning. After providing an overview of service-learning, examples of how service-learning is misrepresented in the literature are discussed. Exemplars of service-learning are also cited. Calling attention to how service-learning is reported in the literature will increase awareness about the need to critically evaluate articles for evidence of reflection. Copyright © 2016 Elsevier Inc. All rights reserved.

Influence of muscle strength on early mobility in critically ill adult patients: Systematic literature review.

PubMed

Roberson, Audrey R; Starkweather, Angela; Grossman, Catherine; Acevedo, Edmund; Salyer, Jeanne

Muscle strength may be one indicator of readiness to mobilize that can be used to guide decisions regarding early mobility efforts and to progressively advance mobilization. To provide a synthesis of current measures of muscle strength in the assessment of early mobilization in critically ill adult patients who are receiving MV therapy. Research studies conducted between 2000-2015 were identified using PubMed, CINHAL, MEDLINE, and the Cochrane Database of Systematic Reviews databases using the search terms "muscle strength", "intensive care", "mechanical ventilation" and "muscle weakness". Nine articles used manual muscle testing, the Medical Research Council scale and/or hand-held dynamometer to provide objective measures for assessing muscle strength in the critically ill adult patient population. Further research is needed to examine the application of standardized measures of muscle strength for guiding decisions regarding early and progressive advancement of mobility goals in adult ICU patients on MV. Copyright © 2017 Elsevier Inc. All rights reserved.

Organizational Responsibility for Age-Friendly Social Participation: Views of Australian Rural Community Stakeholders.

PubMed

Winterton, Rachel

2016-01-01

This qualitative study critically explores the barriers experienced by diverse rural community stakeholders in facilitating environments that enable age-friendly social participation. Twenty-six semi-structured interviews were conducted across two rural Australian communities with stakeholders from local government, health, social care, and community organizations. Findings identify that rural community stakeholders face significant difficulties in securing resources for groups and activities catering to older adults, which subsequently impacts their capacity to undertake outreach to older adults. However, in discussing these issues, questions were raised in relation to whose responsibility it is to provide resources for community groups and organizations providing social initiatives and whose responsibility it is to engage isolated seniors. These findings provide a much-needed critical perspective on current age-friendly research by acknowledging the responsibilities of various macro-level social structures-different community-level organizations, local government, and policy in fostering environments to enable participation of diverse rural older adults.

Group Capability Model

NASA Technical Reports Server (NTRS)

Olejarski, Michael; Appleton, Amy; Deltorchio, Stephen

2009-01-01

The Group Capability Model (GCM) is a software tool that allows an organization, from first line management to senior executive, to monitor and track the health (capability) of various groups in performing their contractual obligations. GCM calculates a Group Capability Index (GCI) by comparing actual head counts, certifications, and/or skills within a group. The model can also be used to simulate the effects of employee usage, training, and attrition on the GCI. A universal tool and common method was required due to the high risk of losing skills necessary to complete the Space Shuttle Program and meet the needs of the Constellation Program. During this transition from one space vehicle to another, the uncertainty among the critical skilled workforce is high and attrition has the potential to be unmanageable. GCM allows managers to establish requirements for their group in the form of head counts, certification requirements, or skills requirements. GCM then calculates a Group Capability Index (GCI), where a score of 1 indicates that the group is at the appropriate level; anything less than 1 indicates a potential for improvement. This shows the health of a group, both currently and over time. GCM accepts as input head count, certification needs, critical needs, competency needs, and competency critical needs. In addition, team members are categorized by years of experience, percentage of contribution, ex-members and their skills, availability, function, and in-work requirements. Outputs are several reports, including actual vs. required head count, actual vs. required certificates, CGI change over time (by month), and more. The program stores historical data for summary and historical reporting, which is done via an Excel spreadsheet that is color-coded to show health statistics at a glance. GCM has provided the Shuttle Ground Processing team with a quantifiable, repeatable approach to assessing and managing the skills in their organization. They now have a common frame of reference across NASA/contractor lines to communicate and mitigate any critical skills concerns.

Knowledge attainment, perceptions, and professionalism in participants completing the didactic phase of an Army reserve critical care nursing residency program.

PubMed

Wynd, C A; Gotschall, W

2000-04-01

Combat hospitals in today's Army demand nurses with critical care nursing "8A" additional skills identifiers. The intensity of future wars and operations other than war, together with highly technological weapons, forecast a large number of casualties evacuated rapidly from combat with wounds that require skillful and intensive nursing care. Many of the critical care nurses providing future care are positioned in the reserve components and require creative approaches to education and training concentrated into one weekend per month. An Army Reserve critical care nursing residency program was designed in one midwestern combat support hospital. The didactic course, phase I, was evaluated for effectiveness in achieving outcomes of increased knowledge attainment, enhanced perceptions of critical care nursing, and higher degrees of professionalism. Twenty-seven registered nurses completed the course, and 30 nurses from the same hospital served as controls. A repeated-measures analysis examined outcomes before intervention (time 1), at course completion (time 2), and at a 6-month follow-up (time 3). The course was effective at increasing scores on knowledge attainment and perceptions of critical care nursing; however; professionalism scores were initially high and remained so throughout the study. This research extends information about critical care nursing education and evaluates a training mechanism for meeting the unique requirements and time constraints of nurses in the reserve components who need to provide a high level of skill to soldiers in combat.

Primary and secondary prevention of periodontal and peri-implant diseases: Introduction to, and objectives of the 11th European Workshop on Periodontology consensus conference.

PubMed

Tonetti, Maurizio S; Chapple, Iain L C; Jepsen, Søren; Sanz, Mariano

2015-04-01

Periodontitis prevalence remains high. Peri-implantitis is an emerging public health issue. Such a high burden of disease and its social, oral and systemic consequences are compelling reasons for increased attention towards prevention for individuals, professionals and public health officials. Sixteen systematic reviews and meta-reviews formed the basis for workshop discussions. Deliberations resulted in four consensus reports. This workshop calls for renewed emphasis on the prevention of periodontitis and peri-implantitis. A critical element is the recognition that prevention needs to be tailored to the individual's needs through diagnosis and risk profiling. Discussions identified critical aspects that may help in the large-scale implementation of preventive programs: (i) a need to communicate to the public the critical importance of gingival bleeding as an early sign of disease, (ii) the need for universal implementation of periodontal screening by the oral health care team, (iii) the role of the oral health team in health promotion and primary and secondary prevention, (iv) understanding the limitations of self-medication with oral health care products without a diagnosis of the underlying condition, and (v) access to appropriate and effective professional preventive care. The workshop provided specific recommendations for individuals, the oral health team and public health officials. Their implementation in different countries requires adaptation to respective specific national oral health care models. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Raising critical issues in the analysis of gender and science in children's literature

NASA Astrophysics Data System (ADS)

Martin, Sonya N.; Siry, Christina A.

2009-12-01

Trevor Owens' paper provides a critique of the role of gender and authority in selected children's books that presented biographies of Albert Einstein and Marie Curie. In the context of discussing Trevor's (2009) article about children's literature, this forum explores issues related to the (a) representation and construction of gender, science, and childhood in literature for children; (b) the need to consider socio/historical/cultural contexts in analytical and theoretical frameworks; and (c) the importance of fostering critical literacy perspectives in pre- and in-service science teachers and the children whom they teach.

Effective ventilation: The most critical intervention for successful delivery room resuscitation.

PubMed

Foglia, Elizabeth E; Te Pas, Arjan B

2018-04-17

Lung aeration is the critical first step that triggers the transition from fetal to postnatal cardiopulmonary physiology after birth. When an infant is apneic or does not breathe sufficiently, intervention is needed to support this transition. Effective ventilation is therefore the cornerstone of neonatal resuscitation. In this article, we review the physiology of cardiopulmonary transition at birth, with particular attention to factors the caregiver should consider when providing ventilation. We then summarize the available clinical evidence for strategies to monitor and perform positive pressure ventilation in the delivery room setting. © 2018 Published by Elsevier Ltd.

YBa2Cu3O x superconducting nanorods

NASA Astrophysics Data System (ADS)

Rieken, William; Bhargava, Atit; Horie, Rie; Akimitsu, Jun; Daimon, Hiroshi

2018-02-01

Herein, we report the synthesis of YBa2Cu3O x superconducting nanorods performed by solution chemistry. Initially, a mixture of fine-grained coprecipitated powder was obtained and subsequently converted to YBa2Cu3O x nanorods by heating to 1223 K in oxygen for 12 h. The nanorods are superconducting without the need for any further sintering or oxygenation, thereby providing an avenue for direct application to substrates at room temperature or direct use as formed nanorods. A critical superconducting transition temperature T c of about 92 K was achieved at a critical magnetic field of 10 Oe.

Agency behind bars: Advance care planning with aging and dying offenders.

PubMed

Sanders, Sara; Stensland, Meredith; Juraco, Kim

2018-01-01

Aging and terminally ill individuals in U.S. prisons are increasing, making critical the need for appropriate end-of-life (EOL) care and advance care planning (ACP). Applying Bandura's agentic perspective, the authors examined 20 aging/dying offenders' EOL preferences and ACP. Findings include 6 themes: decisions in the shadow of the past, what works best for me, feeling blessed, what is really going on, can anyone be trusted, and turning agency over to someone else. This study provides critical information that will assist professionals who work with dying offenders, as it presents a vivid illustration of their dying process.

Hmong mental health needs assessment: a community-based partnership in a small mid-Western community.

PubMed

Collier, Ann Futterman; Munger, Martha; Moua, Yong Kay

2012-03-01

The overall goal of this assessment was to verify the mental health needs of Hmong living in a mid-west community in order clarify the format, content, and feasibility of providing mental health services for Hmong in the future. Using a Community-Based Participatory Research (CBPR) model, we held four focus groups with 36 men, women, adolescents and professionals, all of Hmong descent, as well as interviewed 28 individual medical, mental health, education, and social service providers in the Eau Claire community. Our Hmong sample was frequently unclear about what "mental" health meant, indicating a low level of mental health literacy. Results confirmed that there are significant mental health needs in this refugee and immigrant population. Participants described problems consistent with depression, post-traumatic stress disorder (PTSD), anxiety disorders, somatoform disorders, and severe social stress and acculturation difficulties in every generation. Elder people and male adolescents were described as the most disaffected and in need of immediate services. It will be critical to address mental health literacy before designing future interventions. Treatment suggestions were provided with the intention of removing barriers and incorporating culturally sensitive methodologies, while continuing to work closely with our local mental health providers and Hmong leadership.

Specialty-care access for community health clinic patients: processes and barriers

PubMed Central

Ezeonwu, Mabel C

2018-01-01

Introduction Community health clinics/centers (CHCs) comprise the US’s core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. Materials and methods In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients’ access to specialty care. Analysis of data was done using content analysis. Results The process of coordinating care referrals for CHC patients is complex and begins with a provider’s order for consultation and ends when the referring provider receives the specialist’s note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic–hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Conclusion Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care. PMID:29503559

The factors influencing burnout and job satisfaction among critical care nurses: a study of Saudi critical care nurses.

PubMed

Alharbi, Jalal; Wilson, Rhonda; Woods, Cindy; Usher, Kim

2016-09-01

The aim of the study was to explore the prevalence of burnout and job satisfaction among Saudi national critical care nurses. Burnout is caused by a number of factors, including personal, organisational and professional issues. Previous literature reports a strong relationship between burnout and job satisfaction among critical care nurses. Little is known about this phenomenon among Saudi national critical care nurses. A convenience sample of 150 Saudi national critical care nurses from three hospitals in Hail, Saudi Arabia were included in a cross-sectional survey. Saudi national critical care registered nurses reported moderate to high levels of burnout in the areas of emotional exhaustion and depersonalisation. Participants also reported a feeling of ambivalence and dissatisfaction with their jobs but were satisfied with the nature of their work. Saudi national critical care nurses experience moderate to high levels of burnout and low levels of job satisfaction. Burnout is a predictor of job satisfaction for Saudi national critical care nurses. These results provide clear evidence of the need for nurse managers and policy makers to devise strategies to help nurses better cope with a stressful work environment, thereby also improving job satisfaction among Saudi national critical care nurses. © 2016 John Wiley & Sons Ltd.

Ideology and Palliative Care: Moral Hazards at the Bedside.

PubMed

Rhodes, Rosamond; Strain, James J

2018-01-01

Palliative care has had a long-standing commitment to teaching medical students and other medical professionals about pain management, communication, supporting patients in their decisions, and providing compassionate end-of-life care. Palliative care programs also have a critical role in helping patients understand medical conditions, and in supporting them in dealing with pain, fear of dying, and the experiences of the terminal phase of their lives. We applaud their efforts to provide that critical training and fully support their continued important work in meeting the needs of patients and families. Although we appreciate the contributions of palliative care services, we have noted a problem involving some palliative care professionals' attitudes, methods of decisionmaking, and use of language. In this article we explain these problems by discussing two cases that we encountered.

LANL Institutional Decision Support By Process Modeling and Analysis Group (AET-2)

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

Booth, Steven Richard

2016-04-04

AET-2 has expertise in process modeling, economics, business case analysis, risk assessment, Lean/Six Sigma tools, and decision analysis to provide timely decision support to LANS leading to continuous improvement. This capability is critical during the current tight budgetary environment as LANS pushes to identify potential areas of cost savings and efficiencies. An important arena is business systems and operations, where processes can impact most or all laboratory employees. Lab-wide efforts are needed to identify and eliminate inefficiencies to accomplish Director McMillan’s charge of “doing more with less.” LANS faces many critical and potentially expensive choices that require sound decision supportmore » to ensure success. AET-2 is available to provide this analysis support to expedite the decisions at hand.« less

Overcoming Barriers to Sustained Engagement in Mental Health Care: Perspectives of Rural Veterans and Providers.

