GABA abnormalities in schizophrenia: a methodological review of in vivo studies.

PubMed

Taylor, Stephan F; Tso, Ivy F

2015-09-01

Abnormalities of GABAergic interneurons are some of the most consistent findings from post-mortem studies of schizophrenia. However, linking these molecular deficits with in vivo observations in patients - a critical goal in order to evaluate interventions that would target GABAergic deficits - presents a challenge. Explanatory models have been developed based on animal work and the emerging experimental literature in schizophrenia patients. This literature includes: neuroimaging ligands to GABA receptors, magnetic resonance spectroscopy (MRS) of GABA concentration, transcranial magnetic stimulation of cortical inhibitory circuits and pharmacologic probes of GABA receptors to dynamically challenge the GABA system, usually in combination with neuroimaging studies. Pharmacologic challenges have elicited behavioral changes, and preliminary studies of therapeutic GABAergic interventions have been conducted. This article critically reviews the evidence for GABAergic dysfunction from each of these areas. These methods remain indirect measures of GABAergic function, and a broad array of dysfunction is linked with the putative GABAergic measures, including positive symptoms, cognition, emotion, motor processing and sensory processing, covering diverse brain areas. Measures of receptor binding have not shown replicable group differences in binding, and MRS assays of GABA concentration have yielded equivocal evidence of large-scale alteration in GABA concentration. Overall, the experimental base remains sparse, and much remains to be learned about the role of GABAergic interneurons in healthy brains. Challenges with pharmacologic and functional probes show promise, and may yet enable a better characterization of GABAergic deficits in schizophrenia. Copyright © 2014 Elsevier B.V. All rights reserved.

The main challenges that remain in applying high-throughput sequencing to clinical diagnostics.

PubMed

Loeffelholz, Michael; Fofanov, Yuriy

2015-01-01

Over the last 10 years, the quality, price and availability of high-throughput sequencing instruments have improved to the point that this technology may be close to becoming a routine tool in the diagnostic microbiology laboratory. Two groups of challenges, however, have to be resolved in order to move this powerful research technology into routine use in the clinical microbiology laboratory. The computational/bioinformatics challenges include data storage cost and privacy concerns, requiring analysis to be performed without access to cloud storage or expensive computational infrastructure. The logistical challenges include interpretation of complex results and acceptance and understanding of the advantages and limitations of this technology by the medical community. This article focuses on the approaches to address these challenges, such as file formats, algorithms, data collection, reporting and good laboratory practices.

Current siRNA Targets in Atherosclerosis and Aortic Aneurysm

PubMed Central

Pradhan-Nabzdyk, Leena; Huang, Chenyu; Logerfo, Frank W.; Nabzdyk, Christoph S.

2014-01-01

Atherosclerosis (ATH) and aortic aneurysms (AA) remain challenging chronic diseases that confer high morbidity and mortality despite advances in medical, interventional, and surgical care. RNA interference represents a promising technology that may be utilized to silence genes contributing to ATH and AA. Despite positive results in preclinical and some clinical feasibility studies, challenges such as target/sequence validation, tissue specificity, transfection efficiency, and mitigation of unwanted off-target effects remain to be addressed. In this review the most current targets and some novel approaches in siRNA delivery are being discussed. Due to the plethora of investigated targets, only studies published between 2010 and 2014 were included. PMID:24882715

Current challenges in optimizing systemic therapy for patients with pancreatic cancer: expert perspectives from the Australasian Gastrointestinal Trials Group (AGITG) with invited international faculty.

PubMed

Segelov, Eva; Lordick, Florian; Goldstein, David; Chantrill, Lorraine A; Croagh, Daniel; Lawrence, Ben; Arnold, Dirk; Chau, Ian; Obermannova, Radka; Price, Timothy Jay

2017-10-01

Despite recent progress, the outlook for most patients with pancreatic cancer remains poor. There is variation in how patients are managed globally due to differing interpretations of the evidence, partly because studies in this disease are challenging to undertake. This article collates the evidence upon which current best practice is based and offers an expert opinion from an international faculty on how latest developments should influence current treatment paradigms. Areas covered: Optimal chemotherapy for first and subsequent lines of therapy; optimal management of locally advanced, non-metastatic cancer including the role of neoadjuvant chemo(radio)therapy, current evidence for adjuvant chemotherapy, major advances in pancreatic cancer genomics and challenges in supportive care particularly relevant to patients with pancreatic cancer. For each section, literature was reviewed by comprehensive search techniques, including clinical trial websites and abstracts from international cancer meetings. Expert commentary: For each section, a commentary is provided. Overall the challenges identified were: difficulties in diagnosing pancreatic cancer early, challenges for performing randomised clinical trials in all stages of the disease, some progress in systemic therapy with new agents and in identifying molecular subtypes that may be clinically relevant and move towards personalized therapy, but still, pancreatic cancer remains a very poor prognosis cancer with significant palliative care needs.

IFE Chamber Technology - Status and Future Challenges

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

Meier, W.R.; Raffray, A.R.; Abdel-Khalik, S.I.

2003-07-15

Significant progress has been made on addressing critical issues for inertial fusion energy (IFE) chambers for heavy-ion, laser and Z-pinch drivers. A variety of chamber concepts are being investigated including drywall (currently favored for laser IFE), wetted-wall (applicable to both laser and ion drivers), and thick-liquid-wall (favored by heavy ion and z-pinch drivers). Recent progress and remaining challenges in developing IFE chambers are reviewed.

Peyronie's Disease: Still a Surgical Disease.

PubMed

Martinez, Daniel; Ercole, Cesar E; Hakky, Tariq S; Kramer, Andrew; Carrion, Rafael

2012-01-01

Peyronie's Disease (PD) remains a challenging and clinically significant morbid condition. Since its first description by François Gigot de la Peyronie, much of the treatment for PD remains nonstandardized. PD is characterized by the formation of fibrous plaques at the level of the tunica albuginea. Clinical manifestations include morphologic changes, such as curvatures and hourglass deformities. Here, we review the common surgical techniques for the management of patients with PD.

Collaboration challenges in systematic reviews: a survey of health sciences librarians

PubMed Central

Nicholson, Joey; McCrillis, Aileen; Williams, Jeff D.

2017-01-01

Objective: While many librarians have been asked to participate in systematic reviews with researchers, often these researchers are not familiar with the systematic review process or the appropriate role for librarians. The purpose of this study was to identify the challenges and barriers that librarians face when collaborating on systematic reviews. To take a wider view of the whole process of collaborating on systematic reviews, the authors deliberately focused on interpersonal and methodological issues other than searching itself. Methods: To characterize the biggest challenges that librarians face while collaborating on systematic review projects, we used a web-based survey. The thirteen-item survey included seventeen challenges grouped into two categories: methodological and interpersonal. Participants were required to indicate the frequency and difficulty of the challenges listed. Open-ended questions allowed survey participants to describe challenges not listed in the survey and to describe strategies used to overcome challenges. Results: Of the 17 challenges listed in the survey, 8 were reported as common by over 40% of respondents. These included methodological issues around having too broad or narrow research questions, lacking eligibility criteria, having unclear research questions, and not following established methods. The remaining challenges were interpersonal, including issues around student-led projects and the size of the research team. Of the top 8 most frequent challenges, 5 were also ranked as most difficult to handle. Open-ended responses underscored many of the challenges included in the survey and revealed several additional challenges. Conclusions: These results suggest that the most frequent and challenging issues relate to development of the research question and general communication with team members. Clear protocols for collaboration on systematic reviews, as well as a culture of mentorship, can help librarians prevent and address these challenges. PMID:28983202

Collaboration challenges in systematic reviews: a survey of health sciences librarians.

PubMed

Nicholson, Joey; McCrillis, Aileen; Williams, Jeff D

2017-10-01

While many librarians have been asked to participate in systematic reviews with researchers, often these researchers are not familiar with the systematic review process or the appropriate role for librarians. The purpose of this study was to identify the challenges and barriers that librarians face when collaborating on systematic reviews. To take a wider view of the whole process of collaborating on systematic reviews, the authors deliberately focused on interpersonal and methodological issues other than searching itself. To characterize the biggest challenges that librarians face while collaborating on systematic review projects, we used a web-based survey. The thirteen-item survey included seventeen challenges grouped into two categories: methodological and interpersonal. Participants were required to indicate the frequency and difficulty of the challenges listed. Open-ended questions allowed survey participants to describe challenges not listed in the survey and to describe strategies used to overcome challenges. Of the 17 challenges listed in the survey, 8 were reported as common by over 40% of respondents. These included methodological issues around having too broad or narrow research questions, lacking eligibility criteria, having unclear research questions, and not following established methods. The remaining challenges were interpersonal, including issues around student-led projects and the size of the research team. Of the top 8 most frequent challenges, 5 were also ranked as most difficult to handle. Open-ended responses underscored many of the challenges included in the survey and revealed several additional challenges. These results suggest that the most frequent and challenging issues relate to development of the research question and general communication with team members. Clear protocols for collaboration on systematic reviews, as well as a culture of mentorship, can help librarians prevent and address these challenges.

Big Data, Big Opportunities, and Big Challenges.

PubMed

Frelinger, Jeffrey A

2015-11-01

High-throughput assays have begun to revolutionize modern biology and medicine. The advent of cheap next-generation sequencing (NGS) has made it possible to interrogate cells and human populations as never before. Although this has allowed us to investigate the genetics, gene expression, and impacts of the microbiome, there remain both practical and conceptual challenges. These include data handling, storage, and statistical analysis, as well as an inherent problem of the analysis of heterogeneous cell populations.

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

PubMed Central

2017-01-01

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

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

PubMed

Mburu, Grace; George, Gavin

2017-07-31

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

Peyronie's Disease: Still a Surgical Disease

PubMed Central

Martinez, Daniel; Ercole, Cesar E.; Hakky, Tariq S.; Kramer, Andrew; Carrion, Rafael

2012-01-01

Peyronie's Disease (PD) remains a challenging and clinically significant morbid condition. Since its first description by François Gigot de la Peyronie, much of the treatment for PD remains nonstandardized. PD is characterized by the formation of fibrous plaques at the level of the tunica albuginea. Clinical manifestations include morphologic changes, such as curvatures and hourglass deformities. Here, we review the common surgical techniques for the management of patients with PD. PMID:22956943

Kidney transplantation in the elderly.

PubMed

Singh, Neeraj; Nori, Uday; Pesavento, Todd

2009-08-01

Recent outcome data, ongoing organ shortage and proposed changes in allocation policies are driving the need to review current practices and possible future course of kidney transplantation in the elderly patients. A proposed new kidney allocation system based on matching donor and recipient characteristics to enable 'age-matched' kidney allocation is currently being discussed in the USA. While this system benefits younger recipients, implications for elderly recipients receiving older grafts remain a matter of debate. Despite improved outcomes, there remain significant challenges to kidney transplantation in the elderly, including organ shortage, poor transplant rate, evolving allocation policies, high wait-list mortality and nonstandardized immunosuppression. Prospective studies are needed to evaluate the strategies to meet these challenges and to study the impact of proposed new allocation system.

Advanced protein formulations

PubMed Central

Wang, Wei

2015-01-01

It is well recognized that protein product development is far more challenging than that for small-molecule drugs. The major challenges include inherent sensitivity to different types of stresses during the drug product manufacturing process, high rate of physical and chemical degradation during long-term storage, and enhanced aggregation and/or viscosity at high protein concentrations. In the past decade, many novel formulation concepts and technologies have been or are being developed to address these product development challenges for proteins. These concepts and technologies include use of uncommon/combination of formulation stabilizers, conjugation or fusion with potential stabilizers, site-specific mutagenesis, and preparation of nontraditional types of dosage forms—semiaqueous solutions, nonfreeze-dried solid formulations, suspensions, and other emerging concepts. No one technology appears to be mature, ideal, and/or adequate to address all the challenges. These gaps will likely remain in the foreseeable future and need significant efforts for ultimate resolution. PMID:25858529

Explaining why nurses remain in or leave bedside nursing: a critical ethnography.

PubMed

Mahon, Paula; McPherson, Gladys

2014-09-01

To describe the application of critical ethnography to explain nurses' decisions to remain in or leave bedside nursing, and to describe researcher positioning and reflexivity. Enquiry into hospital nurses' decisions to remain in or leave bedside nursing positions has been conducted from a variety of theoretical perspectives by researchers adopting a range of methodological approaches. This research helps to explain how work environments can affect variables such as job satisfaction and turnover, but provides less insight into how personal and professional factors shape decisions to remain in or leave bedside nursing. A critical theoretical perspective was taken to examine the employment decisions made by nurses in a paediatric intensive care unit (PICU). Data was collected from nurses (n=31) through semi-structured interviews and unobtrusive observation. The authors describe critical ethnography as a powerful research framework for enquiry that allowed them to challenge assumptions about why nurses remain in or leave their jobs, and to explore how issues of fairness and equity contribute to these decisions. Critical ethnography offers a powerful methodology for investigations into complex interactions, such as those between nurses in a PICU. In adopting this methodology, researchers should be sensitised to manifestations of power, attend to their stance and location, and reflexion. The greatest challenges from this research included how to make sense of the insider position, how to acknowledge assumptions and allow these to be challenged, and how to ensure that power relationships in the environment and in the research were attended to.

Problem-Based Learning in Biomechanics: Advantages, Challenges, and Implementation Strategies.

PubMed

Clyne, Alisa Morss; Billiar, Kristen L

2016-07-01

Problem-based learning (PBL) has been shown to be effective in biomedical engineering education, particularly in motivating student learning, increasing knowledge retention, and developing problem solving, communication, and teamwork skills. However, PBL adoption remains limited by real challenges in effective implementation. In this paper, we review the literature on advantages and challenges of PBL and present our own experiences. We also provide practical guidelines for implementing PBL, including two examples of PBL modules from biomechanics courses at two different institutions. Overall, we conclude that the benefits for both professors and students support the use of PBL in biomedical engineering education.

Using high-throughput literature mining to support read-across predictions of toxicity (SOT)

EPA Science Inventory

Building scientific confidence in the development and evaluation of read-across remains an ongoing challenge. Approaches include establishing systematic frameworks to identify sources of uncertainty and ways to address them. One source of uncertainty is related to characterizing ...

High-throughput literature mining to support read-across predictions of toxicity (ASCCT meeting)

EPA Science Inventory

Building scientific confidence in the development and evaluation of read-across remains an ongoing challenge. Approaches include establishing systematic frameworks to identify sources of uncertainty and ways to address them. One source of uncertainty is related to characterizing ...

Smart nanoparticles as targeting platforms for HIV infections

NASA Astrophysics Data System (ADS)

Adhikary, Rishi Rajat; More, Prachi; Banerjee, Rinti

2015-04-01

While Human Immunodeficiency Virus (HIV) infections are reducing in incidence with the advent of Highly Active Anti-retroviral Therapy (HAART), there remain a number of challenges including the existence of reservoirs, drug resistance and anatomical barriers to antiretroviral therapy. To overcome these, smart nanoparticles with stimuli responsive release are proposed for delivery of anti-retroviral agents. The paper highlights the strategic similarities between the design of smart antiretroviral nanocarriers and those optimized for cancer chemotherapy. This includes the development of nanoparticles capable of passive and active targeting as well as those that are responsive to various internal and external triggers. For antiretroviral therapy, the relevant triggers for stimuli responsive release of drugs include semen, enzymes, endosomal escape, temperature and magnetic field. Deriving from the experience of cancer chemotherapy, additional potential triggers are light and ultrasound which remain hitherto unexplored in HIV therapy. In addition, the roles of nanomicrobicides (nanogels) and virus mimetic nanoparticles are discussed from the point of view of prevention of HIV transmission. The challenges associated with translation of smart nanoparticles for HIV infections to realize the Millennium Development Goal of combating HIV infections are discussed.

Smart nanoparticles as targeting platforms for HIV infections.

PubMed

Adhikary, Rishi Rajat; More, Prachi; Banerjee, Rinti

2015-05-07

While Human Immunodeficiency Virus (HIV) infections are reducing in incidence with the advent of Highly Active Anti-retroviral Therapy (HAART), there remain a number of challenges including the existence of reservoirs, drug resistance and anatomical barriers to antiretroviral therapy. To overcome these, smart nanoparticles with stimuli responsive release are proposed for delivery of anti-retroviral agents. The paper highlights the strategic similarities between the design of smart antiretroviral nanocarriers and those optimized for cancer chemotherapy. This includes the development of nanoparticles capable of passive and active targeting as well as those that are responsive to various internal and external triggers. For antiretroviral therapy, the relevant triggers for stimuli responsive release of drugs include semen, enzymes, endosomal escape, temperature and magnetic field. Deriving from the experience of cancer chemotherapy, additional potential triggers are light and ultrasound which remain hitherto unexplored in HIV therapy. In addition, the roles of nanomicrobicides (nanogels) and virus mimetic nanoparticles are discussed from the point of view of prevention of HIV transmission. The challenges associated with translation of smart nanoparticles for HIV infections to realize the Millennium Development Goal of combating HIV infections are discussed.

The Challenge of Managing Psoriasis: Unmet Medical Needs and Stakeholder Perspectives.

PubMed

Feldman, Steven R; Goffe, Bernard; Rice, Gary; Mitchell, Matthew; Kaur, Mandeep; Robertson, Debbie; Sierka, Debra; Bourret, Jeffrey A; Evans, Tamara S; Gottlieb, Alice

2016-12-01

Psoriasis is a debilitating chronic inflammatory autoimmune disease affecting approximately 7.4 million adults in the United States. Plaque psoriasis is the most common form, affecting 80% to 90% of patients. To describe the impact and challenges that psoriasis presents for various stakeholders, and to provide nondermatologist healthcare decision makers with information to enhance their contributions to drug and pharmacy benefit design discussions. Psoriasis carries an increased risk for early mortality and an increased prevalence of comorbidities, including psoriatic arthritis, cardiovascular disease, and diabetes. It is also associated with anxiety, depression, and social isolation, and can negatively impact patients' relationships, productivity, and careers. The physical, psychologic, social, and economic impact of psoriasis, plus the associated stigma, result in cumulative impairment over a patient's lifetime. The current treatments for moderate-to-severe psoriasis include topical therapy, phototherapy, and systemic drugs (nonbiologic and biologic); however, patient satisfaction remains low, combination therapy and treatment switching are common, and many patients remain untreated or undertreated. Clinicians should consider the patient holistically, and should select treatment based on a range of factors, including disease severity (with physical and psychosocial manifestations), susceptibility to cumulative life-course impairment (considering personality, behavior, and cognition), comorbidities, concomitant medication, and patient preference. It is estimated that the total annual direct cost of treating psoriasis in the United States in 2015 exceeded $12.2 billion. Psoriasis is a complex disease, and appropriate management is correspondingly complex. Newer psoriasis treatments provide improved efficacy and safety versus traditional treatments, but challenges remain in ensuring patients access to these medications. An improved understanding of the barriers to appropriate treatment is needed, as well as clear and accessible information for payers and clinicians on current treatment options, to ensure that decision makers can control costs while providing patients with optimal care.

The 5th Canadian Symposium on Hepatitis C Virus: We Are Not Done Yet—Remaining Challenges in Hepatitis C

PubMed Central

van Buuren, Nicholas; Fradette, Lorraine; Grebely, Jason; King, Alexandra; Krajden, Mel; MacParland, Sonya A.; Marshall, Alison; Saeed, Sahar; Wilson, Joyce; Klein, Marina B.

2016-01-01

Hepatitis C virus (HCV) affects approximately 268,000 Canadians and results in more years of life lost than any other infectious disease in the country. Both the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC) have identified HCV-related liver disease as a priority and supported the establishment of a National Hepatitis C Research Network. In 2015, the introduction of new interferon- (IFN-) free therapies with high cure rates (>90%) and few side effects revolutionized HCV therapy. However, a considerable proportion of the population remains undiagnosed and treatment uptake remains low in Canada due to financial, geographical, cultural, and social barriers. Comprehensive prevention strategies, including enhanced harm reduction, broader screening, widespread treatment, and vaccine development, are far from being realized. The theme of the 2016 symposium, “We're not done yet: remaining challenges in Hepatitis C,” was focused on identifying strategies to enhance prevention, diagnosis, and treatment of HCV to reduce disease burden and ultimately eliminate HCV in Canada. PMID:27843889

Work participation and arthritis: a systematic overview of challenges, adaptations and opportunities for interventions.

PubMed

Hoving, Jan L; van Zwieten, Myra C B; van der Meer, Marrit; Sluiter, Judith K; Frings-Dresen, Monique H W

2013-07-01

Understanding the factors that play a role in maintaining people with inflammatory arthritis in the workforce may aid the design of interventions to support work participation. The objective of this systematic overview is to summarize qualitative studies that explore experiences of patients with inflammatory arthritis to remain employed or return to work. Bibliographic databases including MEDLINE, EMBASE and PsycInfo were searched until December 2011 to identify any qualitative studies that focused on experiences, challenges or adaptations of patients with inflammatory arthritis to remain employed. Thematic analyses were used to identify any first or higher order themes for which all data were entered into MAXQDA software. In addition, methodological quality was assessed using an eight-item checklist. Of 6338 citations, 10 studies were included. RA was the condition in eight studies. Individual interviews (six studies) were used more frequently than group interviews (four studies). Methodological quality varied from 2 to 8 points and had no effect on the number of themes identified. Thematic analyses showed seven key concepts important to patients, including disease symptoms, management of the disease, socioeconomic issues, work conditions and adaptations, emotional challenges, interpersonal issues affecting work and family life and meaning of work. By including studies from different countries and settings, we show a comprehensive overview of themes considered important by patients and strengthen our belief that these factors should be considered in interventions that aim to improve work participation for patients with inflammatory arthritis.

Strategies for microbial synthesis of high-value phytochemicals

NASA Astrophysics Data System (ADS)

Li, Sijin; Li, Yanran; Smolke, Christina D.

2018-03-01

Phytochemicals are of great pharmaceutical and agricultural importance, but often exhibit low abundance in nature. Recent demonstrations of industrial-scale production of phytochemicals in yeast have shown that microbial production of these high-value chemicals is a promising alternative to sourcing these molecules from native plant hosts. However, a number of challenges remain in the broader application of this approach, including the limited knowledge of plant secondary metabolism and the inefficient reconstitution of plant metabolic pathways in microbial hosts. In this Review, we discuss recent strategies to achieve microbial biosynthesis of complex phytochemicals, including strategies to: (1) reconstruct plant biosynthetic pathways that have not been fully elucidated by mining enzymes from native and non-native hosts or by enzyme engineering; (2) enhance plant enzyme activity, specifically cytochrome P450 activity, by improving efficiency, selectivity, expression or electron transfer; and (3) enhance overall reaction efficiency of multi-enzyme pathways by dynamic control, compartmentalization or optimization with the host's metabolism. We also highlight remaining challenges to — and future opportunities of — this approach.

Status, Vision, and Challenges of an Intelligent Distributed Engine Control Architecture

NASA Technical Reports Server (NTRS)

Behbahani, Alireza; Culley, Dennis; Garg, Sanjay; Millar, Richard; Smith, Bert; Wood, Jim; Mahoney, Tim; Quinn, Ronald; Carpenter, Sheldon; Mailander, Bill;

Cryptosporidiosis: Environmental, therapeutic, and preventive challenges

PubMed Central

Collinet-Adler, Stefan; Ward, Honorine D.

2014-01-01

Cryptosporidium spp. are responsible for endemic and epidemic disease worldwide. Clinical manifestations may include acute, persistent, or chronic diarrhea, biliary, and pulmonary disease. Disease severity ranges from asymptomatic or mild to severe, intractable diarrhea with wasting depending on immune status, nutrition, and age. Transmission is fecal-oral with both human and animal reservoirs. Disease is often self limited in healthy individuals, but therapy remains a challenge in the immune-compromised. Prevention currently depends on appropriate hygiene and proper water management and treatment. PMID:20521158

Safety assessment of immunomodulatory biologics: the promise and challenges of regulatory T-cell modulation.

PubMed

Ponce, Rafael A

2011-01-01

Regulatory T-cell (T(reg)) modulation is developing as an important therapeutic opportunity for the treatment of a number of important diseases, including cancer, autoimmunity, infection, and organ transplant rejection. However, as demonstrated with IL-2 and TGN-1412, our understanding of the complex immunological interactions that occur with T(reg) modulation in both non-clinical models and in patients remains limited and appears highly contextual. This lack of understanding will challenge our ability to identify the patient population who might derive the highest benefit from T(reg) modulation and creates special challenges as we transition these therapeutics from non-clinical models into humans. Thus, in vivo testing in the most representative animal model systems, with careful progress in the clinic, will remain critical in developing therapeutics targeting T(reg) and understanding their clinical utility. Moreover, toxicology models can inform some of the potential liabilities associated with T(reg) modulation, but not all, suggesting a continued need to explore and validate predictive models.

A Survey of Recent Advances in Particle Filters and Remaining Challenges for Multitarget Tracking

PubMed Central

Wang, Xuedong; Sun, Shudong; Corchado, Juan M.

2017-01-01

We review some advances of the particle filtering (PF) algorithm that have been achieved in the last decade in the context of target tracking, with regard to either a single target or multiple targets in the presence of false or missing data. The first part of our review is on remarkable achievements that have been made for the single-target PF from several aspects including importance proposal, computing efficiency, particle degeneracy/impoverishment and constrained/multi-modal systems. The second part of our review is on analyzing the intractable challenges raised within the general multitarget (multi-sensor) tracking due to random target birth and termination, false alarm, misdetection, measurement-to-track (M2T) uncertainty and track uncertainty. The mainstream multitarget PF approaches consist of two main classes, one based on M2T association approaches and the other not such as the finite set statistics-based PF. In either case, significant challenges remain due to unknown tracking scenarios and integrated tracking management. PMID:29168772

Learning the Rhythm of the Seasons in the Face of Global Change: Phenological Research in the 21st Century

NASA Technical Reports Server (NTRS)

Morisette, Jeffrey T.; Richardson, Andrew D.; Knapp, Alan K.; Fisher, Jeremy I.; Graham, Eric A.; Abatzoglou, John; Wilson, Bruce E.; Breshears, David D.; Hanebry, Geoffrey M.; Hanes, Jonathan M.;

The pain of chronic pancreatitis: a persistent clinical challenge

PubMed Central

2013-01-01

The pain of chronic pancreatitis represents a major challenge to those working in the field, including pain specialists, gastroenterologists and surgeons. This article describes the different aetiologies of chronic pancreatitis and lists the models for the pathogenesis of pain, including novel ideas such as the role of the immune system in the modulation of pain. The patient profile in chronic pancreatitis is discussed along with the social impact of the disease in relation to alcohol misuse. The range of treatment strategies including medical, endoscopic and surgical approaches are evaluated. Common analgesic regimes and their limitations are reviewed. The pain of chronic pancreatitis remains refractory to effective treatment in many cases and further study and understanding of the underlying pathophysiology are required. PMID:26516493

Satellite Tasking via a Tablet Computer

DTIC Science & Technology

2015-09-01

connectivity have helped to overcome the challenges of information delivery , but there remains the challenge of real-time information. This thesis...have helped to overcome the challenges of information delivery , but there remains the challenge of real-time information. This thesis examines the...76  3.  Integration with Existing Programs for Access and Dissemination of Imagery

The role of the speech-language pathologist in identifying and treating children with auditory processing disorder.

PubMed

Richard, Gail J

2011-07-01

A summary of issues regarding auditory processing disorder (APD) is presented, including some of the remaining questions and challenges raised by the articles included in the clinical forum. Evolution of APD as a diagnostic entity within audiology and speech-language pathology is reviewed. A summary of treatment efficacy results and issues is provided, as well as the continuing dilemma for speech-language pathologists (SLPs) charged with providing treatment for referred APD clients. The role of the SLP in diagnosing and treating APD remains under discussion, despite lack of efficacy data supporting auditory intervention and questions regarding the clinical relevance and validity of APD.

Agricultural Bioterrorism What Challenges and Actions Remain

DTIC Science & Technology

2006-03-10

African milk bush.29 In 1966, Bacillus subtilis was released in the New York City subway system to test the vulnerability of biowarfare.30 In 1984...These diseases include: Foot and Mouth Disease (FMD), Rift Valley Fever ( RVF ), Nipah Virus, Avian Influenza, Exotic Newcastle Disease, Classical Swine

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

EPA Science Inventory

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

Application of a Mycobacterium tuberculosis protein array for antigen discovery in Johne's disease

USDA-ARS?s Scientific Manuscript database

Mycobacterium avium subspecies paratuberculosis (Map), the bacterium that causes Johne’s disease, is a major health concern in farmed ruminant livestock including sheep and cattle. Diagnosis of Map infections, particularly of subclinical animals remains challenging, and we lack effective vaccines f...

Fluorescence Sensors for Early Detection of Nitrification in Drinking Water Distribution Systems – Interference Corrections (Abstract)

EPA Science Inventory

Nitrification event detection in chloraminated drinking water distribution systems (DWDSs) remains an ongoing challenge for many drinking water utilities, including Dallas Water Utilities (DWU) and the City of Houston (CoH). Each year, these utilities experience nitrification eve...

Fluorescence Sensors for Early Detection of Nitrification in Drinking Water Distribution Systems – Interference Corrections (Poster)

EPA Science Inventory

Nitrification event detection in chloraminated drinking water distribution systems (DWDSs) remains an ongoing challenge for many drinking water utilities, including Dallas Water Utilities (DWU) and the City of Houston (CoH). Each year, these utilities experience nitrification eve...

Developing Fluorescence Sensor Systems for Early Detection of Nitrification Events in Chloraminated Drinking Water Distribution Systems

EPA Science Inventory

Detection of nitrification events in chloraminated drinking water distribution systems remains an ongoing challenge for many drinking water utilities, including Dallas Water Utilities (DWU) and the City of Houston (CoH). Each year, these utilities experience nitrification events ...

Effects of Cognitive Demand on Word Encoding in Adults Who Stutter

ERIC Educational Resources Information Center

Tsai, Pei-Tzu

2011-01-01

The etiology of persistent stuttering is unknown, but stuttering has been attributed to multiple potential factors, including difficulty in processing language-related information, but findings remain inconclusive regarding any "specific" linguistic deficit potentially causing stuttering. One particular challenge in drawing conclusions is the…

Novel nonstatin strategies to lower low-density lipoprotein cholesterol.

PubMed

Davidson, Michael H

2009-01-01

There remains an unmet need to reduce elevated low-density lipoprotein cholesterol (LDL-C) in patients who are maximized on current therapy or intolerant to statins. Several novel agents have been developed to lower LDL-C, either as monotherapy or in combination with statins. These novel therapies include squalene synthase inhibitors, microsomal triglyceride transfer protein inhibitors, and antisense apolipoprotein B. Although each of these novel therapies effectively lowers LDL-C, challenges remain in the clinical development to assess long-term safety.

Global Power Requires a Global, Persistent Air-to-Air Capability

DTIC Science & Technology

2010-01-01

anywhere on the high seas, and in most coastal waters as well, and sink them if necessary by using guns, missiles, or tor- pedoes . Current Air Force...apparently a number of so-far-undisclosed challenges remain, perhaps including the air refuel- ing of an RPA and maintaining the data link with it in...will remain relatively short- range systems.31 With regard to the data link , a remote pi- lot flies the Predator—our primary opera- tional, fighter-sized

Intercultural Competence: Concepts, Challenges, Evaluations. Intercultural Studies and Foreign Language Learning. Volume 10

ERIC Educational Resources Information Center

Witte, Arnd, Ed.; Harden, Theo, Ed.

2011-01-01

This book explores the idea of "intercultural competence", which, despite its current popularity across various discourses, has remained a vague and oscillating concept. Interculture lacks a universal definition and "competence" is not only a cognitive construct but also includes psychological traits such as attitudes,…

Genomic signatures of a Mannheimia haemolytica lineage associated with bovine respiratory disease

USDA-ARS?s Scientific Manuscript database

A major challenge in the modern age of microbiology is to develop narrow-spectrum interventions that target pathogens, but not the remaining microbiome of a host, including less- or non-virulent strains of the same pathogenic species. Mannheimia haemolytica is a model study organism in that regard....

Challenges to Military Operations in Support of U.S. Interests. Volume 2: Main Report

DTIC Science & Technology

2008-12-01

Challenges to Military Operations in Support of U.S. Interests U.S. conventional military capability remains unmatched by any state. As a result, nations...greater importance. PR EF AC E I xiii Preface U.S. conventional military capability remains unmatched by any state. U.S...scope of the study remained robust, presenting the challenge of how to approach the investigation into U.S. capabilities, capability gaps, and

A systematic and critical review of the evolving methods and applications of value of information in academia and practice.

PubMed

Steuten, Lotte; van de Wetering, Gijs; Groothuis-Oudshoorn, Karin; Retèl, Valesca

2013-01-01

This article provides a systematic and critical review of the evolving methods and applications of value of information (VOI) in academia and practice and discusses where future research needs to be directed. Published VOI studies were identified by conducting a computerized search on Scopus and ISI Web of Science from 1980 until December 2011 using pre-specified search terms. Only full-text papers that outlined and discussed VOI methods for medical decision making, and studies that applied VOI and explicitly discussed the results with a view to informing healthcare decision makers, were included. The included papers were divided into methodological and applied papers, based on the aim of the study. A total of 118 papers were included of which 50 % (n = 59) are methodological. A rapidly accumulating literature base on VOI from 1999 onwards for methodological papers and from 2005 onwards for applied papers is observed. Expected value of sample information (EVSI) is the preferred method of VOI to inform decision making regarding specific future studies, but real-life applications of EVSI remain scarce. Methodological challenges to VOI are numerous and include the high computational demands, dealing with non-linear models and interdependency between parameters, estimations of effective time horizons and patient populations, and structural uncertainties. VOI analysis receives increasing attention in both the methodological and the applied literature bases, but challenges to applying VOI in real-life decision making remain. For many technical and methodological challenges to VOI analytic solutions have been proposed in the literature, including leaner methods for VOI. Further research should also focus on the needs of decision makers regarding VOI.

Advances in anesthesia technology are improving patient care, but many challenges remain.

PubMed

John Doyle, D; Dahaba, Ashraf; LeManach, Yannick

2018-04-13

Although significant advances in clinical monitoring technology and clinical practice development have taken place in the last several decades, in this editorial we argue that much more still needs to be done. We begin by identifying many of the improvements in perioperative technology that have become available in recent years; these include electroencephalographic depth of anesthesia monitoring, bedside ultrasonography, advanced neuromuscular transmission monitoring systems, and other developments. We then discuss some of the perioperative technical challenges that remain to be satisfactorily addressed, such as products that incorporate poor software design or offer a confusing user interface. Finally we suggest that the journal support initiatives to help remedy this problem by publishing reports on the evaluation of medical equipment as a means to restore the link between clinical research and clinical end-users.

Quantification of Liver Iron with MRI: State of the Art and Remaining Challenges

PubMed Central

Hernando, Diego; Levin, Yakir S; Sirlin, Claude B; Reeder, Scott B

2015-01-01

Liver iron overload is the histological hallmark of hereditary hemochromatosis and transfusional hemosiderosis, and can also occur in chronic hepatopathies. Iron overload can result in liver damage, with the eventual development of cirrhosis, liver failure and hepatocellular carcinoma. Assessment of liver iron levels is necessary for detection and quantitative staging of iron overload, and monitoring of iron-reducing treatments. This article discusses the need for non-invasive assessment of liver iron, and reviews qualitative and quantitative methods with a particular emphasis on MRI. Specific MRI methods for liver iron quantification include signal intensity ratio as well as R2 and R2* relaxometry techniques. Methods that are in clinical use, as well as their limitations, are described. Remaining challenges, unsolved problems, and emerging techniques to provide improved characterization of liver iron deposition are discussed. PMID:24585403

Packaging of silicon photonic devices: from prototypes to production

NASA Astrophysics Data System (ADS)

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

2018-02-01

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

First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives.

PubMed

Arch, Joanna J; Craske, Michelle G

2009-09-01

In this article, the authors assess the successes, remaining challenges, and new developments in cognitive behavioral therapy (CBT) for anxiety disorders. They define CBT, examine treatment components, review treatment efficacy, and discuss the challenges of attrition, long-term follow-up, co-occurring/comorbid disorders, limited treatment comparisons, treatment mediators, and broader implementation. In addition, they present recent developments in cognitive behavioral therapy for anxiety disorders, including linking exposure therapy to basic science, mindfulness and acceptance-based treatments, and unified or transdiagnostic treatment protocols.

Astrophysics and Cosmology: International Partnerships

NASA Astrophysics Data System (ADS)

Blandford, Roger

2016-03-01

Most large projects in astrophysics and cosmology are international. This raises many challenges including: --Aligning the sequence of: proposal, planning, selection, funding, construction, deployment, operation, data mining in different countries --Managing to minimize cost growth through reconciling different practices --Communicating at all levels to ensure a successful outcome --Stabilizing long term career opportunities. There has been considerable progress in confronting these challenges. Lessons learned from past collaborations are influencing current facilities but much remains to be done if we are to optimize the scientific and public return on the expenditure of financial and human resources.