PubMed

Fischer, Ellen P; McSweeney, Jean C; Wright, Patricia; Cheney, Ann; Curran, Geoffrey M; Henderson, Kathy; Fortney, John C

2016-09-01

To better understand the attitudes, beliefs, and values that influence use of mental health care among rural veterans. In-depth, semistructured interviews were conducted with 25 rural veterans and 11 rural mental health care providers in 4 states. Experienced qualitative interviewers asked participants about the attitudinal factors they thought most influenced rural veterans' decisions to seek and sustain mental health care. Verbatim transcriptions were analyzed using content analysis and constant comparison. Rural veterans and their mental health care providers reported the same major attitudinal barriers to veterans' mental health treatment-seeking. Pre-eminent among those barriers was the importance rural veterans place on independence and self-reliance. The centrality of self-reliance was attributed variously to rural, military, religious, and/or gender-based belief systems. Stoicism, the stigma associated with mental illness and health care, and a lack of trust in the VA as a caring organization were also frequently mentioned. Perceived need for care and the support of other veterans were critical to overcoming attitudinal barriers to initial treatment-seeking, whereas critical facilitators of ongoing service use included "warm handoffs" from medical to mental health care providers, perceived respect and caring from providers, as well as provider accessibility and continuity. Attitudes and values, like self-reliance, commonly associated with rural culture may play an important role in underutilization of needed mental health services. System support for peer and provider behaviors that generate trust and demonstrate caring may help overcome attitudinal barriers to treatment-seeking and sustained engagement in mental health care among rural veterans. © 2016 National Rural Health Association.

Developing a Business Plan for Critical Care Pharmacy Services

PubMed Central

Erstad, Brian L.; Mann, Henry J.; Weber, Robert J.

2016-01-01

Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients. PMID:27928193

Developing a Business Plan for Critical Care Pharmacy Services.

PubMed

Erstad, Brian L; Mann, Henry J; Weber, Robert J

2016-11-01

Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

Experimental Criticality Benchmarks for SNAP 10A/2 Reactor Cores

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

Krass, A.W.

2005-12-19

This report describes computational benchmark models for nuclear criticality derived from descriptions of the Systems for Nuclear Auxiliary Power (SNAP) Critical Assembly (SCA)-4B experimental criticality program conducted by Atomics International during the early 1960's. The selected experimental configurations consist of fueled SNAP 10A/2-type reactor cores subject to varied conditions of water immersion and reflection under experimental control to measure neutron multiplication. SNAP 10A/2-type reactor cores are compact volumes fueled and moderated with the hydride of highly enriched uranium-zirconium alloy. Specifications for the materials and geometry needed to describe a given experimental configuration for a model using MCNP5 are provided. Themore » material and geometry specifications are adequate to permit user development of input for alternative nuclear safety codes, such as KENO. A total of 73 distinct experimental configurations are described.« less

Method for destroying halocarbon compositions using a critical solvent

DOEpatents

Ginosar, Daniel M.; Fox, Robert V.; Janikowski, Stuart K.

2006-01-10

A method for destroying halocarbons. Halocarbon materials are reacted in a dehalogenation process wherein they are combined with a solvent in the presence of a catalyst. A hydrogen-containing solvent is preferred which functions as both a solvating agent and hydrogen donor. To augment the hydrogen donation capacity of the solvent if needed (or when non-hydrogen-containing solvents are used), a supplemental hydrogen donor composition may be employed. In operation, at least one of the temperature and pressure of the solvent is maintained near, at, or above a critical level. For example, the solvent may be in (1) a supercritical state; (2) a state where one of the temperature or pressure thereof is at or above critical; or (3) a state where at least one of the temperature and pressure thereof is near-critical. This system provides numerous benefits including improved reaction rates, efficiency, and versatility.

A Review of Pediatric Critical Care in Resource-Limited Settings: A Look at Past, Present, and Future Directions

PubMed Central

Turner, Erin L.; Nielsen, Katie R.; Jamal, Shelina M.; von Saint André-von Arnim, Amelie; Musa, Ndidiamaka L.

2016-01-01

Fifteen years ago, United Nations world leaders defined millenium development goal 4 (MDG 4): to reduce under-5-year mortality rates by two-thirds by the year 2015. Unfortunately, only 27 of 138 developing countries are expected to achieve MDG 4. The majority of childhood deaths in these settings result from reversible causes, and developing effective pediatric emergency and critical care services could substantially reduce this mortality. The Ebola outbreak highlighted the fragility of health care systems in resource-limited settings and emphasized the urgent need for a paradigm shift in the global approach to healthcare delivery related to critical illness. This review provides an overview of pediatric critical care in resource-limited settings and outlines strategies to address challenges specific to these areas. Implementation of these tools has the potential to move us toward delivery of an adequate standard of critical care for all children globally, and ultimately decrease global child mortality in resource-limited settings. PMID:26925393

Computer Security: Improvements Needed to Reduce Risk to Critical Federal Operations and Assets

DTIC Science & Technology

2001-11-09

COMPUTER SECURITY Improvements Needed to Reduce Risk to Critical Federal Operations and Assets Statement of Robert F. Dacey Director, Information...Improvements Needed to Reduce Risk to Critical Federal Operations and Assets Contract Number Grant Number Program Element Number Author(s...The benefits have been enormous. Vast amounts of information are now literally at our fingertips, facilitating research on virtually every topic

Do therapeutic imagery practices affect physiological and emotional indicators of threat in high self-critics?

PubMed

Duarte, Joana; McEwan, Kirsten; Barnes, Christopher; Gilbert, Paul; Maratos, Frances A

2015-09-01

Imagery is known to be a powerful means of stimulating various physiological processes and is increasingly used within standard psychological therapies. Compassion-focused imagery (CFI) has been used to stimulate affiliative emotion in people with mental health problems. However, evidence suggests that self-critical individuals may have particular difficulties in this domain with single trials. The aim of the present study was to further investigate the role of self-criticism in responsiveness to CFI by specifically pre-selecting participants based on trait self-criticism. Using the Forms of Self-Criticism/Self-Reassuring Scale, 29 individuals from a total sample of 139 were pre-selected to determine how self-criticism impacts upon an initial instance of imagery. All participants took part in three activities: a control imagery intervention (useable data N = 25), a standard CFI intervention (useable data N = 25), and a non-intervention control (useable data N = 24). Physiological measurements (alpha amylase) as well as questionnaire measures of emotional responding (i.e., the Positive and Negative Affect Schedule, the Types of Positive Affect Scale, and the State Adult Attachment Scale) were taken before and after the different interventions. Following both imagery interventions, repeated measures analyses revealed that alpha amylase increased significantly for high self-critics compared with low self-critics. High self-critics (HSC) also reported greater insecurity on entering the imagery session and more negative CFI experiences compared with low self-critics. Data demonstrate that HSC respond negatively to imagery interventions in a single trial. This highlights that imagery focused therapies (e.g., CFI) need interventions that manage fears, blocks, and resistances to the techniques, particularly in HSC. An initial instance of imagery (e.g., CFI) can be frightening for people who have a tendency to be self-critical. This research provides examples of physiological and emotional responses to imagery type therapies in high and low self-critics, and associated clinical implications. Therapists may find it helpful to be mindful that when introducing imagery based therapies, highly self-critical patients need interventions that manage fears, blocks, and resistances to the techniques. © 2014 The British Psychological Society.

Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic.

PubMed

Maslow, Gary R; Banny, Adrienne; Pollock, McLean; Stefureac, Kristen; Rosa, Kendra; Walter, Barbara Keith; Hobbs Knutson, Katherine; Lucas, Joseph; Heilbron, Nicole

2017-10-01

An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns. Copyright © 2017 Elsevier Inc. All rights reserved.

Architecture Study on Telemetry Coverage for Immediate Post-Separation Phase

NASA Technical Reports Server (NTRS)

Cheung, Kar-Ming; Lee, Charles H.; Kellogg, Kent H.; Stocklin, Frank J.; Zillig, David J.; Fielhauer, Karl B.

2008-01-01

This paper presents the preliminary results of an architecture study that provides continuous telemetry coverage for NASA missions for immediate post-separation phase. This study is a collaboration effort between Jet Propulsion Laboratory (JPL), Goddard Space Flight Center (GSFC), and Applied Physics Laboratory (APL). After launch when the spacecraft separated from the upper stage, the spacecraft typically executes a number of mission-critical operations prior to the deployment of solar panels and the activation of the primary communication subsystem. JPL, GSFC, and APL have similar design principle statements that require continuous coverage of mission-critical telemetry during the immediate post-separation phase. To conform to these design principles, an architecture that consists of a separate spacecraft transmitter and a robust communication network capable of tracking the spacecraft signals is needed.This paper presents the preliminary results of an architecture study that provides continuous telemetry coverage for NASA missions for immediate post-separation phase. This study is a collaboration effort between Jet Propulsion Laboratory (JPL), Goddard Space Flight Center (GSFC), and Applied Physics Laboratory (APL). After launch when the spacecraft separated from the upper stage, the spacecraft typically executes a number of mission-critical operations prior to the deployment of solar panels and the activation of the primary communication subsystem. JPL, GSFC, and APL have similar design principle statements that require continuous coverage of mission-critical telemetry during the immediate post-separation phase. To conform to these design principles, an architecture that consists of a separate spacecraft transmitter and a robust communication network capable of tracking the spacecraft signals is needed. The main results of this study are as follows: 1) At low altitude (< 10000 km) when most post-separation critical operations are executed, Earth-based network (e.g. Deep Space Network (DSN)) can only provide limited coverage, whereas space-based network (e.g. Space Network (SN)) can provide continuous coverage. 2) Commercial-off-the-shelf SN compatible transmitters are available for small satellite applications. In this paper we present the detailed coverage analysis of Earth-based and Space-based networks. We identify the key functional and performance requirements of the architecture, and describe the proposed selection criteria of the spacecraft transmitter. We conclude the paper with a proposed forward plan.

Council of International Neonatal Nurses (COINN) Global Neonatal Provider Database Initiative (CGNPD): Results From an Implementation Focus Group.

PubMed

Eklund, Wakako; Kenner, Carole

2015-12-01

The neonatal nurses are the key component of the essential workforce necessary to address the healthcare needs of the infants globally. The paucity of the data regarding the availability and training of the neonatal workforce challenges the stakeholders at the regional, national, and global levels. The lack of these data makes strategic planning for initiatives especially in low-resourced countries difficult. Up-to-date data are critically needed to describe the role neonatal nurses play in global newborn health outcomes. The purpose of the COINN Global Neonatal Provider Database Initiative (CGNPD) was to develop a workforce database by developing survey questions, conducting a focus group to determine the key reasons such a database was needed and how best to implement it, and incorporating these comments into the workforce survey and launch. Pilot testing of the draft survey instrument was done. This article reports on the findings from the focus group and the development of the survey. A qualitative design using the focus group method was used. The focus group discussions were guided by semi-structured interview questions that had been developed prior to the focus group by neonatal experts. A convenience sample of 14 members from the international delegates and project advisory members who attended the COINN 2013 in Belfast, Northern Ireland, participated. These participants represented 10 countries. Thematic analysis was conducted using verbatim transcripts of the focus group data. Four main themes emerged: (1) the invisibility of neonatal nurses, (2) benchmarking needs for quality and standards, (3) need for partnership to implement the database, and (4) setting priorities for variables needed for the most salient database. The questionnaire examined participants' perceptions of the significance of and the future utilization of the workforce database and elements that should be included in the survey. The global neonatal workforce database is needed to describe who the neonatal nurses are in each country, what they do, how they are trained, and where they work. The data from the focus group aided in the development of the workforce survey that has been pilot tested and provides critical information to guide COINN's global implementation of the database project.

An Integrative Review of the Concealed Connection: Nurse Educators' Critical Thinking.

PubMed

Raymond, Christy; Profetto-McGrath, Joanne; Myrick, Florence; Strean, William B

2017-11-01

The role of nurse educators in the development of students' critical thinking has been overlooked despite the emphasized need for effective teaching methods. An integrative review was performed to examine both quantitative and qualitative research published from 2000 to 2015 related to nurse educators' critical thinking. Many barriers and facilitators existing on individual, interpersonal, and contextual levels affected nurse educators' critical thinking. Various tools have been used to measure nurse educators' critical thinking. This review also highlighted the continued lack of a consensus definition of critical thinking and the limited presence of conceptual models to guide the use of critical thinking in nursing education. Continued examination of nurse educators' critical thinking is needed, given the limited number of studies that have been completed. Much needs to be explored further, including conceptualizations of critical thinking and confirmation of emerging themes identified in this review. [J Nurs Educ. 2017;56(11):648-654.]. © 2017 Raymond, Profetto-McGrath, Myrick, et al.

Empowering Learners in the Reader/Writer Nature of the Digital Informational Space

ERIC Educational Resources Information Center

O'Byrne, W. Ian

2014-01-01

The Internet is the dominant text of this generation, and through intentional use it may provide opportunities for the critical literacy infused pedagogy. As we consider the online and offline literacy practices that our students will need as future events warrant, the one constant is change. This requires a continual re-defining, and…

Leadership Competencies of Branch Campus Administrators in Multi-Campus Community College Systems

ERIC Educational Resources Information Center

Conover, Kitty S.

2009-01-01

Community college leaders are retiring faster than replacements are being prepared creating what is predicted to be a leadership crisis. To keep community colleges functioning in their critical role of providing wider access to higher education and workforce training and re-training, future leaders need to have the skills to lead complex…

The Socratic Method: analyzing ethical issues in health administration.