Public health preparedness: evolution or revolution?

PubMed

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

2006-01-01

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

Crowdsourcing in biomedicine: challenges and opportunities

PubMed Central

Khare, Ritu; Good, Benjamin M.; Leaman, Robert; Su, Andrew I.

2016-01-01

The use of crowdsourcing to solve important but complex problems in biomedical and clinical sciences is growing and encompasses a wide variety of approaches. The crowd is diverse and includes online marketplace workers, health information seekers, science enthusiasts and domain experts. In this article, we review and highlight recent studies that use crowdsourcing to advance biomedicine. We classify these studies into two broad categories: (i) mining big data generated from a crowd (e.g. search logs) and (ii) active crowdsourcing via specific technical platforms, e.g. labor markets, wikis, scientific games and community challenges. Through describing each study in detail, we demonstrate the applicability of different methods in a variety of domains in biomedical research, including genomics, biocuration and clinical research. Furthermore, we discuss and highlight the strengths and limitations of different crowdsourcing platforms. Finally, we identify important emerging trends, opportunities and remaining challenges for future crowdsourcing research in biomedicine. PMID:25888696

The Contemporary College President: Pressures and Challenges.

ERIC Educational Resources Information Center

American Association of State Colleges and Universities, Washington, DC.

The papers include: the college president, 25 years ago and now (Henry L. Ashmore); pressures on the presidential family (Clare S. Mackey); strategies for coping (James Bond); remaining an academic leader and being president (Arliss L. Roaden); role of the chief executive in institutional self-renewal (John A. Marvel); on leadership and management…

The Evolution of School Nursing Data Indicators in Massachusetts: Recommendations for a National Data Set

ERIC Educational Resources Information Center

Gapinski, Mary Ann; Sheetz, Anne H.

2014-01-01

The National Association of School Nurses' research priorities include the recommendation that data reliability, quality, and availability be addressed to advance research in child and school health. However, identifying a national school nursing data set has remained a challenge for school nurses, school nursing leaders, school nurse professional…

Technology Utilisation in Elementary Schools in Turkey's Capital: A Case Study

ERIC Educational Resources Information Center

Karaca, Feride; Can, Gulfidan; Yildirim, Soner

2013-01-01

A case study was conducted to explore teachers' current technology use in elementary schools in Ankara, the capital of Turkey. The data were collected through a survey, and participants included 1030 classroom teachers across eight districts. The present study results revealed that significant challenges remain with regard to technology use in the…

Simulating vegetation controls on hurricane-induced shallow landslides with a distributed ecohydrological model

Treesearch

Taehee Hwang; Lawrence E. Band; T. C. Hales; Chelcy F. Miniat; James M. Vose; Paul V. Bolstad; Brian Miles; Katie Price

2015-01-01

The spatial distribution of shallow landslides in steep forested mountains is strongly controlled by aboveground and belowground biomass, including the distribution of root cohesion. While remote sensing of aboveground canopy properties is relatively advanced, estimating the spatial distribution of root cohesion at the forest landscape scale remains challenging. We...

Where Do Young People Work?

ERIC Educational Resources Information Center

Maguire, Sue; Huddleston, Prue

2009-01-01

The current policy intention, that all young people remain in some form of accredited education or training to the age of 18 by 2015, poses significant challenges. The jobs without training (JWT) group includes young people who are in full-time work and not in receipt of training leading to National Vocational Qualification level 2 (or above);…

Science Supporting Numeric Nutrient Criteria for Lakes and Their Watersheds: A Synopsis of Research Completed for the US Environmental Protection Agency

EPA Science Inventory

Nutrient pollution remains one of the most prevalent causes of water quality impairment in the United States. The U.S. Environmental Protection Agency’s (EPA) approach to addressing the challenge of managing nutrient pollution has included supporting development of numeric nutri...

University Library Browsing: A Study Illustrating a Methodology.

ERIC Educational Resources Information Center

Ridley, Dennis R.; And Others

Previous studies on use of library materials based on borrowing behavior failed to address the issue of how the measurement of library book use might be expanded to a broader definition of use, specifically to include browsing behavior. The development of a non-obtrusive and accurate measurement for browsing behavior has remained a challenge.…

Professional Development in the Digital Age: Case Studies of Blended Communities of Practice

ERIC Educational Resources Information Center

Wagner, Jennifer Michelle

2010-01-01

The need for sustainable, meaningful teacher professional development to support the rising professional demands remains an on-going challenge for education. The use of current technologies, such as online learning systems, to leverage the development of learning communities, including communities of practice (CoPs), where teachers with a common…

Quantifying Media Literacy: Development, Reliability, and Validity of a New Measure

ERIC Educational Resources Information Center

Arke, Edward T.; Primack, Brian A.

2009-01-01

Media literacy has the potential to alter outcomes in various fields, including education, communication, and public health. However, measurement of media literacy remains a critical challenge in advancing this field of inquiry. In this manuscript, we describe the development and testing of a pilot measure of media literacy. Items were formed…

Compact fusion energy based on the spherical tokamak

NASA Astrophysics Data System (ADS)

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

2018-01-01

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

Toward a Digital Thread and Data Package for Metals-Additive Manufacturing.

PubMed

Kim, D B; Witherell, P; Lu, Y; Feng, S

2017-01-01

Additive manufacturing (AM) has been envisioned by many as a driving factor of the next industrial revolution. Potential benefits of AM adoption include the production of low-volume, customized, complicated parts/products, supply chain efficiencies, shortened time-to-market, and environmental sustainability. Work remains, however, for AM to reach the status of a full production-ready technology. Whereas the ability to create unique 3D geometries has been generally proven, production challenges remain, including lack of (1) data manageability through information management systems, (2) traceability to promote product producibility, process repeatability, and part-to-part reproducibility, and (3) accountability through mature certification and qualification methodologies. To address these challenges in part, this paper discusses the building of data models to support the development of validation and conformance methodologies in AM. We present an AM information map that leverages informatics to facilitate part producibility, process repeatability, and part-to-part reproducibility in an AM process. We present three separate case studies to demonstrate the importance of establishing baseline data structures and part provenance through an AM digital thread.

Toward a Digital Thread and Data Package for Metals-Additive Manufacturing

PubMed Central

Kim, D. B.; Witherell, P.; Lu, Y.; Feng, S.

2017-01-01

Additive manufacturing (AM) has been envisioned by many as a driving factor of the next industrial revolution. Potential benefits of AM adoption include the production of low-volume, customized, complicated parts/products, supply chain efficiencies, shortened time-to-market, and environmental sustainability. Work remains, however, for AM to reach the status of a full production-ready technology. Whereas the ability to create unique 3D geometries has been generally proven, production challenges remain, including lack of (1) data manageability through information management systems, (2) traceability to promote product producibility, process repeatability, and part-to-part reproducibility, and (3) accountability through mature certification and qualification methodologies. To address these challenges in part, this paper discusses the building of data models to support the development of validation and conformance methodologies in AM. We present an AM information map that leverages informatics to facilitate part producibility, process repeatability, and part-to-part reproducibility in an AM process. We present three separate case studies to demonstrate the importance of establishing baseline data structures and part provenance through an AM digital thread. PMID:28691115

Sterilization techniques for biodegradable scaffolds in tissue engineering applications

PubMed Central

Dai, Zheng; Ronholm, Jennifer; Tian, Yiping; Sethi, Benu; Cao, Xudong

2016-01-01

Biodegradable scaffolds have been extensively studied due to their wide applications in biomaterials and tissue engineering. However, infections associated with in vivo use of these scaffolds by different microbiological contaminants remain to be a significant challenge. This review focuses on different sterilization techniques including heat, chemical, irradiation, and other novel sterilization techniques for various biodegradable scaffolds. Comparisons of these techniques, including their sterilization mechanisms, post-sterilization effects, and sterilization efficiencies, are discussed. PMID:27247758

The Challenge of Managing Psoriasis: Unmet Medical Needs and Stakeholder Perspectives

PubMed Central

Feldman, Steven R.; Goffe, Bernard; Rice, Gary; Mitchell, Matthew; Kaur, Mandeep; Robertson, Debbie; Sierka, Debra; Bourret, Jeffrey A.; Evans, Tamara S.; Gottlieb, Alice

2016-01-01

Background Psoriasis is a debilitating chronic inflammatory autoimmune disease affecting approximately 7.4 million adults in the United States. Plaque psoriasis is the most common form, affecting 80% to 90% of patients. Objectives To describe the impact and challenges that psoriasis presents for various stakeholders, and to provide nondermatologist healthcare decision makers with information to enhance their contributions to drug and pharmacy benefit design discussions. Discussion Psoriasis carries an increased risk for early mortality and an increased prevalence of comorbidities, including psoriatic arthritis, cardiovascular disease, and diabetes. It is also associated with anxiety, depression, and social isolation, and can negatively impact patients' relationships, productivity, and careers. The physical, psychologic, social, and economic impact of psoriasis, plus the associated stigma, result in cumulative impairment over a patient's lifetime. The current treatments for moderate-to-severe psoriasis include topical therapy, phototherapy, and systemic drugs (nonbiologic and biologic); however, patient satisfaction remains low, combination therapy and treatment switching are common, and many patients remain untreated or undertreated. Clinicians should consider the patient holistically, and should select treatment based on a range of factors, including disease severity (with physical and psychosocial manifestations), susceptibility to cumulative life-course impairment (considering personality, behavior, and cognition), comorbidities, concomitant medication, and patient preference. It is estimated that the total annual direct cost of treating psoriasis in the United States in 2015 exceeded $12.2 billion. Conclusion Psoriasis is a complex disease, and appropriate management is correspondingly complex. Newer psoriasis treatments provide improved efficacy and safety versus traditional treatments, but challenges remain in ensuring patients access to these medications. An improved understanding of the barriers to appropriate treatment is needed, as well as clear and accessible information for payers and clinicians on current treatment options, to ensure that decision makers can control costs while providing patients with optimal care. PMID:28465778

Management of periorbital basal cell carcinoma with orbital invasion.

PubMed

Sun, Michelle T; Wu, Albert; Figueira, Edwin; Huilgol, Shyamala; Selva, Dinesh

2015-11-01

Basal cell carcinoma (BCC) is the most common eyelid malignancy; however, orbital invasion by periocular BCC is rare, and management remains challenging. Established risk factors for orbital invasion by BCC include male gender, advanced age, medial canthal location, previous recurrences, large tumor size, aggressive histologic subtype and perineural invasion. Management requires a multidisciplinary approach with orbital exenteration remaining the treatment of choice. Globe-sparing treatment may be appropriate in selected patients and radiotherapy and chemotherapy are often used as adjuvant therapies for advanced or inoperable cases, although the evidence remains limited. We aim to summarize the presentation and treatment of BCC with orbital invasion to better guide the management of this complex condition.

Gene correction in patient-specific iPSCs for therapy development and disease modeling

PubMed Central

Jang, Yoon-Young

2018-01-01

The discovery that mature cells can be reprogrammed to become pluripotent and the development of engineered endonucleases for enhancing genome editing are two of the most exciting and impactful technology advances in modern medicine and science. Human pluripotent stem cells have the potential to establish new model systems for studying human developmental biology and disease mechanisms. Gene correction in patient-specific iPSCs can also provide a novel source for autologous cell therapy. Although historically challenging, precise genome editing in human iPSCs is becoming more feasible with the development of new genome-editing tools, including ZFNs, TALENs, and CRISPR. iPSCs derived from patients of a variety of diseases have been edited to correct disease-associated mutations and to generate isogenic cell lines. After directed differentiation, many of the corrected iPSCs showed restored functionality and demonstrated their potential in cell replacement therapy. Genome-wide analyses of gene-corrected iPSCs have collectively demonstrated a high fidelity of the engineered endonucleases. Remaining challenges in clinical translation of these technologies include maintaining genome integrity of the iPSC clones and the differentiated cells. Given the rapid advances in genome-editing technologies, gene correction is no longer the bottleneck in developing iPSC-based gene and cell therapies; generating functional and transplantable cell types from iPSCs remains the biggest challenge needing to be addressed by the research field. PMID:27256364

Occupational risks and challenges of seafaring.

PubMed

Oldenburg, Marcus; Baur, Xaver; Schlaich, Clara

2010-01-01

Seafarers are exposed to a high diversity of occupational health hazards onboard ships. The aim of this article is to present a survey of the current, most important hazards in seafaring including recommendations on measures how to deal with these problems. The review is based on maritime expert opinions as well a PubMed analysis related to the occupational risks of seafaring. Despite recent advances in injury prevention, accidents due to harmful working and living conditions at sea and of non-observance of safety rules remain a main cause of injury and death. Mortality in seafaring from cardiovascular diseases (CVD) is mainly caused by increased risks and impaired treatment options of CVD at sea. Further, shipboard stress and high demand may lead to fatigue and isolation which have an impact on the health of onboard seafarers. Communicable diseases in seafaring remain an occupational problem. Exposures to hazardous substances and UV-light are important health risks onboard ships. Because of harsh working conditions onboard including environmental conditions, sufficient recreational activities are needed for the seafarers' compensation both onboard and ashore. However, in reality there is often a lack of leisure time possibilities. Seafaring is still an occupation with specific work-related risks. Thus, a further reduction of occupational hazards aboard ships is needed and poses a challenge for maritime health specialists and stakeholders. Nowadays, maritime medicine encompasses a broad field of workplaces with different job-related challenges.

Current challenges and future directions for bacterial self-healing concrete.

PubMed

Lee, Yun Suk; Park, Woojun

2018-04-01

Microbially induced calcium carbonate precipitation (MICP) has been widely explored and applied in the field of environmental engineering over the last decade. Calcium carbonate is naturally precipitated as a byproduct of various microbial metabolic activities. This biological process was brought into practical use to restore construction materials, strengthen and remediate soil, and sequester carbon. MICP has also been extensively examined for applications in self-healing concrete. Biogenic crack repair helps mitigate the high maintenance costs of concrete in an eco-friendly manner. In this process, calcium carbonate precipitation (CCP)-capable bacteria and nutrients are embedded inside the concrete. These bacteria are expected to increase the durability of the concrete by precipitating calcium carbonate in situ to heal cracks that develop in the concrete. However, several challenges exist with respect to embedding such bacteria; harsh conditions in concrete matrices are unsuitable for bacterial life, including high alkalinity (pH up to 13), high temperatures during manufacturing processes, and limited oxygen supply. Additionally, many biological factors, including the optimum conditions for MICP, the molecular mechanisms involved in MICP, the specific microorganisms suitable for application in concrete, the survival characteristics of the microorganisms embedded in concrete, and the amount of MICP in concrete, remain unclear. In this paper, metabolic pathways that result in conditions favorable for calcium carbonate precipitation, current and potential applications in concrete, and the remaining biological challenges are reviewed.

Developments in the management of Chagas cardiomyopathy

PubMed Central

Tanowitz, Herbert B; Machado, Fabiana S; Spray, David C; Friedman, Joel M; Weiss, Oren S; Lora, Jose N; Nagajyothi, Jyothi; Moraes, Diego N; Garg, Nisha Jain; Nunes, Maria Carmo P; Ribeiro, Antonio Luiz P

2016-01-01

Over 100 years have elapsed since the discovery of Chagas disease and there is still much to learn regarding pathogenesis and treatment. Although there are antiparasitic drugs available, such as benznidazole and nifurtimox, they are not totally reliable and often toxic. A recently released negative clinical trial with benznidazole in patients with chronic Chagas cardiomyopathy further reinforces the concerns regarding its effectiveness. New drugs and new delivery systems, including those based on nanotechnology, are being sought. Although vaccine development is still in its infancy, the reality of a therapeutic vaccine remains a challenge. New ECG methods may help to recognize patients prone to developing malignant ventricular arrhythmias. The management of heart failure, stroke and arrhythmias also remains a challenge. Although animal experiments have suggested that stem cell based therapy may be therapeutic in the management of heart failure in Chagas cardiomyopathy, clinical trials have not been promising. PMID:26496376

Developments in the management of Chagas cardiomyopathy.

PubMed

Tanowitz, Herbert B; Machado, Fabiana S; Spray, David C; Friedman, Joel M; Weiss, Oren S; Lora, Jose N; Nagajyothi, Jyothi; Moraes, Diego N; Garg, Nisha Jain; Nunes, Maria Carmo P; Ribeiro, Antonio Luiz P

2015-12-01

Over 100 years have elapsed since the discovery of Chagas disease and there is still much to learn regarding pathogenesis and treatment. Although there are antiparasitic drugs available, such as benznidazole and nifurtimox, they are not totally reliable and often toxic. A recently released negative clinical trial with benznidazole in patients with chronic Chagas cardiomyopathy further reinforces the concerns regarding its effectiveness. New drugs and new delivery systems, including those based on nanotechnology, are being sought. Although vaccine development is still in its infancy, the reality of a therapeutic vaccine remains a challenge. New ECG methods may help to recognize patients prone to developing malignant ventricular arrhythmias. The management of heart failure, stroke and arrhythmias also remains a challenge. Although animal experiments have suggested that stem cell based therapy may be therapeutic in the management of heart failure in Chagas cardiomyopathy, clinical trials have not been promising.

Missed Opportunities to Prevent Workplace Injuries and Fatalities.

PubMed

Woolford, Marta Helen; Bugeja, Lyndal; Driscoll, Tim; Ibrahim, Joseph Elias

2017-05-01

Prevention efforts, especially in high-income countries, have reduced work-related death and injury. Despite this, the global incidence of workplace fatalities remains unacceptably high with approximately 317 million incidents occurring on the job annually. Of particular concern is the occurrence and re-occurrence of incidents with a similar cause and circumstance, such as fatalities occurring in agriculture and transport industries. Efforts to reduce workplace fatalities include surveillance and reporting, investigation, and regulation. Challenges remain in all three domains, limiting the prevention of work-related injuries and deaths. In this commentary, the nature of these challenges and recommendations on how to overcome them are described. Examples of incidents of workplace injury and death, as well as injury prevention efforts are provided to ensure contextual understanding. Reflecting on the present enhances key stakeholders, policy and decision-makers' understanding of the opportunities to reducing harm and the associated human, and economic and legal costs.

Neonatal Vaccination: Challenges and Intervention Strategies.

PubMed

Morris, Matthew C; Surendran, Naveen

2016-01-01

While vaccines have been tremendously successful in reducing the incidence of serious infectious diseases, newborns remain particularly vulnerable in the first few months of their life to life-threatening infections. A number of challenges exist to neonatal vaccination. However, recent advances in the understanding of neonatal immunology offer insights to overcome many of those challenges. This review will present an overview of the features of neonatal immunity which make vaccination difficult, survey the mechanisms of action of available vaccine adjuvants with respect to the unique features of neonatal immunity, and propose a possible mechanism contributing to the inability of neonates to generate protective immune responses to vaccines. We surveyed recent published findings on the challenges to neonatal vaccination and possible intervention strategies including the use of novel vaccine adjuvants to develop efficacious neonatal vaccines. Challenges in the vaccination of neonates include interference from maternal antibody and excessive skewing towards Th2 immunity, which can be counteracted by the use of proper adjuvants. Synergistic stimulation of multiple Toll-like receptors by incorporating well-defined agonist-adjuvant combinations to vaccines is a promising strategy to ensure a protective vaccine response in neonates. © 2016 S. Karger AG, Basel.

Post-traumatic stress disorder diagnosis in children: challenges and promises

PubMed Central

Cohen, Judith A.; Scheeringa, Michael S.

2009-01-01

Children and adolescents experience high rates of potentially traumatic experiences. Many children subsequently develop mental health problems, including post-traumatic stress disorder (PTSD) symptoms. Accurately diagnosing PTSD in children is challenging. This paper reviews the following important issues: (i) the specificity of the PTSD diagnosis; (ii) children who are symptomatic and impaired but do not have enough symptoms for the diagnosis of PTSD; (iii) developmental considerations for preschool and schooi-age children; and (iv) a variety of assessment challenges that reflect the difficulty and complexity of interviewing children and caregivers about these symptoms. Despite these challenges, PTSD remains the best construct for clinical and research work with trauma survivors. Pediatric PTSD criteria are valuable for identifying children at risk and in need of treatment and can be even more helpful when developmentally modified in ways that are discussed. PMID:19432391

Consequence Maps: A Novel Behavior Management Tool for Educators

ERIC Educational Resources Information Center

Tobin, Catherine E.; Simpson, Richard

2012-01-01

Behavior management remains one of the most significant challenges faced by classroom personnel. One relatively novel and promising management approach involves the use of "Consequence Maps". In this article we discuss the use of this method, including its application and evaluation. A case study of a six-year-old boy in a self-contained special…

75 FR 32841 - Continuation of the National Emergency With Respect to the Actions and Policies of Certain...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

... or institutions, to commit human rights abuses related to political repression, including detentions... political prisoners in the fall of 2008 and our continuing efforts to press for further reforms related to democracy, human rights, and the rule of law in Belarus, serious challenges remain. The actions and policies...

New Considerations in the Prevention of Aversives, Restraint, and Seclusion: Incorporating the Role of Relationships into an Ecological Perspective

ERIC Educational Resources Information Center

Amos, Patricia A.

2004-01-01

While many individuals with challenging behaviors now enjoy the benefits of inclusion and self-determination, large numbers of their peers remain in segregated, restrictive settings and continue to be subjected to coercive intervention plans that include aversives, (nonemergency) restraint, and seclusion as "treatment." A rising tide of…

Single Student Parents Face Financial Difficulties, Debt, without Adequate Aid. Fact Sheet #C394

ERIC Educational Resources Information Center

Miller, Kevin

2012-01-01

Parents with dependent children were nearly one quarter of students enrolled for credit at American postsecondary institutions in 2008. These students face significant challenges to remaining enrolled and graduating, including limited access to affordable child care, difficulty balancing the demands of school with the demands of work and family,…

The 20-20-20 Airships NASA Centennial Challenge

NASA Astrophysics Data System (ADS)

Kiessling, Alina; Diaz, Ernesto; Miller, Sarah; Rhodes, Jason; Ortega, Sam; Hall, Jeffrey L.; Friedl, Randy; Booth, Jeff

2015-01-01

A NASA Centennial Challenge; (www.nasa.gov/challenges) is in development to spur innovation in stratospheric airships as a science platform. We anticipate a multi-million dollar class prize for the first organization to fly a powered airship that remains stationary at 20km (65,000 ft) altitude for over 20 hours with a 20kg payload. The design must be scalable to longer flights with more massive payloads.In NASA's constrained budget environment, there are few opportunities for space missions in astronomy and Earth science, and these have very long lead times. We believe that airships (powered, maneuverable, lighter-than-air vehicles) could offer significant gains in observing time, sky and ground coverage, data downlink capability, and continuity of observations over existing suborbital options at competitive prices. This technology would also have broad commercial applications including communications and asset tracking. We seek to spur private industry (or non-profit institutions, including Universities) to demonstrate the capability for sustained airship flights as astronomy and Earth science platforms. This poster will introduce the challenge in development and provide details of who to contact for more information.

Cranberries and lower urinary tract infection prevention

PubMed Central

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

2012-01-01

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

Trust in Vaccines: Why It Takes More than Good Faith.

PubMed

Begg, Norman

2013-08-12

This Vaccines issue on "Confidence in Vaccines" provides sound evidence through multiple perspectives of life-saving impacts when vaccination programs are effectively implemented in a population. Yet there remain challenges to achieving this impact, including scientific, medical, manufacturing, policy-related and logistical issues. Additionally, socio-cultural, religious and political agendas can come into play, taking public health hostage and sometimes allowing the circulation of myths regarding vaccination. All of these challenges play a role in public confidence in vaccines and vaccination. What we trust, we embrace. What we do not trust, we do not embrace.

Scientific challenges and opportunities in developing novel vaccines for the emerging and developing markets: New Technologies in Emerging Markets, October 16th-18th 2012, World Vaccine Congress, Lyon.

PubMed

Kochhar, Sonali

2013-04-01

Vaccines have had a major role in enhancing the quality of life and increasing life expectancy. Despite these successes and the development of new vaccine technologies, there remain multiple infectious diseases including AIDS, malaria and tuberculosis that require effective prophylactic vaccines. New and traditional technologies have a role in the development and delivery of the new vaccine candidates. The scientific challenges, opportunities and funding models for developing vaccines for low resource settings are highlighted here.

Training for laparoscopic pancreaticoduodenectomy.

PubMed

Kuroki, Tamotsu; Fujioka, Hikaru

2018-05-10

In recent years, laparoscopic procedures have developed rapidly, and the reports of laparoscopic pancreatic resection including laparoscopic pancreaticoduodenectomy (LPD) have increased in number. Although LPD is a complex procedure with high mortality, the training system for LPD remains unestablished. Ensuring patient safety is extremely important, even in challenging surgeries such a LPD. At present, several tools have been developed for surgical education to ensure patient safety preoperatively, such as video learning, virtual reality simulators, and cadaver training. Although LPD is reported as a safe and feasible choice, LPD is still a challenging operation. An LPD training system should be established with a board-certified system.

Sociopolitical Participation of Kuwaiti Women in the Development Process: Current State and Challenges Ahead

PubMed Central

Alzuabi, Ali Z.

2016-01-01

ABSTRACT This study explores the sociocultural status of Kuwaiti women and examines the obstacles that may hinder them from participating in socioeconomic development of Kuwait. The study analyzes the nature of legislative, political, sociocultural, and economic challenges faced by Kuwaiti women and suggests measures to overcome these obstacles to help women in attaining a prime role in the development process. The survey sample included 300 Kuwaiti citizens of both genders selected randomly from different social and professional backgrounds. Statistical analyses including mean values and covariance analysis revealed the awareness of gender-based differences in attitudes on the nature of constraints faced in moving toward the progress of Kuwaiti women. Discussed are social, economic, and knowledge-based constraints that restrain women from playing an active role in the socioeconomic development of Kuwait. Future directions include the acknowledgement of increased levels of education among Kuwaiti women and the available talent pool that will remain underutilized if women are not raised to leadership levels. Further research is needed on the scope and challenges in implementing strategies for the empowerment of women as a part of legislation. PMID:27812232

Experimental intramammary inoculation with Mycoplasma bovis in vaccinated and unvaccinated cows: effect on milk production and milk quality.

PubMed Central

Boothby, J T; Jasper, D E; Thomas, C B

1986-01-01

The effect of vaccination on milk production was evaluated in vaccinated and control cows experimentally challenged in two of four quarters with live Mycoplasma bovis. During the first three weeks after experimental challenge, six of eight unchallenged quarters on vaccinated cows and seven of eight unchallenged quarters on control cows became infected. Most of these quarters secreted normal milk, with negative California Mastitis Test scores and maintained normal milk production throughout most of the study (although some quarters on control cows remained infected). All challenged quarters became infected, had strong California Mastitis Test reactions, and had a drastic (greater than 85%) loss in milk production. Thereafter, four of eight challenged quarters on control cows remained infected, had mostly positive California Mastitis Test scores, produced mostly normal-appearing milk, and recovered some productive capabilities. By the end of the study no M. bovis could be recovered from challenged quarters on vaccinated cows and the milk appeared mostly normal. The California Mastitis Test scores on these quarters, however, remained elevated and milk production remained very low. PMID:3756674

Nurse Jackie and the politics of care.

PubMed

McHugh, Kathleen

2012-01-01

This essay considers Nurse Jackie, one of several recent television shows, including HawthoRNe, and Mercy, that features a nurse as the main character. All 3 shows premiered in 2009 and challenged nursing's longstanding invisibility and misrepresentation on television. Although the plots of each show corrected problematic aspects of nursing's usual media representation, only Nurse Jackie remains on the air. In this paper, I analyze why Nurse Jackie succeeded where the other 2 shows did not, considering the representational politics of care on television and in the national context where health care remains a significant concern. Copyright © 2012 Elsevier Inc. All rights reserved.

Telomerase and the search for the end of cancer.

PubMed

Mocellin, Simone; Pooley, Karen A; Nitti, Donato

2013-02-01

Many of the fundamental molecular mechanisms underlying tumor biology remain elusive and, thus, developing specific anticancer therapies remains a challenge. The recently discovered relationships identified among telomeres, telomerase, aging, and cancer have opened a new avenue in tumor biology research that may revolutionize anticancer therapy. This review summarizes the critical aspects of telomerase biology that underpin the development of novel telomerase-targeting therapies for malignant diseases, and special regard is given to the aspects of telomerase that make it such an appealing target, such as the widespread expression of telomerase in cancers. Despite significant progress, issues remain to be addressed before telomerase-based therapies are truly effective and we include critical discussion of the results obtained thus far. Copyright © 2012 Elsevier Ltd. All rights reserved.

Nanotherapeutic approaches for brain cancer management.

PubMed

Saenz del Burgo, Laura; Hernández, Rosa María; Orive, Gorka; Pedraz, Jose Luis

2014-07-01

Around the world, cancer remains one of the most important causes of morbidity and mortality. Worldwide, approximately 238,000 new cases of brain and other central nervous system tumors are diagnosed every year. Nanotherapeutic approaches hold tremendous potential for diagnosis and treatment of brain cancer, including the ability to target complex molecular cargoes to the tumor sites and the capacity of crossing the blood-brain barrier and accessing to the brain after systemic administration. A new generation of "smart" nanoparticles has been designed as novel targeted delivery devices for new therapies including gene therapy, anti-angiogenic and thermotherapy. This review highlights the latest research, opportunities and challenges for developing novel nanotherapeutics for treating brain cancers. This comprehensive review highlights the latest research results, opportunities and challenges for developing novel nanotherapeutics for treating brain cancers, with a special focus on "smart" nanoparticles as novel targeted delivery devices for new therapies including gene therapy, anti-angiogenic therapy and localized thermotherapy. © 2014.

Participatory Climate Research in a Dynamic Urban Context: Activities of the Consortium for Climate Risk in the Urban Northeast (CCRUN)

NASA Technical Reports Server (NTRS)

Horton, Radley M.; Bader, Daniel A.; Montalto, Franco; Solecki, William

2016-01-01

The Consortium for Climate Risk in the Urban Northeast (CCRUN), one of ten NOAA-RISAs, supports resilience efforts in the urban corridor stretching from Philadelphia to Boston. Challenges and opportunities include the diverse set of needs in broad urban contexts, as well as the integration of interdisciplinary perspectives. CCRUN is addressing these challenges through strategies including: 1) the development of an integrated project framework, 2) stakeholder surveys, 3) leveraging extreme weather events as focusing opportunities, and 4) a seminar series that enables scientists and stakeholders to partner. While recognizing that the most extreme weather events will always lead to surprises (even with sound planning), CCRUN endeavors to remain flexible by facilitating place-based research in an interdisciplinary context.

Advances and challenges in biosensor-based diagnosis of infectious diseases

PubMed Central

Sin, Mandy LY; Mach, Kathleen E; Wong, Pak Kin; Liao, Joseph C

2014-01-01

Rapid diagnosis of infectious diseases and timely initiation of appropriate treatment are critical determinants that promote optimal clinical outcomes and general public health. Conventional in vitro diagnostics for infectious diseases are time-consuming and require centralized laboratories, experienced personnel and bulky equipment. Recent advances in biosensor technologies have potential to deliver point-of-care diagnostics that match or surpass conventional standards in regards to time, accuracy and cost. Broadly classified as either label-free or labeled, modern biosensors exploit micro- and nanofabrication technologies and diverse sensing strategies including optical, electrical and mechanical transducers. Despite clinical need, translation of biosensors from research laboratories to clinical applications has remained limited to a few notable examples, such as the glucose sensor. Challenges to be overcome include sample preparation, matrix effects and system integration. We review the advances of biosensors for infectious disease diagnostics and discuss the critical challenges that need to be overcome in order to implement integrated diagnostic biosensors in real world settings. PMID:24524681

Crowdsourcing in biomedicine: challenges and opportunities.

PubMed

Khare, Ritu; Good, Benjamin M; Leaman, Robert; Su, Andrew I; Lu, Zhiyong

2016-01-01

The use of crowdsourcing to solve important but complex problems in biomedical and clinical sciences is growing and encompasses a wide variety of approaches. The crowd is diverse and includes online marketplace workers, health information seekers, science enthusiasts and domain experts. In this article, we review and highlight recent studies that use crowdsourcing to advance biomedicine. We classify these studies into two broad categories: (i) mining big data generated from a crowd (e.g. search logs) and (ii) active crowdsourcing via specific technical platforms, e.g. labor markets, wikis, scientific games and community challenges. Through describing each study in detail, we demonstrate the applicability of different methods in a variety of domains in biomedical research, including genomics, biocuration and clinical research. Furthermore, we discuss and highlight the strengths and limitations of different crowdsourcing platforms. Finally, we identify important emerging trends, opportunities and remaining challenges for future crowdsourcing research in biomedicine. Published by Oxford University Press 2015. This work is written by US Government employees and is in the public domain in the US.

Clinical ethics revisited

PubMed Central

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

2001-01-01

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

Beginning to Teach the End: The Importance of Including Discharge from Aphasia Therapy in the Curriculum

ERIC Educational Resources Information Center

Hersh, Deborah; Cruice, Madeline

2010-01-01

Background: Discharging clients with long-term aphasia from therapy services constitutes a challenging dilemma for practising clinicians for a multitude of reasons. Although discharge was raised and discussed as a contentious issue in the field of aphasiology ten years ago, it remains an aspect of practice which is complex and underexplored. We…

"Planning Live": Using a Person-Centred Intervention to Reduce Admissions to and Length of Stay in Learning Disability Inpatient Facilities

ERIC Educational Resources Information Center

Bartle, Janet; Crossland, Tom; Hewitt, Olivia

2016-01-01

Background: Recent government policy has focused on reducing the number of people with a learning disability receiving treatment for challenging behaviour or mental health difficulties in hospitals (including in assessment and treatment units; ATU). People with a learning disability should be supported to remain in their community when receiving…

Tweeting in the Classroom: Instant feedback and assessment using a mobile web app

NASA Astrophysics Data System (ADS)

Saravanan, R.

2011-12-01

Cell phones with texting capabilities are ubiquitous in the college classroom, and smart phones are becoming increasingly common. These phones are used primarily for personal activities, including social networking, and are expected to remain switched off during instruction. The powerful communication capability of these devices, which could potentially facilitate novel forms of "instructional networking", remains untapped. Instead, special-purpose devices ("clickers") are used when instant feedback is desired in the classroom. A number of technical and behavioral challenges need to be overcome before mobile phones can be used routinely to assist in classroom instruction. This presentation will describe the experience of developing and deploying a mobile web app that enables students to provide instant feedback in the classroom using their mobile phones. The web app leverages existing social networking infrastructure, e.g., using the Twitter microblogging service to aggregate text messages sent by students, to promote classroom interaction. The web app was deployed both in a regular lecture hall and in a computer lab. Topics to be discussed include the technical challenges of deploying a mobile web app in a classroom setting, such as internet accessibility and latency, as well as non-technical issues relating to privacy, student reactions, etc.

The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms.

PubMed

Barrett, Frederick S; Bradstreet, Matthew P; Leoutsakos, Jeannie-Marie S; Johnson, Matthew W; Griffiths, Roland R

2016-12-01

Acute adverse psychological reactions to classic hallucinogens ("bad trips" or "challenging experiences"), while usually benign with proper screening, preparation, and support in controlled settings, remain a safety concern in uncontrolled settings (such as illicit use contexts). Anecdotal and case reports suggest potential adverse acute symptoms including affective (panic, depressed mood), cognitive (confusion, feelings of losing sanity), and somatic (nausea, heart palpitation) symptoms. Responses to items from several hallucinogen-sensitive questionnaires (Hallucinogen Rating Scale, the States of Consciousness Questionnaire, and the Five-Dimensional Altered States of Consciousness questionnaire) in an Internet survey of challenging experiences with the classic hallucinogen psilocybin were used to construct and validate a Challenging Experience Questionnaire. The stand-alone Challenging Experience Questionnaire was then validated in a separate sample. Seven Challenging Experience Questionnaire factors (grief, fear, death, insanity, isolation, physical distress, and paranoia) provide a phenomenological profile of challenging aspects of experiences with psilocybin. Factor scores were associated with difficulty, meaningfulness, spiritual significance, and change in well-being attributed to the challenging experiences. The factor structure did not differ based on gender or prior struggle with anxiety or depression. The Challenging Experience Questionnaire provides a basis for future investigation of predictors and outcomes of challenging experiences with classic hallucinogens. © The Author(s) 2016.

Update on infection control challenges in special pediatric populations.