PubMed

Gac, E J; Boerstler, H; Ruhnka, J C

1998-01-01

The Socratic Method has long been recognized by the legal profession as an effective tool for promoting critical thinking and analysis in the law. This article describes ways the technique can be used in health administration education to help future administrators develop the "ethical rudder" they will need for effective leadership. An illustrative dialogue is provided.

RADIOMICS.io | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

RADIOMICS.io is a open source platform for informatics developments for radiographic phenotyping using automated algorithms, such as engineered features or using deep learning technologies. With this platform, we aim to establish a reference standard for radiomic analyses, provide a tested and maintained resource, and to grow the community of radiomic developers addressing critical needs in cancer research.

76 FR 34770 - Rensselaer Polytechnic Institute Critical Experiments Facility; Environmental Assessment and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-14

...)) stainless steel tank with an inner diameter of 2.1 m (7 ft). The reactor is fueled with low enriched uranium SPERT fuel pins. Reactivity control is provided by four Boron-10 control rods. A detailed description of... moderator are stainless steel, thus eliminating the need for routine filtration and demineralization of the...

Pluses and Minuses of British Headteacher Reform: Toward a Vision of Instructional Leadership.

ERIC Educational Resources Information Center

Daresh, John C.; Male, Trevor

It is generally accepted that effective principals make for effective schools. In the United Kingdom, the key player providing needed intelligence, vision, energy, and thinking is called the headteacher. The issue considered broadly in this paper is educational leadership in the UK. It addresses the critical role of the headteacher and how to…

Viewing eCare through Nurses' Eyes: A Phenomenological Study

ERIC Educational Resources Information Center

Willey, Jeffrey Allan

2013-01-01

Published research suggests that the future of health care will be dependent on new technologies that serve to decrease the need for increased numbers of critical-care nurses while also increasing the quality of patient care delivery. The eCare technology is one technology that provides this service in the intensive care unit (ICU) setting. The…

School Nurses Make a Difference

ERIC Educational Resources Information Center

Kitchell, Susan

2016-01-01

Susan Kitchell decided to become a school-based healthcare provider after working for more than twenty years in pediatrics and pediatric critical care at Roosevelt Hospital in New York City. She needed a position with daytime hours within her field of expertise that allowed her time to spend with her family. She began working as a school nurse in…

Reimagining Critical Race Theory in Education: Mental Health, Healing, and the Pathway to Liberatory Praxis

ERIC Educational Resources Information Center

McGee, Ebony O.; Stovall, David

2015-01-01

Long-standing theoretical education frameworks and methodologies have failed to provide space for the role mental health can play in mediating educational consequences. To illustrate the need for such space, Ebony McGee and David Stovall highlight the voices of black undergraduates they have served in the capacities of teacher, researcher, and…

Rebuttal of "Flawed Experimental Design Reveals the Need for Guidelines Requiring Appropriate Positive Controls in Endocrine Disruption Research" by (Vom Saa12010)

EPA Science Inventory

In response to the letter to Toxicological Sciences by Vom Saal et al. (2010) that provided criticisms of our recent paper, we have prepared a categorical rebuttal. In this rebuttal we describe • That the developmental effects of the potent environment estrogen Ethinyl Estradio...

Untapped Resources, Untapped Labor Pool: Using Federal Highway Funds to Prepare Women for Careers in Construction

ERIC Educational Resources Information Center

Hegewisch, Ariane; Henrici, Jane; Shaw, Elyse; Hooper, Thomas

2014-01-01

Women are underrepresented in highway, street, and bridge construction where employment is projected to grow by more than 20 percent until 2022. Creating sustainable pathways into construction careers fills critical hiring needs for industry while improving economic security for women, as these jobs typically provide family-supporting wages with…

A Comparison of Several Artificial Neural Network Classifiers for CT Images of Hardwood Logs

Treesearch

Daniel L. Schmoldt; Jing He; A. Lynn Abbott

1998-01-01

Knowledge of internal log defects, obtained by scanning, is critical to efficiency improvements for future hardwood sawmills. Nevertheless, before computed tomography (CT) scanning can be applied in industrial operations, we need to automatically interpret scan information so that it can provide the saw operator with the information necessary to make proper sawing...

The Contributions of Digital Communications Technology to Human Rights Education: A Case Study of Amnesty International

ERIC Educational Resources Information Center

Norlander, Rebecca Joy

2013-01-01

This dissertation addresses the need for critical assessment and evaluation of human rights education (HRE) programs and activities, especially newer initiatives that incorporate the use of digital information and communications technology (ICT). It provides an in-depth case study of the use of digital ICT in Amnesty International's HRE efforts,…

76 FR 59123 - Notice of Intent To Prepare a Draft Environmental Impact Statement for the Puyallup River General...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... 1969, as amended, for a proposed flood-risk management project in the Puyallup River Basin including.... This is a single-purpose flood-risk management study. The goal of this project is to identify the.... Alternative 2: Construct a coordinated flood-risk management project that would provide critically needed...

Transition Planning for Students with Disabilities: What Educators and Service Providers Can Do

ERIC Educational Resources Information Center

Bakken, Jeffrey P.; Obiakor, Festus E.

2008-01-01

The need for transition services for students with exceptionalities is apparent and critical for their success after high school. It is essential for school professionals, parents, and students to work collaboratively and consultively to determine each student's future goals and develop an effective plan to meet those goals successively. This book…

Parenting with Dr. Scoresby: The Guide for Raising Successful Happy Children. [Videotapes].

ERIC Educational Resources Information Center

Scoresby, Lynn

Noting that understanding what your children think, feel, and need at each stage of their development is critical to helping them be successful, these four videotapes outline a new approach to parenting that provides the necessary tools to understand your children's perspective on the world, and establish a family structure to best promote the…

A Theory on Becoming an Entrepreneurial Leader: A Student's Developmental Journey to a Creation-Driven Mindset

ERIC Educational Resources Information Center

Newman, Elizabeth Betsy Lavelle

2013-01-01

There is a compelling need to educate more entrepreneurial leaders of the 21st century with new and innovative approaches; and, higher education is poised to respond. Entrepreneurship plays a critical role in fueling local, national, and global economies and in providing prosperous livelihoods to diverse people, communities, and societies. And…

i-STEM Summer Institute: An Integrated Approach to Teacher Professional Development in STEM

ERIC Educational Resources Information Center

Nadelson, Louis S.; Seifert, Anne; Moll, Amy J.; Coats, Bradley

2012-01-01

The importance of STEM education to societal developments provides justification for assuring K-12 teachers are prepared to teach the related content. Inservice teacher professional development is critical to achieving the goal of enhanced student knowledge of STEM. Combining the need for increased capacity to teach STEM and the extant literature…

Understanding Groups in Outdoor Adventure Education through Social Network Analysis

ERIC Educational Resources Information Center

Jostad, Jeremy; Sibthorp, Jim; Paisley, Karen

2013-01-01

Relationships are a critical component to the experience of an outdoor adventure education (OAE) program, therefore, more fruitful ways of investigating groups is needed. Social network analysis (SNA) is an effective tool to study the relationship structure of small groups. This paper provides an explanation of SNA and shows how it was used by the…

Critical Thinking: Strategies for Improving Student Learning, Part II

ERIC Educational Resources Information Center

Paul, Richard; Elder, Linda

2008-01-01

In the last column we focused (as a primary goal of instruction) on the importance of teaching so that students learn to think their way into and through content. We stressed the need for well-designed daily structures and tactics for fostering deep learning, offering three strategies as examples. In this column, we provide four additional…

Changing the Instructional Model: Utilizing Blended Learning as a Tool of Inquiry Instruction in Middle School Science

ERIC Educational Resources Information Center

Longo, Christopher M.

2016-01-01

Educators need to delve further into effective ways to spark student interest, motivation, and curiosity both in the middle school classroom and in the online environment. A thoughtfully crafted blended learning process, infused with inquiry learning, can provide students with opportunities to collaborate, think critically, and pose questions,…

Adaptive Reading and Writing Instruction in iSTART and W-Pal

ERIC Educational Resources Information Center

Johnson, Amy M.; McCarthy, Kathryn S.; Kopp, Kristopher J.; Perret, Cecile A.; McNamara, Danielle S.

2017-01-01

Intelligent tutoring systems for ill-defined domains, such as reading and writing, are critically needed, yet uncommon. Two such systems, the Interactive Strategy Training for Active Reading and Thinking (iSTART) and Writing Pal (W-Pal) use natural language processing (NLP) to assess learners' written (i.e., typed) responses and provide immediate,…

The Influence of Cultural Immersion on Transcultural Self-Efficacy for Nursing Students at Private Faith-Based Baccalaureate Nursing Programs

ERIC Educational Resources Information Center

Schroeder, Pamela A.

2012-01-01

As multicultural populations throughout the world continually increase, complex challenges and health care disparities are being created. Nurses spend more time in patient care management than any other health care professionals. The need for nurses to provide culturally competent care for increasingly diverse patient populations is critical to…

School Leaders' Guide to Elementary Mathematics

ERIC Educational Resources Information Center

Curtis-Bey, Linda

2013-01-01

High achievement in mathematics is a critical part of the portfolios of students seeking admission to the best high schools and colleges; it is essential to a school's success at district, state, and national levels and to America's future as a global competitor. Elementary school leaders need to provide their students with a balanced,…

Homeowner interactions with residential trees in urban areas

Treesearch

Jana Dilley; Kathleen L. Wolf

2013-01-01

Urban forests are a critical element in sustainable urban areas because of the many environmental, economic, and social benefits that city trees provide. In order to increase canopy cover in urban areas, residential homeowners, who collectively own the majority of the land in most cities, need to engage in planting and retaining trees on their properties. This...

Teaching Innovation in High School Technology Classes

ERIC Educational Resources Information Center

Wright, Geoffrey A.; Skaggs, Paul; West, Richard E.

2013-01-01

Innovation is central to modern industry. It can and should be taught in schools. Not only does providing students a background in innovation benefit them later in life and industry, but it also promotes and further develops their critical thinking and collaboration skills. Despite the need for innovation, many have struggled with how to teach it.…

Complex vestibular macular anatomical relationships need a synthetic approach

NASA Technical Reports Server (NTRS)

Ross, M. D.

2001-01-01

Mammalian vestibular maculae are anatomically organized for complex parallel processing of linear acceleration information. Anatomical findings in rat maculae are provided in order to underscore this complexity, which is little understood functionally. This report emphasizes that a synthetic approach is critical to understanding how maculae function and the kind of information they conduct to the brain.

Undergraduate Students Conducting Research in the Life Sciences: Opportunities for Connected Learning

ERIC Educational Resources Information Center

Levis-Fitzgerald, Marc; Denson, Nida; Kerfeld, Cheryl A.

2005-01-01

Some scholars have publicly criticized large research universities for failing to provide undergraduate students with the skills and abilities needed to succeed both in life and in the workforce. One strategy, taken at UCLA, is to use its strength as a research institution as the foundation of curricular reform; for example, by bringing research…

Potential Energy Surface Database of Group II Dimer

National Institute of Standards and Technology Data Gateway

SRD 143 NIST Potential Energy Surface Database of Group II Dimer (Web, free access)   This database provides critical atomic and molecular data needed in order to evaluate the feasibility of using laser cooled and trapped Group II atomic species (Mg, Ca, Sr, and Ba) for ultra-precise optical clocks or quantum information processing devices.

Effects of habitat loss and fragmentation on amphibians: A review and prospectus

Treesearch

Samuel A. Cushman

2006-01-01

Habitat loss and fragmentation are among the largest threats to amphibian populations. However, most studies have not provided clear insights into their population-level implications. There is a critical need to investigate the mechanisms that underlie patterns of distribution and abundance. In order to understand the population- and species-level implications of...

Collaborative Services: Children Experiencing Neglect and the Side Effects of Prenatal Alcohol Exposure

ERIC Educational Resources Information Center

Rogers-Adkinson, Diana L.; Stuart, Shannon K.

2007-01-01

Purpose: The purpose of this article is to provide critical knowledge regarding children who are served by the child welfare system and how these children's specialized needs affect speech-language services. Specifically, the structure of social services system models is presented, with an emphasis on the cultural and systemic interactions between…

Students with Disabilities & Educational Standards: Recommendations for Policy & Practice.

ERIC Educational Resources Information Center

Ysseldyke, James E.; And Others

1994-01-01

By setting academic standards, America takes its first critical step toward providing a plan that will create an excellent educational system for the 21st century. It is important for those working on standards and those educating students with disabilities to work together as standards are being developed. Four kinds of standards need to be…

SFO Certification: Recognizing High Standards for Managers of School Business Operations Today

ERIC Educational Resources Information Center

Statz, Bambi; Weber, Pam

2010-01-01

These are challenging times for schools across the United States and Canada, and the ability of those providing the fiscal leadership of these multi-million dollar organizations has never been more critical. There is no better time to identify the specific skills and knowledge needed by those managing the business operations of schools today, and…

Innovations in the Delivery of Health Care Services to Rural Communities: Telemedicine and Limited-Service Hospitals.

ERIC Educational Resources Information Center

Capalbo, Susan M.; Heggem, Christine N.

1999-01-01

Presents an overview of the use of telemedicine technologies and critical access hospitals in rural areas. Discusses changes in rural population, hospital closures, and federal health care policy. Provides anecdotal evidence on the impact of these innovations in rural Montana, which suggests that different health care solutions are needed for…

Community College Workforce Training Programs: Expanding the Mission To Meet Critical Needs.