PubMed

Balkhy, Hanan H; Zingg, Walter

2014-08-01

Compared with adults, neonatal and pediatric populations are especially vulnerable patients who have specific diagnostic and therapeutic differences; therefore, the standard infection control practices designed for adults are sometimes not effective or need modifications to work. This review focuses on the recent literature addressing the challenges and successes in preventing healthcare-associated infections (HAIs) in children. Improving the implementation of pediatric versions of preventive bundles focusing on proper catheter insertion and maintenance, mainly as a part of a larger multimodal strategy, is effective in reducing the central-line-associated bloodstream infections in neonatal and pediatric populations including oncology patients. Appropriate feeding, antimicrobial stewardship, and infection control measures should be combined in reducing necrotizing enterocolitis in preterm neonates. Implementing a multimodal bundle strategy adapted for pediatric population is successful in preventing ventilator-associated pneumonia. Appropriate use of antimicrobial prophylaxis remains the cornerstone for preventing surgical-site infections irrespective of age, with few additional effective adjuvant preventive practices in specific pediatric patients. Several evidence-based practices are effective in reducing the incidence and the impact of HAIs in children; however, proper implementation remains a challenge. Additionally, several adult preventive practices are still unestablished in children and need further thorough examination.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2018-01-01

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

Family caregiver recruitment via social media: challenges, opportunities and lessons.

PubMed

Hansen, Dana; Sheehan, Denice K; Stephenson, Pam

2017-02-02

Illness blogs are a way seriously ill people communicate publicly about their illness journey. As communication about serious illness increases on social media, it is important to evaluate how this affects the family caregiver. However, identifying and accessing family caregivers remains challenging, especially via social media. The aim of this article is to report the opportunities, challenges and lessons learned from using social media to recruit family caregivers. Recruitment methods included posting study invitations on illness blogs, advertising through Facebook and placing study fliers in the community. Using social media to recruit was inexpensive and provided a wide geographical reach. One important finding was discovering the importance of using language in the recruitment materials that family caregivers could identify with to help deem themselves as eligible to participate in the study.

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

PubMed Central

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

2018-01-01

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

Physics-based distributed snow models in the operational arena: Current and future challenges

NASA Astrophysics Data System (ADS)

Winstral, A. H.; Jonas, T.; Schirmer, M.; Helbig, N.

2017-12-01

The demand for modeling tools robust to climate change and weather extremes along with coincident increases in computational capabilities have led to an increase in the use of physics-based snow models in operational applications. Current operational applications include the WSL-SLF's across Switzerland, ASO's in California, and USDA-ARS's in Idaho. While the physics-based approaches offer many advantages there remain limitations and modeling challenges. The most evident limitation remains computation times that often limit forecasters to a single, deterministic model run. Other limitations however remain less conspicuous amidst the assumptions that these models require little to no calibration based on their foundation on physical principles. Yet all energy balance snow models seemingly contain parameterizations or simplifications of processes where validation data are scarce or present understanding is limited. At the research-basin scale where many of these models were developed these modeling elements may prove adequate. However when applied over large areas, spatially invariable parameterizations of snow albedo, roughness lengths and atmospheric exchange coefficients - all vital to determining the snowcover energy balance - become problematic. Moreover as we apply models over larger grid cells, the representation of sub-grid variability such as the snow-covered fraction adds to the challenges. Here, we will demonstrate some of the major sensitivities of distributed energy balance snow models to particular model constructs, the need for advanced and spatially flexible methods and parameterizations, and prompt the community for open dialogue and future collaborations to further modeling capabilities.

Unmet medical needs in systemic lupus erythematosus

PubMed Central

2012-01-01

Systemic lupus erythematosus (SLE) is an autoimmune disease of diverse manifestations, with onset usually in young women in the third to fourth decade of life. The chronic nature of this relapsing remitting disease leads to organ damage accrual over time. Mortality and morbidity are increased in patients with SLE compared with the general population. Therapeutic advances over the last few decades have led to significant improvements in patient outcomes. Five-year survival has improved to over 90% from a low of 50% in the 1950s. However, multiple aspects of the management of SLE patients are still far from optimal. Early diagnosis remains a challenge; diagnostic delays leading to delay in definitive treatment are common. Monitoring treatment remains problematic due to the paucity of sensitive biomarkers. Current treatment regimens rely heavily on corticosteroids, even though corticosteroids are well known to cause organ damage. Treatment of refractory disease manifestations such as nephritis, recalcitrant cutaneous lesions and neurological involvement require new approaches with greater efficacy. Cognitive dysfunction is common in SLE patients, but early recognition and adequate treatment are yet to be established. Premature accelerated atherosclerosis remains a leading cause of morbidity and mortality. Fatigue is one of the most disabling symptoms, and contributes to the poor quality of life in patients with SLE. Ongoing research in SLE faces many challenges, including enrollment of homogeneous patient populations, use of reliable outcome measures and a standard control arm. The current review will highlight some of the outstanding unmet challenges in the management of this complex disease. PMID:23281889

Type 1 diabetes: Awareness, management and challenges: Current scenario in India

PubMed Central

Kumar, K.M. Prasanna; Saboo, Banshi; Rao, P.V.; Sarda, Archana; Viswanathan, Vijay; Kalra, Sanjay; Sethi, Bipin; Shah, Nalini; Srikanta, S.S.; Jain, Sunil M; Raghupathy, P.; Shukla, Rishi; Jhingan, Ashok; Chowdhury, Subhankar; Jabbar, P.K.; Kanungo, Alok; Joshi, Rajesh; Kumar, Surendra; Tandon, Nikhil; Khadilkar, Vaman; Chadha, Manoj

2015-01-01

Type 1 diabetes mellitus (T1DM) has a wide presence in children and has a high mortality rates. The disease, if left unmanaged, poses various challenges to the patient and healthcare providers, including development of diabetic complications and thus decreasing the life expectancy of the affected child. The challenges of T1DM include awareness of the disease that is very poor among the general public and also in parents of T1DM children along with the health care professionals. The challenge of lack of awareness of T1DM can be met by increasing public awareness programs, conducting workshops for diabetes educators regarding T1DM in children, newsletters, CMEs, online courses, and by structured teaching modules for diabetes educators. Diagnosis of T1DM was a challenge a few decades ago but the situation has improved today with diagnostic tests and facilities, made available even in villages. Investigation facilities and infrastructure, however, are very poor at the primary care level, especially in rural areas. Insulin availability, acceptability, and affordability are also major problems, compounded by the various types of insulin that are available in the market with a varied price range. But effective use of insulin remains a matter of utmost importance. PMID:25941655

Progress and challenges of disaster health management in China: a scoping review.

PubMed

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2014-01-01

Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Malaria in Uganda: challenges to control on the long road to elimination. I. Epidemiology and current control efforts

PubMed Central

Yeka, Adoke; Gasasira, Anne; Mpimbaza, Arthur; Achan, Jane; Nankabirwa, Joaniter; Nsobya, Sam; Staedke, Sarah G.; Donnelly, Martin J.; Wabwire-Mangen, Fred; Talisuna, Ambrose; Dorsey, Grant; Kamya, Moses R.; Rosenthal, Philip J.

2011-01-01

Malaria remains one of the leading health problems of the developing world, and Uganda bears a particularly large burden from the disease. Our understanding is limited by a lack of reliable data, but it is clear that the prevalence of malaria infection, incidence of disease, and mortality from severe malaria all remain very high. Uganda has made progress in implementing key malaria control measures, in particular distribution of insecticide impregnated bednets, indoor residual spraying of insecticides, utilization of artemisinin-based combination therapy to treat uncomplicated malaria, and provision of intermittent preventive therapy for pregnant women. However, despite enthusiasm regarding the potential for the elimination of malaria in other areas, there is no convincing evidence that the burden of malaria has decreased in Uganda in recent years. Major challenges to malaria control in Uganda include very high malaria transmission intensity, inadequate health care resources, a weak health system, inadequate understanding of malaria epidemiology and the impact of control interventions, increasing resistance of parasites to drugs and of mosquitoes to insecticides, inappropriate case management, inadequate utilization of drugs to prevent malaria, and inadequate epidemic preparedness and response. Despite these challenges, prospects for the control of malaria have improved, and with attention to underlying challenges, progress toward the control of malaria in Uganda can be expected. PMID:21420377

Seven challenges for modelling indirect transmission: Vector-borne diseases, macroparasites and neglected tropical diseases

PubMed Central

Hollingsworth, T. Déirdre; Pulliam, Juliet R.C.; Funk, Sebastian; Truscott, James E.; Isham, Valerie; Lloyd, Alun L.

2015-01-01

Many of the challenges which face modellers of directly transmitted pathogens also arise when modelling the epidemiology of pathogens with indirect transmission – whether through environmental stages, vectors, intermediate hosts or multiple hosts. In particular, understanding the roles of different hosts, how to measure contact and infection patterns, heterogeneities in contact rates, and the dynamics close to elimination are all relevant challenges, regardless of the mode of transmission. However, there remain a number of challenges that are specific and unique to modelling vector-borne diseases and macroparasites. Moreover, many of the neglected tropical diseases which are currently targeted for control and elimination are vector-borne, macroparasitic, or both, and so this article includes challenges which will assist in accelerating the control of these high-burden diseases. Here, we discuss the challenges of indirect measures of infection in humans, whether through vectors or transmission life stages and in estimating the contribution of different host groups to transmission. We also discuss the issues of “evolution-proof” interventions against vector-borne disease. PMID:25843376

Seven challenges for modelling indirect transmission: vector-borne diseases, macroparasites and neglected tropical diseases.

PubMed

Hollingsworth, T Déirdre; Pulliam, Juliet R C; Funk, Sebastian; Truscott, James E; Isham, Valerie; Lloyd, Alun L

2015-03-01

Many of the challenges which face modellers of directly transmitted pathogens also arise when modelling the epidemiology of pathogens with indirect transmission--whether through environmental stages, vectors, intermediate hosts or multiple hosts. In particular, understanding the roles of different hosts, how to measure contact and infection patterns, heterogeneities in contact rates, and the dynamics close to elimination are all relevant challenges, regardless of the mode of transmission. However, there remain a number of challenges that are specific and unique to modelling vector-borne diseases and macroparasites. Moreover, many of the neglected tropical diseases which are currently targeted for control and elimination are vector-borne, macroparasitic, or both, and so this article includes challenges which will assist in accelerating the control of these high-burden diseases. Here, we discuss the challenges of indirect measures of infection in humans, whether through vectors or transmission life stages and in estimating the contribution of different host groups to transmission. We also discuss the issues of "evolution-proof" interventions against vector-borne disease. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Big data are coming to psychiatry: a general introduction.

PubMed

Monteith, Scott; Glenn, Tasha; Geddes, John; Bauer, Michael

2015-12-01

Big data are coming to the study of bipolar disorder and all of psychiatry. Data are coming from providers and payers (including EMR, imaging, insurance claims and pharmacy data), from omics (genomic, proteomic, and metabolomic data), and from patients and non-providers (data from smart phone and Internet activities, sensors and monitoring tools). Analysis of the big data will provide unprecedented opportunities for exploration, descriptive observation, hypothesis generation, and prediction, and the results of big data studies will be incorporated into clinical practice. Technical challenges remain in the quality, analysis and management of big data. This paper discusses some of the fundamental opportunities and challenges of big data for psychiatry.

Challenges Encountered by Vietnamese Nurses When Caring for Patients With Cancer.

PubMed

Thuy Nguyen, Ly; Clemenceau Annoussamy, Lourdes; LeBaron, Virginia T

2017-03-01

Providing holistic care is acknowledged as central to providing quality care for patients with cancer, but providing competent nursing care consistent with these approaches remains a challenge for nurses in Vietnam. Obstacles for Vietnamese oncology nurses include their low status, the limited scope of nursing practice, work overload in a hierarchical system, and cultural beliefs that view death and dying as taboo. Additional research to support oncology nurses in Vietnam must acknowledge the merits of improving nursing education as an important strategy for enhancing nursing autonomy, quality of care, and outcomes for the increasing number of patients with cancer in low- and middle-income countries.

Anorectal injury in pelvic blast.

PubMed

Brogden, Tom G; Garner, J P

2013-03-01

The signature injury of the Afghanistan campaign has, amongst other things, included an increased incidence of destructive anorectal injury. There is no significant body of evidence about this type of injury on which to base management strategies. This review examines the historical military data, later civilian reports, many of which have challenged the military dogmas of Vietnam, and the spartan contemporaneous military data which does not particularly address pelviperineal blast injury. There is no evidence to support a move away from the doctrine of the four D's (diversion, distal washout, drainage and direct repair), but sound surgical judgement remains the mainstay of managing these challenging and highly morbid injuries.

Overcoming Challenges to Childhood Immunizations Status.

PubMed

Sabnis, Svapna S; Conway, James H

2015-10-01

Vaccines are one of the greatest public health achievements, preventing both mortality and morbidity. However, overall immunization rates are still below the 90% target for Healthy People 2020. There remain significant disparities in immunization rates between children of different racial/ethnic groups, as well as among economically disadvantaged populations. There are systemic issues and challenges in providing access to immunization opportunities. In addition, vaccine hesitancy contributes to underimmunization. Multiple strategies are needed to improve immunization rates, including improving access to vaccines and minimizing financial barriers to families. Vaccine status should be assessed and vaccines given at all possible opportunities. Copyright © 2015 Elsevier Inc. All rights reserved.

Native and Reconstituted Plasma Lipoproteins in Nanomedicine: Physicochemical Determinants of Nanoparticle Structure, Stability, and Metabolism

PubMed Central

Pownall, Henry J.; Rosales, Corina; Gillard, Baiba K.; Ferrari, Mauro

2016-01-01

Although many acute and chronic diseases are managed via pharmacological means, challenges remain regarding appropriate drug targeting and maintenance of therapeutic levels within target tissues. Advances in nanotechnology will overcome these challenges through the development of lipidic particles, including liposomes, lipoproteins, and reconstituted high-density lipoproteins (rHDL) that are potential carriers of water-soluble, hydrophobic, and amphiphilic molecules. Herein we summarize the properties of human plasma lipoproteins and rHDL, identify the physicochemical determinants of lipid transfer between phospholipid surfaces, and discuss strategies for increasing the plasma half-life of lipoprotein- and liposome-associated molecules. PMID:27826368

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

PubMed

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

2015-10-01

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

Psychiatric epidemiology: selected recent advances and future directions.

PubMed Central

Kessler, R. C.

2000-01-01

Reviewed in this article are selected recent advances and future challenges for psychiatric epidemiology. Major advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalences and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and programme planning. Advances in analytical and experimental epidemiology have been more modest. A major challenge is for psychiatric epidemiologists to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations. PMID:10885165

Therapeutic and diagnostic challenges for frontotemporal dementia

PubMed Central

D’Alton, Simon; Lewis, Jada

2014-01-01

In the search for therapeutic modifiers, frontotemporal dementia (FTD) has traditionally been overshadowed by other conditions such as Alzheimer’s disease (AD). A clinically and pathologically diverse condition, FTD has been galvanized by a number of recent discoveries such as novel genetic variants in familial and sporadic forms of disease and the identification of TAR DNA binding protein of 43 kDa (TDP-43) as the defining constituent of inclusions in more than half of cases. In combination with an ever-expanding knowledge of the function and dysfunction of tau—a protein which is pathologically aggregated in the majority of the remaining cases—there exists a greater understanding of FTD than ever before. These advances may indicate potential approaches for the development of hypothetical therapeutics, but FTD remains highly complex and the roles of tau and TDP-43 in neurodegeneration are still wholly unclear. Here the challenges facing potential therapeutic strategies are discussed, which include sufficiently accurate disease diagnosis and sophisticated technology to deliver effective therapies. PMID:25191265

Review of geochemical reference sample programs since G-1 and W-1: progress to date and remaining challenges

USGS Publications Warehouse

Kane, J.S.

1991-01-01

A brief history of programs to develop geochemical reference samples and certified reference samples for use in geochemical analysis is presented. While progress has been made since G-1 and W-1 were issued, many challenges remain. ?? 1991.

Improving on Army Field Gauze for Lethal Vascular Injuries: Challenges in Dressing Development

USDA-ARS?s Scientific Manuscript database

Accounting for half of all deaths, uncontrolled hemorrhage remains the leading cause of death on the battlefield. Gaining hemostatic control of lethal vascular injuries sustained in combat using topical agents remains a challenge. Recent animal testing using a lethal arterial injury model compared a...

Current state and challenges in developing oral vaccines.

PubMed

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

2017-05-15

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

The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms

PubMed Central

Barrett, Frederick S.; Bradstreet, Matthew P.; Leoutsakos, Jeannie-Marie S.; Johnson, Matthew W.; Griffiths, Roland R.

2017-01-01

Acute adverse psychological reactions to classic hallucinogens (“bad trips”, or “challenging experiences”), while usually benign with proper screening, preparation, and support in controlled settings, remain a safety concern in uncontrolled settings (such as illicit use contexts). Anecdotal and case reports suggest potential adverse acute symptoms including affective (panic, depressed mood), cognitive (confusion, feelings of losing sanity), and somatic (nausea, heart palpitation) symptoms. Responses to items from several hallucinogen-sensitive questionnaires (Hallucinogen Rating Scale, the States of Consciousness Questionnaire, and the 5-Dimensional Altered States of Consciousness questionnaire) in an internet survey of challenging experiences with the classic hallucinogen psilocybin were used to construct and validate a Challenging Experience Questionnaire (CEQ). The stand-alone CEQ was then validated in a separate sample. Seven CEQ factors (grief, fear, death, insanity, isolation, physical distress, and paranoia) provide a phenomenological profile of challenging aspects of experiences with psilocybin. Factor scores were associated with the difficulty, meaningfulness, spiritual significance, and change in well-being attributed to the challenging experiences. The factor structure did not differ based on gender or prior struggle with anxiety or depression. The CEQ provides a basis for future investigation of predictors and outcomes of challenging experiences with psilocybin, and should be explored as a measure of challenging experiences with the broad class of classic hallucinogens. PMID:27856683

Contrasting selected reproductive challenges of today with those of antiquity—the past is prologue

PubMed Central

Jones, Christopher A.; Sills, Eric Scott

2013-01-01

Viewing human history through a medical lens provides a renewed appreciation for today’s vexing reproductive challenges, as some modern dilemmas are actually continuations of similar challenges experienced long ago. Certainly there are many examples of assisted fertility therapy that were entirely theoretical only a generation ago, but have become commonplace in modern practice and society. In particular posthumous birth and infertility have, over time, been the focus of compelling social interest, occasionally even impacting national security and dynastic succession. While the concepts have remained static, the tools available to extend and improve reproductive success have changed radically. Appropriately regarded as confidential and private, an individual’s reproductive details are typically impervious to formal study. Yet, archival sources including ancient literature and formal court records can occasionally provide evidence of otherwise deeply personal concerns of a different era. Our assessment finds the issues, worries, and desires of patients of antiquity to align closely with contemporary reproductive challenges. Because children and family have always been central to the human experience, the consequences of reproduction (or the lack thereof) can make substantial imprints upon the cultural, economic, and political landscape—irrespective of civilization or century. In this article, selected motifs are described in a broad historical context to illustrate how challenges of human reproduction have remained essentially unchanged, despite a vast accumulation of knowledge made possible by gains in reproductive science and technology. Plus ça change, plus c’est la même chose. -Jean-Baptiste Alphonse Karr (1808–1890) PMID:24505149

The Computational Fluid Dynamics Rupture Challenge 2013—Phase I: prediction of rupture status in intracranial aneurysms.

PubMed

Janiga, G; Berg, P; Sugiyama, S; Kono, K; Steinman, D A

2015-03-01

Rupture risk assessment for intracranial aneurysms remains challenging, and risk factors, including wall shear stress, are discussed controversially. The primary purpose of the presented challenge was to determine how consistently aneurysm rupture status and rupture site could be identified on the basis of computational fluid dynamics. Two geometrically similar MCA aneurysms were selected, 1 ruptured, 1 unruptured. Participating computational fluid dynamics groups were blinded as to which case was ruptured. Participants were provided with digitally segmented lumen geometries and, for this phase of the challenge, were free to choose their own flow rates, blood rheologies, and so forth. Participants were asked to report which case had ruptured and the likely site of rupture. In parallel, lumen geometries were provided to a group of neurosurgeons for their predictions of rupture status and site. Of 26 participating computational fluid dynamics groups, 21 (81%) correctly identified the ruptured case. Although the known rupture site was associated with low and oscillatory wall shear stress, most groups identified other sites, some of which also experienced low and oscillatory shear. Of the 43 participating neurosurgeons, 39 (91%) identified the ruptured case. None correctly identified the rupture site. Geometric or hemodynamic considerations favor identification of rupture status; however, retrospective identification of the rupture site remains a challenge for both engineers and clinicians. A more precise understanding of the hemodynamic factors involved in aneurysm wall pathology is likely required for computational fluid dynamics to add value to current clinical decision-making regarding rupture risk. © 2015 by American Journal of Neuroradiology.

Regulatory perspective on remaining challenges for utilization of pharmacogenomics-guided drug developments.

PubMed

Otsubo, Yasuto; Ishiguro, Akihiro; Uyama, Yoshiaki

2013-01-01

Pharmacogenomics-guided drug development has been implemented in practice in the last decade, resulting in increased labeling of drugs with pharmacogenomic information. However, there are still many challenges remaining in utilizing this process. Here, we describe such remaining challenges from the regulatory perspective, specifically focusing on sample collection, biomarker qualification, ethnic factors, codevelopment of companion diagnostics and means to provide drugs for off-target patients. To improve the situation, it is important to strengthen international harmonization and collaboration among academia, industries and regulatory agencies, followed by the establishment of an international guideline on this topic. Communication with a regulatory agency from an early stage of drug development is also a key to success.

Aneurysms of the petrous internal carotid artery: anatomy, origins, and treatment.

PubMed

Liu, James K; Gottfried, Oren N; Amini, Amin; Couldwell, William T

2004-11-15

Aneurysms arising in the petrous segment of the internal carotid artery (ICA) are rare. Although the causes of petrous ICA aneurysms remain unclear, traumatic, infectious, and congenital origins have been implicated in their development. These lesions can be detected incidentally on routine neuroimaging. Patients can also present with a wide spectrum of signs and symptoms, including cranial nerve palsies, Horner syndrome, pulsatile tinnitus, epistaxis, and otorrhagia. The treatment of petrous ICA aneurysms remains challenging. Treatment options include close observation, endovascular therapies, and surgical trapping with or without revascularization. Management dilemmas exist, particularly for incidental lesions found in asymptomatic patients. The authors review the literature and discuss the anatomy of the petrous ICA as well as the pathophysiological features of aneurysms arising in this region, and they propose a management paradigm with current treatment options.

Detecting drug-target binding in cells using fluorescence-activated cell sorting coupled with mass spectrometry analysis.

PubMed

Wilson, Kris; Webster, Scott P; Iredale, John P; Zheng, Xiaozhong; Homer, Natalie Z; Pham, Nhan T; Auer, Manfred; Mole, Damian J

2017-12-15

The assessment of drug-target engagement for determining the efficacy of a compound inside cells remains challenging, particularly for difficult target proteins. Existing techniques are more suited to soluble protein targets. Difficult target proteins include those with challenging in vitro solubility, stability or purification properties that preclude target isolation. Here, we report a novel technique that measures intracellular compound-target complex formation, as well as cellular permeability, specificity and cytotoxicity-the toxicity-affinity-permeability-selectivity (TAPS) technique. The TAPS assay is exemplified here using human kynurenine 3-monooxygenase (KMO), a challenging intracellular membrane protein target of significant current interest. TAPS confirmed target binding of known KMO inhibitors inside cells. We conclude that the TAPS assay can be used to facilitate intracellular hit validation on most, if not all intracellular drug targets.

Detecting drug-target binding in cells using fluorescence-activated cell sorting coupled with mass spectrometry analysis

NASA Astrophysics Data System (ADS)

Wilson, Kris; Webster, Scott P.; Iredale, John P.; Zheng, Xiaozhong; Homer, Natalie Z.; Pham, Nhan T.; Auer, Manfred; Mole, Damian J.

2018-01-01

The assessment of drug-target engagement for determining the efficacy of a compound inside cells remains challenging, particularly for difficult target proteins. Existing techniques are more suited to soluble protein targets. Difficult target proteins include those with challenging in vitro solubility, stability or purification properties that preclude target isolation. Here, we report a novel technique that measures intracellular compound-target complex formation, as well as cellular permeability, specificity and cytotoxicity-the toxicity-affinity-permeability-selectivity (TAPS) technique. The TAPS assay is exemplified here using human kynurenine 3-monooxygenase (KMO), a challenging intracellular membrane protein target of significant current interest. TAPS confirmed target binding of known KMO inhibitors inside cells. We conclude that the TAPS assay can be used to facilitate intracellular hit validation on most, if not all intracellular drug targets.

Engineering empty space between Si nanoparticles for lithium-ion battery anodes.

PubMed

Wu, Hui; Zheng, Guangyuan; Liu, Nian; Carney, Thomas J; Yang, Yuan; Cui, Yi

2012-02-08

Silicon is a promising high-capacity anode material for lithium-ion batteries yet attaining long cycle life remains a significant challenge due to pulverization of the silicon and unstable solid-electrolyte interphase (SEI) formation during the electrochemical cycles. Despite significant advances in nanostructured Si electrodes, challenges including short cycle life and scalability hinder its widespread implementation. To address these challenges, we engineered an empty space between Si nanoparticles by encapsulating them in hollow carbon tubes. The synthesis process used low-cost Si nanoparticles and electrospinning methods, both of which can be easily scaled. The empty space around the Si nanoparticles allowed the electrode to successfully overcome these problems Our anode demonstrated a high gravimetric capacity (~1000 mAh/g based on the total mass) and long cycle life (200 cycles with 90% capacity retention). © 2012 American Chemical Society

Dead Reckoning in the Desert Ant: A Defence of Connectionist Models.

PubMed

Mole, Christopher

2014-01-01

Dead reckoning is a feature of the navigation behaviour shown by several creatures, including the desert ant. Recent work by C. Randy Gallistel shows that some connectionist models of dead reckoning face important challenges. These challenges are thought to arise from essential features of the connectionist approach, and have therefore been taken to show that connectionist models are unable to explain even the most primitive of psychological phenomena. I show that Gallistel's challenges are successfully met by one recent connectionist model, proposed by Ulysses Bernardet, Sergi Bermúdez i Badia, and Paul F.M.J. Verschure. The success of this model suggests that there are ways to implement dead reckoning with neural circuits that fall within the bounds of what many people regard as neurobiologically plausible, and so that the wholesale dismissal of the connectionist modelling project remains premature.

Cardiopulmonary bypass for pediatric cardiac surgery.

PubMed

Hirata, Yasutaka

2018-02-01

The management of cardiopulmonary bypass for pediatric cardiac surgery is more challenging than that in adults due to the smaller size, immaturity, and complexity of the anatomy in children. Despite major improvements in cardiopulmonary bypass, there remain many subjects of debate. This review article discusses the physiology of cardiopulmonary bypass for pediatric and congenital heart surgery, including topics related to hemodilution, hypothermia, acid-base strategies, inflammatory response, and myocardial protection.

Methods of ex vivo expansion of human cord blood cells: challenges, successes and clinical implications.

PubMed

Baron, Frédéric; Ruggeri, Annalisa; Nagler, Arnon

2016-03-01

More than 40,000 unrelated cord blood transplantations (UCBT) have been performed worldwide as treatment for patients with malignant or non-malignant life threatening hematologic disorders. However, low absolute numbers of hematopoietic stem and progenitor cells (HSPCs) within a single cord blood unit has remained a limiting factor for this transplantation modality, particularly in adult recipients. Further, because UCB contains low numbers of mostly naïve T cells, immune recovery after UCBT is slow, predisposing patients to severe infections. Other causes of UCBT failure has included graft-versus-host disease (GVHD) and relapse of the underlying disease. In this article, we first review the current landscape of cord blood engineering aimed at improving engraftment. This includes approaches of UCB-HSPCs expansion and methods aimed at improving UCB-HSCPs homing. We then discuss recent approaches of cord blood engineering developed to prevent infection [generation of multivirus-specific cytotoxic T cells (VSTs) from UCB], relapse [transduction of UCB-T cells with tumor-specific chimeric receptor antigens (CARs)] and GVHD (expansion of regulatory T cells from UCB). Although many of these techniques of UCB engineering remain currently technically challenging and expensive, they are likely to revolutionize the field of UCBT in the next decades.

Integration of existing systematic reviews into new reviews: identification of guidance needs

PubMed Central

2014-01-01

Background An exponential increase in the number of systematic reviews published, and constrained resources for new reviews, means that there is an urgent need for guidance on explicitly and transparently integrating existing reviews into new systematic reviews. The objectives of this paper are: 1) to identify areas where existing guidance may be adopted or adapted, and 2) to suggest areas for future guidance development. Methods We searched documents and websites from healthcare focused systematic review organizations to identify and, where available, to summarize relevant guidance on the use of existing systematic reviews. We conducted informational interviews with members of Evidence-based Practice Centers (EPCs) to gather experiences in integrating existing systematic reviews, including common issues and challenges, as well as potential solutions. Results There was consensus among systematic review organizations and the EPCs about some aspects of incorporating existing systematic reviews into new reviews. Current guidance may be used in assessing the relevance of prior reviews and in scanning references of prior reviews to identify studies for a new review. However, areas of challenge remain. Areas in need of guidance include how to synthesize, grade the strength of, and present bodies of evidence composed of primary studies and existing systematic reviews. For instance, empiric evidence is needed regarding how to quality check data abstraction and when and how to use study-level risk of bias assessments from prior reviews. Conclusions There remain areas of uncertainty for how to integrate existing systematic reviews into new reviews. Methods research and consensus processes among systematic review organizations are needed to develop guidance to address these challenges. PMID:24956937

Critical features of acute stress-induced cross-sensitization identified through the hypothalamic-pituitary-adrenal axis output.

PubMed

Belda, Xavier; Nadal, Roser; Armario, Antonio

2016-08-11

Stress-induced sensitization represents a process whereby prior exposure to severe stressors leaves animals or humans in a hyper-responsive state to further stressors. Indeed, this phenomenon is assumed to be the basis of certain stress-associated pathologies, including post-traumatic stress disorder and psychosis. One biological system particularly prone to sensitization is the hypothalamic-pituitary-adrenal (HPA) axis, the prototypic stress system. It is well established that under certain conditions, prior exposure of animals to acute and chronic (triggering) stressors enhances HPA responses to novel (heterotypic) stressors on subsequent days (e.g. raised plasma ACTH and corticosterone levels). However, such changes remain somewhat controversial and thus, the present study aimed to identify the critical characteristics of the triggering and challenging stressors that affect acute stress-induced HPA cross-sensitization in adult rats. We found that HPA cross-sensitization is markedly influenced by the intensity of the triggering stressor, whereas the length of exposure mainly affects its persistence. Importantly, HPA sensitization is more evident with mild than strong challenging stressors, and it may remain unnoticed if exposure to the challenging stressor is prolonged beyond 15 min. We speculate that heterotypic HPA sensitization might have developed to optimize biologically adaptive responses to further brief stressors.

Critical features of acute stress-induced cross-sensitization identified through the hypothalamic-pituitary-adrenal axis output

PubMed Central

Belda, Xavier; Nadal, Roser; Armario, Antonio

2016-01-01

Stress-induced sensitization represents a process whereby prior exposure to severe stressors leaves animals or humans in a hyper-responsive state to further stressors. Indeed, this phenomenon is assumed to be the basis of certain stress-associated pathologies, including post-traumatic stress disorder and psychosis. One biological system particularly prone to sensitization is the hypothalamic-pituitary-adrenal (HPA) axis, the prototypic stress system. It is well established that under certain conditions, prior exposure of animals to acute and chronic (triggering) stressors enhances HPA responses to novel (heterotypic) stressors on subsequent days (e.g. raised plasma ACTH and corticosterone levels). However, such changes remain somewhat controversial and thus, the present study aimed to identify the critical characteristics of the triggering and challenging stressors that affect acute stress-induced HPA cross-sensitization in adult rats. We found that HPA cross-sensitization is markedly influenced by the intensity of the triggering stressor, whereas the length of exposure mainly affects its persistence. Importantly, HPA sensitization is more evident with mild than strong challenging stressors, and it may remain unnoticed if exposure to the challenging stressor is prolonged beyond 15 min. We speculate that heterotypic HPA sensitization might have developed to optimize biologically adaptive responses to further brief stressors. PMID:27511270

Understanding Shale Gas: Recent Progress and Remaining Challenges

DOE PAGES

Striolo, Alberto; Cole, David R.

2017-08-27

Because of a number of technological advancements, unconventional hydrocarbons, and in particular shale gas, have transformed the US economy. Much is being learned, as demonstrated by the reduced cost of extracting shale gas in the US over the past five years. However, a number of challenges still need to be addressed. Many of these challenges represent grand scientific and technological tasks, overcoming which will have a number of positive impacts, ranging from the reduction of the environmental footprint of shale gas production to improvements and leaps forward in diverse sectors, including chemical manufacturing and catalytic transformations. This review addresses recentmore » advancements in computational and experimental approaches, which led to improved understanding of, in particular, structure and transport of fluids, including hydrocarbons, electrolytes, water, and CO 2 in heterogeneous subsurface rocks such as those typically found in shale formations. Finally, the narrative is concluded with a suggestion of a few research directions that, by synergistically combining computational and experimental advances, could allow us to overcome some of the hurdles that currently hinder the production of hydrocarbons from shale formations.« less

Ethical Issues and Practical Challenges in Suicide Research.

PubMed

Hom, Melanie A; Podlogar, Matthew C; Stanley, Ian H; Joiner, Thomas E

2017-03-01

Research with human subjects represents a critical avenue for suicide prevention efforts; however, such research is not without its ethical and practical challenges. Specifically, given the nature of research with individuals at elevated risk for suicide (e.g., increased concerns regarding participant safety, adverse events, liability, difficulties often arise during the institutional review board (IRB) evaluation and approval process. This paper aims to discuss IRB-related issues associated with suicide prevention research, including researcher and IRB panel member responsibilities, suicide risk assessment and management ethics and procedures, informed consent considerations, preparation of study protocols, and education and training. Points to consider and components to potentially include in an IRB application for suicide-related research are additionally provided. Literature relevant to ethics in suicide research and suicide risk assessment and management was reviewed and synthesized. Suicide research can be conducted in accordance with ethical principles while also furthering the science of suicide prevention. Despite the challenging nature of suicide prevention research, empirically informed solutions exist to address difficulties that may emerge in interfacing with IRBs. There remain areas for improvement in the IRB approval process that warrant further investigation and work.

Assessing Species Diversity Using Metavirome Data: Methods and Challenges.

PubMed

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

2017-01-01

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

Positioning challenges in reconfigurable semi-autonomous robotic NDE inspection

NASA Astrophysics Data System (ADS)

Pierce, S. Gareth; Dobie, Gordon; Summan, Rahul; Mackenzie, Liam; Hensman, James; Worden, Keith; Hayward, Gordon

2010-03-01

This paper describes work conducted into mobile, wireless, semi-autonomous NDE inspection robots developed at The University of Strathclyde as part of the UK Research Centre for Non Destructive Evaluation (RCNDE). The inspection vehicles can incorporate a number of different NDE payloads including ultrasonic, eddy current, visual and magnetic based payloads, and have been developed to try and improve NDE inspection techniques in challenging inspection areas (for example oil, gas, and nuclear structures). A significant research challenge remains in the accurate positioning and guidance of such vehicles for real inspection tasks. Employing both relative and absolute position measurements, we discuss a number of approaches to position estimation including Kalman and particle filtering. Using probabilistic approaches enables a common mathematical framework to be employed for both positioning and data fusion from different NDE sensors. In this fashion the uncertainties in both position and defect identification and classification can be dealt with using a consistent approach. A number of practical constraints and considerations to different precision positioning techniques are discussed, along with NDE applications and the potential for improved inspection capabilities by utilising the inherent reconfigurable capabilities of the inspection vehicles.

Progress and challenges of disaster health management in China: a scoping review

PubMed Central

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2014-01-01

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level). PMID:25215910

Radiation Hardness Assurance (RHA): Challenges and New Considerations

NASA Technical Reports Server (NTRS)

Campola, Michael J.

2017-01-01

Use of commercial-off-the-shelf (COTS) components and emerging technologies often require space flight missions to accept elevated risk. The Radiation Hardness Assurance (RHA) flow includes environment definition, hazard evaluation, requirements definition, evaluation of design, and design trades to accommodate and mitigate the risk a project or program takes. Depending on the mission profile and environment, different missions may not necessarily benefit from the same risk reduction efforts or cost reduction attempts. While this poses challenges for the radiation engineer, it also presents opportunities to tailor the RHA flow to minimize risk based on the environment or design criticality while remaining within budget. This presentation will focus on an approach to RHA amidst the present challenges, using the same RHA flow as in the past, with examples from recent radiation test results. The current challenges and the types of risk will be identified. How these risks drive requirements development and realization will be explained with examples of device results and data for single event effects (SEE) and in one case total ionizing dose (TID).

Implementing the World Report on Disability in West Africa: challenges and opportunities for Ghana.