ERIC Educational Resources Information Center

Beckman, Brenda Marshall; Doucette, Don

1993-01-01

In fall 1992, the League for Innovation in the Community College conducted a survey of 1,042 community colleges to determine the extent and nature of their involvement in workforce training programs, the types of companies served, funding mechanisms, and perceived obstacles to providing effective training. Study findings, based on a 73.2% response…

Human influences on forest ecosystems: the southern wildland-urban interface assessment: summary report

Treesearch

Edward A. Macie; L. Annie Hermansen

2003-01-01

This summary report synthesizes the findings contained in the Southern Wildland-Urban Interface Assessment (General Technical Report SRS-55). The Assessment provides a review of critical wildland-urban interface issues, challenges, and needs for the Southern United States. Topics include population and demographic trends, economic and tax issues, land use planning and...

Applying Systems Thinking to Improve Special Education in Ohio

ERIC Educational Resources Information Center

Levenson, Nathan

2012-01-01

This report was written at the request of the Thomas B. Fordham Institute and the Educational Service Center of Central Ohio, to inform the discussion of state-level policy makers and other stakeholders on how to improve the quality and cost-effectiveness of services provided to Ohio's students with special needs. It is critical for Ohio to find…

Student Teams' Development over Time: Tracing the Relationship between the Quality of Communication and Teams' Performance

ERIC Educational Resources Information Center

Pöysä-Tarhonen, Johanna; Elen, Jan; Tarhonen, Pasi

2016-01-01

Current discussions in higher education and alumni training acknowledge the challenges training programs face in responding to the authentic needs of the labor market. In addition to academic knowledge, higher education institutions are expected to provide general twenty-first-century skills, such as problem-solving, critical thinking,…

A Children's Defense Budget: An Analysis of the FY 1987 Federal Budget and Children.

ERIC Educational Resources Information Center

Children's Defense Fund, Washington, DC.

This analysis of the implications for children of the FY 1987 Federal budget begins by criticizing the Reagan administration's policy on poor children and families and recommending needed action. Chapter 1 provides a rationale for investing in children and families. Specific attention is given to costs of child poverty, declining Federal help for…

Lessons from the Labor Organizing Community and Health Project: Meeting the Challenges of Student Engagement in Community Based Participatory Research

ERIC Educational Resources Information Center

Allison, Juliann Emmons; Khan, Tabassum; Reese, Ellen; Dobias, Becca Spence; Struna, Jason

2015-01-01

Community Based Participatory Research (CBPR) provides opportunities for scholars and students to respond directly to community needs; students also practice critical thinking, problem-solving, and conflict-resolution skills necessary for professional life and engaged citizenship. The challenges of involving undergraduate students in CBPR include…

Classic Teenplots: A Booktalk Guide to Use with Readers Ages 12-18

ERIC Educational Resources Information Center

Gillespie, John T.; Naden, Corinne

2006-01-01

This resource provides tools needed to create compelling booktalks featuring outstanding young adult novels that are mainstays in library collections. For each of the 100 titles selected, there is background information on the book and the author, a list of principal characters, a detailed plot summary, critical comment and notes on suitability,…

Analysis of the characteristics and management of critical values in a newborn tertiary center in China.

PubMed

Wang, Zheng-Li; Du, Li-Zhong; Chen, Yi-Yu; Li, Lu-Quan; Lu, Qi; Liu, Ying; Cao, Lu-Ying; He, Yu; Yu, Jia-Lin

2017-02-01

Critical value reporting has been widely adopted by hospitals throughout the world, but there were few reports about neonatal critical values. This study aimed to analyze characteristics of the neonatal critical values considered at our center and to provide information on improving neonatal intensive care. A retrospective study of critical values at a newborn tertiary center in China was conducted to assess neonatal critical values according to test, distribution, reporting time, patient outcome and the impact to the therapy. In total, 926 critical values were recorded. Overall, 66.52% (616/926) of the items were reported within 24 hours of admission, 50.28% (465/926) during duty times and 54.75% (507/926) in the neonatal intensive care unit (NICU). The routine coagulation test was the most frequent source of critical values. Electrocardiography, blood gas analysis and therapeutic drug monitoring of drug levels were associated with the highest rates of treatment intervention (100%); routine coagulation tests were the lowest (23.14%). Sample quality was the main cause of false-positive critical values. The incidence of neonatal critical values peaked during the first 24 hours post-admission and during duty periods. Each newborn center needs to enact rapid treatment guidelines to address common critical values in order to facilitate clinical interventions. Periodically reviewing critical values could help to optimize clinical practices.

The Individuals With Disabilities Education Act (IDEA) for Children With Special Educational Needs.

PubMed

Lipkin, Paul H; Okamoto, Jeffrey

2015-12-01

The pediatric health care provider has a critical role in supporting the health and well-being of children and adolescents in all settings, including early intervention (EI), preschool, and school environments. It is estimated that 15% of children in the United States have a disability. The Individuals with Disabilities Education Act entitles every affected child in the United States from infancy to young adulthood to a free appropriate public education through EI and special education services. These services bolster development and learning of children with various disabilities. This clinical report provides the pediatric health care provider with a summary of key components of the most recent version of this law. Guidance is also provided to ensure that every child in need receives the EI and special education services to which he or she is entitled. Copyright © 2015 by the American Academy of Pediatrics.

Different Diagnosis, Shared Vulnerabilities: The Value of Cross Disorder Validation of Capacity to Consent.

PubMed

Rosen, Allyson; Weitlauf, Julie C

2015-01-01

A screening measure of capacity to consent can provide an efficient method of determining the appropriateness of including individuals from vulnerable patient populations in research, particularly in circumstances in which no caregiver is available to provide surrogate consent. Seaman et al. (2015) cross-validate a measure of capacity to consent to research developed by Jeste et al. (2007). They provide data on controls, caregivers, and patients with mild cognitive impairment and dementia. The study demonstrates the importance of validating measures across disorders with different domains of incapacity, as well as the need for timely and appropriate follow-up with potential participants who yield positive screens. Ultimately clinical measures need to adapt to the dimensional diagnostic approaches put forward in DSM 5. Integrative models of constructs, such as capacity to consent, will make this process more efficient by avoiding the need to test measures in each disorder. Until then, cross-validation studies, such as the work by Seaman et al. (2015) are critical.

MarFS, Version 1

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

Inman, Jeffrey; Bonnie, David; Broomfield, Matthew

There is a sea (mar is Spanish for sea) of data out there that needs to be handled efficiently. Object Stores are filling the hole of managing large amounts of data efficiently. However, in many cases, and our HPC case in particular, we need a traditional file (POSIX) interface to this data as HPC I/O models have not moved to object interfaces, such as Amazon S3, CDMI, etc.Eventually Object Store providers may deliver file interfaces to their object stores, but at this point those interfaces are not ready to do the job that we need done. MarFS will glue togethermore » two existing scalable components: a file system's scalable metadata component that provides the file interface; and existing scalable object stores (from one or more providers). There will be utilities to do work that is not critical to be done in real-time so that MarFS can manage the space used by objects and allocated to individual users.« less

Ventilator Technologies Sustain Critically Injured Patients

NASA Technical Reports Server (NTRS)

2012-01-01

Consider this scenario: A soldier has been critically wounded in a sudden firefight in a remote region of Afghanistan. The soldier s comrades attend to him and radio for help, but the soldier needs immediate medical expertise and treatment that is currently miles away. The connection between medical support for soldiers on the battlefield and astronauts in space may not be immediately obvious. But when it comes to providing adequate critical care, NASA and the military have very similar operational challenges, says Shannon Melton of NASA contractor Wyle Integrated Science and Engineering. Melton works within Johnson Space Center s Space Medicine Division, which supports astronaut crew health before, during, and after flight. In space, we have a limited number of care providers, and those providers are not always clinicians with extensive medical training. We have limited room to provide care, limited consumables, and our environment is not like that of a hospital, she says. The Space Medicine Division s Advanced Projects Group works on combining the expertise of both clinicians and engineers to develop new capabilities that address the challenges of medical support in space, including providing care to distant patients. This field, called telemedicine, blends advanced communications practices and technologies with innovative medical devices and techniques to allow caregivers with limited or no medical experience to support a patient s needs. NASA, just by its nature, has been doing remote medicine since the beginning of the Space Program, says Melton, an engineer in the Advanced Projects Group. Since part of NASA s mandate is to transfer the results of its technological innovation for the benefit of the public, the Agency has worked with doctors and private industry to find ways to apply the benefits of space medicine on Earth. In one such case, a NASA partnership has resulted in new technologies that may improve the quality of emergency medicine for wounded soldiers on the battlefield and regular civilians.

Challenges of postgraduate critical care nursing program in Iran.

PubMed

Dehghan Nayeri, Nahid; Shariat, Esmaeil; Tayebi, Zahra; Ghorbanzadeh, Majid

2017-01-01

Background: The main philosophy of postgraduate preparation for working in critical care units is to ensure the safety and quality of patients' care. Increasing the complexity of technology, decision-making challenges and the high demand for advanced communication skills necessitate the need to educate learners. Within this aim, a master's degree in critical care nursing has been established in Iran. Current study was designed to collect critical care nursing students' experiences as well as their feedback to the field critical care nursing. Methods: This study used qualitative content analysis through in-depth semi-structured interviews. Graneheim and Lundman method was used for data analysis. Results: The results of the total 15 interviews were classified in the following domains: The vision of hope and illusion; shades of grey attitude; inefficient program and planning; inadequacy to run the program; and multiple outcomes: Far from the effectiveness. Overall findings indicated the necessity to review the curriculum and the way the program is implemented. Conclusion: The findings of this study provided valuable information to improve the critical care-nursing program. It also facilitated the next review of the program by the authorities.

Response of general practitioners to computer-generated critiques of hypertension therapy.

PubMed

van der Lei, J; van der Does, E; Man in 't Veld, A J; Musen, M A; van Bemmel, J H

1993-04-01

We recently have shown that a computer system, known as HyperCritic, can successfully audit general practitioners' treatment of hypertension by analyzing computer-based patient records. HyperCritic reviews the electronic medical records and offers unsolicited advice. To determine which unsolicited advice might be perceived as inappropriate, builders of programs such as HyperCritic need insight into providers' responses to computer-generated critique of their patient care. Twenty medical charts, describing in total 243 visits of patients with hypertension, were audited by 8 human reviewers and by the critiquing-system HyperCritic. A panel of 14 general practitioners subsequently judged the relevance of those critiques on a five-point scale ranging from relevant critique to erroneous or harmful critique. The panel judged reviewers' comments to be either relevant or somewhat relevant in 61 to 68% of cases, and either erroneous or possibly erroneous in 15 to 18%; the panel judged HyperCritic's comments to be either relevant or somewhat relevant in 65% of cases, and either erroneous or possibly erroneous in 16%. Comparison of individual members of the panel showed large differences; for example, the portion of HyperCritic's comments judged relevant ranged from 0 to 82%. We conclude that, from the perspective of general practitioners, critiques generated by the critiquing system HyperCritic are perceived equally beneficial as critiques generated by human reviewers. Different general practitioners, however, judge the critiques differently. Before auditing systems based on computer-based patient records that are acceptable to practitioners can be introduced, additional studies are needed to evaluate the reasons a physician may have for judging critiques to be irrelevant, and to evaluate the effect of critiques on physician behavior.

Strategy for future space weather observational assets

NASA Astrophysics Data System (ADS)

Davies, Jackie; Bogdanova, Yulia; Harrison, Richard; Bisi, Mario; Hapgood, Mike

2017-04-01

Observations from an ad-hoc suite of mainly aging, scientific, space-borne assets currently underpin space weather forecasting capabilities world-wide. While efforts have begun to replace / supplement these assets - in particular with the recent launch of the DSCOVR spacecraft - it is widely accepted that there is an urgent need to accelerate these endeavours in order to mitigate the risk of losing these critical observations. It is hence opportune to critically review the possible options for the provision of space weather observations, particularly in terms of identifying the optimum vantage point(s) and the instrumentation that will provide the most beneficial measurements to support space weather prediction. Here we present the results of several recent European studies that aim to identify the best solution for space-based space weather monitoring - obviously within realistic financial constraints and bearing in mind the immediacy with which such a mission needs to be realised.

Care erosion in hospitals: Problems in reflective nursing practice and the role of cognitive dissonance.

PubMed

de Vries, Jan; Timmins, Fiona

2016-03-01

Care erosion - gradual decline in care level - is an important problem in health care today. Unfortunately, the mechanism whereby it occurs is complex and poorly understood. This paper seeks to address this by emphasising problems in reflective nursing practice. Critical reflection on quality of care which should drive good care instead spawns justifications, denial, and trivialisation of deficient care. This perpetuates increasingly poor care levels. We argue that cognitive dissonance theory provides a highly effective understanding of this process and suggest for this approach to be incorporated in all efforts to address care erosion. The paper includes a detailed discussion of examples and implications for practice, in particular the need to restore critical reflection in nursing, the importance of embracing strong values and standards, and the need for increased awareness of signs of care erosion. Copyright © 2015 Elsevier Ltd. All rights reserved.

American Society for Microbiology resources in support of an evidence-based approach to teaching microbiology.

PubMed

Merkel, Susan M

2016-08-01

Numerous national reports have addressed the need for changing how science courses in higher education are taught, so that students develop a deeper understanding of critical concepts and the analytical and cognitive skills needed to address future challenges. This review presents some evidence-based approaches to curriculum development and teaching. Results from discipline-based education research indicate that it is critically important for educators to formulate learning goals, provide frequent and authentic assessments and actively engage students in their learning. Professional societies can play a role in helping to put these changes into practice. To this end, the American Society for Microbiology has developed a number of educational programs and resources, which are described here to encourage the implementation of student-centered learning in microbiology education. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

What does public health ethics tell (or not tell) us about intervening in non-communicable diseases?

PubMed

Upshur, Ross

2013-03-01

Obesity has been described as pandemic and a public health crisis. It has been argued that concerted research efforts are needed to enhance our understanding and develop effective interventions for the complex and multiple dimensions of the health challenges posed by obesity. This would provide a secure evidence base in order to justify clinical interventions and public policy. This paper critically examines these claims through the examination of models of public health and public health ethics. I argue that the concept of an effective public health intervention is unclear and underdeveloped and, as a consequence, normative frameworks reliant on meeting the effectiveness criterion may miss morally salient dimensions of the problems. I conclude by arguing for the need to consider both an ecological model of public health and inclusion of a critical public health ethics perspective for an adequate account of the public health challenges posed by obesity.

Critical asset and portfolio risk analysis: an all-hazards framework.

PubMed

Ayyub, Bilal M; McGill, William L; Kaminskiy, Mark

2007-08-01

This article develops a quantitative all-hazards framework for critical asset and portfolio risk analysis (CAPRA) that considers both natural and human-caused hazards. Following a discussion on the nature of security threats, the need for actionable risk assessments, and the distinction between asset and portfolio-level analysis, a general formula for all-hazards risk analysis is obtained that resembles the traditional model based on the notional product of consequence, vulnerability, and threat, though with clear meanings assigned to each parameter. Furthermore, a simple portfolio consequence model is presented that yields first-order estimates of interdependency effects following a successful attack on an asset. Moreover, depending on the needs of the decisions being made and available analytical resources, values for the parameters in this model can be obtained at a high level or through detailed systems analysis. Several illustrative examples of the CAPRA methodology are provided.

Foundational biomedical informatics research in the clinical and translational science era: a call to action.

PubMed

Payne, Philip R O; Embi, Peter J; Niland, Joyce

2010-01-01

Advances in clinical and translational science, along with related national-scale policy and funding mechanisms, have provided significant opportunities for the advancement of applied clinical research informatics (CRI) and translational bioinformatics (TBI). Such efforts are primarily oriented to application and infrastructure development and are critical to the conduct of clinical and translational research. However, they often come at the expense of the foundational CRI and TBI research needed to grow these important biomedical informatics subdisciplines and ensure future innovations. In light of this challenge, it is critical that a number of steps be taken, including the conduct of targeted advocacy campaigns, the development of community-accepted research agendas, and the continued creation of forums for collaboration and knowledge exchange. Such efforts are needed to ensure that the biomedical informatics community is able to advance CRI and TBI science in the context of the modern clinical and translational science era.

Can you hear me now? Teaching listening skills.

PubMed

Nemec, Patricia B; Spagnolo, Amy Cottone; Soydan, Anne Sullivan

2017-12-01

This column provides an overview of methods for training to improve service provider active listening and reflective responding skills. Basic skills in active listening and reflective responding allow service providers to gather information about and explore the needs, desires, concerns, and preference of people using their services-activities that are of critical importance if services are to be truly person-centered and person-driven. Sources include the personal experience of the authors as well as published literature on the value of basic counseling skills and best practices in training on listening and other related soft skills. Training in listening is often needed but rarely sought by behavioral health service providers. Effective curricula exist, providing content and practice opportunities that can be incorporated into training, supervision, and team meetings. When providers do not listen well to the people who use their services, the entire premise of recovery-oriented person-driven services is undermined. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN).

PubMed

Ranade-Kharkar, Pallavi; Weir, Charlene; Norlin, Chuck; Collins, Sarah A; Scarton, Lou Ann; Baker, Gina B; Borbolla, Damian; Taliercio, Vanina; Del Fiol, Guilherme

2017-09-01

Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

An Introduction to Flight Software Development: FSW Today, FSW 2010

NASA Technical Reports Server (NTRS)

Gouvela, John

2004-01-01

Experience and knowledge gained from ongoing maintenance of Space Shuttle Flight Software and new development projects including Cockpit Avionics Upgrade are applied to projected needs of the National Space Exploration Vision through Spiral 2. Lessons learned from these current activities are applied to create a sustainable, reliable model for development of critical software to support Project Constellation. This presentation introduces the technologies, methodologies, and infrastructure needed to produce and sustain high quality software. It will propose what is needed to support a Vision for Space Exploration that places demands on the innovation and productivity needed to support future space exploration. The technologies in use today within FSW development include tools that provide requirements tracking, integrated change management, modeling and simulation software. Specific challenges that have been met include the introduction and integration of Commercial Off the Shelf (COTS) Real Time Operating System for critical functions. Though technology prediction has proved to be imprecise, Project Constellation requirements will need continued integration of new technology with evolving methodologies and changing project infrastructure. Targets for continued technology investment are integrated health monitoring and management, self healing software, standard payload interfaces, autonomous operation, and improvements in training. Emulation of the target hardware will also allow significant streamlining of development and testing. The methodologies in use today for FSW development are object oriented UML design, iterative development using independent components, as well as rapid prototyping . In addition, Lean Six Sigma and CMMI play a critical role in the quality and efficiency of the workforce processes. Over the next six years, we expect these methodologies to merge with other improvements into a consolidated office culture with all processes being guided by automated office assistants. The infrastructure in use today includes strict software development and configuration management procedures, including strong control of resource management and critical skills coverage. This will evolve to a fully integrated staff organization with efficient and effective communication throughout all levels guided by a Mission-Systems Architecture framework with focus on risk management and attention toward inevitable product obsolescence. This infrastructure of computing equipment, software and processes will itself be subject to technological change and need for management of change and improvement,

NASA's Astronant Family Support Office

NASA Technical Reports Server (NTRS)

Beven, Gary; Curtis, Kelly D.; Holland, Al W.; Sipes, Walter; VanderArk, Steve

2014-01-01

During the NASA-Mir program of the 1990s and due to the challenges inherent in the International Space Station training schedule and operations tempo, it was clear that a special focus on supporting families was a key to overall mission success for the ISS crewmembers pre-, in- and post-flight. To that end, in January 2001 the first Family Services Coordinator was hired by the Behavioral Health and Performance group at NASA JSC and matrixed from Medical Operations into the Astronaut Office's organization. The initial roles and responsibilities were driven by critical needs, including facilitating family communication during training deployments, providing mission-specific and other relevant trainings for spouses, serving as liaison for families with NASA organizations such as Medical Operations, NASA management and the Astronaut Office, and providing assistance to ensure success of an Astronaut Spouses Group. The role of the Family Support Office (FSO) has modified as the ISS Program matured and the needs of families changed. The FSO is currently an integral part of the Astronaut Office's ISS Operations Branch. It still serves the critical function of providing information to families, as well as being the primary contact for US and international partner families with resources at JSC. Since crews launch and return on Russian vehicles, the FSO has the added responsibility for coordinating with Flight Crew Operations, the families, and their guests for Soyuz launches, landings, and Direct Return to Houston post-flight. This presentation will provide a summary of the family support services provided for astronauts, and how they have changed with the Program and families the FSO serves. Considerations for future FSO services will be discussed briefly as NASA proposes one year missions and beyond ISS missions. Learning Objective: 1) Obtain an understanding of the reasons a Family Support Office was important for NASA. 2) Become familiar with the services provided for astronauts and their families and how they changed with the Program and family needs.

Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program.

PubMed

Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya

2016-12-01

Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.

Preferences of Knowledge Users for Two Formats of Summarizing Results from Systematic Reviews: Infographics and Critical Appraisals.

PubMed

Crick, Katelynn; Hartling, Lisa

2015-01-01

To examine and compare preferences of knowledge users for two different formats of summarizing results from systematic reviews: infographics and critical appraisals. Cross-sectional. Annual members' meeting of a Network of Centres of Excellence in Knowledge Mobilization called TREKK (Translating Emergency Knowledge for Kids). TREKK is a national network of researchers, clinicians, health consumers, and relevant organizations with the goal of mobilizing knowledge to improve emergency care for children. Members of the TREKK Network attending the annual meeting in October 2013. Overall preference for infographic vs. critical appraisal format. Members' rating of each format on a 10-point Likert scale for clarity, comprehensibility, and aesthetic appeal. Members' impressions of the appropriateness of the two formats for their professional role and for other audiences. Among 64 attendees, 58 members provided feedback (91%). Overall, their preferred format was divided with 24/47 (51%) preferring the infographic to the critical appraisal. Preference varied by professional role, with 15/22 (68%) of physicians preferring the critical appraisal and 8/12 (67%) of nurses preferring the infographic. The critical appraisal was rated higher for clarity (mean 7.8 vs. 7.0; p = 0.03), while the infographic was rated higher for aesthetic appeal (mean 7.2 vs. 5.0; p<0.001). There was no difference between formats for comprehensibility (mean 7.6 critical appraisal vs. 7.1 infographic; p = 0.09). Respondents indicated the infographic would be most useful for patients and their caregivers, while the critical appraisal would be most useful for their professional roles. Infographics are considered more aesthetically appealing for summarizing evidence; however, critical appraisal formats are considered clearer and more comprehensible. Our findings show differences in terms of audience-specific preferences for presentation of research results. This study supports other research indicating that tools for knowledge dissemination and translation need to be targeted to specific end users' preferences and needs.

Preferences of Knowledge Users for Two Formats of Summarizing Results from Systematic Reviews: Infographics and Critical Appraisals

PubMed Central

Crick, Katelynn; Hartling, Lisa

2015-01-01

Objectives To examine and compare preferences of knowledge users for two different formats of summarizing results from systematic reviews: infographics and critical appraisals. Design Cross-sectional. Setting Annual members’ meeting of a Network of Centres of Excellence in Knowledge Mobilization called TREKK (Translating Emergency Knowledge for Kids). TREKK is a national network of researchers, clinicians, health consumers, and relevant organizations with the goal of mobilizing knowledge to improve emergency care for children. Participants Members of the TREKK Network attending the annual meeting in October 2013. Outcome Measures Overall preference for infographic vs. critical appraisal format. Members’ rating of each format on a 10-point Likert scale for clarity, comprehensibility, and aesthetic appeal. Members’ impressions of the appropriateness of the two formats for their professional role and for other audiences. Results Among 64 attendees, 58 members provided feedback (91%). Overall, their preferred format was divided with 24/47 (51%) preferring the infographic to the critical appraisal. Preference varied by professional role, with 15/22 (68%) of physicians preferring the critical appraisal and 8/12 (67%) of nurses preferring the infographic. The critical appraisal was rated higher for clarity (mean 7.8 vs. 7.0; p = 0.03), while the infographic was rated higher for aesthetic appeal (mean 7.2 vs. 5.0; p<0.001). There was no difference between formats for comprehensibility (mean 7.6 critical appraisal vs. 7.1 infographic; p = 0.09). Respondents indicated the infographic would be most useful for patients and their caregivers, while the critical appraisal would be most useful for their professional roles. Conclusions Infographics are considered more aesthetically appealing for summarizing evidence; however, critical appraisal formats are considered clearer and more comprehensible. Our findings show differences in terms of audience-specific preferences for presentation of research results. This study supports other research indicating that tools for knowledge dissemination and translation need to be targeted to specific end users’ preferences and needs. PMID:26466099

Breast Cancer: Exploring the Facts and Holistic Needs during and beyond Treatment

PubMed Central

Ng, Zhi Xuan; Ong, Mei Shan; Jegadeesan, Tamilarasi; Deng, Shuo; Yap, Celestial T.

2017-01-01

Breast cancer patients face challenges throughout the journey of diagnosis, treatment, post-treatment, and recovery. The breast cancer patient is exposed to a multidisciplinary team including doctors, nurses, therapists, counselors, and psychologists. While the team assembled together aims to address multiple facets in breast cancer care, the sub-specialized nature of individual professional practices may constrain the overview of patients’ holistic needs and a comprehensive approach to cancer management. This paper aims to provide an overview of the holistic needs of breast cancer patients at each stage of their cancer journey, addressing their complex physical, psychological, and social needs. As every patient is different, cancer care has to be tailored to each patient based on a holistic needs assessment. This paper also explores how support can be provided from the perspectives of the healthcare providers, family members and caretakers. Examples of general practices at healthcare institutions worldwide as well as supportive care provided by support groups are discussed. The needs of breast cancer patients extend beyond the resolution of cancer as a disease, and the restoration of health as far as possible is a critical component of healing. Understanding the complex issues involved in the journey of breast cancer will aid healthcare providers to be better equipped to sensitively address their concerns and focus on healing the patient holistically. Methodology: This paper provides a literature review of validated practices in different countries and elaborates on the holistic needs of patients at various stages of recovery. This review is based on more than a decade of publications sourced from multiple resources including PubMed journal articles; books and official websites of breast cancer organizations. PMID:28538673

Breast Cancer: Exploring the Facts and Holistic Needs during and beyond Treatment.

PubMed

Ng, Zhi Xuan; Ong, Mei Shan; Jegadeesan, Tamilarasi; Deng, Shuo; Yap, Celestial T

2017-05-24

Breast cancer patients face challenges throughout the journey of diagnosis, treatment, post-treatment, and recovery. The breast cancer patient is exposed to a multidisciplinary team including doctors, nurses, therapists, counselors, and psychologists. While the team assembled together aims to address multiple facets in breast cancer care, the sub-specialized nature of individual professional practices may constrain the overview of patients' holistic needs and a comprehensive approach to cancer management. This paper aims to provide an overview of the holistic needs of breast cancer patients at each stage of their cancer journey, addressing their complex physical, psychological, and social needs. As every patient is different, cancer care has to be tailored to each patient based on a holistic needs assessment. This paper also explores how support can be provided from the perspectives of the healthcare providers, family members and caretakers. Examples of general practices at healthcare institutions worldwide as well as supportive care provided by support groups are discussed. The needs of breast cancer patients extend beyond the resolution of cancer as a disease, and the restoration of health as far as possible is a critical component of healing. Understanding the complex issues involved in the journey of breast cancer will aid healthcare providers to be better equipped to sensitively address their concerns and focus on healing the patient holistically. This paper provides a literature review of validated practices in different countries and elaborates on the holistic needs of patients at various stages of recovery. This review is based on more than a decade of publications sourced from multiple resources including PubMed journal articles; books and official websites of breast cancer organizations.