PubMed

Tuakli-Wosornu, Yetsa A; Haig, Andrew J

2014-01-01

Disability issues have taken a prominent role on international stages in recent years. Beginning with the May 2005 World Health Assembly Resolution 58.23 and culminating in the June 2011 World Bank and World Health Organization World Report on Disability, comprehensive disability analyses from nations at various stages of development can now be accessed and used by relevant stakeholders in health, policy, and aide arenas. The implementation of this landmark report is critical for the advancement of social inclusion in diverse countries, including those with limited resources. However, activating the World Report on Disability in resource-limited countries remains a significant challenge because of threadbare data and cultural, institutional, and physical barriers to social inclusion. This review summarizes current national disability data and describes challenges and opportunities for the implementation of the World Report on Disability in Ghana. As a structural point of departure, the article uses the three broad categories of challenges outlined by the World Health Organization: attitudinal, physical, and institutional.

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

NASA Technical Reports Server (NTRS)

McGuire, Robert E.

2011-01-01

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

Advanced Development of the rF1V and rBV A/B Vaccines: Progress and Challenges

PubMed Central

Hart, Mary Kate; Saviolakis, George A.; Welkos, Susan L.; House, Robert V.

2012-01-01

The development of vaccines for microorganisms and bacterial toxins with the potential to be used as biowarfare and bioterrorism agents is an important component of the US biodefense program. DVC is developing two vaccines, one against inhalational exposure to botulinum neurotoxins A1 and B1 and a second for Yersinia pestis, with the ultimate goal of licensure by the FDA under the Animal Rule. Progress has been made in all technical areas, including manufacturing, nonclinical, and clinical development and testing of the vaccines, and in assay development. The current status of development of these vaccines, and remaining challenges are described in this chapter. PMID:22028978

Non-targeted and delayed effects of exposure to ionizing radiation: I. Radiation-induced genomic instability and bystander effects in vitro

NASA Technical Reports Server (NTRS)

Morgan, William F.

2003-01-01

A long-standing dogma in the radiation sciences is that energy from radiation must be deposited in the cell nucleus to elicit a biological effect. A number of non-targeted, delayed effects of ionizing radiation have been described that challenge this dogma and pose new challenges to evaluating potential hazards associated with radiation exposure. These effects include induced genomic instability and non-targeted bystander effects. The in vitro evidence for non-targeted effects in radiation biology will be reviewed, but the question as to how one extrapolates from these in vitro observations to the risk of radiation-induced adverse health effects such as cancer remains open.

GiniClust: detecting rare cell types from single-cell gene expression data with Gini index.

PubMed

Jiang, Lan; Chen, Huidong; Pinello, Luca; Yuan, Guo-Cheng

2016-07-01

High-throughput single-cell technologies have great potential to discover new cell types; however, it remains challenging to detect rare cell types that are distinct from a large population. We present a novel computational method, called GiniClust, to overcome this challenge. Validation against a benchmark dataset indicates that GiniClust achieves high sensitivity and specificity. Application of GiniClust to public single-cell RNA-seq datasets uncovers previously unrecognized rare cell types, including Zscan4-expressing cells within mouse embryonic stem cells and hemoglobin-expressing cells in the mouse cortex and hippocampus. GiniClust also correctly detects a small number of normal cells that are mixed in a cancer cell population.

Current understanding of the human microbiome.

PubMed

Gilbert, Jack A; Blaser, Martin J; Caporaso, J Gregory; Jansson, Janet K; Lynch, Susan V; Knight, Rob

2018-04-10

Our understanding of the link between the human microbiome and disease, including obesity, inflammatory bowel disease, arthritis and autism, is rapidly expanding. Improvements in the throughput and accuracy of DNA sequencing of the genomes of microbial communities that are associated with human samples, complemented by analysis of transcriptomes, proteomes, metabolomes and immunomes and by mechanistic experiments in model systems, have vastly improved our ability to understand the structure and function of the microbiome in both diseased and healthy states. However, many challenges remain. In this review, we focus on studies in humans to describe these challenges and propose strategies that leverage existing knowledge to move rapidly from correlation to causation and ultimately to translation into therapies.

Challenges of Bystander Intervention in Male-Dominated Professional Sport: Lessons From the Australian Football League.

PubMed

Corboz, Julienne; Flood, Michael; Dyson, Sue

2016-03-01

Programs aimed at preventing violence against women have increasingly adopted bystander approaches, yet large gaps remain in our knowledge about what drives bystanders to act or not, particularly in settings where there is an increased risk of violence against women occurring. This article contributes to this gap by examining data from research with professional male athletes from the Australian Football League. Drawing from a mixed methods approach, including a survey and interviews with football players, we outline some of the challenges to bystander intervention faced by professional athletes and discuss some of the possible similarities and differences between these and other groups of men. © The Author(s) 2015.

Current understanding of the human microbiome

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

Gilbert, Jack A.; Blaser, Martin J.; Caporaso, J. Gregory

Our understanding of the link between the human microbiome and disease, including obesity, inflammatory bowel disease, arthritis and autism, is rapidly expanding. Improvements in the throughput and accuracy of DNA sequencing of the genomes of microbial communities associated with human samples, complemented by analysis of transcriptomes, proteomes, metabolomes and immunomes, and mechanistic experiments in model systems, have vastly improved our ability to understand the structure and function of the microbiome in both diseased and healthy states. However, many challenges remain. In this Review we focus on studies in humans to describe these challenges, and propose strategies that leverage existing knowledgemore » to move rapidly from correlation to causation, and ultimately to translation.« less

Hurdles to clinical translation of human induced pluripotent stem cells

PubMed Central

Neofytou, Evgenios; O’Brien, Connor Galen; Couture, Larry A.; Wu, Joseph C.

2015-01-01

Human pluripotent stem cells are known to have the capacity to renew indefinitely, being intrinsically able to differentiate into many different cell types. These characteristics have generated tremendous enthusiasm about the potential applications of these cells in regenerative medicine. However, major challenges remain with the development and testing of novel experimental stem cell therapeutics in the field. In this Review, we focus on the nature of the preclinical challenges and discuss potential solutions that could help overcome them. Furthermore, we discuss the use of allogeneic versus autologous stem cell products, including a review of their respective advantages and disadvantages, major clinical requirements, quality standards, time lines, and costs of clinical grade development. PMID:26132109

Hurdles to clinical translation of human induced pluripotent stem cells.

PubMed

Neofytou, Evgenios; O'Brien, Connor Galen; Couture, Larry A; Wu, Joseph C

2015-07-01

Human pluripotent stem cells are known to have the capacity to renew indefinitely, being intrinsically able to differentiate into many different cell types. These characteristics have generated tremendous enthusiasm about the potential applications of these cells in regenerative medicine. However, major challenges remain with the development and testing of novel experimental stem cell therapeutics in the field. In this Review, we focus on the nature of the preclinical challenges and discuss potential solutions that could help overcome them. Furthermore, we discuss the use of allogeneic versus autologous stem cell products, including a review of their respective advantages and disadvantages, major clinical requirements, quality standards, time lines, and costs of clinical grade development.

Disease management for chronically ill beneficiaries in traditional Medicare.

PubMed

Bott, David M; Kapp, Mary C; Johnson, Lorraine B; Magno, Linda M

2009-01-01

We summarize the Centers for Medicare and Medicaid Services' (CMS's) experience with disease management (DM) in fee-for-service Medicare. Since 1999, the CMS has conducted seven DM demonstrations involving some 300,000 beneficiaries in thirty-five programs. Programs include provider-based, third-party, and hybrid models. Reducing costs sufficient to cover program fees has proved particularly challenging. Final evaluations on twenty programs found three with evidence of quality improvement at or near budget-neutrality, net of fees. Interim monitoring covering at least twenty-one months on the remaining fifteen programs suggests that four are close to covering their fees. Characteristics of the traditional Medicare program present a challenge to these DM models.

Microfluidic technology for molecular diagnostics.

PubMed

Robinson, Tom; Dittrich, Petra S

2013-01-01

Molecular diagnostics have helped to improve the lives of millions of patients worldwide by allowing clinicians to diagnose patients earlier as well as providing better ongoing therapies. Point-of-care (POC) testing can bring these laboratory-based techniques to the patient in a home setting or to remote settings in the developing world. However, despite substantial progress in the field, there still remain many challenges. Progress in molecular diagnostics has benefitted greatly from microfluidic technology. This chapter aims to summarise the more recent advances in microfluidic-based molecular diagnostics. Sections include an introduction to microfluidic technology, the challenges of molecular diagnostics, how microfluidic advances are working to solve these issues, some alternative design approaches, and detection within these systems.

Inhalation delivery of protein therapeutics.

PubMed

Kane, Colleen; O'Neil, Karyn; Conk, Michelle; Picha, Kristen

2013-04-01

Inhaled therapeutics are used routinely to treat a variety of pulmonary diseases including asthma, COPD and cystic fibrosis. In addition, biological therapies represent the fastest growing segment of approved pharmaceuticals. However, despite the increased availability of biological therapies, nearly all inhaled therapeutics are small molecule drugs with only a single inhaled protein therapeutic approved. There remains a significant unmet need for therapeutics in pulmonary diseases, and biological therapies with potential to alter disease progression represent a significant opportunity to treat these challenging diseases. This review provides a background into efforts to develop inhaled biological therapies and highlights some of the associated challenges. In addition, we speculate on the ideal properties of a biologic therapy for inhaled delivery.

Materials for solar fuels and chemicals.

PubMed

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

2016-12-20

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

Synergistic Effects of Chinese Herbal Medicine: A Comprehensive Review of Methodology and Current Research

PubMed Central

Zhou, Xian; Seto, Sai Wang; Chang, Dennis; Kiat, Hosen; Razmovski-Naumovski, Valentina; Chan, Kelvin; Bensoussan, Alan

2016-01-01

Traditional Chinese medicine (TCM) is an important part of primary health care in Asian countries that has utilized complex herbal formulations (consisting 2 or more medicinal herbs) for treating diseases over thousands of years. There seems to be a general assumption that the synergistic therapeutic effects of Chinese herbal medicine (CHM) derive from the complex interactions between the multiple bioactive components within the herbs and/or herbal formulations. However, evidence to support these synergistic effects remains weak and controversial due to several reasons, including the very complex nature of CHM, misconceptions about synergy and methodological challenges to study design. In this review, we clarify the definition of synergy, identify common errors in synergy research and describe current methodological approaches to test for synergistic interaction. We discuss the strengths and weaknesses of these models in the context of CHM and summarize the current status of synergy research in CHM. Despite the availability of some scientific data to support the synergistic effects of multi-herbal and/or herb-drug combinations, the level of evidence remains low, and the clinical relevancy of most of these findings is undetermined. There remain significant challenges in the development of suitable methods for synergistic studies of complex herbal combinations. PMID:27462269

Tackling tuberculosis: Insights from an international TB Summit in London

PubMed Central

Maitra, Arundhati; Danquah, Cynthia A; Scotti, Francesca; Howard, Tracey K; Kamil, Tengku K; Bhakta, Sanjib

2015-01-01

Tuberculosis (TB) poses a grave predicament to the world as it is not merely a scientific challenge but a socio-economic burden as well. A prime cause of mortality in human due to an infectious disease; the malady and its cause, Mycobacterium tuberculosis have remained an enigma with many questions that remain unanswered. The ability of the pathogen to survive and switch between varied physiological states necessitates a protracted therapeutic regimen that exerts an excessive strain on low-resource countries. To complicate things further, there has been a significant rise of antimicrobial resistance. Existing control measures, including treatment regimens have remained fairly uniform globally for at least half a century and require reinvention. Overcoming the societal and scientific challenges requires an increase in dialog to identify key regions that need attention and effective partners with whom successful collaborations can be fostered. In this report, we explore the discussions held at the International TB Summit 2015 hosted by EuroSciCon, which served as an excellent platform for researchers to share their recent findings. Ground-breaking results require outreach to affect policy design, governance and control of the disease. Hence, we feel it is important that meetings such as these reach a wider, global audience. PMID:26151309

An Empirical Investigation of Pre-Project Partnering Activities on Project Performance in the Software Industry

ERIC Educational Resources Information Center

Proffitt, Curtis K.

2012-01-01

Project failure remains a challenge within the software development field especially during the early stages of the IT project development. Despite the herculean efforts by project managers and organizations to identify and offset problems, projects remain plagued with issues. If these challenges are not mitigated, to a successful degree,…

Human Papillomavirus Vaccination Requirements in US Schools: Recommendations for Moving Forward.

PubMed

North, Anna L; Niccolai, Linda M

2016-10-01

Safe and effective human papillomavirus (HPV) vaccines have been available and recommended for adolescents for a decade in the United States, yet vaccination rates remain suboptimal. School entry requirements have increased uptake of other vaccines for adolescents and made coverage more equitable. However, only 3 jurisdictions require HPV vaccine for school. We summarize the current status of HPV vaccine requirements and discuss the rationales for and against these policies. The rationales for requirements include HPV vaccine efficacy and safety, effectiveness of requirements for increasing vaccine uptake and making it more equitable, and use of requirements as "safety nets" and to achieve herd immunity. The rationales against requirements include low parental acceptance of HPV vaccine, the financial burden on educational systems and health departments, and the possibility for alternatives to increase vaccine uptake. Many challenges to HPV vaccine requirements are addressable, and we conclude with recommendations on how to approach these challenges.

The Shigella human challenge model.

PubMed

Porter, C K; Thura, N; Ranallo, R T; Riddle, M S

2013-02-01

Shigella is an important bacterial cause of infectious diarrhoea globally. The Shigella human challenge model has been used since 1946 for a variety of objectives including understanding disease pathogenesis, human immune responses and allowing for an early assessment of vaccine efficacy. A systematic review of the literature regarding experimental shigellosis in human subjects was conducted. Summative estimates were calculated by strain and dose. While a total of 19 studies evaluating nine strains at doses ranging from 10 to 1 × 1010 colony-forming units were identified, most studies utilized the S. sonnei strain 53G and the S. flexneri strain 2457T. Inoculum solution and pre-inoculation buffering has varied over time although diarrhoea attack rates do not appear to increase above 75-80%, and dysentery rates remain fairly constant, highlighting the need for additional dose-ranging studies. Expansion of the model to include additional strains from different serotypes will elucidate serotype and strain-specific outcome variability.

Catalog of 174 Binary Black Hole Simulations for Gravitational Wave Astronomy

NASA Astrophysics Data System (ADS)

Mroué, Abdul H.; Scheel, Mark A.; Szilágyi, Béla; Pfeiffer, Harald P.; Boyle, Michael; Hemberger, Daniel A.; Kidder, Lawrence E.; Lovelace, Geoffrey; Ossokine, Serguei; Taylor, Nicholas W.; Zenginoğlu, Anıl; Buchman, Luisa T.; Chu, Tony; Foley, Evan; Giesler, Matthew; Owen, Robert; Teukolsky, Saul A.

2013-12-01

This Letter presents a publicly available catalog of 174 numerical binary black hole simulations following up to 35 orbits. The catalog includes 91 precessing binaries, mass ratios up to 8∶1, orbital eccentricities from a few percent to 10-5, black hole spins up to 98% of the theoretical maximum, and radiated energies up to 11.1% of the initial mass. We establish remarkably good agreement with post-Newtonian precession of orbital and spin directions for two new precessing simulations, and we discuss other applications of this catalog. Formidable challenges remain: e.g., precession complicates the connection of numerical and approximate analytical waveforms, and vast regions of the parameter space remain unexplored.

Update on Islet Transplantation

PubMed Central

McCall, Michael; James Shapiro, A.M.

2012-01-01

Clinical islet transplantation has progressed considerably over the past 12 years, and >750 patients with type 1 diabetes have received islet transplants internationally over this time. Many countries are beginning to accept the transition from research to accepted and funded clinical care, especially for patients with brittle control that cannot be stabilized by more conventional means. Major challenges remain, including the need for more than one donor, and the requirement for potent, chronic immunosuppression. Combining immunological tolerance both to allo- and autoantigens, and a limitless expandable source of stem cell- or xenograft-derived insulin-secreting cells represent remaining hurdles in moving this effective treatment to a potential cure for all those with type 1 or 2 diabetes. PMID:22762022

Catalog of 174 binary black hole simulations for gravitational wave astronomy.

PubMed

Mroué, Abdul H; Scheel, Mark A; Szilágyi, Béla; Pfeiffer, Harald P; Boyle, Michael; Hemberger, Daniel A; Kidder, Lawrence E; Lovelace, Geoffrey; Ossokine, Serguei; Taylor, Nicholas W; Zenginoğlu, Anıl; Buchman, Luisa T; Chu, Tony; Foley, Evan; Giesler, Matthew; Owen, Robert; Teukolsky, Saul A

2013-12-13

This Letter presents a publicly available catalog of 174 numerical binary black hole simulations following up to 35 orbits. The catalog includes 91 precessing binaries, mass ratios up to 8∶1, orbital eccentricities from a few percent to 10(-5), black hole spins up to 98% of the theoretical maximum, and radiated energies up to 11.1% of the initial mass. We establish remarkably good agreement with post-Newtonian precession of orbital and spin directions for two new precessing simulations, and we discuss other applications of this catalog. Formidable challenges remain: e.g., precession complicates the connection of numerical and approximate analytical waveforms, and vast regions of the parameter space remain unexplored.

The Lenfest Ocean Program's experience in building institutional support for connecting science and decision-making in marine systems

NASA Astrophysics Data System (ADS)

Bednarek, A.; Close, S.; Curran, K.; Hudson, C.

2017-12-01

Addressing contemporary sustainability challenges requires attention to the integration of scientific knowledge into decision-making and deliberation. However, this remains a challenge in practice. We contend that careful stewardship of this process of integration can result in positive, durable outcomes by reconciling the production and use of scientific knowledge, and improve its relevance and utility to decision-makers. We will share lessons learned from a grantmaking program that has addressed this challenge through programmatic innovations, including by supporting staff devoted to an intermediary role. Over the past 13 years, the Lenfest Ocean Program served in a boundary spanning role by integrating decision-makers into the scoping and outreach of program supported scientific research grants. Program staff engage with decision-makers and influencers to identify policy-relevant research questions and approaches, ensuring that the research direction addresses users' needs. As research progresses, the staff monitor the grant's progress to improve the match between the research and user needs. The process is resource-intensive, however, and raises interesting questions about the role and development of this kind of specialist within different kinds of institutions, including funding agencies. We suggest that nurturing this role as a practice and profession could ultimately help the scientific community more efficiently respond to sustainability challenges.

Challenges to recruitment and retention of African Americans in the gene-environment trial of response to dietary interventions (GET READI) for heart health

PubMed Central

Kennedy, Betty M.; Harsha, David W.; Bookman, Ebony B.; Hill, Yolanda R.; Rankinen, Tuomo; Rodarte, Ruben Q.; Murla, Connie D.

2011-01-01

In this paper, challenges to recruiting African Americans specifically for a dietary feeding trial are examined, learning experiences gained and suggestions to overcome these challenges in future trials are discussed. A total of 333 individuals were randomized in the trial and 234 (167 sibling pairs and 67 parents/siblings) completed the dietary intervention and required DNA blood sampling for genetic analysis. The trial used multiple strategies for recruitment. Hand distributed letters and flyers through mass distribution at various churches resulted in the largest number (n = 153, 46%) of African Americans in the trial. Word of mouth accounted for the second largest number (n = 120, 36%) and included prior study participants. These two recruitment sources represented 82% (n = 273) of the total number of individuals randomized in GET READI. The remaining 18% (n = 60) consisted of a combination of sources including printed message on check stubs, newspaper articles, radio and TV appearances, screening events and presentations. Though challenging, the recruitment efforts for GET READI produced a significant number of African American participants despite the inability to complete the trial as planned because of low recruitment yields. Nevertheless, the recruitment process produced substantial numbers that successfully completed all study requirements. PMID:21865154

Repatriation of human remains following death in international travellers.

PubMed

Connolly, Ruairi; Prendiville, Richard; Cusack, Denis; Flaherty, Gerard

2017-03-01

Death during international travel and the repatriation of human remains to one's home country is a distressing and expensive process. Much organization is required involving close liaison between various agencies. A review of the literature was conducted using the PubMed database. Search terms included: 'repatriation of remains', 'death', 'abroad', 'tourism', 'travel', 'travellers', 'travelling' and 'repatriation'. Additional articles were obtained from grey literature sources and reference lists. The local national embassy, travel insurance broker and tour operator are important sources of information to facilitate the repatriation of the deceased traveller. Formal identification of the deceased's remains is required and a funeral director must be appointed. Following this, the coroner in the country or jurisdiction receiving the repatriated remains will require a number of documents prior to providing clearance for burial. Costs involved in repatriating remains must be borne by the family of the deceased although travel insurance may help defray some of the costs. If the death is secondary to an infectious disease, cremation at the site of death is preferred. No standardized procedure is in place to deal with the remains of a migrant's body at present and these remains are often not repatriated to their country of origin. Repatriation of human remains is a difficult task which is emotionally challenging for the bereaving family and friends. As a travel medicine practitioner, it is prudent to discuss all eventualities, including the risk of death, during the pre-travel consultation. Awareness of the procedures involved in this process may ease the burden on the grieving family at a difficult time. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Green tribology: principles, research areas and challenges.

PubMed

Nosonovsky, Michael; Bhushan, Bharat

2010-10-28

In this introductory paper for the Theme Issue on green tribology, we discuss the concept of green tribology and its relation to other areas of tribology as well as other 'green' disciplines, namely, green engineering and green chemistry. We formulate the 12 principles of green tribology: the minimization of (i) friction and (ii) wear, (iii) the reduction or complete elimination of lubrication, including self-lubrication, (iv) natural and (v) biodegradable lubrication, (vi) using sustainable chemistry and engineering principles, (vii) biomimetic approaches, (viii) surface texturing, (ix) environmental implications of coatings, (x) real-time monitoring, (xi) design for degradation, and (xii) sustainable energy applications. We further define three areas of green tribology: (i) biomimetics for tribological applications, (ii) environment-friendly lubrication, and (iii) the tribology of renewable-energy application. The integration of these areas remains a primary challenge for this novel area of research. We also discuss the challenges of green tribology and future directions of research.

A Brief Literature Overview of Various Routes to Biorenewable Fuels from Lipids for the National Alliance for Advanced Biofuels and Bio-products (NAABB) Consortium

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

Albrecht, Karl O.; Hallen, Richard T.

2011-03-29

Renewable methods of producing transportation fuels are currently the focus of numerous large research efforts across the globe. Renewable fuel produced from algal lipids is one aspect of this research that could have profound implications on future transportation fuel requirements. However, technical challenges remain in several areas of algal-lipid-based fuels. These challenges include the identification and development of robust and productive algal species as well as extraction methods to recover the produced lipids. Not the least of these technical challenges is the conversion of the algae lipids to fungible fuels. This brief literature review focuses primarily on state-of-the-art “downstream” applicationsmore » of producing fuel from fats and lipids, which can be applied to ongoing research with algae-derived lipids.« less

An experimental comparison of online object-tracking algorithms

NASA Astrophysics Data System (ADS)

Wang, Qing; Chen, Feng; Xu, Wenli; Yang, Ming-Hsuan

2011-09-01

This paper reviews and evaluates several state-of-the-art online object tracking algorithms. Notwithstanding decades of efforts, object tracking remains a challenging problem due to factors such as illumination, pose, scale, deformation, motion blur, noise, and occlusion. To account for appearance change, most recent tracking algorithms focus on robust object representations and effective state prediction. In this paper, we analyze the components of each tracking method and identify their key roles in dealing with specific challenges, thereby shedding light on how to choose and design algorithms for different situations. We compare state-of-the-art online tracking methods including the IVT,1 VRT,2 FragT,3 BoostT,4 SemiT,5 BeSemiT,6 L1T,7 MILT,8 VTD9 and TLD10 algorithms on numerous challenging sequences, and evaluate them with different performance metrics. The qualitative and quantitative comparative results demonstrate the strength and weakness of these algorithms.

Challenges and opportunities for meningococcal vaccination in the developing world.

PubMed

Shaker, Rouba; Fayad, Danielle; Dbaibo, Ghassan

2018-05-04

Meningococcal disease continues to be a life threatening infection with high morbidity and mortality even in appropriately treated patients. Meningococcal vaccination plays a major role in the control of the disease; however, implementing vaccination remains problematic in the developing world. The objective of this review is to identify the challenges facing the use of meningococcal vaccines in the developing world in order to discuss the opportunities and available solutions to improve immunization in these countries. Inadequate epidemiologic information necessary to implement vaccination and financial challenges predominate. Multiple measures are needed to achieve the successful implementation of meningococcal conjugate vaccination programs that protect against circulating serogroups in developing countries including enhanced surveillance systems, financial support and aid through grants, product development partnerships that are the end result of effective collaboration and communication between different interdependent stakeholders to develop affordable vaccines, and demonstration of the cost-effectiveness of new meningococcal vaccines.

Sexual Abuse in Cameroon: A Four-Year-Old Girl Victim of Rape in Buea Case Study.

PubMed

Chishugi, John; Franke, Trixy

2016-01-01

A young girl was brought to the emergency unit after suffering sexual abuse by an older male. Additional abuses against women and girls include physical beating, forced marriage, female genital mutilation, breast ironing, widow's rites, psychological abuse, and discrimination in education, finance, employment, and legal access. Cameroon has adopted strategies aimed at eliminating violence against women, including ratification of international policies, penal codes, and support of local and international efforts that promote women; however, many of the laws remain in name only and are rarely enforced, given women's lack of financial access to quality lawyers and an unsympathetic male-dominated police force. Underreporting and culturally accepted abuses remain a challenge, too, as the country seeks to understand the extent of abuses and how to effectively fight against them. A complete paradigm shift in cultural attitude toward the female gender is required for abuses to cease.

[Tissular expansion in giant congenital nevi treatment].

PubMed

Nguyen Van Nuoi, V; Francois-Fiquet, C; Diner, P; Sergent, B; Zazurca, F; Franchi, G; Buis, J; Vazquez, M-P; Picard, A; Kadlub, N

2014-08-01

Surgical management of giant melanotic naevi remains a surgical challenge. Tissue expansion provides tissue of the same quality for the repair of defects. The aim of this study is to review tissular expansion for giant melanotic naevi. We conducted a retrospective study from 2000 to 2012. All children patients who underwent a tissular expansion for giant congenital naevi had been included. Epidemiological data, surgical procedure, complication rate and results had been analysed. Thirty-tree patients had been included; they underwent 61 procedures with 79 tissular-expansion prosthesis. Previous surgery, mostly simple excision had been performed before tissular expansion. Complete naevus excision had been performed in 63.3% of the cases. Complications occurred in 45% of the cases, however in 50% of them were minor. Iterative surgery increased the complication rate. Tissular expansion is a valuable option for giant congenital naevus. However, complication rate remained high, especially when iterative surgery is needed. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Atypical Pneumonia: Updates on Legionella, Chlamydophila, and Mycoplasma Pneumonia.

PubMed

Sharma, Lokesh; Losier, Ashley; Tolbert, Thomas; Dela Cruz, Charles S; Marion, Chad R

2017-03-01

Community-acquired pneumonia (CAP) has multiple causes and is associated with illness that requires admission to the hospital and mortality. The causes of atypical CAP include Legionella species, Chlamydophila, and Mycoplasma. Atypical CAP remains a diagnostic challenge and, therefore, likely is undertreated. This article reviews the advancements in the evaluation and treatment of patients and discusses current conflicts and controversies of atypical CAP. Copyright © 2016 Elsevier Inc. All rights reserved.

Effective grouping for energy and performance: Construction of adaptive, sustainable, and maintainable data storage

NASA Astrophysics Data System (ADS)

Essary, David S.

The performance gap between processors and storage systems has been increasingly critical over the years. Yet the performance disparity remains, and further, storage energy consumption is rapidly becoming a new critical problem. While smarter caching and predictive techniques do much to alleviate this disparity, the problem persists, and data storage remains a growing contributor to latency and energy consumption. Attempts have been made at data layout maintenance, or intelligent physical placement of data, yet in practice, basic heuristics remain predominant. Problems that early studies sought to solve via layout strategies were proven to be NP-Hard, and data layout maintenance today remains more art than science. With unknown potential and a domain inherently full of uncertainty, layout maintenance persists as an area largely untapped by modern systems. But uncertainty in workloads does not imply randomness; access patterns have exhibited repeatable, stable behavior. Predictive information can be gathered, analyzed, and exploited to improve data layouts. Our goal is a dynamic, robust, sustainable predictive engine, aimed at improving existing layouts by replicating data at the storage device level. We present a comprehensive discussion of the design and construction of such a predictive engine, including workload evaluation, where we present and evaluate classical workloads as well as our own highly detailed traces collected over an extended period. We demonstrate significant gains through an initial static grouping mechanism, and compare against an optimal grouping method of our own construction, and further show significant improvement over competing techniques. We also explore and illustrate the challenges faced when moving from static to dynamic (i.e. online) grouping, and provide motivation and solutions for addressing these challenges. These challenges include metadata storage, appropriate predictive collocation, online performance, and physical placement. We reduced the metadata needed by several orders of magnitude, reducing the required volume from more than 14% of total storage down to less than 1/2%. We also demonstrate how our collocation strategies outperform competing techniques. Finally, we present our complete model and evaluate a prototype implementation against real hardware. This model was demonstrated to be capable of reducing device-level accesses by up to 65%. Keywords: computer systems, collocation, data management, file systems, grouping, metadata, modeling and prediction, operating systems, performance, power, secondary storage.

"Finding my own time": examining the spatially produced experiences of rural RNs in the rural nursing certificate program.

PubMed

Place, Jessica; MacLeod, Martha; John, Norma; Adamack, Monica; Lindsey, A Elizabeth

2012-07-01

Rural nurses require access to education that exposes them to the most up-to-date information and skill development. However, since most education opportunities are located in urban centers and focused on providing skills to urban nurses, geography effectively acts as a barrier to accessing education that meets the needs of rural nurses. The Rural Nursing Certificate Program is a post-basic education program that addresses these concerns by providing rural-relevant content online, with limited campus sessions. Does online delivery of rural nursing curriculum overcome challenges related to geography? This study employed surveys with some open-ended questions. Analysis included descriptive statistics and content analysis. Students reported that online delivery improved access. Benefits included not having to relocate; being able to continue working; and, flexibility. Challenges included travel for practical experiences and time management related to staffing shortages, personal-professional overlap and family responsibilities. Online learning improved access to nursing education. However, the realities of rural nursing made it impossible to completely overcome geography: sense of obligation to work overtime, cost and time of traveling to workshops and practicums, uneven access to the Internet and computer services, and distance from peer and university support remained challenges. Copyright © 2011 Elsevier Ltd. All rights reserved.

Materials Genome in Action: Identifying the Performance Limits of Physical Hydrogen Storage

PubMed Central

2017-01-01

The Materials Genome is in action: the molecular codes for millions of materials have been sequenced, predictive models have been developed, and now the challenge of hydrogen storage is targeted. Renewably generated hydrogen is an attractive transportation fuel with zero carbon emissions, but its storage remains a significant challenge. Nanoporous adsorbents have shown promising physical adsorption of hydrogen approaching targeted capacities, but the scope of studies has remained limited. Here the Nanoporous Materials Genome, containing over 850 000 materials, is analyzed with a variety of computational tools to explore the limits of hydrogen storage. Optimal features that maximize net capacity at room temperature include pore sizes of around 6 Å and void fractions of 0.1, while at cryogenic temperatures pore sizes of 10 Å and void fractions of 0.5 are optimal. Our top candidates are found to be commercially attractive as “cryo-adsorbents”, with promising storage capacities at 77 K and 100 bar with 30% enhancement to 40 g/L, a promising alternative to liquefaction at 20 K and compression at 700 bar. PMID:28413259

Materials genome in action: Identifying the performance limits of physical hydrogen storage

DOE PAGES

Thornton, Aaron W.; Simon, Cory M.; Kim, Jihan; ...

2017-03-08

The Materials Genome is in action: the molecular codes for millions of materials have been sequenced, predictive models have been developed, and now the challenge of hydrogen storage is targeted. Renewably generated hydrogen is an attractive transportation fuel with zero carbon emissions, but its storage remains a significant challenge. Nanoporous adsorbents have shown promising physical adsorption of hydrogen approaching targeted capacities, but the scope of studies has remained limited. Here the Nanoporous Materials Genome, containing over 850 000 materials, is analyzed with a variety of computational tools to explore the limits of hydrogen storage. Optimal features that maximize net capacitymore » at room temperature include pore sizes of around 6 Å and void fractions of 0.1, while at cryogenic temperatures pore sizes of 10 Å and void fractions of 0.5 are optimal. Finally, our top candidates are found to be commercially attractive as “cryo-adsorbents”, with promising storage capacities at 77 K and 100 bar with 30% enhancement to 40 g/L, a promising alternative to liquefaction at 20 K and compression at 700 bar.« less

Development of a transmission-blocking malaria vaccine: progress, challenges, and the path forward.

PubMed

Nunes, Julia K; Woods, Colleen; Carter, Terrell; Raphael, Theresa; Morin, Merribeth J; Diallo, Diadier; Leboulleux, Didier; Jain, Sanjay; Loucq, Christian; Kaslow, David C; Birkett, Ashley J

2014-09-29

New interventions are needed to reduce morbidity and mortality associated with malaria, as well as to accelerate elimination and eventual eradication. Interventions that can break the cycle of parasite transmission, and prevent its reintroduction, will be of particular importance in achieving the eradication goal. In this regard, vaccines that interrupt malaria transmission (VIMT) have been highlighted as an important intervention, including transmission-blocking vaccines that prevent human-to-mosquito transmission by targeting the sexual, sporogonic, or mosquito stages of the parasite (SSM-VIMT). While the significant potential of this vaccine approach has been appreciated for decades, the development and licensure pathways for vaccines that target transmission and the incidence of infection, as opposed to prevention of clinical malaria disease, remain ill-defined. This article describes the progress made in critical areas since 2010, highlights key challenges that remain, and outlines important next steps to maximize the potential for SSM-VIMTs to contribute to the broader malaria elimination and eradication objectives. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Chronic hypersensitivity pneumonitis: important considerations in the work-up of this fibrotic lung disease.

PubMed

Glazer, Craig S

2015-03-01

Chronic hypersensitivity pneumonitis is increasingly recognized as an important mimic of other fibrotic lung diseases. This review will summarize recent data regarding the importance and difficulty of determining causative exposures both for accurate diagnosis and prognosis, and describe the expanded pathologic spectrum of the disease, the effects of fibrosis on prognosis and challenges in the diagnostic evaluation. Several recent publications show the potential pathologic patterns induced by chronic hypersensitivity pneumonitis are broader than the classic triad of bronchiolitis, interstitial infiltrates and granulomas. Other pathologic patterns include nonspecific interstitial pneumonia, usual interstitial pneumonia, organizing pneumonia, bronchiolitis and airway centric fibrosis. Detecting a causative antigen in fibrotic hypersensitivity pneumonitis is challenging but critically important both for accurate diagnosis and improved prognosis. The prognosis in hypersensitivity pneumonitis worsens in the presence of fibrosis, but it remains significantly better than idiopathic pulmonary fibrosis. Hypersensitivity pneumonitis is increasingly recognized as an important cause of fibrotic interstitial lung disease. Hypersensitivity pneumonitis demonstrates a remarkable tendency to mimic other idiopathic interstitial pneumonias. A detailed exposure history remains a cornerstone of diagnosis and management.

Materials genome in action: Identifying the performance limits of physical hydrogen storage

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

Thornton, Aaron W.; Simon, Cory M.; Kim, Jihan

The Materials Genome is in action: the molecular codes for millions of materials have been sequenced, predictive models have been developed, and now the challenge of hydrogen storage is targeted. Renewably generated hydrogen is an attractive transportation fuel with zero carbon emissions, but its storage remains a significant challenge. Nanoporous adsorbents have shown promising physical adsorption of hydrogen approaching targeted capacities, but the scope of studies has remained limited. Here the Nanoporous Materials Genome, containing over 850 000 materials, is analyzed with a variety of computational tools to explore the limits of hydrogen storage. Optimal features that maximize net capacitymore » at room temperature include pore sizes of around 6 Å and void fractions of 0.1, while at cryogenic temperatures pore sizes of 10 Å and void fractions of 0.5 are optimal. Finally, our top candidates are found to be commercially attractive as “cryo-adsorbents”, with promising storage capacities at 77 K and 100 bar with 30% enhancement to 40 g/L, a promising alternative to liquefaction at 20 K and compression at 700 bar.« less

Management of intracerebral hemorrhage.

PubMed

Thabet, A M; Kottapally, M; Hemphill, J Claude

2017-01-01

Intracerebral hemorrhage (ICH) is a potentially devastating neurologic injury representing 10-15% of stroke cases in the USA each year. Numerous risk factors, including age, hypertension, male gender, coagulopathy, genetic susceptibility, and ethnic descent, have been identified. Timely identification, workup, and management of this condition remain a challenge for clinicians as numerous factors can present obstacles to achieving good functional outcomes. Several large clinical trials have been conducted over the prior decade regarding medical and surgical interventions. However, no specific treatment has shown a major impact on clinical outcome. Current management guidelines do exist based on medical evidence and consensus and these provide a framework for care. While management of hypertension and coagulopathy are generally considered basic tenets of ICH management, a variety of measures for surgical hematoma evacuation, intracranial pressure control, and intraventricular hemorrhage can be further pursued in the emergent setting for selected patients. The complexity of management in parenchymal cerebral hemorrhage remains challenging and offers many areas for further investigation. A systematic approach to the background, pathology, and early management of spontaneous parenchymal hemorrhage is provided. © 2017 Elsevier B.V. All rights reserved.