Present Challenges, Critical Needs, and Future Technological Directions for NASA's GN and C Engineering Discipline

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.

2010-01-01

The National Aeronautics and Space Administration (NASA) is currently undergoing a substantial redirection. Notable among the changes occurring within NASA is the stated emphasis on technology development, integration, and demonstration. These new changes within the Agency should have a positive impact on the GN&C discipline given the potential for sizeable investments for technology development and in-space demonstrations of both Autonomous Rendezvous & Docking (AR&D) systems and Autonomous Precision Landing (APL) systems. In this paper the NASA Technical Fellow for Guidance, Navigation and Control (GN&C) provides a summary of the present technical challenges, critical needs, and future technological directions for NASA s GN&C engineering discipline. A brief overview of the changes occurring within NASA that are driving a renewed emphasis on technology development will be presented as background. The potential benefits of the planned GN&C technology developments will be highlighted. This paper will provide a GN&C State-of-the-Discipline assessment. The discipline s readiness to support the goals & objectives of each of the four NASA Mission Directorates is evaluated and the technical challenges and barriers currently faced by the discipline are summarized. This paper will also discuss the need for sustained investments to sufficiently mature the several classes of GN&C technologies required to implement NASA crewed exploration and robotic science missions.

Gravitational Biology Facility on Space Station: Meeting the needs of space biology

NASA Technical Reports Server (NTRS)

Allen, Katherine; Wade, Charles

1992-01-01

The Gravitational Biology Facility (GBF) is a set of generic laboratory equipment needed to conduct research on Space Station Freedom (SSF), focusing on Space Biology Program science (Cell and Developmental Biology and Plant Biology). The GBF will be functional from the earliest utilization flights through the permanent manned phase. Gravitational biology research will also make use of other Life Sciences equipment on the space station as well as existing equipment developed for the space shuttle. The facility equipment will be developed based on requirements derived from experiments proposed by the scientific community to address critical questions in the Space Biology Program. This requires that the facility have the ability to house a wide variety of species, various methods of observation, and numerous methods of sample collection, preservation, and storage. The selection of the equipment will be done by the members of a scientific working group (5 members representing cell biology, 6 developmental biology, and 6 plant biology) who also provide requirements to design engineers to ensure that the equipment will meet scientific needs. All equipment will undergo extensive ground based experimental validation studies by various investigators addressing a variety of experimental questions. Equipment will be designed to be adaptable to other space platforms. The theme of the Gravitational Biology Facility effort is to provide optimal and reliable equipment to answer the critical questions in Space Biology as to the effects of gravity on living systems.

Confirmational study: a positive-based thumb and finger sucking elimination program.

PubMed

Green, Shari E

2010-11-01

This article emphasizes the critical need for information specifically regarding the topic of retained sucking behaviors. The study aimed to confirm results provided by Van Norman of 723 subjects in 1997. Parent surveys were collected on 441 subjects who received an orofacial myofunctional treatment program provided by one certified orofacial myologist. Results of this study do confirm that retained digit sucking behavior may be addressed successfully and expediently by a program based on positive behavior modification techniques.

Consumer-perceived value: the key to a successful business strategy in the healthcare marketplace.

PubMed

Ettinger, W H

1998-01-01

The Medicare market is becoming increasingly competitive and uncertain. To compete successfully for a share of the Medicare market, providers must: Have a cogent strategy that defines their customers and the value proposition for those customers Design their services to maximize the benefits of outcomes and service process that are important to consumers Determine the needed structure and infrastructure to put those services in place Marketing research is critical in this regard, as is effectiveness tracking. This approach is different from that usually taken by healthcare providers in the marketplace. It means being strategic rather than tactical and proactive rather than reactive. Most importantly, providers must shift their focus externally to the consumer's needs rather than their own. Finally, this approach requires working together in an integrated organization with common goals.

Health information technology knowledge and skills needed by HIT employers.

PubMed

Fenton, S H; Gongora-Ferraez, M J; Joost, E

2012-01-01

To evaluate the health information technology (HIT) workforce knowledge and skills needed by HIT employers. Statewide face-to-face and online focus groups of identified HIT employer groups in Austin, Brownsville, College Station, Dallas, El Paso, Houston, Lubbock, San Antonio, and webinars for rural health and nursing informatics. HIT employers reported needing an HIT workforce with diverse knowledge and skills ranging from basic to advanced, while covering information technology, privacy and security, clinical practice, needs assessment, contract negotiation, and many other areas. Consistent themes were that employees needed to be able to learn on the job and must possess the ability to think critically and problem solve. Many employers wanted persons with technical skills, yet also the knowledge and understanding of healthcare operations. The HIT employer focus groups provided valuable insight into employee skills needed in this fast-growing field. Additionally, this information will be utilized to develop a statewide HIT workforce needs assessment survey.

A comprehensive approach to women’s health: lessons from the Mexican health reform

PubMed Central

2012-01-01

Background This paper discusses the way in which women’s health concerns were addressed in Mexico as part of a health system reform. Discussion The first part sets the context by examining the growing complexity that characterizes the global health field, where women’s needs occupy center stage. Part two briefly describes a critical conceptual evolution, i.e. from maternal to reproductive to women’s health. In the third and last section, the novel “women and health” (W&H) approach and its translation into policies and programs in the context of a structural health reform in Mexico is discussed. W&H simultaneously focuses on women’s health needs and women’s critical roles as both formal and informal providers of health care, and the links between these two dimensions. Summary The most important message of this paper is that broad changes in health systems offer the opportunity to address women’s health needs through innovative approaches focused on promoting gender equality and empowering women as drivers of change. PMID:23228037

Diversity: creating an environment of inclusiveness.

PubMed

Swanson, Jane W

2004-01-01

Diversity is a concept that most organizations espouse but find challenging to put into practice. It is especially critical for healthcare organizations to be responsive in addressing issues of diversity related to not only employees but also clients. This article identifies the following 3 areas that must be addressed if an organization is to succeed in creating an environment where diversity and inclusiveness are honored: (1) organizations and their leaders need to be aware of their reactions "those who are different" in their organization. This awareness is critical in identifying the underlying obstacles that prevent a truly inclusive workplace; (2) organizations and their leaders need to be able to expand their perspectives allowing them to not only understand but appreciate others. These expanded perspectives can provide a potentially powerful tool for both problem solving and conflict resolution; (3) if organizations and their leaders are actively engaged in exploring options and are open to alternatives, they will find that they not only succeed in creating an environment of inclusiveness but also are in a better position to meet the needs of employees, patients, and a multicultural society.

Maternal Zinc Intakes and Homeostatic Adjustments during Pregnancy and Lactation

PubMed Central

Donangelo, Carmen Marino; King, Janet C.

2012-01-01

Zinc plays critical roles during embryogenesis, fetal growth, and milk secretion, which increase the zinc need for pregnancy and lactation. Increased needs can be met by increasing the dietary zinc intake, along with making homeostatic adjustments in zinc utilization. Potential homeostatic adjustments include changes in circulating zinc, increased zinc absorption, decreased zinc losses, and changes in whole body zinc kinetics. Although severe zinc deficiency during pregnancy has devastating effects, systematic reviews and meta-analysis of the effect of maternal zinc supplementation on pregnancy outcomes have consistently shown a limited benefit. We hypothesize, therefore, that zinc homeostatic adjustments during pregnancy and lactation improve zinc utilization sufficiently to provide the increased zinc needs in these stages and, therefore, mitigate immediate detrimental effects due to a low zinc intake. The specific questions addressed are the following: How is zinc utilization altered during pregnancy and lactation? Are those homeostatic adjustments influenced by maternal zinc status, dietary zinc, or zinc supplementation? These questions are addressed by critically reviewing results from published human studies on zinc homeostasis during pregnancy and lactation carried out in different populations worldwide. PMID:22852063

The Virtual Observatory as Critical Scientific Cyber Infrastructure.

NASA Astrophysics Data System (ADS)

Fox, P.

2006-12-01

Virtual Observatories can provide access to vast stores of scientific data: observations and models as well as services to analyze, visualize and assimilate multiple data sources. As these electronic resource become widely used, there is potential to improve the efficiency, interoperability, collaborative potential, and impact of a wide range of interdisciplinary scientific research. In addition, we know that as the diversity of collaborative science and volume of accompanying data and data generators/consumers grows so do the challenges. In order for Virtual Observatories to realize their potential and become indispensible infrastructure, social, political and technical challenges need to be addressed concerning (at least) roles and responsibilities, data and services policies, representations and interoperability of services, data search, access, and usability. In this presentation, we discuss several concepts and instances of the Virtual Observatory and related projects that may, and may not, be meeting the abovementioned challanges. We also argue that science driven needs and architecture development are critical in the development of sustainable (and thus agile) cyberinfrastructure. Finally we some present or emerging candidate technologies and organizational constructs that will need to be pursued.

Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care.

PubMed

Adler-Milstein, Julia; Embi, Peter J; Middleton, Blackford; Sarkar, Indra Neil; Smith, Jeff

2017-09-01

While great progress has been made in digitizing the US health care system, today's health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed. The result is a chasm between the current health IT ecosystem and the health IT ecosystem that is desperately needed.In this paper, we identify a set of focal goals and associated near-term achievable actions that are critical to pursue in order to enable the health IT ecosystem to meet the acute needs of modern health care delivery. These ideas emerged from discussions that occurred during the 2015 American Medical Informatics Association Policy Invitational Meeting. To illustrate the chasm and motivate our recommendations, we created a vignette from the multistakeholder perspectives of a patient, his provider, and researchers/innovators. It describes an idealized scenario in which each stakeholder's needs are supported by an integrated health IT environment. We identify the gaps preventing such a reality today and present associated policy recommendations that serve as a blueprint for critical actions that would enable us to cross the current health IT chasm by leveraging systems and information to routinely deliver high-value care. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The wicked question answered: positive deviance delivers patient-centered care.

PubMed

Gary, Jodie C

2014-01-01

How nurses respond when faced with the dilemma of providing patient-centered care in the absence of patient-centered practice guidelines remains relatively unreported. Standards may not be available to guide nurses or may not be realistic for implementation at the point of care. Nurses may be forced to react creatively to meet the needs of their patients. The purpose was to understand nursing care when standard practice guidelines did not meet patient-specific care needs and to develop various viewpoints related to the use of positive deviance in providing patient-centered care. Complexity theory and the framework of a wicked question were used to guide a 3-round online national Delphi study from November 2011 to February 2012. The panel was accessed through the American Association of Critical Care Nurses to expose the care provided when standard practice guidelines were lacking. Findings support the presence of positive deviance and expose care provided by nurses when standard practice guidelines lacked the ability to provide patient-centered care. Dominant themes of positive deviance are recommended as priorities for future research. Better guidelines are needed that work for nurses, instead of against them, that would not force a nurse into actions that are not patient centered. Guidelines should guide practice and assist in allowing nurses to provide care that is centered on the best needs of the patient in the specific care situation.

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective.

PubMed

Huang, Stephen J; McLean, Anthony S

2010-01-01

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed.

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective

PubMed Central

2010-01-01

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed. PMID:20550724

Visible and thermal spectrum synthetic image generation with DIRSIG and MuSES for ground vehicle identification training

NASA Astrophysics Data System (ADS)

May, Christopher M.; Maurer, Tana O.; Sanders, Jeffrey S.

2017-05-01

There is a ubiquitous and never ending need in the US armed forces for training materials that provide the warfighter with the skills needed to differentiate between friendly and enemy forces on the battlefield. The current state of the art in battlefield identification training is the Recognition of Combat Vehicles (ROCV) tool created and maintained by the Communications - Electronics Research, Development and Engineering Center Night Vision and Electronic Sensors Directorate (CERDEC NVESD). The ROC-V training package utilizes measured visual and thermal imagery to train soldiers about the critical visual and thermal cues needed to accurately identify modern military vehicles and combatants. This paper presents an approach that has been developed to augment the existing ROC-V imagery database with synthetically generated multi-spectral imagery that will allow NVESD to provide improved training imagery at significantly lower costs.

21. century customers: Volume 1 -- Industry and manufacturing. Final report

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

Hanley, P.H.; Asfour, A.; Tripp, S.

1998-12-01

The arrival of 21st century information technologies has compelled traditional heavy industries such as steel, chemicals, and paper/pulp to invest in new plants and technologies, efficiency moves, globalization of sourcing, and aggressive pursuit of foreign direct investment. This report will assist strategic planners and marketing executives charged with identifying the needs of the widely dispersed industrial sector and provide insights regarding how to improve long-term profitability. Understanding and meeting the evolving needs of industrial customers could be critical to the future prosperity of energy enterprises. This report examines five significant industries that are undergoing dramatic changes in their markets andmore » relationships to buyers of their products--steel and aluminum, paper and pulp, chemicals, plastics, and food processing. The report provides a companion to Volume 2, ``21st Century Customers: Volume 2: Business and Commerce``, covering the evolving needs of five commercial sector businesses.« less

SECONDARY WASTE/ETF (EFFLUENT TREATMENT FACILITY) PRELIMINARY PRE-CONCEPTUAL ENGINEERING STUDY

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

MAY TH; GEHNER PD; STEGEN GARY

2009-12-28

This pre-conceptual engineering study is intended to assist in supporting the critical decision (CD) 0 milestone by providing a basis for the justification of mission need (JMN) for the handling and disposal of liquid effluents. The ETF baseline strategy, to accommodate (WTP) requirements, calls for a solidification treatment unit (STU) to be added to the ETF to provide the needed additional processing capability. This STU is to process the ETF evaporator concentrate into a cement-based waste form. The cementitious waste will be cast into blocks for curing, storage, and disposal. Tis pre-conceptual engineering study explores this baseline strategy, in additionmore » to other potential alternatives, for meeting the ETF future mission needs. Within each reviewed case study, a technical and facility description is outlined, along with a preliminary cost analysis and the associated risks and benefits.« less

What Preparatory Science is Needed in Coronal Structure and Activity

NASA Technical Reports Server (NTRS)

Antiochos, S. K.