Remaining Useful Life Estimation in Prognosis: An Uncertainty Propagation Problem

NASA Technical Reports Server (NTRS)

Sankararaman, Shankar; Goebel, Kai

2013-01-01

The estimation of remaining useful life is significant in the context of prognostics and health monitoring, and the prediction of remaining useful life is essential for online operations and decision-making. However, it is challenging to accurately predict the remaining useful life in practical aerospace applications due to the presence of various uncertainties that affect prognostic calculations, and in turn, render the remaining useful life prediction uncertain. It is challenging to identify and characterize the various sources of uncertainty in prognosis, understand how each of these sources of uncertainty affect the uncertainty in the remaining useful life prediction, and thereby compute the overall uncertainty in the remaining useful life prediction. In order to achieve these goals, this paper proposes that the task of estimating the remaining useful life must be approached as an uncertainty propagation problem. In this context, uncertainty propagation methods which are available in the literature are reviewed, and their applicability to prognostics and health monitoring are discussed.

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations.

PubMed

Zada, Gabriel; Cavallo, Luigi M; Esposito, Felice; Fernandez-Jimenez, Julio Cesar; Tasiou, Anastasia; De Angelis, Michelangelo; Cafiero, Tullio; Cappabianca, Paolo; Laws, Edward R

2010-10-01

In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone-secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed. Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.

Addressing the next challenges: A summary of the 22nd international symposium on hepatitis C virus and related viruses.

PubMed

Baumert, Thomas F; Schuster, Catherine; Cosset, François-Loïc; Dubuisson, Jean; Hofmann, Maike; Tautz, Norbert; Zeisel, Mirjam B; Thimme, Robert

2016-04-01

Following the discovery of the hepatitis C virus (HCV) more than 25 years ago the field has succeeded to develop methods that have changed the safety of blood products, understand the molecular virology, epidemiology and clinical disease of HCV, and identify specific targets for the development of direct-acting antivirals for HCV cure. Nevertheless, major clinical and scientific challenges remain: therapy is still only available to a fraction of infected patients worldwide and many patients remain undiagnosed and/or live in countries where therapy is unattainable. An urgently needed HCV vaccine to eradicate infection remains still elusive. Scientifically, major questions remain regarding the life cycle, pathogenesis and mechanisms of viral clearance and persistence. Addressing these challenges, this meeting report reviews key findings of the 22nd International Symposium on Hepatitis C Virus and Related Viruses in Strasbourg, France from October 9 to 13, 2015. Copyright © 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Clinical decision-making and secondary findings in systems medicine.

PubMed

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

2016-05-21

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

Realization of Configurable One-Dimensional Reflectarray

DTIC Science & Technology

2017-08-31

Maximum 200 words) A fundamental challenge remains in dynamically controlling the steering of long wavelength radiation (λ > 8 μm) using metal... dynamic , nanoribbons 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT: SAR 18. NUMBER OF PAGES 20 19a. NAME OF RESPONSIBLE PERSON...challenge remains in dynamically controlling the steering of long wavelength radiation (λ > 8 μm) using metal nanostructures or metamaterials (with critical

The CRC 20 years: An overview of some of the major achievements and remaining challenges.

PubMed

Doek, Jaap E

2009-11-01

On 20 November 1989, the General Assembly of the United Nations adopted the Convention on the Rights of the Child (CRC). It entered into force on 2 September 1990 and has by now been ratified by 193 States, making the most universally ratified human rights treaty. This overview will present and discuss the impact of this treaty both at the international and the national level, an overview which necessarily has to be limited to some of the developments as a result of the implementation of the CRC. The first part of this paper will be devoted to the impact the CRC had and still has on the setting and development of the international agenda for the promotion and protection of the rights and welfare of children. Special attention will given to developments, achievements, and remaining challenges at the international level with regard to protection of children in armed conflict; prevention and the protection of children from sexual exploitation; and from all forms of violence. This will include some information on the impact of these international developments and actions at the national level, for example, in the area of legislation. The second part will focus on the impact at the national level. Given the wide scope of the CRC this part will be limited to some of the General Measures of Implementation (law reform, national programmes, and independent monitoring) and the General Principles (non-discrimination, best interest, right to be heard) of the CRC. This will be based on reports of States on the implementation of the CRC submitted to the CRC Committee and the Concluding Observations of this Committee and on a number of studies. The conclusion will provide remarks on poverty as one of the major remaining challenges for the implementation of children's rights.

Taking Action on Air Pollution Control in the Beijing-Tianjin-Hebei (BTH) Region: Progress, Challenges and Opportunities

PubMed Central

Wang, Li; Zhang, Fengying; Pilot, Eva; Yu, Jie; Holdaway, Jennifer; Yang, Linsheng; Li, Yonghua; Wang, Wuyi; Vardoulakis, Sotiris; Krafft, Thomas

2018-01-01

Due to rapid urbanization, industrialization and motorization, a large number of Chinese cities are affected by heavy air pollution. In order to explore progress, remaining challenges, and sustainability of air pollution control in the Beijing-Tianjin-Hebei (BTH) region after 2013, a mixed method analysis was undertaken. The quantitative analysis comprised an overview of air quality management in the BTH region. Semi-structured expert interviews were conducted with 12 stakeholders from various levels of government and research institutions who played substantial roles either in decision-making or in research and advising on air pollution control in the BTH region. The results indicated that with the stringent air pollution control policies, the air quality in BTH meets the targets of the Air Pollution Prevention and Control Action Plan. However, improvements vary across the region and for different pollutants. Although implementation has been decisive and was at least in parts effectively enforced, significant challenges remained with regard to industrial and traffic emission control, and national air quality limits continued to be significantly exceeded and competing development interests remained mainly unsolved. There were also concerns about the sustainability of the current air pollution control measures especially for industries due to the top-down enforcement, and the associated large burden of social cost including unemployment and social inequity resulting industrial restructuring. Better mechanisms for ensuring cross-sectoral coordination and for improved central-local government communication were suggested. Further suggestions were provided to improve the conceptual design and effective implementation of respective air pollution control strategies in BTH. Our study highlights some of the major hurdles that need to be addressed to succeed with a comprehensive air pollution control management for the Chinese mega-urban agglomerations. PMID:29425189

Taking Action on Air Pollution Control in the Beijing-Tianjin-Hebei (BTH) Region: Progress, Challenges and Opportunities.

PubMed

Wang, Li; Zhang, Fengying; Pilot, Eva; Yu, Jie; Nie, Chengjing; Holdaway, Jennifer; Yang, Linsheng; Li, Yonghua; Wang, Wuyi; Vardoulakis, Sotiris; Krafft, Thomas

2018-02-09

Due to rapid urbanization, industrialization and motorization, a large number of Chinese cities are affected by heavy air pollution. In order to explore progress, remaining challenges, and sustainability of air pollution control in the Beijing-Tianjin-Hebei (BTH) region after 2013, a mixed method analysis was undertaken. The quantitative analysis comprised an overview of air quality management in the BTH region. Semi-structured expert interviews were conducted with 12 stakeholders from various levels of government and research institutions who played substantial roles either in decision-making or in research and advising on air pollution control in the BTH region. The results indicated that with the stringent air pollution control policies, the air quality in BTH meets the targets of the Air Pollution Prevention and Control Action Plan. However, improvements vary across the region and for different pollutants. Although implementation has been decisive and was at least in parts effectively enforced, significant challenges remained with regard to industrial and traffic emission control, and national air quality limits continued to be significantly exceeded and competing development interests remained mainly unsolved. There were also concerns about the sustainability of the current air pollution control measures especially for industries due to the top-down enforcement, and the associated large burden of social cost including unemployment and social inequity resulting industrial restructuring. Better mechanisms for ensuring cross-sectoral coordination and for improved central-local government communication were suggested. Further suggestions were provided to improve the conceptual design and effective implementation of respective air pollution control strategies in BTH. Our study highlights some of the major hurdles that need to be addressed to succeed with a comprehensive air pollution control management for the Chinese mega-urban agglomerations.

Challenges, health implications, and advocacy opportunities for lesbian, gay, bisexual, and transgender global health providers.

PubMed

Nagata, Jason M

2017-01-01

In this commentary, I reflect on challenges with conducting global health research internationally as a lesbian, gay, bisexual, and transgender (LGBT) person, grapple with decisions related to coming out in regions with anti-LGBT laws, and outline the risks and benefits of different advocacy options related to the promotion of LGBT health globally. Despite significant advances in LGBT rights in many countries, homosexuality remains illegal in many others. Using a critical medical anthropology framework, I argue that anti-LGBT laws constitute structural violence and have many detrimental consequences including discrimination and violence; poorer mental and physical health outcomes; and risky sexual behaviors. As a global health provider, there are many options for the promotion of LGBT health worldwide.

Data science, learning, and applications to biomedical and health sciences.

PubMed

Adam, Nabil R; Wieder, Robert; Ghosh, Debopriya

2017-01-01

The last decade has seen an unprecedented increase in the volume and variety of electronic data related to research and development, health records, and patient self-tracking, collectively referred to as Big Data. Properly harnessed, Big Data can provide insights and drive discovery that will accelerate biomedical advances, improve patient outcomes, and reduce costs. However, the considerable potential of Big Data remains unrealized owing to obstacles including a limited ability to standardize and consolidate data and challenges in sharing data, among a variety of sources, providers, and facilities. Here, we discuss some of these challenges and potential solutions, as well as initiatives that are already underway to take advantage of Big Data. © 2017 New York Academy of Sciences.

Under the sea: microbial life in volcanic oceanic crust.

PubMed

Edwards, Katrina J; Wheat, C Geoffrey; Sylvan, Jason B

2011-09-06

Exploration of the microbiology in igneous, 'hard rock' oceanic crust represents a major scientific frontier. The igneous crust harbours the largest aquifer system on Earth, most of which is hydrologically active, resulting in a substantial exchange of fluids, chemicals and microorganisms between oceanic basins and crustal reservoirs. Study of the deep-subsurface biosphere in the igneous crust is technically challenging. However, technologies have improved over the past decade, providing exciting new opportunities for the study of deep-seated marine life, including in situ and cross-disciplinary experimentation in microbiology, geochemistry and hydrogeology. In this Progress article, we describe the recent advances, available technology and remaining challenges in the study of the marine intraterrestrial microbial life that is harboured in igneous oceanic crust.

Central Role of the Trehalose Biosynthesis Pathway in the Pathogenesis of Human Fungal Infections: Opportunities and Challenges for Therapeutic Development

PubMed Central

Thammahong, Arsa; Puttikamonkul, Srisombat; Perfect, John R.; Brennan, Richard G.

2017-01-01

SUMMARY Invasive fungal infections cause significant morbidity and mortality in part due to a limited antifungal drug arsenal. One therapeutic challenge faced by clinicians is the significant host toxicity associated with antifungal drugs. Another challenge is the fungistatic mechanism of action of some drugs. Consequently, the identification of fungus-specific drug targets essential for fitness in vivo remains a significant goal of medical mycology research. The trehalose biosynthetic pathway is found in a wide variety of organisms, including human-pathogenic fungi, but not in humans. Genes encoding proteins involved in trehalose biosynthesis are mechanistically linked to the metabolism, cell wall homeostasis, stress responses, and virulence of Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus. While there are a number of pathways for trehalose production across the tree of life, the TPS/TPP (trehalose-6-phosphate synthase/trehalose-6-phosphate phosphatase) pathway is the canonical pathway found in human-pathogenic fungi. Importantly, data suggest that proteins involved in trehalose biosynthesis play other critical roles in fungal metabolism and in vivo fitness that remain to be fully elucidated. By further defining the biology and functions of trehalose and its biosynthetic pathway components in pathogenic fungi, an opportunity exists to leverage this pathway as a potent antifungal drug target. The goal of this review is to cover the known roles of this important molecule and its associated biosynthesis-encoding genes in the human-pathogenic fungi studied to date and to employ these data to critically assess the opportunities and challenges facing development of this pathway as a therapeutic target. PMID:28298477

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges

PubMed Central

Singhal, Ayush; Leaman, Robert; Catlett, Natalie; Lemberger, Thomas; McEntyre, Johanna; Polson, Shawn; Xenarios, Ioannis; Arighi, Cecilia; Lu, Zhiyong

2016-01-01

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system ‘accuracy’ remains a challenge and identify several additional common difficulties and potential research directions including (i) the ‘scalability’ issue due to the increasing need of mining information from millions of full-text articles, (ii) the ‘interoperability’ issue of integrating various text-mining systems into existing curation workflows and (iii) the ‘reusability’ issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. Finally, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators. PMID:28025348

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges

DOE PAGES

Singhal, Ayush; Leaman, Robert; Catlett, Natalie; ...

2016-12-26

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system ‘accuracy’ remains a challenge and identify several additional common difficulties and potential research directions including (i) the ‘scalability’ issue due to themore » increasing need of mining information from millions of full-text articles, (ii) the ‘interoperability’ issue of integrating various text-mining systems into existing curation workflows and (iii) the ‘reusability’ issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. In conclusion, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators.« less

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges

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

Singhal, Ayush; Leaman, Robert; Catlett, Natalie

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system ‘accuracy’ remains a challenge and identify several additional common difficulties and potential research directions including (i) the ‘scalability’ issue due to themore » increasing need of mining information from millions of full-text articles, (ii) the ‘interoperability’ issue of integrating various text-mining systems into existing curation workflows and (iii) the ‘reusability’ issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. In conclusion, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators.« less

Employing the Intelligence Cycle Process Model Within the Homeland Security Enterprise

DTIC Science & Technology

2013-12-01

the Iraq anti-war movement, a former U.S. Congresswoman, the U.S. Treasury Department and hip hop bands to spread Sharia law in the U.S. A Virginia...challenges remain with threat notification, access to information, and database management of information that may have contributed the 2013 Boston...The FBI said it took a number of investigative steps to check on the request, including looking at his travel history, checking databases for

Current screening and treatments in retinopathy of prematurity in the US

PubMed Central

Suelves, Ana M; Shulman, Julia P

2016-01-01

Retinopathy of prematurity (ROP) is a complex disease characterized by an aberrant developmental retinal angiogenesis in preterm infants and can carry significant visual morbidity, including retinal detachment and blindness. Though large scale, randomized clinical trials have improved our understanding of the pathophysiology and progression of the disease, the management of ROP remains a challenge for ophthalmologists. This review addresses the up-to-date screening approach, diagnosis, and treatment guidelines for ROP in the US. PMID:28539800

Current screening and treatments in retinopathy of prematurity in the US.

PubMed

Suelves, Ana M; Shulman, Julia P

2016-01-01

Retinopathy of prematurity (ROP) is a complex disease characterized by an aberrant developmental retinal angiogenesis in preterm infants and can carry significant visual morbidity, including retinal detachment and blindness. Though large scale, randomized clinical trials have improved our understanding of the pathophysiology and progression of the disease, the management of ROP remains a challenge for ophthalmologists. This review addresses the up-to-date screening approach, diagnosis, and treatment guidelines for ROP in the US.

NATO and the Challenges of Austerity

DTIC Science & Technology

2012-01-01

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

A qualitative study of health information technology in the Canadian public health system.

PubMed

Zinszer, Kate; Tamblyn, Robyn; Bates, David W; Buckeridge, David L

2013-05-25

Although the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system. A qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Identified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health. The application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy.

Adjunctive Strategies in the Management of Resistant, ‘Undilatable’ Coronary Lesions After Successfully Crossing a CTO with a Guidewire

PubMed Central

Fairley, Sara L.; Spratt, James C.; Rana, Omar; Talwar, Suneel; Hanratty, Colm; Walsh, Simon

2014-01-01

Successful revascularisation of chronic total occlusions (CTOs) remains one of the greatest challenges in the era of contemporary percutaneous coronary intervention (PCI). Such lesions are encountered with increasing frequency in current clinical practice. A predictable increase in the future burden of CTO management can be anticipated given the ageing population, increased rates of renal failure, graft failure and diabetes mellitus. Given recent advances and developments in CTO PCI management, successful recanalisation can be anticipated in the majority of procedures undertaken at high-volume centres when performed by expert operators. Despite advances in device technology, the management of resistant, calcific lesions remains one of the greatest challenges in successful CTO intervention. Established techniques to modify calcific lesions include the use of high-pressure non-compliant balloon dilation, cutting-balloons, anchor balloons and high speed rotational atherectomy (HSRA). Novel approaches have proven to be safe and technically feasible where standard approaches have failed. A step-wise progression of strategies is demonstrated, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. These methods will be described in the setting of clinical examples and include use of very high-pressure non-compliant balloon dilation, intentional balloon rupture with vessel dissection or balloon assisted micro-dissection (BAM), excimer coronary laser atherectomy (ECLA) and use of HSRA in various ‘offlabel’ settings. PMID:24694106

Life Extension Activities for the Hubble Space Telescope

NASA Technical Reports Server (NTRS)

Walyus, Keith D.; Pepe, Joyce A. K.; Prior, Michael

2004-01-01

With the cancellation of the Hubble Space Telescope (HST) Servicing Mission 4 (SM4), the HST Project will face numerous challenges to keep the Telescope operating during the remainder of the decade. As part of the SM4, the HST Project had planned to install various upgrades to the Telescope including the installation of new batteries and new rate integrating gyros. Without these upgrades, reliability analysis indicates that the spacecraft will lose the capability to conduct science operations later this decade. The HST team will be severely challenged to maximize the Telescope's remaining operational lifetime, while still trying to maximize - its science output and quality. Two of the biggest areas of concern are the age and condition of the batteries and gyros. Together they offer the largest potential extension in Telescope lifetime and present the biggest challenges to the HST team. The six Ni-H batteries on HST are the original batteries from launch. With fourteen years of operational life, these batteries have collectively lasted longer than any other comparable mission. Yet as with all batteries, their capacity has been declining. Engineers are examining various methods to prolong the life of these mission critical batteries, and retard the rate of degradation. This paper will focus on these and other efforts to prolong the life of the HST, thus enabling it to remain a world-class observatory for as long as possible.

Molecular signature of pancreatic adenocarcinoma: an insight from genotype to phenotype and challenges for targeted therapy

PubMed Central

Sahin, Ibrahim H; Iacobuzio-Donahue, Christine A; O’Reilly, Eileen M

2016-01-01

Introduction Pancreatic adenocarcinoma remains one of the most clinically challenging cancers despite an in-depth characterization of the molecular underpinnings and biology of this disease. Recent whole-genome-wide studies have elucidated the diverse and complex genetic alterations which generate a unique oncogenic signature for an individual pancreatic cancer patient and which may explain diverse disease behavior in a clinical setting. Areas covered In this review article, we discuss the key oncogenic pathways of pancreatic cancer including RAS-MAPK, PI3KCA and TGF-β signaling, as well as the impact of these pathways on the disease behavior and their potential targetability. The role of tumor suppressors particularly BRCA1 and BRCA2 genes and their role in pancreatic cancer treatment are elaborated upon. We further review recent genomic studies and their impact on future pancreatic cancer treatment. Expert opinion Targeted therapies inhibiting pro-survival pathways have limited impact on pancreatic cancer outcomes. Activation of pro-apoptotic pathways along with suppression of cancer-stem-related pathways may reverse treatment resistance in pancreatic cancer. While targeted therapy or a ‘precision medicine’ approach in pancreatic adenocarcinoma remains an elusive challenge for the majority of patients, there is a real sense of optimism that the strides made in understanding the molecular underpinnings of this disease will translate into improved outcomes. PMID:26439702

New medications for treatment of obesity: metabolic and cardiovascular effects.

PubMed

Pucci, Andrea; Finer, Nicholas

2015-02-01

The management of obesity remains a major challenge. Dietary therapy often fails, whereas bariatric surgery, although successful, is demanding and applicable to a limited number of patients. Drug therapy has had many setbacks over the past 20 years because of serious adverse effects; however, several new drugs for the treatment of obesity are either licensed in some parts of the world, submitted for registration, or completing phase III trials. These include combinations (at low dose) of existing drugs, e.g., bupropion + naltrexone (Contrave), phentermine + topiramate (Qsymia), higher doses of existing drugs licensed for other indications (liraglutide, 3 mg), and new entities (lorcaserin). We discuss the challenges and opportunities for obesity pharmacotherapy and review in detail the efficacy of the new drugs regarding weight loss and both desirable and potential undesirable cardiovascular (CV) and metabolic risk factors. Substantial barriers remain, even if the drugs are approved, in successfully integrating these agents into weight management practice, largely related to cost, patient acceptability, and clinician willingness to be engaged in obesity treatment. Although hard clinical outcome benefit (at least for CV outcomes) has yet to be established, obesity pharmacotherapy may soon address many of the challenges in the clinical management of obesity, although newer and better drug combinations and more evidence of benefit from appropriately designed outcome trials is needed. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Age, sex and (the) race: gender and geriatrics in the ultra-endurance age.

PubMed

Whyte, Greg

2014-01-01

Ultra-endurance challenges were once the stuff of legend isolated to the daring few who were driven to take on some of the greatest physical endurance challenges on the planet. With a growing fascination for major physical challenges during the nineteenth century, the end of the Victorian era witnessed probably the greatest ultra-endurance race of all time; Scott and Amundsen's ill-fated race to the South Pole. Ultra-endurance races continued through the twentieth century; however, these events were isolated to the elite few. In the twenty-first century, mass participation ultra-endurance races have grown in popularity. Endurance races once believed to be at the limit of human durability, i.e. marathon running, are now viewed as middle-distance races with the accolade of true endurance going to those willing to travel significantly further in a single effort or over multiple days. The recent series of papers in Extreme Physiology & Medicine highlights the burgeoning research data from mass participation ultra-endurance events. In support of a true 'mass participation' ethos Knetchtle et al. reported age-related changes in Triple and Deca Iron-ultra-triathlon with an upper age of 69 years! Unlike their shorter siblings, the ultra-endurance races appear to present larger gender differences in the region of 20% to 30% across distance and modality. It would appear that these gender differences remain for multi-day events including the 'Marathon des Sables'; however, this gap may be narrower in some events, particularly those that require less load bearing (i.e. swimming and cycling), as evidenced from the 'Ultraman Hawaii' and 'Swiss Cycling Marathon', and shorter (a term I used advisedly!) distances including the Ironman Triathlon where differences are similar to those of sprint and endurance distances i.e. c. 10%. The theme running through this series of papers is a continual rise in participation to the point where major events now require selection races to remain within reasonable limits. With the combination of distance and environment placing a significant physiological bordering on pathophysiological burden on the participants of such events, one question remains: Are we destined for another Scott vs. Amundsen? How long is too long?

ETHICS OF SMART HOUSE WELFARE TECHNOLOGY FOR OLDER ADULTS: A SYSTEMATIC LITERATURE REVIEW.

PubMed

Sánchez, Veralia Gabriela; Taylor, Ingrid; Bing-Jonsson, Pia Cecilie

2017-01-01

The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. This article reviews reported ethical challenges to implementing smart houses for older adults. A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges. Smart houses offer a promising way to improve access to home care for older adults and people with disabilities. However, important ethical challenges arise when implementing smart houses, including cost-effectiveness, privacy, autonomy, informed consent, dignity, safety, and trust. The identified ethical challenges are important to consider when developing smart house systems. Due to the limitations of smart house technology, designers and users should be mindful that smart houses can achieve a safer and more dignified life-style but cannot solve all the challenges related to ageing, disabilities, and disease. At some point, smart houses can no longer help persons as they develop needs that smart houses cannot meet.

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

PubMed Central

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

2018-01-01

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

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

PubMed

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

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

Implementation of a community-based secondhand smoke reduction intervention for caregivers of urban children with asthma: process evaluation, successes and challenges

PubMed Central

Blaakman, Susan; Tremblay, Paul J.; Halterman, Jill S.; Fagnano, Maria; Borrelli, Belinda

2013-01-01

Many children, including those with asthma, remain exposed to secondhand smoke. This manuscript evaluates the process of implementing a secondhand smoke reduction counseling intervention using motivational interviewing (MI) for caregivers of urban children with asthma, including reach, dose delivered, dose received and fidelity. Challenges, strategies and successes in applying MI are highlighted. Data for 140 children (3–10 years) enrolled in the School Based Asthma Therapy trial, randomized to the treatment condition and living with one or more smoker, were analyzed. Summary statistics describe the sample, process measures related to intervention implementation, and primary caregiver (PCG) satisfaction with the intervention. The full intervention was completed by 79% of PCGs, but only 17% of other smoking caregivers. Nearly all (98%) PCGs were satisfied with the care study nurses provided and felt the program might be helpful to others. Despite challenges, this intervention was feasible and well received reaching caregivers who were not actively seeking treatment for smoking cessation or secondhand smoke reduction. Anticipating the strategies required to implement such an intervention may help promote participant engagement and retention to enhance the program’s ultimate success. PMID:22717938

Verification Challenges at Low Numbers

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

Benz, Jacob M.; Booker, Paul M.; McDonald, Benjamin S.

2013-07-16

This paper will explore the difficulties of deep reductions by examining the technical verification challenges. At each step on the road to low numbers, the verification required to ensure compliance of all parties will increase significantly. Looking post New START, the next step will likely include warhead limits in the neighborhood of 1000 (Pifer 2010). Further reductions will include stepping stones at 100’s of warheads, and then 10’s of warheads before final elimination could be considered of the last few remaining warheads and weapons. This paper will focus on these three threshold reduction levels, 1000, 100’s, 10’s. For each, themore » issues and challenges will be discussed, potential solutions will be identified, and the verification technologies and chain of custody measures that address these solutions will be surveyed. It is important to note that many of the issues that need to be addressed have no current solution. In these cases, the paper will explore new or novel technologies that could be applied. These technologies will draw from the research and development that is ongoing throughout the national lab complex, and will look at technologies utilized in other areas of industry for their application to arms control verification.« less

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

PubMed Central

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

2013-01-01

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

The Changing Landscape of Genetic Testing for Inherited Breast Cancer Predisposition.

PubMed

Afghahi, Anosheh; Kurian, Allison W

2017-05-01

The advent of multiple-gene germline panel testing has led to significant advances in hereditary breast and ovarian cancer risk assessment. These include guideline-specific cancer risk management recommendations for patients and their families, such as screening with breast magnetic resonance imaging and risk-reducing surgeries, which have the potential to reduce substantially the morbidity and mortality associated with a hereditary cancer predisposition. However, controversy remains about the clinical validity and actionability of genetic testing in a broader patient population. We discuss events leading to the wider availability of commercialized multiple-gene germline panel testing, the recent data that support using this powerful tool to improve cancer risk assessment and reduction strategies, and remaining challenges to clinical optimization of this new genetic technology.

Advances in Candida detection platforms for clinical and point-of-care applications

PubMed Central

Safavieh, Mohammadali; Coarsey, Chad; Esiobu, Nwadiuto; Memic, Adnan; Vyas, Jatin Mahesh; Shafiee, Hadi; Asghar, Waseem

2016-01-01

Invasive candidiasis remains one of the most serious community and healthcare-acquired infections worldwide. Conventional Candida detection methods based on blood and plate culture are time-consuming and require at least 2–4 days to identify various Candida species. Despite considerable advances for candidiasis detection, the development of simple, compact and portable point-of-care diagnostics for rapid and precise testing that automatically performs cell lysis, nucleic acid extraction, purification and detection still remains a challenge. Here, we systematically review most prominent conventional and nonconventional techniques for the detection of various Candida species, including Candida staining, blood culture, serological testing and nucleic acid-based analysis. We also discuss the most advanced lab on a chip devices for candida detection. PMID:27093473

Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices

PubMed Central

Luo, Nancy; Rogers, Joseph G.; Dodson, Gwen C.; Patel, Chetan B.; Galanos, Anthony N.; Milano, Carmelo A.; O’Connor, Christopher M.; Mentz, Robert J.

2016-01-01

Within the last decade, advancements in left ventricular assist device (LVAD) therapy have allowed end-stage heart failure patients to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for LVAD therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists. Despite these advantages, palliative care remains underused in many advanced heart failure programs. Here, we describe the benefits of palliative care, barriers to use within heart failure, and specific applications to the integrated care of patients on mechanical circulatory support. PMID:27474339

Exploring the Concept of HIV-Related Stigma

PubMed Central

Florom-Smith, Aubrey L.; De Santis, Joseph P.

2013-01-01

BACKGROUND HIV infection is a chronic, manageable illness. Despite advances in the care and treatment of people living with HIV infection, HIV-related stigma remains a challenge to HIV testing, care, and prevention. Numerous studies have documented the impact of HIV-related stigma among various groups of people living with HIV infection, but the concept of HIV-related stigma remains unclear. PURPOSE Concept exploration of HIV-related stigma via an integrative literature review was conducted in order to examine the existing knowledge base of this concept. METHODS Search engines were employed to review the existing knowledge base of this concept. CONCLUSION After the integrative literature review, an analysis of HIV-related stigma emerged. Implications for future concept analysis, research, and practice are included. PMID:22861652

Interventional Cardiology for Congenital Heart Disease

PubMed Central

2018-01-01

Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years. PMID:29671282

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

NASA Astrophysics Data System (ADS)

Russo, James; Hopkins, Sarah

2017-09-01

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

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

PubMed

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

2017-05-01

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

The 20-20-20 Airship Challenge

NASA Astrophysics Data System (ADS)

Kiessling, Alina; Diaz, Ernesto; Miller, Sarah; Rhodes, Jason

2014-06-01

A NASA Centennial Challenge; (http://www.nasa.gov/directorates/spacetech/centennial_challenges/index.html) is in development to spur innovation in stratospheric airships as a science platform. We anticipate a million dollar class prize for the first organization to fly a powered airship that remains stationary at 20km (65,000 ft) altitude for over 20 hours with a 20kg payload. The design must be scalable to longer flights with more massive payloads.In NASA’s constrained budget environment, there are few opportunities for space missions in astronomy and Earth science, and these have very long lead times. We believe that airships (powered, maneuverable, lighter-than-air vehicles) could offer significant gains in observing time, sky and ground coverage, data downlink capability, and continuity of observations over existing suborbital options at competitive prices. We seek to spur private industry (or non-profit institutions, including FFRDCs and Universities) to demonstrate the capability for sustained airship flights as astronomy and Earth science platforms. This poster will introduce the challenge in development and provide details of who to contact for more information.

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria.

PubMed

Sam-Agudu, Nadia A; Aliyu, Muktar H; Adeyemi, Olusegun A; Oronsaye, Frank; Oyeledun, Bolanle; Ogidi, Amaka G; Ezeanolue, Echezona E

2018-04-17

Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.

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

PubMed

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

2011-03-15

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

Generation of global political priority for early childhood development: the challenges of framing and governance.

PubMed

Shawar, Yusra Ribhi; Shiffman, Jeremy

2017-01-07

Despite progress, early childhood development (ECD) remains a neglected issue, particularly in resource-poor countries. We analyse the challenges and opportunities that ECD proponents face in advancing global priority for the issue. We triangulated among several data sources, including 19 semi-structured interviews with individuals involved in global ECD leadership, practice, and advocacy, as well as peer-reviewed research, organisation reports, and grey literature. We undertook a thematic analysis of the collected data, drawing on social science scholarship on collective action and a policy framework that elucidates why some global initiatives are more successful in generating political priority than others. The analysis indicates that the ECD community faces two primary challenges in advancing global political priority. The first pertains to framing: generation of internal consensus on the definition of the problem and solutions, agreement that could facilitate the discovery of a public positioning of the issue that could generate political support. The second concerns governance: building of effective institutions to achieve collective goals. However, there are multiple opportunities to advance political priority for ECD, including an increasingly favourable political environment, advances in ECD metrics, and the existence of compelling arguments for investment in ECD. To advance global priority for ECD, proponents will need to surmount the framing and governance challenges and leverage these opportunities. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed Central

2014-01-01

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

Targeting of non-dominant antigens as a vaccine strategy to broaden T-cell responses during chronic viral infection.

PubMed

Holst, Peter J; Jensen, Benjamin A H; Ragonnaud, Emeline; Thomsen, Allan R; Christensen, Jan P

2015-01-01

In this study, we compared adenoviral vaccine vectors with the capacity to induce equally potent immune responses against non-dominant and immunodominant epitopes of murine lymphocytic choriomeningitis virus (LCMV). Our results demonstrate that vaccination targeting non-dominant epitopes facilitates potent virus-induced T-cell responses against immunodominant epitopes during subsequent challenge with highly invasive virus. In contrast, when an immunodominant epitope was included in the vaccine, the T-cell response associated with viral challenge remained focussed on that epitope. Early after challenge with live virus, the CD8+ T cells specific for vaccine-encoded epitopes, displayed a phenotype typically associated with prolonged/persistent antigenic stimulation marked by high levels of KLRG-1, as compared to T cells reacting to epitopes not included in the vaccine. Notably, this association was lost over time in T cells specific for the dominant T cell epitopes, and these cells were fully capable of expanding in response to a new viral challenge. Overall, our data suggests a potential for broadening of the antiviral CD8+ T-cell response by selecting non-dominant antigens to be targeted by vaccination. In addition, our findings suggest that prior adenoviral vaccination is not likely to negatively impact the long-term and protective immune response induced and maintained by a vaccine-attenuated chronic viral infection.

Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre.

PubMed

Johnston, Sharon; Liddy, Clare; Hogg, William; Donskov, Melissa; Russell, Grant; Gyorfi-Dyke, Elizabeth

2010-12-13

While some research has been conducted examining recruitment methods to engage physicians and practices in primary care research, further research is needed on recruitment methodology as it remains a recurrent challenge and plays a crucial role in primary care research. This paper reviews recruitment strategies, common challenges, and innovative practices from five recent primary care health services research studies in Ontario, Canada. We used mixed qualitative and quantitative methods to gather data from investigators and/or project staff from five research teams. Team members were interviewed and asked to fill out a brief survey on recruitment methods, results, and challenges encountered during a recent or ongoing project involving primary care practices or physicians. Data analysis included qualitative analysis of interview notes and descriptive statistics generated for each study. Recruitment rates varied markedly across the projects despite similar initial strategies. Common challenges and creative solutions were reported by many of the research teams, including building a sampling frame, developing front-office rapport, adapting recruitment strategies, promoting buy-in and interest in the research question, and training a staff recruiter. Investigators must continue to find effective ways of reaching and involving diverse and representative samples of primary care providers and practices by building personal connections with, and buy-in from, potential participants. Flexible recruitment strategies and an understanding of the needs and interests of potential participants may also facilitate recruitment.

The 20-20-20 Airships NASA Centennial Challenge

NASA Astrophysics Data System (ADS)

Kiessling, Alina; Diaz, Ernesto; Rhodes, Jason; Ortega, Sam; Eberly, Eric

2015-08-01

A 2013 Keck Institute for Space Studies (KISS) study examined airships as a possible platform for Earth and space science. Airships, lighter than air, powered, maneuverable vehicles, could offer significant gains in observing time, sky and ground coverage, data downlink capability, and continuity of observations over existing suborbital options at competitive prices. The KISS study recommended three courses of action to spur the development and use of airships as a science platform. One of those recommendations was that a prize competition be developed to demonstrate a stratospheric airship. Consequently, we have been developing a NASA Centennial Challenge; (www.nasa.gov/challenges) to spur innovation in stratospheric airships as a science platform. We anticipate a multi-million dollar class prize for the first organization to fly a powered airship that remains stationary at 20km (65,000 ft) altitude for over 20 hours with a 20kg payload. The design must be scalable to longer flights with more massive payloads. A second prize tier, for a 20km flight lasting 200 hours with a 200kg payload would incentivize a further step toward a scientifically compelling and viable new platform. This technology would also have broad commercial applications including communications, asset tracking, and surveillance. Via the 20-20-20 Centennial Challenge, we are seeking to spur private industry (or non-profit institutions, including Universities) to demonstrate the capability for sustained airship flights as astronomy and Earth science platforms.

The 24-Hour Mathematical Modeling Challenge

ERIC Educational Resources Information Center

Galluzzo, Benjamin J.; Wendt, Theodore J.