2011-01-01

Solar Orbiter and Solar Probe Plus will launch in six short years! Before then, we need to accomplish a great deal of science in order to be able to maximize the return of these missions. Preparatory science is especially important for exploratory missions such as SO and SPP, because they truly will be going "where no mission has gone before". Such preparatory science may include all types of research: theory, modeling, data exploitation, and supporting observations. This meeting provides an opportunity for the community to define and begin this critical preparatory work. In this talk I will provide an overview of our state of knowledge in coronal structure and activity, describe what I believe are the most promising opportunities for advances by SO and SPP, and lead a discussion on what programs need to be implemented now in order to achieve these science advances by the time SO and SPP launch.

Atomic Data for Stellar Astrophysics: from the UV to the IR

NASA Technical Reports Server (NTRS)

Wahlgren, Glenn M.

2011-01-01

The study of stars and stellar evolution relies heavily on the analysis of stellar spectra. The need for atomic line data from the ultraviolet (UV) to the infrared (lR) regions is greater now than ever. In the past twenty years, the time since the launch of the Hubble Space Telescope, great progress has been made in acquiring atomic data for UV transitions. The optical wavelength region, now expanded by progress in detector technology, continues to provide motivation for new atomic data. In addition, investments in new instrumentation for ground-based and space observatories has lead to the availability of high-quality spectra at IR wavelengths, where the need for atomic data is most critical. In this review, examples are provided of the progress made in generating atomic data for stellar studies, with a look to the future for addressing the accuracy and completeness of atomic data for anticipated needs.

Personalized Location-Based Recommendation Services for Tour Planning in Mobile Tourism Applications

NASA Astrophysics Data System (ADS)

Yu, Chien-Chih; Chang, Hsiao-Ping

Travel and tour planning is a process of searching, selecting, grouping and sequencing destination related products and services including attractions, accommodations, restaurants, and activities. Personalized recommendation services aim at suggesting products and services to meet users’ preferences and needs, while location-based services focus on providing information based on users’ current positions. Due to the fast growing of user needs in the mobile tourism domain, how to provide personalized location-based tour recommendation services becomes a critical research and practical issue. The objective of this paper is to propose a system architecture and design methods for facilitating the delivery of location-based recommendation services to support personalized tour planning. Based on tourists’ current location and time, as well as personal preferences and needs, various recommendations regarding sightseeing spots, hotels, restaurants, and packaged tour plans can be generated efficiently. An application prototype is also implemented to illustrate and test the system feasibility and effectiveness.

From the Office of the National Coordinator: the strategy for advancing the exchange of health information.

PubMed

Williams, Claudia; Mostashari, Farzad; Mertz, Kory; Hogin, Emily; Atwal, Parmeeth

2012-03-01

Electronic health information exchange addresses a critical need in the US health care system to have information follow patients to support patient care. Today little information is shared electronically, leaving doctors without the information they need to provide the best care. With payment reforms providing a strong business driver, the demand for health information exchange is poised to grow. The Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, has led the process of establishing the essential building blocks that will support health information exchange. Over the coming year, this office will develop additional policies and standards that will make information exchange easier and cheaper and facilitate its use on a broader scale.

Do we need methodological theory to do qualitative research?

PubMed

Avis, Mark

2003-09-01

Positivism is frequently used to stand for the epistemological assumption that empirical science based on principles of verificationism, objectivity, and reproducibility is the foundation of all genuine knowledge. Qualitative researchers sometimes feel obliged to provide methodological alternatives to positivism that recognize their different ethical, ontological, and epistemological commitments and have provided three theories: phenomenology, grounded theory, and ethnography. The author argues that positivism was a doomed attempt to define empirical foundations for knowledge through a rigorous separation of theory and evidence; offers a pragmatic, coherent view of knowledge; and suggests that rigorous, rational empirical investigation does not need methodological theory. Therefore, qualitative methodological theory is unnecessary and counterproductive because it hinders critical reflection on the relation between methodological theory and empirical evidence.

Clinical Reasoning in Athletic Training Education: Modeling Expert Thinking

ERIC Educational Resources Information Center

Geisler, Paul R.; Lazenby, Todd W.

2009-01-01

Objective: To address the need for a more definitive approach to critical thinking during athletic training educational experiences by introducing the clinical reasoning model for critical thinking. Background: Educators are aware of the need to teach students how to think critically. The multiple domains of athletic training are comprehensive and…

Accessible high performance computing solutions for near real-time image processing for time critical applications

NASA Astrophysics Data System (ADS)

Bielski, Conrad; Lemoine, Guido; Syryczynski, Jacek

2009-09-01

High Performance Computing (HPC) hardware solutions such as grid computing and General Processing on a Graphics Processing Unit (GPGPU) are now accessible to users with general computing needs. Grid computing infrastructures in the form of computing clusters or blades are becoming common place and GPGPU solutions that leverage the processing power of the video card are quickly being integrated into personal workstations. Our interest in these HPC technologies stems from the need to produce near real-time maps from a combination of pre- and post-event satellite imagery in support of post-disaster management. Faster processing provides a twofold gain in this situation: 1. critical information can be provided faster and 2. more elaborate automated processing can be performed prior to providing the critical information. In our particular case, we test the use of the PANTEX index which is based on analysis of image textural measures extracted using anisotropic, rotation-invariant GLCM statistics. The use of this index, applied in a moving window, has been shown to successfully identify built-up areas in remotely sensed imagery. Built-up index image masks are important input to the structuring of damage assessment interpretation because they help optimise the workload. The performance of computing the PANTEX workflow is compared on two different HPC hardware architectures: (1) a blade server with 4 blades, each having dual quad-core CPUs and (2) a CUDA enabled GPU workstation. The reference platform is a dual CPU-quad core workstation and the PANTEX workflow total computing time is measured. Furthermore, as part of a qualitative evaluation, the differences in setting up and configuring various hardware solutions and the related software coding effort is presented.

IEEE 802.15.4 Frame Aggregation Enhancement to Provide High Performance in Life-Critical Patient Monitoring Systems

PubMed Central

Akbar, Muhammad Sajjad; Yu, Hongnian; Cang, Shuang

2017-01-01

In wireless body area sensor networks (WBASNs), Quality of Service (QoS) provision for patient monitoring systems in terms of time-critical deadlines, high throughput and energy efficiency is a challenging task. The periodic data from these systems generates a large number of small packets in a short time period which needs an efficient channel access mechanism. The IEEE 802.15.4 standard is recommended for low power devices and widely used for many wireless sensor networks applications. It provides a hybrid channel access mechanism at the Media Access Control (MAC) layer which plays a key role in overall successful transmission in WBASNs. There are many WBASN’s MAC protocols that use this hybrid channel access mechanism in variety of sensor applications. However, these protocols are less efficient for patient monitoring systems where life critical data requires limited delay, high throughput and energy efficient communication simultaneously. To address these issues, this paper proposes a frame aggregation scheme by using the aggregated-MAC protocol data unit (A-MPDU) which works with the IEEE 802.15.4 MAC layer. To implement the scheme accurately, we develop a traffic patterns analysis mechanism to understand the requirements of the sensor nodes in patient monitoring systems, then model the channel access to find the performance gap on the basis of obtained requirements, finally propose the design based on the needs of patient monitoring systems. The mechanism is initially verified using numerical modelling and then simulation is conducted using NS2.29, Castalia 3.2 and OMNeT++. The proposed scheme provides the optimal performance considering the required QoS. PMID:28134853

IEEE 802.15.4 Frame Aggregation Enhancement to Provide High Performance in Life-Critical Patient Monitoring Systems.

PubMed

Akbar, Muhammad Sajjad; Yu, Hongnian; Cang, Shuang

2017-01-28

In wireless body area sensor networks (WBASNs), Quality of Service (QoS) provision for patient monitoring systems in terms of time-critical deadlines, high throughput and energy efficiency is a challenging task. The periodic data from these systems generates a large number of small packets in a short time period which needs an efficient channel access mechanism. The IEEE 802.15.4 standard is recommended for low power devices and widely used for many wireless sensor networks applications. It provides a hybrid channel access mechanism at the Media Access Control (MAC) layer which plays a key role in overall successful transmission in WBASNs. There are many WBASN's MAC protocols that use this hybrid channel access mechanism in variety of sensor applications. However, these protocols are less efficient for patient monitoring systems where life critical data requires limited delay, high throughput and energy efficient communication simultaneously. To address these issues, this paper proposes a frame aggregation scheme by using the aggregated-MAC protocol data unit (A-MPDU) which works with the IEEE 802.15.4 MAC layer. To implement the scheme accurately, we develop a traffic patterns analysis mechanism to understand the requirements of the sensor nodes in patient monitoring systems, then model the channel access to find the performance gap on the basis of obtained requirements, finally propose the design based on the needs of patient monitoring systems. The mechanism is initially verified using numerical modelling and then simulation is conducted using NS2.29, Castalia 3.2 and OMNeT++. The proposed scheme provides the optimal performance considering the required QoS.

Driving with indirect viewing sensors: understanding the visual perception issues

NASA Astrophysics Data System (ADS)

O'Kane, Barbara L.

1996-05-01

Visual perception is one of the most important elements of driving in that it enables the driver to understand and react appropriately to the situation along the path of the vehicle. The visual perception of the driver is enabled to the greatest extent while driving during the day. Noticeable decrements in visual acuity, range of vision, depth of field and color perception occur at night and under certain weather conditions. Indirect viewing sensors, utilizing various technologies and spectral bands, may assist the driver's normal mode of driving. Critical applications in the military as well as other official activities may require driving at night without headlights. In these latter cases, it is critical that the device, being the only source of scene information, provide the required scene cues needed for driving on, and often-times, off road. One can speculate about the scene information that a driver needs, such as road edges, terrain orientation, people and object detection in or near the path of the vehicle, and so on. But the perceptual qualities of the scene that give rise to these perceptions are little known and thus not quantified for evaluation of indirect viewing devices. This paper discusses driving with headlights and compares the scene content with that provided by a thermal system in the 8 - 12 micrometers micron spectral band, which may be used for driving at some time. The benefits and advantages of each are discussed as well as their limitations in providing information useful for the driver who must make rapid and critical decisions based upon the scene content available. General recommendations are made for potential avenues of development to overcome some of these limitations.

Contraceptive security, information flow, and local adaptations: family planning Morocco.

PubMed

Chandani, Y; Breton, G

2001-12-01

Many developing countries increasingly recognize and acknowledge family planning as a critical part of socio-economic development. However, with few health dollars to go around, countries tend to provide essential drugs for curative care, rather than for family planning products. Donors have historically provided free contraceptives for family planning services. Whether products are donated or purchased by the country, a successful family planning program depends on an uninterrupted supply of products, beginning with the manufacturer and ending with the customer. Any break in the supply chain may cause a family planning program to fail. A well-functioning logistics system can manage the supply chain and ensure that the customers have the products they need, when they need them. Morocco was selected for the case study. The researchers had ready access to key informants and information about the Logistics Management Information System. Because the study had time and resource constraints, research included desktop reviews and interview, rather than data collection in the field. The case study showed that even in a challenging environment an LMIS can be successfully deployed and fully supported by the users. It is critical to customize the system to a country-specific situation to ensure buy-in for the implementation. Significant external support funding and technical expertise are critical components to ensure the initial success of the system. Nonetheless, evidence from the case study shows that, after a system has been implemented, the benefits may not ensure its institutionalization. Other support, including local funding and technical expertise, is required.

Crossing the quality chasm: creating the ideal patient care experience.

PubMed

Gold, Kathleen S

2007-01-01

To create a health system that better meets patients' needs requires a fundamental redesign of our care delivery system and a new framework. Without a payment mechanism to reflect the value of care provided other than the face-to-face visit, adoption of advanced medical home principles will be challenging. The hand-off of the patient between providers and settings of care is a critical time for the patient and its effectiveness impacts patient care outcomes. The appropriate utilization of hospital and other health system resources is crucial, especially as hospitals, emergency departments, and other health care venues increasingly face capacity constraints and throughput challenges. It becomes the responsibility of the multidisciplinary team of providers to ensure that patients being discharged have an identified personal physician or team who will provide a medical home, and that the handoff to this medical home is thorough and well coordinated. An ideal patient care experience is one in which all systems and processes are geared to meet the needs of the patient: a safety-oriented system that provides standardized, evidence-based care supported by technology, but that recognizes and responds to individual needs.

The Importance of Southern Hemisphere CZOs for Evaluating Spatial Patterns of Chemical Structure in the Critical Zone and Assisting Human Development

NASA Astrophysics Data System (ADS)

Chadwick, O.

2014-12-01

The US Critical Zone Exploration Network (CZEN) is a network of sites designed to provide a better understanding of the integrated Earth surface system. The capacity of the critical zone to withstand perturbations, whether driven by climate, land use change, or spread of invasive species, depends on its chemical composition and physical state, which in turn depends on the time evolution of the critical zone. Many temperate and/or tectonically active critical zones contain a relatively short history due to rapid erosion but tectonically quiescent, tropical regions of the planet contain much longer records that need to be understood to cover the full suite of critical zone processes. Southern Hemisphere Critical Zone Observatories such as those proposed for Kruger National Park (KNP) in South Africa and for portions of the Yilgarn Craton in Western Australa will allow us to extend our temporal understanding of development of spatial heterogeneity in the chemical and physical structure of the critical zone. In addition to considering Earth and climate boundary conditions, these sites incorporate the roles that humans play in driving critical zone processes. For instance along the edges of KNP there is strong evidence of soil erosions due to periurbanization and small-scale agriculture. The existence of KNP provides an important contrast between a "natural" and "human-dominated" landscape that can be exploited to evaluate human impacts on critical zone resources and to develop targeted mitigation strategies. Western Australia has an exploitive economy that relies on large-scale agriculture and mineral extraction, both are intensive users of water which is scarce. The proposed CZO there will be partly focused on managing water under intense economic pressures. It is evident that if funding can be found for these sites they will enhance both critical zone science and practical applied science.

Scoping Study Investigating PWR Instrumentation during a Severe Accident Scenario

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

Rempe, J. L.; Knudson, D. L.; Lutz, R. J.

The accidents at the Three Mile Island Unit 2 (TMI-2) and Fukushima Daiichi Units 1, 2, and 3 nuclear power plants demonstrate the critical importance of accurate, relevant, and timely information on the status of reactor systems during a severe accident. These events also highlight the critical importance of understanding and focusing on the key elements of system status information in an environment where operators may be overwhelmed with superfluous and sometimes conflicting data. While progress in these areas has been made since TMI-2, the events at Fukushima suggests that there may still be a potential need to ensure thatmore » critical plant information is available to plant operators. Recognizing the significant technical and economic challenges associated with plant modifications, it is important to focus on instrumentation that can address these information critical needs. As part of a program initiated by the Department of Energy, Office of Nuclear Energy (DOE-NE), a scoping effort was initiated to assess critical information needs identified for severe accident management and mitigation in commercial Light Water Reactors (LWRs), to quantify the environment instruments monitoring this data would have to survive, and to identify gaps where predicted environments exceed instrumentation qualification envelop (QE) limits. Results from the Pressurized Water Reactor (PWR) scoping evaluations are documented in this report. The PWR evaluations were limited in this scoping evaluation to quantifying the environmental conditions for an unmitigated Short-Term Station BlackOut (STSBO) sequence in one unit at the Surry nuclear power station. Results were obtained using the MELCOR models developed for the US Nuclear Regulatory Commission (NRC)-sponsored State of the Art Consequence Assessment (SOARCA) program project. Results from this scoping evaluation indicate that some instrumentation identified to provide critical information would be exposed to conditions that significantly exceeded QE limits for extended time periods for the low frequency STSBO sequence evaluated in this study. It is recognized that the core damage frequency (CDF) of the sequence evaluated in this scoping effort would be considerably lower if evaluations considered new FLEX equipment being installed by industry. Nevertheless, because of uncertainties in instrumentation response when exposed to conditions beyond QE limits and alternate challenges associated with different sequences that may impact sensor performance, it is recommended that additional evaluations of instrumentation performance be completed to provide confidence that operators have access to accurate, relevant, and timely information on the status of reactor systems for a broad range of challenges associated with risk important severe accident sequences.« less

First-Year Student Experiences in Community College: Making Transitions, Forming Connections, and Developing Perceptions of Student Learning. Draft.

ERIC Educational Resources Information Center

Jalomo, Romero Espinoza, Jr.

This paper provides theoretical background and methodology for a focus group study of influences on first-time Latino community college students. The first chapter identifies the need for research on Latino students, citing high attrition rates and focusing on three critical dynamics: making the transition to college, making connections on campus…

Transitional Support for Adults with Severe Mental Illness: Critical Time Intervention and Its Roots in Assertive Community Treatment

ERIC Educational Resources Information Center

Herman, Daniel B.

2014-01-01

Professional social workers and other mental health providers have for many years been involved in delivering treatment and support services focused on the needs of adults with severe mental illnesses living in the community. While some models have evolved largely through practice experience, others have developed through research paradigms in…

A comprehensive draft genome sequence for lupin (Lupinus angustifolius), an emerging health food: Insights into plant-microbe interactions and legume evolution

USDA-ARS?s Scientific Manuscript database

Lupins are important grain legume crops that form a critical part of sustainable farming systems, by reducing the need for fertilizer and providing disease breaks. Narrow-leafed lupin (Lupinus angustifolius L.) is gaining popularity as a human health food, as a non-GM alternative to soybean with the...

Avoiding Legal Hassles: What School Administrators Really Need To Know. Second Edition.

ERIC Educational Resources Information Center

Streshly, William A.; Walsh, John; Frase, Larry E.

An understanding of school law is of critical importance if one is to remain successful as a school administrator in America. This book's purpose is to provide busy school administrators with a quick source of information about the law and court decisions that shape the education playing field. It is both comprehensive and brief. Chapter 1…

Critical Incident Stress Management in Schools: Mental Health Component.

ERIC Educational Resources Information Center

Tortorici Luna, Joanne M.

This manual provides a brief framework of organization that serves as a response tool for a wide spectrum of crisis circumstances encountered by schools. It is meant to be a generic guide for school teams and should be customized by each school that uses it. Even with emergency procedures in place, each crisis at a school needs to be evaluated as…

Solving Real World Problems with Alternate Reality Gaming: Student Experiences in the Global Village Playground Capstone Course Design

ERIC Educational Resources Information Center

Dondlinger, Mary Jo; McLeod, Julie K.

2015-01-01

The Global Village Playground (GVP) was a capstone learning experience designed to address institutional assessment needs while providing an integrated and authentic learning experience for students aimed at fostering complex problem solving, as well as critical and creative thinking. In the GVP, students work on simulated and real-world problems…

Closing the Research to Practice Gap in Therapeutic Residential Care: Service Provider-University Partnerships Focused on Evidence-Based Practice

ERIC Educational Resources Information Center

Thompson, Ronald W.; Duppong Hurley, Kristin; Trout, Alexandra L.; Huefner, Jonathan C.; Daly, Daniel L.

2017-01-01

Residential care has been criticized for its high cost and limited research evidence. While recent studies and reviews of the literature suggest that a number of evidence-based practices are being implemented in residential care settings, more research is needed to develop and test empirically based practices that can be successfully implemented…

Integrating separation and conversion - Conversion of biorefinery process streams to biobased chemicals and fuels

Treesearch

Joseph J. Bozell; Berenger Biannic; Diana Cedeno; Thomas Elder; Omid Hosseinaei; Lukas Delbeck; Jae-Woo Kim; C.J. O' Lenick; Timothy Young

2014-01-01

Abstract The concept of the integrated biorefinery is critical to developing a robust biorefining industry in the USA.Within this model, the biorefinery will produce fuel as a highvolume output addressing domestic energy needs and biobased chemical products (high-value organics) as an output providing necessary economic support for fuel production. This paper will...

Tailoring the Education Message: A Diversity of Settings and Needs. Symposium Report

ERIC Educational Resources Information Center

Academy for Educational Development, 2007

2007-01-01

This is a report on the Symposium that accompanied the 15-16 May, 2007 meeting of the UNAIDS Inter-Agency Task Team (IATT) on Education. The IATT Symposium provided an opportunity to address in some detail two selected problems that are critical to stemming the advance of HIV infection--areas that have had some attention, but remain insufficiently…

Reframing Equity under Common Core: A Commentary on the Text Exemplar List for Grades 9-12

ERIC Educational Resources Information Center

Schieble, Melissa

2013-01-01

This article provides a commentary on the text exemplar list for Grade bands 9-12 included in the Common Core documents in the United States. It is argued that a critical literacy perspective supports ELA teachers to assert a professional voice when making complex text selections based on diverse students' needs and interests. Implications…

Measures of progress for collaboration: case study of the Applegate Partnership.

Treesearch

Su. Rolle

2002-01-01

Using the Applegate Partnership as a case study, this paper proposes a number of ways to measure the success of collaborative groups. These measures allow for providing evaluation and feedback, engaging needed participants, and responding to groups critical of the collaborative process. Arguing for the concept of progress in place of success, this paper points out that...

Workshop Report: Joint Requirements. Oversight Council Process.

DTIC Science & Technology

1996-02-28

provides media for professional exchange and peer criticism among students, theoreticians, practitioners, and users of military operations research. These... exchange of ideas and methods. involvement in the annual Joint Warfare Inter- Subsequent efforts could include multiple operability Demonstrations (JWID...forums for exchange of ideas at the working level, clear, visible relations but studies and analysis opportunities as well. between the JWCAs need to

Developing Autism Screening Criteria for the Brief Infant Toddler Social Emotional Assessment (BITSEA)

ERIC Educational Resources Information Center

Giserman Kiss, Ivy; Feldman, Melanie S.; Sheldrick, R. Christopher; Carter, Alice S.

2017-01-01

There is a critical need for evidence-based, broadband behavioral, and ASD screening measures for use in pediatric and early educational settings to ensure that young children at risk for developing social-emotional disorders and/or ASD are provided with early intervention services to optimize long-term outcomes. The BITSEA is a 42-item screener…

Keeping Your Child Safe on the Information SuperHighway: A Parent's Guide.

ERIC Educational Resources Information Center

Nevada State Attorney General's Office, Carson City.

This booklet is intended to provide parents with some critical information to help monitor and control their child's behavior on the Internet. Highlights include: the need for ground rules; how to gain knowledge about the Internet; what the Internet is; the World Wide Web; Internet Relay Chat (IRC); Usenet groups and e-mail; some red flags;…

Becoming the Change: A Critical Evaluation of the Changing Face of Life Science, as Reflected in the NGSS

ERIC Educational Resources Information Center

Bowman, Larry L., Jr.; Govett, Aimee L.

2015-01-01

Twenty-six states voluntarily partnered to provide leadership and guidance for the purpose of adoption of the Next Generation Science Standards (NGSS). However, a need exists to examine the NGSS versus state standards to better understand changes in curriculum and instruction to make their implementation successful for all states. The present…

Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

ERIC Educational Resources Information Center

Davitt, Joan K.

2014-01-01

Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

Less Hope, More Paint: On the Political War Being Waged in Urban Contexts

ERIC Educational Resources Information Center

Boda, Phillip A.

2017-01-01

In this response to the call for transformative models of teaching students in urban contexts, the author presents his own experiences in becoming a critical pedagogue, the path that led him there, and three models of classrooms that he sees in such contexts. He emphasizes the need to reject an apolitical stance in urban education, and provides a…

Toward a Unifying Theory of Post-Elementary School Reading: The "Languaging in the Content Areas" Thesis.

ERIC Educational Resources Information Center

Manzo, Anthony V.; Sherk, John K., Jr.

This paper discusses the central theoretical aspects of the "Languaging in the Content Areas" (LICA) thesis, intended to provide postelementary reading with a sense of definition and purpose compatible with contemporary needs and conditions. The objective of the LICA thesis is not merely to teach students how to read critically what has been…

Reconsidering Social Cohesion: Developing a Definition and Analytical Framework for Empirical Research

ERIC Educational Resources Information Center

Chan, Joseph; To, Ho-Pong; Chan, Elaine

2006-01-01

Despite its growing currency in academic and policy circles, social cohesion is a term in need of a clearer and more rigorous definition. This article provides a critical review of the ways social cohesion has been conceptualized in the literature in many cases, definitions are too loosely made, with a common confusion between the content and the…

A Co-Created Journey: Designing a College-Wide Graduate Certificate Program in Social Justice Education

ERIC Educational Resources Information Center

Thurston, Linda P.; Yelich Biniecki, Susan M.

2017-01-01

A strengths assessment of the College of Education at Kansas State University in the United States showed that a majority of faculty had strong interests in social justice issues in education. The need for providing continuing post-graduate education in social justice education with theory-to-practice relevancy is critical in formal and informal…

Fostering Transformative Learning: The Role of the Professors and Students of the University of Prishtina

ERIC Educational Resources Information Center

Tahiri, Afredita

2010-01-01

The author discuses transformative learning as a means to explore the centrality of experiences, provide critical reflection, and a rational discourse to examine a set of conditions which need to be fulfilled to foster the application of the transformative learning process for professors and the students at the University of Prishtina. The author…

Transportation Information: A Report to the Committee on Appropriations, U.S. House of Representatives, from the Secretary of Transportation.

ERIC Educational Resources Information Center

Volpe, John A.

This report presents an initial five-year program for meeting the critical transportation information needs of industry and government at national, state and local levels. The program provides for information on the flows of persons and goods, information on the activities (population and industry) that generate the flows, and information on the…

A Framework to Guide the Development of a Teaching Mathematics with Technology Massive Open Online Course for Educators (MOOC-Ed)

ERIC Educational Resources Information Center

Hollebrands, Karen F.

2017-01-01

Mathematics teacher educators face a challenge of preparing teachers to use technology that is rapidly changing and easily available. Teachers have access to thousands of digital tools to use with students and need guidance about how to critically choose and use tools to support students' mathematics learning. Research provides guidance to…

In Their Own Words: Critical Thinking in Artists' Diaries and Interviews

ERIC Educational Resources Information Center

Green, Gaye

2006-01-01

It is not uncommon for art educators to always justify that artmaking is a serious endeavor that requires thought and reasoned judgment. Always, they also find themselves worried that arts will be reduced or eliminated when districts announce that cuts are needed to balance the budget or provide more room for the basics. These are problems often…