2015-01-01

Across the mathematics curriculum there is a renewed emphasis on applications of mathematics and on mathematical modeling. Providing students with modeling experiences beyond the ordinary classroom setting remains a challenge, however. In this article, we describe the 24-hour Mathematical Modeling Challenge, an extracurricular event that exposes…

Gene Editing of Microalgae: Scientific Progress and Regulatory Challenges in Europe

PubMed Central

Spicer, Andrew

2018-01-01

It is abundantly clear that the development of gene editing technologies, represents a potentially powerful force for good with regard to human and animal health and addressing the challenges we continue to face in a growing global population. This now includes the development of approaches to modify microalgal strains for potential improvements in productivity, robustness, harvestability, processability, nutritional composition, and application. The rapid emergence and ongoing developments in this area demand a timely review and revision of the current definitions and regulations around genetically modified organisms (GMOs), particularly within Europe. Current practices within the EU provide exemptions from the GMO directives for organisms, including crop plants and micro-organisms that are produced through chemical or UV/radiation mutagenesis. However, organisms generated through gene editing, including microalgae, where only genetic changes in native genes are made, remain currently under the GMO umbrella; they are, as such, excluded from practical and commercial opportunities in the EU. In this review, we will review the advances that are being made in the area of gene editing in microalgae and the impact of regulation on commercial advances in this area with consideration to the current regulatory framework as it relates to GMOs including GM microalgae in Europe. PMID:29509719

Gene Editing of Microalgae: Scientific Progress and Regulatory Challenges in Europe.

PubMed

Spicer, Andrew; Molnar, Attila

2018-03-06

It is abundantly clear that the development of gene editing technologies, represents a potentially powerful force for good with regard to human and animal health and addressing the challenges we continue to face in a growing global population. This now includes the development of approaches to modify microalgal strains for potential improvements in productivity, robustness, harvestability, processability, nutritional composition, and application. The rapid emergence and ongoing developments in this area demand a timely review and revision of the current definitions and regulations around genetically modified organisms (GMOs), particularly within Europe. Current practices within the EU provide exemptions from the GMO directives for organisms, including crop plants and micro-organisms that are produced through chemical or UV/radiation mutagenesis. However, organisms generated through gene editing, including microalgae, where only genetic changes in native genes are made, remain currently under the GMO umbrella; they are, as such, excluded from practical and commercial opportunities in the EU. In this review, we will review the advances that are being made in the area of gene editing in microalgae and the impact of regulation on commercial advances in this area with consideration to the current regulatory framework as it relates to GMOs including GM microalgae in Europe.

Space Station: Actions Under Way to Manage Cost, but Significant Challenges Remain

DTIC Science & Technology

2002-07-01

GAO United States General Accounting OfficeReport to Congressional CommitteesJuly 2002 SPACE STATION Actions Under Way to Manage Cost , but...because NASA does not have good cost - accounting systems or practices. 1 The estimated cost growth is having a profound effect on the utility of the...SPACE STATION: Actions Under Way to Manage Cost , but Significant Challenges Remain Contract Number Grant Number Program Element Number Author(s

Nanonization strategies for poorly water-soluble drugs.

PubMed

Chen, Huabing; Khemtong, Chalermchai; Yang, Xiangliang; Chang, Xueling; Gao, Jinming

2011-04-01

Poor water solubility for many drugs and drug candidates remains a major obstacle to their development and clinical application. Conventional formulations to improve solubility suffer from low bioavailability and poor pharmacokinetics, with some carriers rendering systemic toxicities (e.g. Cremophor(®) EL). In this review, several major nanonization techniques that seek to overcome these limitations for drug solubilization are presented. Strategies including drug nanocrystals, nanoemulsions and polymeric micelles are reviewed. Finally, perspectives on existing challenges and future opportunities are highlighted. Published by Elsevier Ltd.

Out of the healthcare crisis.

PubMed

Siriwardena, A Niroshan

2011-01-01

W Edwards Deming's Out of the Crisis, was first published almost three decades ago.(1) It was a bestseller and remains a classic text written by one of the foremost quality improvement experts of the 20th century. It is a book which certainly warrants re-examination in light of today's challenges for health care. This discussion paper reviews what Deming can teach us about causes of failure in management, including health care, what can be done to remedy them and how to avert problems in future.

Physicochemical properties of radiographic contrast media, potential nephrotoxicity and prophylaxis.

PubMed

Hogstrom, Barry; Ikei, Nobuhiro

2015-12-01

Contrast induced nephropathy (CIN) remains a controversial topic. The clinical relevance of changes in laboratory parameters has been challenged; some authors have even suggested that CIN simply reflects natural fluctuations. Other areas of controversy include the pathophysiology of CIN, effectiveness of prophylactic approaches and differences in nephrotoxicity between individual contrast media (CM). The aim of this review is to summarize the current understanding of laboratory findings and explore its relationship to CM toxicity. © 2015 Wiley Publishing Asia Pty Ltd.

Diffusion weighted magnetic resonance imaging and its recent trend—a survey

PubMed Central

Chilla, Geetha Soujanya; Tan, Cher Heng

2015-01-01

Since its inception in 1985, diffusion weighted magnetic resonance imaging has been evolving and is becoming instrumental in diagnosis and investigation of tissue functions in various organs including brain, cartilage, and liver. Even though brain related pathology and/or investigation remains as the main application, diffusion weighted magnetic resonance imaging (DWI) is becoming a standard in oncology and in several other applications. This review article provides a brief introduction of diffusion weighted magnetic resonance imaging, challenges involved and recent advancements. PMID:26029644

Therapeutic modalities for cow's milk allergy.

PubMed

Seidman, Ernest G; Singer, Sanford

2003-06-01

To discuss current therapeutic modalities for cow's milk allergy and its prevention. The sources of data include original clinical studies carried out at Ste. Justine Hospital, as well as a systematic search of the published English and French language scientific literature restricted to human subjects using computerized searches (National Public Library of Medicine, Cochrane Database Systems Review) from 1997 to 2002. Search terms for article retrieval included food allergy, milk allergy, therapy, and prevention. The therapy of food allergies depends upon an accurate diagnosis, which remains a challenge in non--IgE-mediated cases. Dietary exclusion remains the mainstay of therapy, with medications reserved for exceptional patients. Preliminary evidence suggests that pancreatic enzyme supplementation may be of benefit for cases with multiple food allergies and severe eczema. Hydrolysate formula use is currently recommended for dietary allergy prevention in infants at an increased risk when maternal milk is insufficient or unavailable. The use of partially hydrolyzed formulas to prevent allergic disorders, including atopic dermatitis, is supported by clinical studies, but cannot be used in the already sensitized, milk-allergic child. Probiotics show enormous potential in preventing food allergic disorders as well.

Workflows and performances in the ranking prediction of 2016 D3R Grand Challenge 2: lessons learned from a collaborative effort.

PubMed

Gao, Ying-Duo; Hu, Yuan; Crespo, Alejandro; Wang, Deping; Armacost, Kira A; Fells, James I; Fradera, Xavier; Wang, Hongwu; Wang, Huijun; Sherborne, Brad; Verras, Andreas; Peng, Zhengwei

2018-01-01

The 2016 D3R Grand Challenge 2 includes both pose and affinity or ranking predictions. This article is focused exclusively on affinity predictions submitted to the D3R challenge from a collaborative effort of the modeling and informatics group. Our submissions include ranking of 102 ligands covering 4 different chemotypes against the FXR ligand binding domain structure, and the relative binding affinity predictions of the two designated free energy subsets of 15 and 18 compounds. Using all the complex structures prepared in the same way allowed us to cover many types of workflows and compare their performances effectively. We evaluated typical workflows used in our daily structure-based design modeling support, which include docking scores, force field-based scores, QM/MM, MMGBSA, MD-MMGBSA, and MacroModel interaction energy estimations. The best performing methods for the two free energy subsets are discussed. Our results suggest that affinity ranking still remains very challenging; that the knowledge of more structural information does not necessarily yield more accurate predictions; and that visual inspection and human intervention are considerably important for ranking. Knowledge of the mode of action and protein flexibility along with visualization tools that depict polar and hydrophobic maps are very useful for visual inspection. QM/MM-based workflows were found to be powerful in affinity ranking and are encouraged to be applied more often. The standardized input and output enable systematic analysis and support methodology development and improvement for high level blinded predictions.

Workflows and performances in the ranking prediction of 2016 D3R Grand Challenge 2: lessons learned from a collaborative effort

NASA Astrophysics Data System (ADS)

Gao, Ying-Duo; Hu, Yuan; Crespo, Alejandro; Wang, Deping; Armacost, Kira A.; Fells, James I.; Fradera, Xavier; Wang, Hongwu; Wang, Huijun; Sherborne, Brad; Verras, Andreas; Peng, Zhengwei

2018-01-01

The 2016 D3R Grand Challenge 2 includes both pose and affinity or ranking predictions. This article is focused exclusively on affinity predictions submitted to the D3R challenge from a collaborative effort of the modeling and informatics group. Our submissions include ranking of 102 ligands covering 4 different chemotypes against the FXR ligand binding domain structure, and the relative binding affinity predictions of the two designated free energy subsets of 15 and 18 compounds. Using all the complex structures prepared in the same way allowed us to cover many types of workflows and compare their performances effectively. We evaluated typical workflows used in our daily structure-based design modeling support, which include docking scores, force field-based scores, QM/MM, MMGBSA, MD-MMGBSA, and MacroModel interaction energy estimations. The best performing methods for the two free energy subsets are discussed. Our results suggest that affinity ranking still remains very challenging; that the knowledge of more structural information does not necessarily yield more accurate predictions; and that visual inspection and human intervention are considerably important for ranking. Knowledge of the mode of action and protein flexibility along with visualization tools that depict polar and hydrophobic maps are very useful for visual inspection. QM/MM-based workflows were found to be powerful in affinity ranking and are encouraged to be applied more often. The standardized input and output enable systematic analysis and support methodology development and improvement for high level blinded predictions.

Current Challenges in the Management of Prolactinomas.

PubMed

Maiter, Dominique

2015-04-01

Although the diagnosis of prolactinoma is often straightforward and the treatment strategy has been well defined in recent guidelines, several challenging issues persist in their management. The differential diagnosis of a large pituitary tumour with moderately elevated prolactin (PRL) concentrations is sometimes difficult, and prolonged treatment with a dopamine agonist may be inappropriate when the diagnosis of a prolactinoma is not sufficiently well substantiated. Also, timely withdrawal of dopamine agonist treatment and the remaining indications of transsphenoidal surgery are still matters of debate. Last but not least, the management of resistant or aggressive prolactinomas remains a challenge for the clinician, especially when they occur in young patients.

Current Challenges in the Management of Prolactinomas

PubMed Central

2015-01-01

Summary Although the diagnosis of prolactinoma is often straightforward and the treatment strategy has been well defined in recent guidelines, several challenging issues persist in their management. The differential diagnosis of a large pituitary tumour with moderately elevated prolactin (PRL) concentrations is sometimes difficult, and prolonged treatment with a dopamine agonist may be inappropriate when the diagnosis of a prolactinoma is not sufficiently well substantiated. Also, timely withdrawal of dopamine agonist treatment and the remaining indications of transsphenoidal surgery are still matters of debate. Last but not least, the management of resistant or aggressive prolactinomas remains a challenge for the clinician, especially when they occur in young patients. PMID:29632566

Toward Wearable Self-Charging Power Systems: The Integration of Energy-Harvesting and Storage Devices.

PubMed

Pu, Xiong; Hu, Weiguo; Wang, Zhong Lin

2018-01-01

One major challenge for wearable electronics is that the state-of-the-art batteries are inadequate to provide sufficient energy for long-term operations, leading to inconvenient battery replacement or frequent recharging. Other than the pursuit of high energy density of secondary batteries, an alternative approach recently drawing intensive attention from the research community, is to integrate energy-generation and energy-storage devices into self-charging power systems (SCPSs), so that the scavenged energy can be simultaneously stored for sustainable power supply. This paper reviews recent developments in SCPSs with the integration of various energy-harvesting devices (including piezoelectric nanogenerators, triboelectric nanogenerators, solar cells, and thermoelectric nanogenerators) and energy-storage devices, such as batteries and supercapacitors. SCPSs with multiple energy-harvesting devices are also included. Emphasis is placed on integrated flexible or wearable SCPSs. Remaining challenges and perspectives are also examined to suggest how to bring the appealing SCPSs into practical applications in the near future. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The Enduring Challenge of Determining Pneumonia Etiology in Children: Considerations for Future Research Priorities

PubMed Central

Hammitt, Laura L.; Murdoch, David R.; O’Brien, Katherine L.; Scott, J. Anthony G.

2017-01-01

Abstract Pneumonia kills more children each year worldwide than any other disease. Nonetheless, accurately determining the causes of childhood pneumonia has remained elusive. Over the past century, the focus of pneumonia etiology research has shifted from studies of lung aspirates and postmortem specimens intent on identifying pneumococcal disease to studies of multiple specimen types distant from the lung that are tested for multiple pathogens. Some major challenges facing modern pneumonia etiology studies include the use of nonspecific and variable case definitions, poor access to pathologic lung tissue and to specimens from fatal cases, poor diagnostic accuracy of assays (especially when testing nonpulmonary specimens), and the interpretation of results when multiple pathogens are detected in a given individual. The future of childhood pneumonia etiology research will likely require integrating data from complementary approaches, including applications of advanced molecular diagnostics and vaccine probe studies, as well as a renewed emphasis on lung aspirates from radiologically confirmed pneumonia and postmortem examinations. PMID:28575369

Out of the box: A psychedelic model to study the creative mind.

PubMed

Kuypers, K P C

2018-06-01

Our creativity is challenged daily when facing new situations asking for novel solutions. Creativity, a multicomponent construct includes flexible divergent and rigid convergent thinking. Psychedelic drugs like psilocybin can enhance creativity and affect state of mind (mood, empathy, openness). Of note, flexible thinking is disturbed in psychopathological conditions like anxiety disorders and depression and preliminary findings have shown psychedelics to be efficacious in the treatment of those conditions. The question how psychedelics induce this state of enhanced flexible thinking remains to be answered and investigating the neurobiology underlying this phenomenon will not only help in understanding why psychedelics are of use in the therapeutic setting but also in other settings where flexible thinking is challenged. A model including neuronal networks, neurotransmitters and personal factors playing a role in this process will be proposed which can be put to the test by means of placebo-controlled pharmaco-imaging studies in healthy volunteers. Copyright © 2018 The Author. Published by Elsevier Ltd.. All rights reserved.

Human pluripotent stem cells: Prospects and challenges as a source of cardiomyocytes for in vitro modeling and cell-based cardiac repair.

PubMed

Hartman, Matthew E; Dai, Dao-Fu; Laflamme, Michael A

2016-01-15

Human pluripotent stem cells (PSCs) represent an attractive source of cardiomyocytes with potential applications including disease modeling, drug discovery and safety screening, and novel cell-based cardiac therapies. Insights from embryology have contributed to the development of efficient, reliable methods capable of generating large quantities of human PSC-cardiomyocytes with cardiac purities ranging up to 90%. However, for human PSCs to meet their full potential, the field must identify methods to generate cardiomyocyte populations that are uniform in subtype (e.g. homogeneous ventricular cardiomyocytes) and have more mature structural and functional properties. For in vivo applications, cardiomyocyte production must be highly scalable and clinical grade, and we will need to overcome challenges including graft cell death, immune rejection, arrhythmogenesis, and tumorigenic potential. Here we discuss the types of human PSCs, commonly used methods to guide their differentiation into cardiomyocytes, the phenotype of the resultant cardiomyocytes, and the remaining obstacles to their successful translation. Copyright © 2015 Elsevier B.V. All rights reserved.

Use of Urine Biomarkers to Assess Sodium Intake: Challenges and Opportunities

PubMed Central

Maalouf, Joyce; Elliott, Paul; Loria, Catherine M.; Patel, Sheena; Bowman, Barbara A.

2017-01-01

This article summarizes current data and approaches to assess sodium intake in individuals and populations. A review of the literature on sodium excretion and intake estimation supports the continued use of 24-h urine collections for assessing population and individual sodium intake. Since 2000, 29 studies used urine biomarkers to estimate population sodium intake, primarily among adults. More than half used 24-h urine; the rest used a spot/casual, overnight, or 12-h specimen. Associations between individual sodium intake and health outcomes were investigated in 13 prospective cohort studies published since 2000. Only three included an indicator of long-term individual sodium intake, i.e., multiple 24-h urine specimens collected several days apart. Although not insurmountable, logistic challenges of 24-h urine collection remain a barrier for research on the relationship of sodium intake and chronic disease. Newer approaches, including modeling based on shorter collections, offer promise for estimating population sodium intake in some groups. PMID:25974702

Application of GRACE for Monitoring Groundwater in Data Scarce Regions

NASA Technical Reports Server (NTRS)

Rodell, Matt; Li, Bailing; Famiglietti, Jay; Zaitchik, Ben

2012-01-01

In the United States, groundwater storage is somewhat well monitored (spatial and temporal data gaps notwithstanding) and abundant data are freely and easily accessible. Outside of the U.S., groundwater often is not monitored systematically and where it is the data are rarely centralized and made available. Since 2002 the Gravity Recovery and Climate Experiment (GRACE) satellite mission has delivered gravity field observations which have been used to infer variations in total terrestrial water storage, including groundwater, at regional to continental scales. Challenges to using GRACE for groundwater monitoring include its relatively coarse spatial and temporal resolutions, its inability to differentiate groundwater from other types of water on and under the land surface, and typical 2-3 month data latency. Data assimilation can be used to overcome these challenges, but uncertainty in the results remains and is difficult to quantify without independent observations. Nevertheless, the results are preferable to the alternative - no data at all- and GRACE has already revealed groundwater variability and trends in regions where only anecdotal evidence existed previously.

The road to treating smoldering multiple myeloma.

PubMed

Korde, Neha; Mailankody, Sham; Landgren, Ola

2014-09-01

The management of smoldering multiple myeloma (SMM) has been a challenge to clinicians, ever since the condition was first characterized in 1980. While the risk of progression to symptomatic myeloma is greater for SMM (10% per year) compared to MGUS (1% per year), several SMM patients remain asymptomatic for years without evidence of disease progression. Early clinical trials focusing on early treatment of SMM have been equivocal with no clear benefit. However, the last decade has seen a greater understanding of the pathogenesis of plasma cell disorders, including SMM, and development of better therapeutics. A recent randomized trial has provided evidence of clinical benefit with early treatment of high-risk SMM. In this review, we summarize issues related to the early treatment of SMM including risk stratification and possible outcomes with therapy initiation. In the context of reviewing recent clinical trial data supporting early treatment, we define challenges faced by clinicians and provide future directions to the road to treating SMM. Published by Elsevier Inc.

Modern Pathologic Diagnosis of Renal Oncocytoma.

PubMed

Wobker, Sara E; Williamson, Sean R

2017-01-01

Oncocytoma is a well-defined benign renal tumor, with classic gross and histologic features, including a tan or mahogany-colored mass with central scar, microscopic nested architecture, bland cytology, and round, regular nuclei with prominent central nucleoli. As a result of variations in this classic appearance, difficulty in standardizing diagnostic criteria, and entities that mimic oncocytoma, such as eosinophilic variant chromophobe renal cell carcinoma and succinate dehydrogenase-deficient renal cell carcinoma, pathologic diagnosis remains a challenge. This review addresses the current state of pathologic diagnosis of oncocytoma, with emphasis on modern diagnostic markers, areas of controversy, and emerging techniques for less invasive diagnosis, including renal mass biopsy and advanced imaging.

Principles of Statistics: What the Sports Medicine Professional Needs to Know.

PubMed

Riemann, Bryan L; Lininger, Monica R

2018-07-01

Understanding the results and statistics reported in original research remains a large challenge for many sports medicine practitioners and, in turn, may be among one of the biggest barriers to integrating research into sports medicine practice. The purpose of this article is to provide minimal essentials a sports medicine practitioner needs to know about interpreting statistics and research results to facilitate the incorporation of the latest evidence into practice. Topics covered include the difference between statistical significance and clinical meaningfulness; effect sizes and confidence intervals; reliability statistics, including the minimal detectable difference and minimal important difference; and statistical power. Copyright © 2018 Elsevier Inc. All rights reserved.

Whole-body transcriptome of selectively bred, resistant-, control-, and susceptible-line rainbow trout following experimental challenge with Flavobacterium psychrophilum

PubMed Central

Marancik, David; Gao, Guangtu; Paneru, Bam; Ma, Hao; Hernandez, Alvaro G.; Salem, Mohamed; Yao, Jianbo; Palti, Yniv; Wiens, Gregory D.

2014-01-01

Genetic improvement for enhanced disease resistance in fish is an increasingly utilized approach to mitigate endemic infectious disease in aquaculture. In domesticated salmonid populations, large phenotypic variation in disease resistance has been identified but the genetic basis for altered responsiveness remains unclear. We previously reported three generations of selection and phenotypic validation of a bacterial cold water disease (BCWD) resistant line of rainbow trout, designated ARS-Fp-R. This line has higher survival after infection by either standardized laboratory challenge or natural challenge as compared to two reference lines, designated ARS-Fp-C (control) and ARS-Fp-S (susceptible). In this study, we utilized 1.1 g fry from the three genetic lines and performed RNA-seq to measure transcript abundance from the whole body of naive and Flavobacterium psychrophilum infected fish at day 1 (early time-point) and at day 5 post-challenge (onset of mortality). Sequences from 24 libraries were mapped onto the rainbow trout genome reference transcriptome of 46,585 predicted protein coding mRNAs that included 2633 putative immune-relevant gene transcripts. A total of 1884 genes (4.0% genome) exhibited differential transcript abundance between infected and mock-challenged fish (FDR < 0.05) that included chemokines, complement components, tnf receptor superfamily members, interleukins, nod-like receptor family members, and genes involved in metabolism and wound healing. The largest number of differentially expressed genes occurred on day 5 post-infection between naive and challenged ARS-Fp-S line fish correlating with high bacterial load. After excluding the effect of infection, we identified 21 differentially expressed genes between the three genetic lines. In summary, these data indicate global transcriptome differences between genetic lines of naive animals as well as differentially regulated transcriptional responses to infection. PMID:25620978

Lifelong antiretroviral therapy or HIV cure: The benefits for the individual patient.

PubMed

Buell, Kevin G; Chung, Christopher; Chaudhry, Zain; Puri, Aiysha; Nawab, Khizr; Ravindran, Rahul Prashanth

2016-01-01

There are an estimated 35 million people living with human immunodeficiency virus (HIV) globally, 19 million of whom are unaware of their HIV status and, in the absence of antiretroviral therapy (ART), will have a shortened life expectancy. Although ART remains the "gold standard" for treatment of HIV infection, the requirement for lifelong treatment poses multiple challenges for the patient. These include stigma, an untenable pill burden, side effects, and the threat of viral resistance in the case of non-compliance. This review evaluates the challenges of accessing, delivering, and sustaining ART for people living with HIV and will discuss the case for pursuing a goal of HIV cure, the potential benefits of such a cure for the individual patient, and the current potential candidates for such a cure.

Cloud-Top Entrainment in Stratocumulus Clouds

NASA Astrophysics Data System (ADS)

Mellado, Juan Pedro

2017-01-01

Cloud entrainment, the mixing between cloudy and clear air at the boundary of clouds, constitutes one paradigm for the relevance of small scales in the Earth system: By regulating cloud lifetimes, meter- and submeter-scale processes at cloud boundaries can influence planetary-scale properties. Understanding cloud entrainment is difficult given the complexity and diversity of the associated phenomena, which include turbulence entrainment within a stratified medium, convective instabilities driven by radiative and evaporative cooling, shear instabilities, and cloud microphysics. Obtaining accurate data at the required small scales is also challenging, for both simulations and measurements. During the past few decades, however, high-resolution simulations and measurements have greatly advanced our understanding of the main mechanisms controlling cloud entrainment. This article reviews some of these advances, focusing on stratocumulus clouds, and indicates remaining challenges.

Challenges in the quality assurance of elemental and isotopic analyses in the nuclear domain benefitting from high resolution ICP-OES and sector field ICP-MS.

PubMed

Krachler, Michael; Alvarez-Sarandes, Rafael; Van Winckel, Stefaan

Accurate analytical data reinforces fundamentally the meaningfulness of nuclear fuel performance assessments and nuclear waste characterization. Regularly lacking matrix-matched certified reference materials, quality assurance of elemental and isotopic analysis of nuclear materials remains a challenging endeavour. In this context, this review highlights various dedicated experimental approaches envisaged at the European Commission-Joint Research Centre-Institute for Transuranium Elements to overcome this limitation, mainly focussing on the use of high resolution-inductively coupled plasma-optical emission spectrometry (HR-ICP-OES) and sector field-inductively coupled plasma-mass spectrometry (SF-ICP-MS). However, also α- and γ-spectrometry are included here to help characterise extensively the investigated actinide solutions for their actual concentration, potential impurities and isotopic purity.

Endocrinology research-reflecting on the past decade and looking to the next.

PubMed

Herold, Kevan C; Majzoub, Joseph A; Melmed, Shlomo; Pendergrass, Merri; Schlumberger, Martin

2015-11-01

The inaugural issue of this journal, published in November 2005, included articles on thyroid cancer, type 2 diabetes mellitus, the metabolic syndrome, pituitary adenomas and obesity. 10 years later, we are still publishing articles on these topics (and many others). Although a great deal of progress has been made in our understanding of the pathogenesis, diagnosis and treatment of diseases of the endocrine system over the past 10 years, many challenges still remain. For this Viewpoint, we have asked five of our Advisory Board Members to comment on the progress and challenges from the past 10 years. They were also asked to offer their thoughts on where money should be spent going forward, and their predictions for what advances might be achieved in the next 10 years.

Ice Surfaces.

PubMed

Shultz, Mary Jane

2017-05-05

Ice is a fundamental solid with important environmental, biological, geological, and extraterrestrial impact. The stable form of ice at atmospheric pressure is hexagonal ice, I h . Despite its prevalence, I h remains an enigmatic solid, in part due to challenges in preparing samples for fundamental studies. Surfaces of ice present even greater challenges. Recently developed methods for preparation of large single-crystal samples make it possible to reproducibly prepare any chosen face to address numerous fundamental questions. This review describes preparation methods along with results that firmly establish the connection between the macroscopic structure (observed in snowflakes, microcrystallites, or etch pits) and the molecular-level configuration (detected with X-ray or electron scattering techniques). Selected results of probing interactions at the ice surface, including growth from the melt, surface vibrations, and characterization of the quasi-liquid layer, are discussed.

Nutritional issues for older adults: addressing degenerative ageing with long-term studies.

PubMed

de Groot, Lisette C P G M

2016-05-01

The ageing process is influenced by a variety of factors, including extrinsic, malleable lifestyle variables. The present paper deals with the epidemiological evidence for the role of dietary patterns and key nutritional concerns in relation to survival and ageing-related disorders that present themselves in later life. Healthful dietary patterns appear to be most relevant in old age. Specific nutritional concerns are related to vitamin D, vitamin B12 and protein malnutrition. An important challenge to further expand the knowledge base is currently addressed by the NuAge project, acknowledging the complexity of the ageing process and integrating different dimensions of research into human healthy ageing. In the meantime, reversing poor adherence to existing guidelines for a healthy diet remains a first challenge in public health nutritional practices.

Modeling and Simulation of Nanoindentation

NASA Astrophysics Data System (ADS)

Huang, Sixie; Zhou, Caizhi

2017-11-01

Nanoindentation is a hardness test method applied to small volumes of material which can provide some unique effects and spark many related research activities. To fully understand the phenomena observed during nanoindentation tests, modeling and simulation methods have been developed to predict the mechanical response of materials during nanoindentation. However, challenges remain with those computational approaches, because of their length scale, predictive capability, and accuracy. This article reviews recent progress and challenges for modeling and simulation of nanoindentation, including an overview of molecular dynamics, the quasicontinuum method, discrete dislocation dynamics, and the crystal plasticity finite element method, and discusses how to integrate multiscale modeling approaches seamlessly with experimental studies to understand the length-scale effects and microstructure evolution during nanoindentation tests, creating a unique opportunity to establish new calibration procedures for the nanoindentation technique.

The Open Microscopy Environment: open image informatics for the biological sciences

NASA Astrophysics Data System (ADS)

Blackburn, Colin; Allan, Chris; Besson, Sébastien; Burel, Jean-Marie; Carroll, Mark; Ferguson, Richard K.; Flynn, Helen; Gault, David; Gillen, Kenneth; Leigh, Roger; Leo, Simone; Li, Simon; Lindner, Dominik; Linkert, Melissa; Moore, Josh; Moore, William J.; Ramalingam, Balaji; Rozbicki, Emil; Rustici, Gabriella; Tarkowska, Aleksandra; Walczysko, Petr; Williams, Eleanor; Swedlow, Jason R.

2016-07-01

Despite significant advances in biological imaging and analysis, major informatics challenges remain unsolved: file formats are proprietary, storage and analysis facilities are lacking, as are standards for sharing image data and results. While the open FITS file format is ubiquitous in astronomy, astronomical imaging shares many challenges with biological imaging, including the need to share large image sets using secure, cross-platform APIs, and the need for scalable applications for processing and visualization. The Open Microscopy Environment (OME) is an open-source software framework developed to address these challenges. OME tools include: an open data model for multidimensional imaging (OME Data Model); an open file format (OME-TIFF) and library (Bio-Formats) enabling free access to images (5D+) written in more than 145 formats from many imaging domains, including FITS; and a data management server (OMERO). The Java-based OMERO client-server platform comprises an image metadata store, an image repository, visualization and analysis by remote access, allowing sharing and publishing of image data. OMERO provides a means to manage the data through a multi-platform API. OMERO's model-based architecture has enabled its extension into a range of imaging domains, including light and electron microscopy, high content screening, digital pathology and recently into applications using non-image data from clinical and genomic studies. This is made possible using the Bio-Formats library. The current release includes a single mechanism for accessing image data of all types, regardless of original file format, via Java, C/C++ and Python and a variety of applications and environments (e.g. ImageJ, Matlab and R).

Update on Neonatal Hypoglycemia

PubMed Central

Rozance, Paul J.

2014-01-01

Purpose of Review Neonatal hypoglycemia is one of the most common biochemical abnormalities encountered in the newborn. However, controversy remains surrounding its definition and management especially in asymptomatic patients. Recent Findings New information has been published that describes the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia. Furthermore, one large prospective study failed to find an association between repetitive low glucose concentrations and poor neurodevelopmental outcomes in preterm infants. But hypoglycemia due to hyperinsulinism, especially genetic causes, continued to be associated with brain injury. New advances were made in the diagnosis and management of hyperinsulinism, including acquired hyperinsulinism in small for gestational age infants and others. Continuous glucose monitoring remains an attractive strategy for future research in this area. Summary The fundamental question of how best to manage asymptomatic newborns with low glucose concentrations remains unanswered. Balancing the risks of over treating newborns with low glucose concentrations who are undergoing a normal transition following birth against the risks of under treating those in whom low glucose concentrations are pathological, dangerous, and/or a harbinger of serious metabolic disease remains a challenge. PMID:24275620

Update on neonatal hypoglycemia.

PubMed

Rozance, Paul J

2014-02-01

Neonatal hypoglycemia is one of the most common biochemical abnormalities encountered in the newborn. However, controversy remains surrounding its definition and management especially in asymptomatic patients. New information has been published that describes the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia. Furthermore, one large prospective study failed to find an association between repetitive low glucose concentrations and poor neurodevelopmental outcomes in preterm infants. But hypoglycemia due to hyperinsulinism, especially genetic causes, continued to be associated with brain injury. New advances were made in the diagnosis and management of hyperinsulinism, including acquired hyperinsulinism in small for gestational age infants and others. Continuous glucose monitoring remains an attractive strategy for future research in this area. The fundamental question of how best to manage asymptomatic newborns with low glucose concentrations remains unanswered. Balancing the risks of overtreating newborns with low glucose concentrations who are undergoing a normal transition following birth against the risks of undertreating those in whom low glucose concentrations are pathological, dangerous, and/or a harbinger of serious metabolic disease remains a challenge.

Changing tracks as situations change: humanitarian and health response along the Liberia-Côte d'Ivoire border.

PubMed

Derderian, Katharine

2014-10-01

In recent years, protracted crises and fragile post-conflict settings have challenged the co-existence, and even the linear continuum, of relief and development aid. Forced migration has tested humanitarian and development paradigms where sudden-onset emergencies, violence and displacement arise alongside ongoing development work. Drawing on Médecins Sans Frontières interventions in the region from December 2010 to May 2011, this paper examines aid and healthcare responses to displacement in Côte d'Ivoire and Liberia; it focuses on challenges to the maintenance of preparedness for such foreseeable emergencies and to adaptation in response to changing situations of displacement and insecurity. This 'backsliding' from development to emergency remains a substantial challenge to aid; yet, in exactly such cases, it also presents the opportunity to ensure access to medical care that is much more urgently needed in times of crisis, including the suspension of user fees for medical care. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

Environmental cleanup: The challenge at the Hanford Site, Washington, USA

NASA Astrophysics Data System (ADS)

Gray, Robert H.; Becker, C. Dale

1993-07-01

Numerous challenges face those involved with developing a coordinated and consistent approach to cleaning up the US Department of Energy’s (DOE) Hanford Site in southeastern Washington. These challenges are much greater than those encountered when the site was selected and the world’s first nuclear complex was developed almost 50 years ago. This article reviews Hanford’s history, operations, waste storage/disposal activities, environmental monitoring, and today’s approach to characterize and clean up Hanford under a Federal Facility Agreement and Consent Order, signed by DOE, the Environmental Protection Agency, and the Washington Sate Department of Ecology. Although cleanup of defense-related waste at Hanford holds many positive benefits, negative features include high costs to the US taxpayer, numerous uncertainties concerning the technologies to be employed and the risks involved, and the high probability that special interest groups and activists at large will never be completely satisfied. Issues concerning future use of the site, whether to protect and preserve its natural features or open it to public exploitation, remain to be resolved.

United States-Mexico cross-border health insurance initiatives: Salud Migrante and Medicare in Mexico.

PubMed

Vargas Bustamante, Arturo; Laugesen, Miriam; Caban, Mabel; Rosenau, Pauline

2012-01-01

While U.S. health care reform will most likely reduce the overall number of uninsured Mexican-Americans, it does not address challenges related to health care coverage for undocumented Mexican immigrants, who will remain uninsured under the measures of the reform; documented low-income Mexican immigrants who have not met the five-year waiting period required for Medicaid benefits; or the growing number of retired U.S. citizens living in Mexico, who lack easy access to Medicare-supported services. This article reviews two promising binational initiatives that could help address these challenges-Salud Migrante and Medicare in Mexico; discusses their prospective applications within the context of U.S. health care reform; and identifies potential challenges to their implementation (legal, political, and regulatory), as well as the possible benefits, including coverage of uninsured Mexican immigrants, and their integration into the U.S. health care system (through Salud Migrante), and access to lower-cost Medicare-supported health care for U.S. retirees in Mexico (Medicare in Mexico).

Numerical simulations of merging black holes for gravitational-wave astronomy

NASA Astrophysics Data System (ADS)

Lovelace, Geoffrey

2014-03-01

Gravitational waves from merging binary black holes (BBHs) are among the most promising sources for current and future gravitational-wave detectors. Accurate models of these waves are necessary to maximize the number of detections and our knowledge of the waves' sources; near the time of merger, the waves can only be computed using numerical-relativity simulations. For optimal application to gravitational-wave astronomy, BBH simulations must achieve sufficient accuracy and length, and all relevant regions of the BBH parameter space must be covered. While great progress toward these goals has been made in the almost nine years since BBH simulations became possible, considerable challenges remain. In this talk, I will discuss current efforts to meet these challenges, and I will present recent BBH simulations produced using the Spectral Einstein Code, including a catalog of publicly available gravitational waveforms [black-holes.org/waveforms]. I will also discuss simulations of merging black holes with high mass ratios and with spins nearly as fast as possible, the most challenging regions of the BBH parameter space.

The sleepy teenager - diagnostic challenges.

PubMed

Landtblom, Anne-Marie; Engström, Maria

2014-01-01

The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character - and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area.

The Sleepy Teenager – Diagnostic Challenges

PubMed Central

Landtblom, Anne-Marie; Engström, Maria

2014-01-01

The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character – and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area. PMID:25136329

Operational challenges in delivering CD4 diagnostics in sub-Saharan Africa.

PubMed

Thairu, L; Katzenstein, D; Israelski, D

2011-07-01

Access to reliable and low cost CD4 T-cell enumeration to stage illness and monitor anti-retroviral therapy remains elusive in resource-limited settings. We report challenges in delivering CD4 testing using the microcapillary Fluorescence-Activated Cell Sorter (FACS) methodology (Guava EasyCD4 instrument Guava Technologies, Hayward) in Burkina Faso and Zimbabwe. Resources, instruments, reagents, and training were provided to local laboratories within the existing infrastructure and data on CD4 were collected from routine laboratory testing. Challenges encountered included frequent instrument breakdown; poor manufacturer maintenance; difficulties in managing reagent stocks; high technician turnover; reliance on antiquated data management systems; redundant service provision; and lack of repeat testing in male HIV+ patients and in patients with higher CD4 counts after initial staging. While adopting newer, less expensive technologies such as fluorescent platforms and point of care tests can facilitate access to lower cost CD4 testing, our experience suggests that supply chain, corporate commitment to implementation, and community factors also require consideration.

More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain.

PubMed

Mechanic, David

2014-08-01

The high prevalence of mental illness and substance abuse disorders and their significant impact on disability, mortality, and other chronic diseases have encouraged new initiatives in mental health policy including important provisions of the Affordable Care Act and changes in Medicaid. This article examines the development and status of the behavioral health services system, gaps in access to and quality of care, and the challenges to implementing aspirations for improved behavioral and related medical services. Although many more people than ever before are receiving behavioral health services in the United States-predominantly pharmaceutical treatments-care is poorly allocated and rarely meets evidence-based standards, particularly in the primary care sector. Ideologies, finances, and pharmaceutical marketing have shaped the provision of services more than treatment advances or guidance from a growing evidence base. Among the many challenges to overcome are organizational and financial realignments and improved training of primary care physicians and the behavioral health workforce. Project HOPE—The People-to-People Health Foundation, Inc.

Modeling the Effects of Turbulence in Rotating Detonation Engines

NASA Astrophysics Data System (ADS)

Towery, Colin; Smith, Katherine; Hamlington, Peter; van Schoor, Marthinus; TESLa Team; Midé Team

2014-03-01

Propulsion systems based on detonation waves, such as rotating and pulsed detonation engines, have the potential to substantially improve the efficiency and power density of gas turbine engines. Numerous technical challenges remain to be solved in such systems, however, including obtaining more efficient injection and mixing of air and fuels, more reliable detonation initiation, and better understanding of the flow in the ejection nozzle. These challenges can be addressed using numerical simulations. Such simulations are enormously challenging, however, since accurate descriptions of highly unsteady turbulent flow fields are required in the presence of combustion, shock waves, fluid-structure interactions, and other complex physical processes. In this study, we performed high-fidelity three dimensional simulations of a rotating detonation engine and examined turbulent flow effects on the operation, performance, and efficiency of the engine. Along with experimental data, these simulations were used to test the accuracy of commonly-used Reynolds averaged and subgrid-scale turbulence models when applied to detonation engines. The authors gratefully acknowledge the support of the Defense Advanced Research Projects Agency (DARPA).

Regulatory Decisions on Endocrine Disrupting Chemicals Should be Based on the Principles of Endocrinology

PubMed Central

Vandenberg, Laura N.; Colborn, Theo; Hayes, Tyrone B.; Heindel, Jerrold J.; Jacobs, David R.; Lee, Duk-Hee; Myers, John Peterson; Shioda, Toshi; Soto, Ana M.; vom Saal, Frederick S.; Welshons, Wade V.; Zoeller, R. Thomas

2013-01-01

For years, scientists from various disciplines have studied the effects of endocrine disrupting chemicals (EDCs) on the health and wellbeing of humans and wildlife. Some studies have specifically focused on the effects of low doses, i.e. those in the range that are thought to be safe for humans and/or animals. Others have focused on the existence of non-monotonic dose-response curves. These concepts challenge the way that chemical risk assessment is performed for EDCs. Continued discussions have clarified exactly what controversies and challenges remain. We address several of these issues, including why the study and regulation of EDCs should incorporate endocrine principles; what level of consensus there is for low dose effects; challenges to our understanding of non-monotonicity; and whether EDCs have been demonstrated to produce adverse effects. This discussion should result in a better understanding of these issues, and allow for additional dialogue on their impact on risk assessment. PMID:23411111

DMDs for multi-object near-infrared spectrographs in astronomy

NASA Astrophysics Data System (ADS)

Smee, Stephen A.; Barkhouser, Robert; Hope, Stephen; Conley, Devin; Gray, Aidan; Hope, Gavin; Robberto, Massimo

2018-02-01

The Digital Micromirror Device (DMD), typically used in projection screen technology, has utility in instrumentation for astronomy as a digitally programmable slit in a spectrograph. When placed at an imaging focal plane the device can be used to selectively direct light from astronomical targets into the optical path of a spectrograph, while at the same time directing the remaining light into an imaging camera, which can be used for slit alignment, science imaging, or both. To date the use of DMDs in astronomy has been limited, especially for instruments that operate in the near infrared (1 - 2.5 μm). This limitation is due in part to a host of technical challenges with respect to DMDs that, to date, have not been thoroughly explored. Those challenges include operation at cryogenic temperature, control electronics that facilitate DMD use at these temperatures, window coatings properly coated for the near infrared bandpass, and scattered light. This paper discusses these technical challenges and presents progress towards understanding and mitigating them.

Community Cloud Computing

NASA Astrophysics Data System (ADS)

Marinos, Alexandros; Briscoe, Gerard

Cloud Computing is rising fast, with its data centres growing at an unprecedented rate. However, this has come with concerns over privacy, efficiency at the expense of resilience, and environmental sustainability, because of the dependence on Cloud vendors such as Google, Amazon and Microsoft. Our response is an alternative model for the Cloud conceptualisation, providing a paradigm for Clouds in the community, utilising networked personal computers for liberation from the centralised vendor model. Community Cloud Computing (C3) offers an alternative architecture, created by combing the Cloud with paradigms from Grid Computing, principles from Digital Ecosystems, and sustainability from Green Computing, while remaining true to the original vision of the Internet. It is more technically challenging than Cloud Computing, having to deal with distributed computing issues, including heterogeneous nodes, varying quality of service, and additional security constraints. However, these are not insurmountable challenges, and with the need to retain control over our digital lives and the potential environmental consequences, it is a challenge we must pursue.

Brain Metastasis: Unique Challenges and Open Opportunities

PubMed Central

Lowery, Frank J.; Yu, Dihua

2016-01-01

The metastasis of cancer to the central nervous system (CNS) remains a devastating clinical reality, carrying an estimated survival time of less than one year in spite of recent therapeutic breakthroughs for other disease contexts. Advances in brain metastasis research are hindered by a number of reasons, including its complicated nature and the difficulty of modeling metastatic cancer growth in the unique brain microenvironment. In this review, we will discuss the clinical challenge, and compare the values and limitations of the available models for brain metastasis research. Additionally, we will specifically address current knowledge on how brain metastases take advantage of the unique brain environment to benefit their own growth. Finally, we will explore the distinctive metabolic and nutrient characteristics of the brain; how these paradoxically represent barriers to establishment of brain metastasis, but also provide ample supplies for metastatic cells’ growth in the brain. We envision that multi-disciplinary innovative approaches will open opportunities for the field to make breakthroughs in tackling unique challenges of brain metastasis. PMID:27939792

Coupling of Large Amplitude Inversion with Other States

NASA Astrophysics Data System (ADS)

Pearson, John; Yu, Shanshan

2016-06-01

The coupling of a large amplitude motion with a small amplitude vibration remains one of the least well characterized problems in molecular physics. Molecular inversion poses a few unique and not intuitively obvious challenges to the large amplitude motion problem. In spite of several decades of theoretical work numerous challenges in calculation of transition frequencies and more importantly intensities persist. The most challenging aspect of this problem is that the inversion coordinate is a unique function of the overall vibrational state including both the large and small amplitude modes. As a result, the r-axis system and the meaning of the K-quantum number in the rotational basis set are unique to each vibrational state of large or small amplitude motion. This unfortunate reality has profound consequences to calculation of intensities and the coupling of nearly degenerate vibrational states. The case of NH3 inversion and inversion through a plane of symmetry in alcohols will be examined to find a general path forward.

Bioengineering Solutions for Manufacturing Challenges in CAR T Cells

PubMed Central

Piscopo, Nicole J.; Mueller, Katherine P.; Das, Amritava; Hematti, Peiman; Murphy, William L.; Palecek, Sean P.; Capitini, Christian M.

2017-01-01

The next generation of therapeutic products to be approved for the clinic is anticipated to be cell therapies, termed “living drugs” for their capacity to dynamically and temporally respond to changes during their production ex vivo and after their administration in vivo. Genetically engineered chimeric antigen receptor (CAR) T cells have rapidly developed into powerful tools to harness the power of immune system manipulation against cancer. Regulatory agencies are beginning to approve CAR T cell therapies due to their striking efficacy in treating some hematological malignancies. However, the engineering and manufacturing of such cells remains a challenge for widespread adoption of this technology. Bioengineering approaches including biomaterials, synthetic biology, metabolic engineering, process control and automation, and in vitro disease modeling could offer promising methods to overcome some of these challenges. Here, we describe the manufacturing process of CAR T cells, highlighting potential roles for bioengineers to partner with biologists and clinicians to advance the manufacture of these complex cellular products under rigorous regulatory and quality control. PMID:28840981

Does Challenge by Choice Increase Participation?

ERIC Educational Resources Information Center

Chase, Daniel L.

2015-01-01

Challenge by choice (CBC) has been regarded as a foundational principle for challenge ropes course programs. Although CBC is widely accepted as the primary mechanism for facilitating intended ropes course outcomes, especially a participant's involvement, until recently it had remained an untested assumption. This study explored the role of CBC as…

Challenges for Cooperative Learning Implementation: Reports from Elementary School Teachers

ERIC Educational Resources Information Center

Buchs, Céline; Filippou, Dimitra; Pulfrey, Caroline; Volpé, Yann

2017-01-01

Despite the well-established benefits of cooperative learning, implementation remains a challenge. This research aims to document these challenges at the elementary school level, drawing on teachers' beliefs regarding learning as well as the difficulties teachers report. Results indicate that the most frequent instructional strategies reported are…

Efficacy of Coaching Preschool Teachers to Manage Challenging Behavior

ERIC Educational Resources Information Center

Brock, Matthew E.; Beaman-Diglia, Lauren E.

2018-01-01

Many early educators cite behavior management as a top professional development need. Evidence-based practices exist to address severe challenging behavior, but promoting implementation of these practices remains a challenge. In this single-case design study, two preschool teachers received coaching focused on implementing three evidence-based…

Assessment of anorexia nervosa: an overview of universal issues and contextual challenges

PubMed Central

2013-01-01

Aim Anorexia Nervosa (AN) is a complex and clinically challenging syndrome. Intended for specialist audiences, this narrative review aims to summarise the available literature related to assessment in the adult patient context, synthesising both research evidence and clinical consensus guidelines. Method We provide a review of the available literature on specialist assessment of AN focusing on common trajectories into assessment, obstacles accessing assessment, common presenting issues and barriers to the assessment process, the necessary scope of assessment, and tools and techniques. It describes the further step of synthesising assessment information in ways that can inform resultant care plans. Results In addition to assessment of core behaviours and diagnostic skills, considerations for the expert assessor include the functions of primary care, systemic and personal barriers, knowledge of current assessment tools and research pertaining to comorbid pathology in AN, assessing severity of illness, role of family at assessment, as well as medical, nutritional and compulsory elements of assessment. Conclusion Comprehensive assessment of AN in the current healthcare context still remains largely the remit of the specialist ED clinician. Assessment should remain an on-going process, paying particular attention to available empirical evidence, thereby reducing the gap between research and practice. PMID:24999408

History of cannabis and its preparations in saga, science, and sobriquet.

PubMed

Russo, Ethan B

2007-08-01

Cannabis sativa L. is possibly one of the oldest plants cultivated by man, but has remained a source of controversy throughout its history. Whether pariah or panacea, this most versatile botanical has provided a mirror to medicine and has pointed the way in the last two decades toward a host of medical challenges from analgesia to weight loss through the discovery of its myriad biochemical attributes and the endocannabinoid system wherein many of its components operate. This study surveys the history of cannabis, its genetics and preparations. A review of cannabis usage in Ancient Egypt will serve as an archetype, while examining first mentions from various Old World cultures and their pertinence for contemporary scientific investigation. Cannabis historians of the past have provided promising clues to potential treatments for a wide array of currently puzzling medical syndromes including chronic pain, spasticity, cancer, seizure disorders, nausea, anorexia, and infectious disease that remain challenges for 21st century medicine. Information gleaned from the history of cannabis administration in its various forms may provide useful points of departure for research into novel delivery techniques and standardization of cannabis-based medicines that will allow their prescription for treatment of these intractable medical conditions.

Remote Monitoring to Reduce Heart Failure Readmissions.

PubMed

Emani, Sitaramesh

2017-02-01

Rehospitalization for heart failure remains a challenge in the treatment of affected patients. The ability to remotely monitor patients for worsening heart failure may provide an avenue through which therapeutic interventions can be made to prevent a rehospitalization. Available data on remote monitoring to reduce heart failure rehospitalizations are reviewed within. Strategies to reduce readmissions include clinical telemonitoring, bioimpedance changes, biomarkers, and remote hemodynamic monitoring. Telemonitoring is readily available, but has low sensitivity and adherence. No data exist to demonstrate the efficacy of this strategy in reducing admissions. Bioimpedance offers improved sensitivity compared to telemonitoring, but has not demonstrated an ability to reduce hospitalizations and is currently limited to those patients who have separate indications for an implantable device. Biomarker levels have shown variable results in the ability to reduce hospitalizations and remain without definitive proof supporting their utilization. Remote hemodynamic monitoring has shown the strongest ability to reduce heart failure readmissions and is currently approved for this purpose. However, remote hemodynamic monitoring requires an invasive procedure and may not be cost-effective. All currently available strategies to reduce hospitalizations with remote monitoring have drawbacks and challenges. Remote hemodynamic monitoring is currently the most efficacious based on data, but is not without its own imperfections.

Intra-abdominal pedicled rectus abdominis muscle flap for treatment of high-output enterocutaneous fistulae: case reports and review of literature.

PubMed

Carey, Joseph N; Sheckter, Clifford C; Watt, Andrew J; Lee, Gordon K

2013-08-01

Despite advances in nutritional supplementation, sepsis management, percutaneous drainage and surgical technique, enterocutaneous fistulae remain a considerable source of morbidity and mortality. Use of adjunctive modalities including negative pressure wound therapy and fibrin glue have been shown to improve the rapidity of fistula closure; however, the overall rate of closure remains poor. The challenge of managing chronic, high-output proximal enterocutaneous fistulae can be successfully achieved with appropriate medical management and intra-abdominal placement of pedicled rectus abdominis muscle flaps. We report two cases of recalcitrant high output enterocutaneous fistulae that were treated successfully with pedicled intra-abdominal rectus muscle flaps. Indications for pedicled intra-abdominal rectus muscle flaps include persistent patency despite a reasonable trial of non-operative intervention, failure of traditional operative interventions (serosal patch, Graham patch), and persistent electrolyte and nutritional abnormalities in the setting of a high-output fistula. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Isolation, Separation, and Preconcentration of Biologically Active Compounds from Plant Matrices by Extraction Techniques.

PubMed

Raks, Victoria; Al-Suod, Hossam; Buszewski, Bogusław

2018-01-01

Development of efficient methods for isolation and separation of biologically active compounds remains an important challenge for researchers. Designing systems such as organomineral composite materials that allow extraction of a wide range of biologically active compounds, acting as broad-utility solid-phase extraction agents, remains an important and necessary task. Selective sorbents can be easily used for highly selective and reliable extraction of specific components present in complex matrices. Herein, state-of-the-art approaches for selective isolation, preconcentration, and separation of biologically active compounds from a range of matrices are discussed. Primary focus is given to novel extraction methods for some biologically active compounds including cyclic polyols, flavonoids, and oligosaccharides from plants. In addition, application of silica-, carbon-, and polymer-based solid-phase extraction adsorbents and membrane extraction for selective separation of these compounds is discussed. Potential separation process interactions are recommended; their understanding is of utmost importance for the creation of optimal conditions to extract biologically active compounds including those with estrogenic properties.

Reconstruction of Long Bone Infections Using the Induced Membrane Technique: Tips and Tricks.

PubMed

Mauffrey, Cyril; Hake, Mark E; Chadayammuri, Vivek; Masquelet, Alain-Charles

2016-06-01

The management of posttraumatic long bone osteomyelitis remains a challenging clinical problem. A systematic approach is necessary, beginning with eradication of the infected bone and soft tissue. There are a number of options for reconstruction of the remaining bone defect, including the induced membrane technique developed by Masquelet. We describe our technique for the 2-stage treatment of long bone osteomyelitis. The first stage involves a radical debridement, stabilization of the bone with either external fixation or an antibiotic-coated intramedullary nail, and placement of a polymethylmethacrylate spacer. The second stage includes excision of the spacer and placement of autologous bone graft. Various resection methods, fixation strategies, antibiotic additives, and types of bone grafts or substitutes can be used. The purpose of our technical article is to share our personal experience and describe several nuances that are critical for the success of this treatment strategy. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MILITARY PAY: Processes for Retaining Injured Army National Guard and Reserve Soldiers on Active Duty Have Been Improved, but Some Challenges Remain

DTIC Science & Technology

2007-05-01

Active Duty Have Been Improved, but Some Challenges Remain The Army’s MRP program has largely resolved the widespread delays in order processing that...interviewed confirmed that they did not experience gaps in pay and associated benefits because of order processing delays. However, some of the...and injured reserve component soldiers we interviewed, these improvements have virtually eliminated the widespread delays in order processing that

Central Role of the Trehalose Biosynthesis Pathway in the Pathogenesis of Human Fungal Infections: Opportunities and Challenges for Therapeutic Development.

PubMed

Thammahong, Arsa; Puttikamonkul, Srisombat; Perfect, John R; Brennan, Richard G; Cramer, Robert A

2017-06-01

Invasive fungal infections cause significant morbidity and mortality in part due to a limited antifungal drug arsenal. One therapeutic challenge faced by clinicians is the significant host toxicity associated with antifungal drugs. Another challenge is the fungistatic mechanism of action of some drugs. Consequently, the identification of fungus-specific drug targets essential for fitness in vivo remains a significant goal of medical mycology research. The trehalose biosynthetic pathway is found in a wide variety of organisms, including human-pathogenic fungi, but not in humans. Genes encoding proteins involved in trehalose biosynthesis are mechanistically linked to the metabolism, cell wall homeostasis, stress responses, and virulence of Candida albicans , Cryptococcus neoformans , and Aspergillus fumigatus . While there are a number of pathways for trehalose production across the tree of life, the TPS/TPP (trehalose-6-phosphate synthase/trehalose-6-phosphate phosphatase) pathway is the canonical pathway found in human-pathogenic fungi. Importantly, data suggest that proteins involved in trehalose biosynthesis play other critical roles in fungal metabolism and in vivo fitness that remain to be fully elucidated. By further defining the biology and functions of trehalose and its biosynthetic pathway components in pathogenic fungi, an opportunity exists to leverage this pathway as a potent antifungal drug target. The goal of this review is to cover the known roles of this important molecule and its associated biosynthesis-encoding genes in the human-pathogenic fungi studied to date and to employ these data to critically assess the opportunities and challenges facing development of this pathway as a therapeutic target. Copyright © 2017 American Society for Microbiology.

Pressing needs of biomedical text mining in biocuration and beyond: opportunities and challenges.

PubMed

Singhal, Ayush; Leaman, Robert; Catlett, Natalie; Lemberger, Thomas; McEntyre, Johanna; Polson, Shawn; Xenarios, Ioannis; Arighi, Cecilia; Lu, Zhiyong

2016-01-01

Text mining in the biomedical sciences is rapidly transitioning from small-scale evaluation to large-scale application. In this article, we argue that text-mining technologies have become essential tools in real-world biomedical research. We describe four large scale applications of text mining, as showcased during a recent panel discussion at the BioCreative V Challenge Workshop. We draw on these applications as case studies to characterize common requirements for successfully applying text-mining techniques to practical biocuration needs. We note that system 'accuracy' remains a challenge and identify several additional common difficulties and potential research directions including (i) the 'scalability' issue due to the increasing need of mining information from millions of full-text articles, (ii) the 'interoperability' issue of integrating various text-mining systems into existing curation workflows and (iii) the 'reusability' issue on the difficulty of applying trained systems to text genres that are not seen previously during development. We then describe related efforts within the text-mining community, with a special focus on the BioCreative series of challenge workshops. We believe that focusing on the near-term challenges identified in this work will amplify the opportunities afforded by the continued adoption of text-mining tools. Finally, in order to sustain the curation ecosystem and have text-mining systems adopted for practical benefits, we call for increased collaboration between text-mining researchers and various stakeholders, including researchers, publishers and biocurators. Published by Oxford University Press 2016. This work is written by US Government employees and is in the public domain in the US.

No One Likes a Snitch.

PubMed

Redman, Barbara; Caplan, Arthur

2015-08-01

Whistleblowers remain essential as complainants in allegations of research misconduct. Frequently internal to the research team, they are poorly protected from acts of retribution, which may deter the reporting of misconduct. In order to perform their important role, whistleblowers must be treated fairly. Draft regulations for whistleblower protection were published for public comment almost a decade ago but never issued (Dahlberg 2013). In the face of the growing challenge of research fraud, we suggest vigorous steps, to include: organizational responsibility to certify the accuracy of research including audit, required whistleblower action in the face of imminent or grave harm to subjects, strengthened legal protections against retaliation including prompt enactment of Federal whistleblower protections and consideration of criminalizing the most egregious cases of research misconduct.

Aging in Place vs. Relocation for Older Adults with a Neurocognitive Disorder: Applications of Wiseman’s Behavioral Model

PubMed Central

Kaplan, Daniel; Andersen, Troy; Lehning, Amanda; Perry, Tam Elisabeth

2015-01-01

Some older adults are more vulnerable to housing concerns due to physical and cognitive challenges, including those with a neurocognitive disorder who need extensive support. Environmental gerontology frameworks, including Wiseman’s (1980) Behavioral Model of Elderly Migration, have informed scholarship on aging in place and relocation. It remains unclear, however, the extent to which this conceptual work informs services and supports for older adults, and the Wiseman model has not been applied to people with a neurocognitive disorder. Understanding Wiseman’s model, including considerations for working with families confronting a neurocognitive disorder, can help practitioners ensure that older clients live in settings that best meet their wants and needs. PMID:26016530

Defining metrics of the Quasi-Biennial Oscillation in global climate models

NASA Astrophysics Data System (ADS)

Schenzinger, Verena; Osprey, Scott; Gray, Lesley; Butchart, Neal

2017-06-01

As the dominant mode of variability in the tropical stratosphere, the Quasi-Biennial Oscillation (QBO) has been subject to extensive research. Though there is a well-developed theory of this phenomenon being forced by wave-mean flow interaction, simulating the QBO adequately in global climate models still remains difficult. This paper presents a set of metrics to characterize the morphology of the QBO using a number of different reanalysis datasets and the FU Berlin radiosonde observation dataset. The same metrics are then calculated from Coupled Model Intercomparison Project 5 and Chemistry-Climate Model Validation Activity 2 simulations which included a representation of QBO-like behaviour to evaluate which aspects of the QBO are well captured by the models and which ones remain a challenge for future model development.

The Challenge of Clean Air

ERIC Educational Resources Information Center

Turner, John M.

1974-01-01

The country's first two-year education program in Air Pollution Technology trains students to work for industry or government. Although two to three jobs are available for each graduate, attracting interested students remains a challenge. (AJ)

How could health information exchange better meet the needs of care practitioners?

PubMed

Kierkegaard, P; Kaushal, R; Vest, J R

2014-01-01

Health information exchange (HIE) has the potential to improve the quality of healthcare by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high. We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners. We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State. The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows. Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.

Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors.

PubMed

Mooney, Deirdre M; Fung, Erik; Doshi, Rahul N; Shavelle, David M

2015-01-01

Heart failure (HF) is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF) can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.

The contemporary refugee crisis: an overview of mental health challenges.

PubMed

Silove, Derrick; Ventevogel, Peter; Rees, Susan

2017-06-01

There has been an unprecedented upsurge in the number of refugees worldwide, the majority being located in low-income countries with limited resources in mental health care. This paper considers contemporary issues in the refugee mental health field, including developments in research, conceptual models, social and psychological interventions, and policy. Prevalence data yielded by cross-sectional epidemiological studies do not allow a clear distinction to be made between situational forms of distress and frank mental disorder, a shortcoming that may be addressed by longitudinal studies. An evolving ecological model of research focuses on the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the background disruptions of core psychosocial systems, the scope extending beyond the individual to the conjugal couple and the family. Although brief, structured psychotherapies administered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses, questions remain whether these interventions can be sustained in low-resource settings and whether they meet the needs of complex cases. In the ideal circumstance, a comprehensive array of programs should be provided, including social and psychotherapeutic interventions, generic mental health services, rehabilitation, and special programs for vulnerable groups. Sustainability of services, ensuring best practice, evidence-based approaches, and promoting equity of access must remain the goals of future developments, a daunting challenge given that most refugees reside in settings where skills and resources in mental health care are in shortest supply. © 2017 World Psychiatric Association.

The contemporary refugee crisis: an overview of mental health challenges

PubMed Central

Silove, Derrick; Ventevogel, Peter; Rees, Susan

2017-01-01

There has been an unprecedented upsurge in the number of refugees worldwide, the majority being located in low‐income countries with limited resources in mental health care. This paper considers contemporary issues in the refugee mental health field, including developments in research, conceptual models, social and psychological interventions, and policy. Prevalence data yielded by cross‐sectional epidemiological studies do not allow a clear distinction to be made between situational forms of distress and frank mental disorder, a shortcoming that may be addressed by longitudinal studies. An evolving ecological model of research focuses on the dynamic inter‐relationship of past traumatic experiences, ongoing daily stressors and the background disruptions of core psychosocial systems, the scope extending beyond the individual to the conjugal couple and the family. Although brief, structured psychotherapies administered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses, questions remain whether these interventions can be sustained in low‐resource settings and whether they meet the needs of complex cases. In the ideal circumstance, a comprehensive array of programs should be provided, including social and psychotherapeutic interventions, generic mental health services, rehabilitation, and special programs for vulnerable groups. Sustainability of services, ensuring best practice, evidence‐based approaches, and promoting equity of access must remain the goals of future developments, a daunting challenge given that most refugees reside in settings where skills and resources in mental health care are in shortest supply. PMID:28498581

Cellular regeneration strategies for macular degeneration: past, present and future.

PubMed

Chichagova, Valeria; Hallam, Dean; Collin, Joseph; Zerti, Darin; Dorgau, Birthe; Felemban, Majed; Lako, Majlinda; Steel, David H

2018-05-01

Despite considerable effort and significant therapeutic advances, age-related macular degeneration (AMD) remains the commonest cause of blindness in the developed world. Progressive late-stage AMD with outer retinal degeneration currently has no proven treatment. There has been significant interest in the possibility that cellular treatments may slow or reverse visual loss in AMD. A number of modes of action have been suggested, including cell replacement and rescue, as well as immune modulation to delay the neurodegenerative process. Their appeal in this enigmatic disease relate to their generic, non-pathway-specific effects. The outer retina in particular has been at the forefront of developments in cellular regenerative therapies being surgically accessible, easily observable, as well as having a relatively simple architecture. Both the retinal pigment epithelium (RPE) and photoreceptors have been considered for replacement therapies as both sheets and cell suspensions. Studies using autologous RPE, and to a lesser extent, foetal retina, have shown proof of principle. A wide variety of cell sources have been proposed with pluripotent stem cell-derived cells currently holding the centre stage. Recent early-phase trials using these cells for RPE replacement have met safety endpoints and hinted at possible efficacy. Animal studies have confirmed the promise that photoreceptor replacement, even in a completely degenerated outer retina may restore some vision. Many challenges, however, remain, not least of which include avoiding immune rejection, ensuring long-term cellular survival and maximising effect. This review provides an overview of progress made, ongoing studies and challenges ahead.

Recommendations for developing and applying genetic tools to assess and manage biological invasions in marine ecosystems

PubMed Central

Darling, John A.; Galil, Bella S.; Carvalho, Gary R.; Rius, Marc; Viard, Frédérique; Piraino, Stefano

2018-01-01

The European Union’s Marine Strategy Framework Directive (MSFD) aims to adopt integrated ecosystem management approaches to achieve or maintain “Good Environmental Status” for marine waters, habitats and resources, including mitigation of the negative effects of non-indigenous species (NIS). The Directive further seeks to promote broadly standardized monitoring efforts and assessment of temporal trends in marine ecosystem condition, incorporating metrics describing the distribution and impacts of NIS. Accomplishing these goals will require application of advanced tools for NIS surveillance and risk assessment, particularly given known challenges associated with surveying and monitoring with traditional methods. In the past decade, a host of methods based on nucleic acids (DNA and RNA) analysis have been developed or advanced that promise to dramatically enhance capacity in assessing and managing NIS. However, ensuring that these rapidly evolving approaches remain accessible and responsive to the needs of resource managers remains a challenge. This paper provides recommendations for future development of these genetic tools for assessment and management of NIS in marine systems, within the context of the explicit requirements of the MSFD. Issues considered include technological innovation, methodological standardization, data sharing and collaboration, and the critical importance of shared foundational resources, particularly integrated taxonomic expertise. Though the recommendations offered here are not exhaustive, they provide a basis for future intentional (and international) collaborative development of a genetic toolkit for NIS research, capable of fulfilling the immediate and long term goals of marine ecosystem and resource conservation. PMID:29681680

UK Renal Registry 16th annual report: chapter 13 clinical, haematological and biochemical parameters in patients receiving renal replacement therapy in paediatric centres in the uk in 2012: national and centre-specific analyses.

PubMed

Pruthi, Rishi; Maxwell, Heather; Casula, Anna; Braddon, Fiona; Lewis, Malcolm; O'Brien, Catherine; Stojanovic, Jelena; Tse, Yincent; Inward, Carol; Sinha, Manish D

2013-01-01

The British Association for Paediatric Nephrology Registry (BAPN) was established to analyse data related to renal replacement therapy (RRT) in children. The registry receives data from the 13 paediatric nephrology centres in the UK. This chapter aims to provide centre specific data so that individual centres can reflect on the contribution that their data makes to the national picture and to determine the extent to which their patient parameters meet nationally agreed audit standards for the management of children with established renal failure (ERF). Data returns included a mixture of electronic (92%) and paper (8%) returns. Data were analysed to calculate summary statistics and where applicable the percentage achieving an audit standard. The standards used were those set out by the Renal Association and the National Institute for Health and Clinical Excellence. Anthropometric data confirmed that children receiving RRT were short compared to healthy peers. Amongst patients with a height of <2SD between 2001 and 2012, 29.2%were receiving growth hormone if they were on dialysis compared to 11.9% if they had a functioning transplant. Prevalence rates of overweight and obese status in children with ERF remain concerningly high. Blood pressure control remained challenging with wide inter-centre variation although this was significantly better in children with a functioning transplant. Over a quarter of haemodialysis patients and 17.3% of peritoneal dialysis patients were anaemic, compared to only 8.3% of transplanted patients. ESA use in the dialysis population exceeded 90% amongst anaemic patients. The control of renal bone disease remained challenging. Optimising growth and reducing prevalent excess weight in children on RRT remains challenging. The likelihood of complete electronic reporting in the near future with plans for quarterly reporting in the format of the recently finalised NEW paediatric dataset will hopefully improve quality of data and their reporting, allowing improvements in patient care. © 2014 S. Karger AG, Basel.

Why primary care practices should become digital health information hubs for their patients.

PubMed

Baird, Aaron; Nowak, Samantha

2014-11-25

Two interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible. We contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive. We view the primary care practice as a central component of digital information coordination, especially when considering the current challenges of digital health information fragmentation. Given these fragmentation issues and the emphasis on primary care as central to improving health and lower overall health care costs, we suggest that primary care practices should embrace their evolving role and should seek to become digital health information hubs for their patients.

The Challenge of Teacher Retention in Urban Schools: Evidence of Variation from a Cross-Site Analysis

ERIC Educational Resources Information Center

Papay, John P.; Bacher-Hicks, Andrew; Page, Lindsay C.; Marinell, William H.

2017-01-01

Substantial teacher turnover poses a challenge to staffing public schools with effective teachers. The scope of the teacher retention challenge across school districts, however, remains poorly defined. Applying consistent data practices and analytical techniques to administrative data sets from 16 urban districts, we document substantial…

College Access Improves for Black Students but for Which Ones?

ERIC Educational Resources Information Center

Cokley, Kevin; Obaseki, Victor; Moran-Jackson, Karen; Jones, Leonie; Vohra-Gupta, Shetal

2016-01-01

The challenges for increasing opportunities and college access for black students typically focus on the traditional barriers related to academic preparation, the racial gap in standardized test scores, and dropping out of high school. While these challenges remain, new and emerging challenges to college access are also important to discuss. They…

Multiple Methods for Identifying Outcomes of a High Challenge Adventure Activity

ERIC Educational Resources Information Center

Davidson, Curt; Ewert, Alan; Chang, Yun

2016-01-01

The purpose of this study was to provide insight into what occurs in moments of high challenge within participants during an outdoor adventure education (OAE) program. Given the inherent risk and remote locations often associated with OAE programs, it has remained challenging to measure selected psychological constructs while the program is taking…

Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease

PubMed Central

2011-01-01

Background Due to the restrictive nature of a gluten-free diet, celiac patients are looking for alternative therapies. While drug-development programs include gluten challenges, knowledge regarding the duration of gluten challenge and gluten dosage is insufficient. We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration. Methods Twenty-five celiac disease adults were challenged with low (1-3 g) or moderate (3-5g) doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs) and celiac serology were determined. Results Both moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients. Conclusions Low amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis. PMID:22115041

Mannitol challenge testing for asthma in a community cohort of young adults.

PubMed

White, Elisha C; de Klerk, Nicholas; Hantos, Zoltan; Priston, Monique; Hollams, Elysia M; James, Alan; Sly, Peter D; Holt, Patrick G; Hall, Graham L

2017-05-01

Mannitol challenge testing is an established tool for clinical asthma diagnosis, and can be performed outside of specialized respiratory laboratories. Despite applicability in both clinical and non-clinical populations, with different pre-test asthma probabilities, differences in diagnostic properties have not been well explored. This study aimed to quantify the diagnostic utility of mannitol challenge testing for asthma in a community cohort and a symptomatic wheezing subset of this cohort. During the 22-year follow-up of the Western Australian Pregnancy (Raine) Cohort, 772 participants (384 males) completed mannitol challenge and skin prick testing and respiratory health questionnaires, of whom 148 reporting wheeze in the past 12 months were included in a wheezing subset. Responsiveness to mannitol had low sensitivity (19%) and high specificity (97%) to identify current asthma in the complete cohort, with positive and negative predictive values (PPV and NPV) of 45% and 92%, respectively. Within the wheezing subset, sensitivity (19%) and specificity (94%) remained similar, but PPV increased to 79%, and NPV decreased to 52%. Our findings support previously reported high specificity and good PPV for mannitol challenge testing in symptomatic wheezing populations, and highlight the need for caution when interpreting mannitol test results in non-clinical populations. © 2016 Asian Pacific Society of Respirology.

Interventional Cardiology for Congenital Heart Disease.

PubMed

Kenny, Damien

2018-05-01

Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years. Copyright © 2018. The Korean Society of Cardiology.

Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration.

PubMed

Embi, Peter J; Hebert, Courtney; Gordillo, Gayle; Kelleher, Kelly; Payne, Philip R O

2013-08-01

As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues common to such data reuse. After reviewing the current state of knowledge regarding biomedical informatics challenges and best practices related to CER, we then present 2 research projects at our institution. We analyze these and highlight several common themes and challenges related to the conduct of CER studies. Finally, we represent these emergent themes. The informatics challenges commonly encountered by those conducting CER studies include issues related to data information and knowledge management (eg, data reuse, data preparation) as well as those related to people and organizational issues (eg, sociotechnical factors and organizational factors). Examples of these are described in further detail and a formal framework for describing these findings is presented. Significant challenges face researchers attempting to use often diverse and heterogeneous datasets for CER. These challenges must be understood in order to be dealt with successfully and can often be overcome with the appropriate use of informatics best practices. Many research and policy questions remain to be answered in order to realize the full potential of the increasingly electronic clinical data available for such research.

Martin Drake power plant

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

Schimmoller, B.K.

2005-08-01

The relatively old Martin Drake coal-fired plant at Colorado Springs is facing challenges to meet environmental requirements whilst satisfying power demands and remaining competition. The article describes measures taken and planned to tackle these challenges. 2 photos.

Regenerative medicine in Brazil: small but innovative.

PubMed

McMahon, Dominique S; Singer, Peter A; Daar, Abdallah S; Thorsteinsdóttir, Halla

2010-11-01

Although Brazil has received attention for conducting one of the world's largest stem cell clinical trials for heart disease, little has been published regarding Brazil's regenerative medicine (RM) sector. Here we present a comprehensive case study of RM in Brazil, including analysis of the current activity, the main motivations for engaging in RM and the remaining challenges to development in this field. Our case study is primarily based on semi-structured interviews with experts on RM in Brazil, including researchers, policymakers, clinicians, representatives of firms and regulators. Driven by domestic health needs and strategic government support, Brazil is producing innovative RM research, particularly for clinical research in cardiology, orthopedics, diabetes and neurology. We describe the main RM research currently taking place in Brazil, as well as some of the economic, regulatory and policy events that have created a favorable environment for RM development. Brazilian RM researchers need to overcome several formidable challenges to research: research funding is inconsistent, importation of materials is costly and slow, and weak linkages between universities, hospitals and industry impede translational research. Although Brazil's contribution to the RM sector is small, its niche emphasis on clinical applications may become of global importance, particularly if Brazil manages to address the challenges currently impinging on RM innovation.

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

Andres Liebenthal; Roland Michelitsch; Ethel Tarazona

How effectively has the World Bank Group assisted its clients in enhancing the contribution of the extractive industries to sustainable development? (Extractive industries include oil, gas, and mining of minerals including coals and metals.) This evaluation finds that with its global mandate and experience, comprehensive country development focus, and overarching mission to fight poverty, the World Bank Group is well positioned to help countries overcome the policy, institutional, and technical challenges that prevent them from transforming resource endowments into sustainable benefits. Furthermore, the World Bank Group's achievements are many. On the whole, its extractive industries projects have produced positive economicmore » and financial results, though compliance with its environmental and social safeguards remains a challenge. Its research has broadened and deepened understanding of the causes for the disappointing performance of resource-rich countries. Its guidelines for the mitigation of adverse environmental and social impacts have been widely used and appreciated. More recently, it has begun to address the challenge of country governance with a variety of instruments. The World Bank Group can, however, do much to improve its performance in enhancing the extractive industry sector's contribution to sustainable development and poverty reduction. The report identifies three main areas for improvement - formulating an integrated strategy, strengthening implementation and engagement of stakeholders. 5 annexes.« less

Clinical evaluation incorporating a personal genome

PubMed Central

Ashley, Euan A.; Butte, Atul J.; Wheeler, Matthew T.; Chen, Rong; Klein, Teri E.; Dewey, Frederick E.; Dudley, Joel T.; Ormond, Kelly E.; Pavlovic, Aleksandra; Hudgins, Louanne; Gong, Li; Hodges, Laura M.; Berlin, Dorit S.; Thorn, Caroline F.; Sangkuhl, Katrin; Hebert, Joan M.; Woon, Mark; Sagreiya, Hersh; Whaley, Ryan; Morgan, Alexander A.; Pushkarev, Dmitry; Neff, Norma F; Knowles, Joshua W.; Chou, Mike; Thakuria, Joseph; Rosenbaum, Abraham; Zaranek, Alexander Wait; Church, George; Greely, Henry T.; Quake, Stephen R.; Altman, Russ B.

2010-01-01

Background The cost of genomic information has fallen steeply but the path to clinical translation of risk estimates for common variants found in genome wide association studies remains unclear. Since the speed and cost of sequencing complete genomes is rapidly declining, more comprehensive means of analyzing these data in concert with rare variants for genetic risk assessment and individualisation of therapy are required. Here, we present the first integrated analysis of a complete human genome in a clinical context. Methods An individual with a family history of vascular disease and early sudden death was evaluated. Clinical assessment included risk prediction for coronary artery disease, screening for causes of sudden cardiac death, and genetic counselling. Genetic analysis included the development of novel methods for the integration of whole genome sequence data including 2.6 million single nucleotide polymorphisms and 752 copy number variations. The algorithm focused on predicting genetic risk of genes associated with known Mendelian disease, recognised drug responses, and pathogenicity for novel variants. In addition, since integration of risk ratios derived from case control studies is challenging, we estimated posterior probabilities from age and sex appropriate prior probability and likelihood ratios derived for each genotype. In addition, we developed a visualisation approach to account for gene-environment interactions and conditionally dependent risks. Findings We found increased genetic risk for myocardial infarction, type II diabetes and certain cancers. Rare variants in LPA are consistent with the family history of coronary artery disease. Pharmacogenomic analysis suggested a positive response to lipid lowering therapy, likely clopidogrel resistance, and a low initial dosing requirement for warfarin. Many variants of uncertain significance were reported. Interpretation Although challenges remain, our results suggest that whole genome sequencing can yield useful and clinically relevant information for individual patients, especially for those with a strong family history of significant disease. PMID:20435227

Lessons Learned in Evaluating a Multisite, Comprehensive Teen Dating Violence Prevention Strategy: Design and Challenges of the Evaluation of Dating Matters: Strategies to Promote Healthy Teen Relationships.

PubMed

Niolon, Phyllis Holditch; Taylor, Bruce G; Latzman, Natasha E; Vivolo-Kantor, Alana M; Valle, Linda Anne; Tharp, Andra T

2016-03-01

This paper describes the multisite, longitudinal cluster randomized controlled trial (RCT) design of the evaluation of the Dating Matters: Strategies to Promote Healthy Relationships initiative, and discusses challenges faced in conducting this evaluation. Health departments in 4 communities are partnering with middle schools in high-risk, urban communities to implement 2 models of teen dating violence (TDV) prevention over 4 years. Schools were randomized to receive either the Dating Matters comprehensive strategy or the "standard of care" strategy (an existing, evidence-based TDV prevention curriculum). Our design permits comparison of the relative effectiveness of the comprehensive and standard of care strategies. Multiple cohorts of students from 46 middle schools are surveyed in middle school and high school, and parents and educators from participating schools are also surveyed. Challenges discussed in conducting a multisite RCT include site variability, separation of implementation and evaluation responsibilities, school retention, parent engagement in research activities, and working within the context of high-risk urban schools and communities. We discuss the strengths and weaknesses of our approaches to these challenges in the hopes of informing future research. Despite multiple challenges, the design of the Dating Matters evaluation remains strong. We hope this paper provides researchers who are conducting complex evaluations of behavioral interventions with thoughtful discussion of the challenges we have faced and potential solutions to such challenges.

Lessons Learned in Evaluating a Multisite, Comprehensive Teen Dating Violence Prevention Strategy: Design and Challenges of the Evaluation of Dating Matters: Strategies to Promote Healthy Teen Relationships

PubMed Central

Niolon, Phyllis Holditch; Taylor, Bruce G.; Latzman, Natasha E.; Vivolo-Kantor, Alana M.; Valle, Linda Anne; Tharp, Andra T.

2018-01-01

Objective This paper describes the multisite, longitudinal cluster randomized controlled trial (RCT) design of the evaluation of the Dating Matters: Strategies to Promote Healthy Relationships initiative, and discusses challenges faced in conducting this evaluation. Method Health departments in 4 communities are partnering with middle schools in high-risk, urban communities to implement 2 models of teen dating violence (TDV) prevention over 4 years. Schools were randomized to receive either the Dating Matters comprehensive strategy or the “standard of care” strategy (an existing, evidence-based TDV prevention curriculum). Our design permits comparison of the relative effectiveness of the comprehensive and standard of care strategies. Multiple cohorts of students from 46 middle schools are surveyed in middle school and high school, and parents and educators from participating schools are also surveyed. Results Challenges discussed in conducting a multisite RCT include site variability, separation of implementation and evaluation responsibilities, school retention, parent engagement in research activities, and working within the context of high-risk urban schools and communities. We discuss the strengths and weaknesses of our approaches to these challenges in the hopes of informing future research. Conclusions Despite multiple challenges, the design of the Dating Matters evaluation remains strong. We hope this paper provides researchers who are conducting complex evaluations of behavioral interventions with thoughtful discussion of the challenges we have faced and potential solutions to such challenges. PMID:29607239

Remaining Relevant: Historical Contributions, Civil-Military Challenges, and Anti-Submarine Warfare Capabilities on Coast Guard Cutters

DTIC Science & Technology

2018-03-01

HISTORICAL CONTRIBUTIONS, CIVIL-MILITARY CHALLENGES, AND ANTI-SUBMARINE WARFARE CAPABILITIES ON COAST GUARD CUTTERS by Brian A. Smicklas...CONTRIBUTIONS, CIVIL- MILITARY CHALLENGES, AND ANTI-SUBMARINE WARFARE CAPABILITIES ON COAST GUARD CUTTERS 5. FUNDING NUMBERS 6. AUTHOR(S) Brian A...MILITARY CHALLENGES, AND ANTI-SUBMARINE WARFARE CAPABILITIES ON COAST GUARD CUTTERS Brian A. Smicklas Commander, U.S. Coast Guard B.S., Coast

An integrated conceptual framework for evaluating and improving 'understanding' in informed consent.

PubMed

Bossert, Sabine; Strech, Daniel

2017-10-17

The development of understandable informed consent (IC) documents has proven to be one of the most important challenges in research with humans as well as in healthcare settings. Therefore, evaluating and improving understanding has been of increasing interest for empirical research on IC. However, several conceptual and practical challenges for the development of understandable IC documents remain unresolved. In this paper, we will outline and systematize some of these challenges. On the basis of our own experiences in empirical user testing of IC documents as well as the relevant literature on understanding in IC, we propose an integrated conceptual model for the development of understandable IC documents. The proposed conceptual model integrates different methods for the participatory improvement of written information, including IC, as well as quantitative methods for measuring understanding in IC. In most IC processes, understandable written information is an important prerequisite for valid IC. To improve the quality of IC documents, a conceptual model for participatory procedures of testing, revising, and retesting can be applied. However, the model presented in this paper needs further theoretical and empirical elaboration and clarification of several conceptual and practical challenges.

Expanding Access to Malaria Diagnosis through Retail Shops in Western Kenya: What Do Shop Workers Think?

PubMed

Rusk, Andria; Goodman, Catherine; Naanyu, Violet; Koech, Beatrice; Obala, Andrew; O'Meara, Wendy Prudhomme

2013-01-01

Background. The common symptoms of malaria reduce the specificity of clinical diagnosis. Presumptive treatment is conventional but can lead to overdiagnosis of malaria, delay of appropriate treatment, overprescription of antimalarials, and drug resistance. Routine use of diagnostic tests can address many of these concerns. Though treatment is often procured from retailers, there is low availability of rapid diagnostic tests for malaria (MRDTs), a simple, inexpensive, and accurate diagnostic solution. We know little about the challenges to expanding access to diagnostics through these outlets. Methods. To understand the perceptions of the benefits and challenges to selling rapid diagnostic tests for malaria, we conducted focus group discussions with antimalarial retailers who serve the residents of the Webuye Health and Demographic Surveillance Site in western Kenya. Results. Medicine retailers perceived MRDTs to be beneficial to their customers and businesses but also included cost, fear of the tests, risks of self-treatment, and regulatory concerns among the challenges to using and selling MRDTs. Conclusion. MRDTs represent a viable approach to increase access to malaria diagnostic testing. Medicine retailers are eager for MRDTs to be made available to them. However, certain challenges remain to implementation in retail outlets and should be addressed in advance.

Integrative Understanding of Emergent Brain Properties, Quantum Brain Hypotheses, and Connectome Alterations in Dementia are Key Challenges to Conquer Alzheimer's Disease.

PubMed

Kuljiš, Rodrigo O

2010-01-01

The biological substrate for cognition remains a challenge as much as defining this function of living beings. Here, we examine some of the difficulties to understand normal and disordered cognition in humans. We use aspects of Alzheimer's disease and related disorders to illustrate how the wealth of information at many conceptually separate, even intellectually decoupled, physical scales - in particular at the Molecular Neuroscience versus Systems Neuroscience/Neuropsychology levels - presents a challenge in terms of true interdisciplinary integration towards a coherent understanding. These unresolved dilemmas include critically the as yet untested quantum brain hypothesis, and the embryonic attempts to develop and define the so-called connectome in humans and in non-human models of disease. To mitigate these challenges, we propose a scheme incorporating the vast array of scales of the space and time (space-time) manifold from at least the subatomic through cognitive-behavioral dimensions of inquiry, to achieve a new understanding of both normal and disordered cognition, that is essential for a new era of progress in the Generative Sciences and its application to translational efforts for disease prevention and treatment.

What we can and cannot (yet) do with functional near infrared spectroscopy

PubMed Central

Strait, Megan; Scheutz, Matthias

2014-01-01

Functional near infrared spectroscopy (NIRS) is a relatively new technique complimentary to EEG for the development of brain-computer interfaces (BCIs). NIRS-based systems for detecting various cognitive and affective states such as mental and emotional stress have already been demonstrated in a range of adaptive human–computer interaction (HCI) applications. However, before NIRS-BCIs can be used reliably in realistic HCI settings, substantial challenges oncerning signal processing and modeling must be addressed. Although many of those challenges have been identified previously, the solutions to overcome them remain scant. In this paper, we first review what can be currently done with NIRS, specifically, NIRS-based approaches to measuring cognitive and affective user states as well as demonstrations of passive NIRS-BCIs. We then discuss some of the primary challenges these systems would face if deployed in more realistic settings, including detection latencies and motion artifacts. Lastly, we investigate the effects of some of these challenges on signal reliability via a quantitative comparison of three NIRS models. The hope is that this paper will actively engage researchers to acilitate the advancement of NIRS as a more robust and useful tool to the BCI community. PMID:24904261

Global nurse leader perspectives on health systems and workforce challenges.

PubMed

Gantz, Nancy Rollins; Sherman, Rose; Jasper, Melanie; Choo, Chua Gek; Herrin-Griffith, Donna; Harris, Kathy

2012-05-01

As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future. Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies. © 2012 Blackwell Publishing Ltd.

An interferon inducing porcine reproductive and respiratory syndrome virus vaccine candidate elicits protection against challenge with the heterologous virulent type 2 strain VR-2385 in pigs.

PubMed

Fontanella, Eve; Ma, Zexu; Zhang, Yanjin; de Castro, Alessandra M M G; Shen, Huigang; Halbur, Patrick G; Opriessnig, Tanja

2017-01-03

Achieving consistent protection by vaccinating pigs against porcine reproductive and respiratory syndrome virus (PRRSV) remains difficult. Recently, an interferon-inducing PRRSV vaccine candidate strain A2MC2 was demonstrated to be attenuated and induced neutralizing antibodies. The objective of this study was to determine the efficacy of passage 90 of A2MC2 (A2P90) to protect pigs against challenge with moderately virulent PRRSV strain VR-2385 (92.3% nucleic acid identity with A2MC2) and highly virulent atypical PRRSV MN184 (84.5% nucleic acid identity with A2MC2). Forty 3-week old pigs were randomly assigned to five groups including a NEG-CONTROL group (non-vaccinated, non-challenged), VAC-VR2385 (vaccinated, challenged with strain VR-2385), VR2385 (challenged with strain VR-2385), VAC-MN184 (vaccinated, challenged with strain MN184) and a MN184 group (challenged with MN184 virus). Vaccination was done at 3weeks of age followed by challenge at 8weeks of age. No viremia was detectable in any of the vaccinated pigs; however, by the time of challenge, 15/16 vaccinated pigs had seroconverted based on ELISA and had neutralizing antibodies against a homologous strain with titers ranging from 8 to 128. Infection with VR-2385 resulted in mild-to-moderate clinical disease and lesions. For VR-2385 infected pigs, vaccination significantly lowered PRRSV viremia and nasal shedding by 9days post challenge (dpc), significantly reduced macroscopic lung lesions, and significantly increased the average daily weight gain compared to the non-vaccinated pigs. Infection with MN184 resulted in moderate-to-severe clinical disease and lesions regardless of vaccination status; however, vaccinated pigs had significantly less nasal shedding by dpc 5 compared to non-vaccinated pigs. Under the study conditions, the A2P90 vaccine strain was attenuated without detectable shedding, improved weight gain, and offered protection to the pigs challenged with VR-2385 by reduction of virus load and macroscopic lung lesions. Further work is needed to investigate different vaccination and challenge protocols, including routes, doses, timing and strains. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2017-01-01

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

A multi-site community randomized trial of community health workers to provide counseling and support for patients newly entering HIV care in rural Ethiopia: study design and baseline implementation.

PubMed

Lifson, Alan R; Workneh, Sale; Hailemichael, Abera; MacLehose, Richard F; Horvath, Keith J; Hilk, Rose; Fabian, Lindsey; Sites, Anne; Shenie, Tibebe

2018-06-01

Although HIV therapy is delivered to millions globally, treatment default (especially soon after entering care) remains a challenge. Community health workers (CHWs) can provide many services for people with HIV, including in rural and resource-limited settings. We designed and implemented a 32 site community randomized trial throughout southern Ethiopia to assess an intervention using CHWs to improve retention in HIV care. Sixteen district hospital and 16 local health center HIV clinics were randomized 1:1 to be intervention or control sites. From each site, we enrolled adults newly entering HIV care. Participants at intervention sites were assigned a CHW who provided: HIV and health education; counseling and social support; and facilitated communication with HIV clinics. All participants are followed through three years with annual health surveys, plus HIV clinic record abstraction including clinic visit dates. CHWs record operational data about their client contacts. 1799 HIV patients meeting inclusion criteria were enrolled and randomized: 59% were female, median age = 32 years, median CD4 + count = 263 cells/mm 3 , and 41% were WHO Stage III or IV. A major enrollment challenge was fewer new HIV patients initiating care at participating sites due to shortage of HIV test kits. At intervention sites, 71 CHWs were hired, trained and assigned to clients. In meeting with clients, CHWs needed to accommodate to various challenges, including HIV stigma, distance, and clients lacking cell phones. This randomized community HIV trial using CHWs in a resource-limited setting was successfully launched, but required flexibility to adapt to unforeseen challenges.

Getting Out or Remaining in the Cage of Inauthentic Self: The Meaning of Existential Challenges in Patients' with Cancer

PubMed Central

Khoshnood, Zohreh; Iranmanesh, Sedigheh; Rayyani, Masoud; Dehghan, Mahlegha

2018-01-01

Context: Cancer as a life-threatening disease develops a range of existential challenges in persons. These challenges cause the patients to encounter some existential questions and tensions. This study method focuses on a person's experience about them. Aims: The aim of this study is to illuminate the meaning of existential challenges in patients with cancer in Iran. Subjects and Methods: A hermeneutic phenomenological approach, influenced by the philosophy of Ricoeur, was used to analyze the experiences of 10 Iranian patients with cancer. Data analysis was based on three stages of simple and fast understanding, structural analysis, and comprehensive understanding. Results: The present study showed that existential challenges in patients with cancer can be considered as getting out or remaining in the cage of inauthentic self. This theme consists of two subthemes “Being exposed to the light of awareness that revealed the cage of inauthentic self” and “The tension between getting out of the cage or remaining.” First, being exposed to the light of awareness revealed the cage of inauthentic self which subjectively refers to the emergence of existential questions, the past, the fear of future, and the collapse of physical body identity. Second, the tension between getting out of the cage or still staying which is characterized by anger, denial, sense of loneliness, and depression. Conclusions: According to the results of this qualitative study, it is possible to form discussion groups with peers or have self-reflective practice teaching groups to reflect patients' questions and existential challenges. In this way, participants can express themselves, share their experiences, challenges, learn, and find the answers. PMID:29736113

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation.

PubMed

Kolandai-Matchett, Komathi; Landon, Jason; Bellringer, Maria; Abbott, Max

2018-03-06

In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere. Evaluation criteria, based on the programme's official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff. Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common. The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

Nanotechnology-based Cryopreservation of Cell-Scaffold Constructs: A New Breakthrough to Clinical Application.

PubMed

Chen, G; Lv, Y

The developments of "off-the-shelf" cell-scaffold constructs received an increasing interest in tissue engineering and regenerative medicine. Although the direct cryopreservation of a single-cell suspension in the tube is a relative mature technology, the cryopreservation of cell-scaffold constructs remains a challenge. Nanotechnology shows tremendous potential for cryopreservation in regulating of freezing and thawing processes. For example, nanoparticles have been reported to modify the cryoprotective agent (CPA), adjust the process of cooling and warming cycles. In this review, we provide an overview of cryopreservation of cell-scaffold constructs firstly. The review further focuses on the effects of nanotechnology on cryopreservation of cell-scaffold constructs, including the nanostructure of scaffold, nanoparticles in cooling and warming process in cryopreservation. The perspectives on future challenges in this filed are also pointed out.

DNA Nanotechnology-Enabled Interfacial Engineering for Biosensor Development.

PubMed

Ye, Dekai; Zuo, Xiaolei; Fan, Chunhai

2018-06-12

Biosensors represent biomimetic analytical tools for addressing increasing needs in medical diagnosis, environmental monitoring, security, and biodefense. Nevertheless, widespread real-world applications of biosensors remain challenging due to limitations of performance, including sensitivity, specificity, speed, and reproducibility. In this review, we present a DNA nanotechnology-enabled interfacial engineering approach for improving the performance of biosensors. We first introduce the main challenges of the biosensing interfaces, especially under the context of controlling the DNA interfacial assembly. We then summarize recent progress in DNA nanotechnology and efforts to harness DNA nanostructures to engineer various biological interfaces, with a particular focus on the use of framework nucleic acids. We also discuss the implementation of biosensors to detect physiologically relevant nucleic acids, proteins, small molecules, ions, and other biomarkers. This review highlights promising applications of DNA nanotechnology in interfacial engineering for biosensors and related areas.

Stop TB-Halte à la Tuberculose-Canada: engaging industrialised nations in the challenge to meet global targets.

PubMed

Fanning, A; Billo, N; Tannenbaum, T; Phypers, M; Little, C; Graham, B; Mill, J

2004-01-01

The Stop TB Partnership has engaged the 22 high-burden countries in a drive toward the goal of finding 70% of cases and curing 85% by 2005. Traditional partners, aid agencies and governments of industrialised nations have joined the Partnership, but the broader range of civil society remains outside the discourse, risking disinterest on the part of the donor community. Stop TB-Halte à la Tuberculose-Canada was organised to engage new partners to support the Canadian government's commitment to the goal of reducing poverty and diseases of poverty, including tuberculosis, by 50% by 2010. The successes and challenges are explored, and the possibility raised that having a Stop TB movement in every country will ensure that support is sustained and goals of global tuberculosis control reached.

Exosome levels in human body fluids: A tumor marker by themselves?

PubMed

Cappello, Francesco; Logozzi, Mariantonia; Campanella, Claudia; Bavisotto, Celeste Caruso; Marcilla, Antonio; Properzi, Francesca; Fais, Stefano

2017-01-01

Despite considerable research efforts, the finding of reliable tumor biomarkers remains challenging and unresolved. In recent years a novel diagnostic biomedical tool with high potential has been identified in extracellular nanovesicles or exosomes. They are released by the majority of the cells and contain detailed molecular information on the cell of origin including tumor hallmarks. Exosomes can be isolated from easy accessible body fluids, and most importantly, they can provide several biomarkers, with different levels of specificity. Recent clinical evidence shows that the levels of exosomes released into body fluids may themselves represent a predictive/diagnostic of tumors, discriminating cancer patients from healthy subjects. The aim of this review is to highlight these latest challenging findings to provide novel and groundbreaking ideas for successful tumor early diagnosis and follow-up. Copyright © 2016 Elsevier B.V. All rights reserved.

Emerging infections: a perpetual challenge

PubMed Central

Morens, David M; Folkers, Gregory K; Fauci, Anthony S

2008-01-01

Emerging and re-emerging infectious diseases, and their determinants, have recently attracted substantial scientific and popular attention. HIV/AIDS, severe acute respiratory syndrome, H5N1 avian influenza, and many other emerging diseases have either proved fatal or caused international alarm. Common and interactive co-determinants of disease emergence, including population growth, travel, and environmental disruption, have been increasingly documented and studied. Are emerging infections a new phenomenon related to modern life, or do more basic determinants, transcending time, place, and human progress, govern disease generation? By examining a number of historically notable epidemics, we suggest that emerging diseases, similar in their novelty, impact, and elicitation of control responses, have occurred throughout recorded history. Fundamental determinants, typically acting in concert, seem to underlie their emergence, and infections such as these are likely to continue to remain challenges to human survival. PMID:18992407

Post-apartheid challenges: household access and use of health care in South Africa.

PubMed

Gilson, Lucy; McIntyre, Di

2007-01-01

Since 1994 the South African government has placed equity at the heart of its health policy goals. However, there has as yet been surprisingly little assessment of the success of policies in reducing inequity. This article provides insights on these issues by applying the Affordability Ladder conceptual framework in synthesizing evidence drawn from a series of household surveys and studies undertaken between 1992 and 2003. These data suggest that, despite policy efforts, inequities in access and utilization between socioeconomic groups remain. Underlying challenges include worsening community perceptions of the quality of publicly provided care and the influence of insurance status on utilization patterns. Further and more detailed evaluation of household-level policy impacts requires both improvements in the quality of South African survey data, particularly in enhancing consistency in survey design over time, and more detailed, focused studies.

The challenges of modulating the 'rest and digest' system: acetylcholine receptors as drug targets.

PubMed

VanPatten, Sonya; Al-Abed, Yousef

2017-01-01

Acetylcholine, a major neurotransmitter of the parasympathetic and sympathetic nervous systems, was discovered in the early 1900s. Over the years, researchers have revealed much about its regulation, properties of its receptors and features of the downstream signaling that influence its terminal effects. The acetylcholine system, traditionally associated with neuromuscular communication, is now known to play a crucial part in modulation of the immune system and other 'rest and digest' effects. Recent research seeks to elucidate the system's role in brain functions including cognition, sleep, arousal, motivation, reward and pain. We highlight clinically approved and experimental drugs that modulate the acetylcholine receptors. The complexities in targeting the acetylcholine receptors are vast and finding future indications for drug development associated with specific acetylcholine receptors remains a challenge. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Model for Value-Added E-Marketplace Provisioning: Case Study from Alibaba.com

NASA Astrophysics Data System (ADS)

Qing, Hong Hong; Xue, Zi Shan

Alibaba.com is one of the leading B2B e-Commerce companies in China. It provides an e-Marketplace connecting small and medium-sized buyers and suppliers both in China and around the world. Alibaba.com has grown admirably from its initial beginning as a general e-Market to a giant e-Marketplace. During its rapid growth, it has incurred challenges and became more exposed to greater competition. Currently the quality of its services and achieving profitability remain Alibaba’s greatest challenges. In this paper we examine the key factors of the strategies of Alibaba.com, including trust, market, search, payment and tools. Alibaba’s strategies led to its success: strong brand, providing customers with outstanding value and a superior shopping experience, massive sales volume and realizing economies of scale.

The environmental-data automated track annotation (Env-DATA) system: linking animal tracks with environmental data

USGS Publications Warehouse

Dodge, Somayeh; Bohrer, Gil; Weinzierl, Rolf P.; Davidson, Sarah C.; Kays, Roland; Douglas, David C.; Cruz, Sebastian; Han, J.; Brandes, David; Wikelski, Martin

2013-01-01

The movement of animals is strongly influenced by external factors in their surrounding environment such as weather, habitat types, and human land use. With advances in positioning and sensor technologies, it is now possible to capture animal locations at high spatial and temporal granularities. Likewise, scientists have an increasing access to large volumes of environmental data. Environmental data are heterogeneous in source and format, and are usually obtained at different spatiotemporal scales than movement data. Indeed, there remain scientific and technical challenges in developing linkages between the growing collections of animal movement data and the large repositories of heterogeneous remote sensing observations, as well as in the developments of new statistical and computational methods for the analysis of movement in its environmental context. These challenges include retrieval, indexing, efficient storage, data integration, and analytical techniques.

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

PubMed Central

Asgary, Saeed

2014-01-01

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

Perspectives of HER2-targeting in gastric and esophageal cancer.

PubMed

Gerson, James N; Skariah, Sam; Denlinger, Crystal S; Astsaturov, Igor

2017-05-01

The blockade of HER2 signaling has significantly improved the outlook for esophagogastric cancer patients. However, targeting HER2 still remains challenging due to complex biology of this receptor in gastric and esophageal cancers. Areas covered: Here, we review complex HER2 biology, current methods of HER2 testing and tumor heterogeneity of gastroesophageal cancer. Ongoing and completed clinical research data are discussed. Expert opinion: HER2 overexpression is a validated target in gastroesophageal cancer, with therapeutic implications resulting in prolonged survival when inhibited in the front-line setting. With standardized HER2 testing in gastro-esophageal cancer, the ongoing trials are testing newer agents and combinations including combination of anti-HER2 antibodies with immunotherapy. Clonal heterogeneity and emergence of resistance will challenge our approach to treating these patients beyond the frontline settings.

Challenges in the Management of Geriatric Trauma: A Case Report.

PubMed

Gaebel, Ashley; Keiser, Megan

This article describes geriatric trauma and commonly associated difficulties emphasizing both the epidemiology and assessment of geriatric trauma. There is little data guiding decisions for trauma patients 65 years or older, as there are many unique characteristics to the geriatric population, including comorbidities, medications, and the aging physiology. The geriatric population in the United States has been steadily climbing for the last 20 years and is projected to continue on this trend. Although each patient presents differently, there remains a need for the consistent utilization of standard guidelines to help dictate care for geriatric patients, particularly for patients not receiving care at a trauma center. This review uses a case study about an elderly woman with many comorbidities, followed by a comprehensive discussion of geriatric trauma and the challenges that result from a lack of guideline utilization to direct management.

Gender and leadership in healthcare administration: 21st century progress and challenges.

PubMed

Lantz, Paula M

2008-01-01

The need for strong leadership and increased diversity is a prominent issue in today's health services workforce. This article reviews the latest literature, including research and proposed agendas, regarding women in executive healthcare leadership. Data suggest that the number of women in leadership roles is increasing, but women remain underrepresented in the top echelons of healthcare leadership, and gender differences exist in the types of leadership roles women do attain. Salary disparity prevails, even when controlling for gender differences in educational attainment, age, and experience. Despite widespread awareness of these problems in the field, current action and policy recommendations are severely lacking. Along with the challenges of cost, quality, and an aging population, the time has come for a more thoughtful, policy-focused approach to amend the discrepancy between gender and leadership in healthcare administration.

Prospects for neural stem cell-based therapies for neurological diseases.

PubMed

Imitola, Jaime

2007-10-01

Neural stem and progenitor cells have great potential for the treatment of neurological disorders. However, many obstacles remain to translate this field to the patient's bedside, including rationales for using neural stem cells in individual neurological disorders; the challenges of neural stem cell biology; and the caveats of current strategies of isolation and culturing neural precursors. Addressing these challenges is critical for the translation of neural stem cell biology to the clinic. Recent work using neural stem cells has yielded novel biologic concepts such as the importance of the reciprocal interaction between neural stem cells and the neurodegenerative environment. The prospect of using transplants of neural stem cells and progenitors to treat neurological diseases requires a better understanding of the molecular mechanisms of both neural stem cell behavior in experimental models and the intrinsic repair capacity of the injured brain.

Deep sequencing of evolving pathogen populations: applications, errors, and bioinformatic solutions

PubMed Central

2014-01-01

Deep sequencing harnesses the high throughput nature of next generation sequencing technologies to generate population samples, treating information contained in individual reads as meaningful. Here, we review applications of deep sequencing to pathogen evolution. Pioneering deep sequencing studies from the virology literature are discussed, such as whole genome Roche-454 sequencing analyses of the dynamics of the rapidly mutating pathogens hepatitis C virus and HIV. Extension of the deep sequencing approach to bacterial populations is then discussed, including the impacts of emerging sequencing technologies. While it is clear that deep sequencing has unprecedented potential for assessing the genetic structure and evolutionary history of pathogen populations, bioinformatic challenges remain. We summarise current approaches to overcoming these challenges, in particular methods for detecting low frequency variants in the context of sequencing error and reconstructing individual haplotypes from short reads. PMID:24428920

Viral pathogen discovery

PubMed Central

Chiu, Charles Y

2015-01-01

Viral pathogen discovery is of critical importance to clinical microbiology, infectious diseases, and public health. Genomic approaches for pathogen discovery, including consensus polymerase chain reaction (PCR), microarrays, and unbiased next-generation sequencing (NGS), have the capacity to comprehensively identify novel microbes present in clinical samples. Although numerous challenges remain to be addressed, including the bioinformatics analysis and interpretation of large datasets, these technologies have been successful in rapidly identifying emerging outbreak threats, screening vaccines and other biological products for microbial contamination, and discovering novel viruses associated with both acute and chronic illnesses. Downstream studies such as genome assembly, epidemiologic screening, and a culture system or animal model of infection are necessary to establish an association of a candidate pathogen with disease. PMID:23725672

The economics of alcohol abuse and alcohol-control policies.

PubMed

Cook, Philip J; Moore, Michael J

2002-01-01

Economic research has contributed to the evaluation of alcohol policy through empirical analysis of the effects of alcohol-control measures on alcohol consumption and its consequences. It has also provided an accounting framework for defining and comparing costs and benefits of alcohol consumption and related policy interventions, including excise taxes. The most important finding from the economics literature is that consumers tend to drink less ethanol, and have fewer alcohol-related problems, when alcoholic beverage prices are increased or alcohol availability is restricted. That set of findings is relevant for policy purposes because alcohol abuse imposes large "external" costs on others. Important challenges remain, including developing a better understanding of the effects of drinking on labor-market productivity.

Challenges and Opportunities for Typhoid Fever Control: A Call for Coordinated Action

PubMed Central

Steele, A. Duncan; Hay Burgess, Deborah C.; Diaz, Zoey; Carey, Megan E.; Zaidi, Anita K. M.

2016-01-01

The burden of enteric fever caused by Salmonella enterica serovars Typhi and Paratyphi is substantial and has high impact in toddlers and young children. This burden is relatively well documented in Asia, and this supplement provides new data on the substantial burden in several sub-Saharan African countries. Challenges in standardized surveillance and imperfect diagnostic tools have resulted in patchy local disease data, which are not well acknowledged or integrated into local country evidence and health awareness for decision making. There is a need to strengthen diagnostics for the generation of burden data in country. Furthermore, the guidelines and training for treatment of enteric fever cases in Africa are sorely needed to help mitigate the inappropriate use of antimicrobial treatment. Classic water safety and access to sanitation development remain powerful tools for the control of typhoid fever, yet the huge economic costs and long timelines are unlikely to provide a short- to middle-term solution. Emerging threats, including multidrug resistance and increasing urbanization in regions such as sub-Saharan Africa, warrant focused attention to shorter-term interventions including immunization, and must include vaccine strategies with the new typhoid conjugate vaccines. PMID:26933019

Perceptions of Challenges and Barriers to Career Advancement by Women Administrators in the University of North Carolina System

ERIC Educational Resources Information Center

Blue, Katina Michelle

2014-01-01

While women have made significant inroads and gains in the twentieth century, there remain challenges and barriers in regard to their satisfaction with career advancement opportunities. This mixed-method research study investigated perceptions of challenges and barriers to career advancement by women administrators at Group 2 institutions in the…

Leaderboard Now Open: CPTAC’s DREAM Proteogenomics Computational Challenge | Office of Cancer Clinical Proteomics Research

Cancer.gov

The National Cancer Institute’s Clinical Proteomic Tumor Analysis Consortium (CPTAC) is pleased to announce the opening of the leaderboard to its Proteogenomics Computational DREAM Challenge. The leadership board remains open for submissions during September 25, 2017 through October 8, 2017, with the Challenge expected to run until November 17, 2017.

Oil-Free Shaft Support System Rotordynamics: Past, Present, and Future Challenges and Opportunities

NASA Technical Reports Server (NTRS)

DellaCorte, Christopher

2011-01-01

Recent breakthroughs in Oil-Free technologies have enabled new high-speed rotor systems and turbomachinery. Such technologies can include compliant-surface gas bearings, magnetic bearings, and advanced solid lubricants and tribo-materials. This presentation briefly reviews critical technology developments and the current state-of-the-art, emerging Oil-Free rotor systems and discusses obstacles preventing more widespread use. Key examples of "best practices" for deploying Oil-Free technologies will be presented and remaining major technical questions surrounding Oil-Free technologies will be brought forward.

Newborn Screening for Lysosomal Storage Disorders

PubMed Central

Peake, Roy W. A.; Bodamer, Olaf A.

2016-01-01

Newborn screening is one of the most important public health initiatives to date, focusing on the identification of presymptomatic newborn infants with treatable conditions to reduce morbidity and mortality. The number of screening conditions continues to expand due to advances in screening technologies and the development of novel therapies. Consequently, some of the lysosomal storage disorders are now considered as candidates for newborn screening, although many challenges including identification of late-onset phenotypes remain. This review provides a critical appraisal of the current state of newborn screening for lysosomal storage disorders. PMID:28180027

Timing of Operative Debridement in Open Fractures.

PubMed

Rozell, Joshua C; Connolly, Keith P; Mehta, Samir

2017-01-01

The optimal treatment of open fractures continues to be an area of debate in the orthopedic literature. Recent research has challenged the dictum that open fractures should be debrided within 6 hours of injury. However, the expedient administration of intravenous antibiotics remains of paramount importance in infection prevention. Multiple factors, including fracture severity, thoroughness of debridement, time to initial treatment, and antibiotic administration, among other variables, contribute to the incidence of infection and complicate identifying an optimal time to debridement. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of Nanoclay Exfoliation Strategies for Thermoset Polyimide Nanocomposite Systems

NASA Technical Reports Server (NTRS)

Ginter, Michael J.; Jana, Sadhan C.; Miller, Sandi G.

2007-01-01

Prior works show exfoliated layered silicate reinforcement improves polymer composite properties. However, achieving full clay exfoliation in high performance thermoset polyimides remains a challenge. This study explores a new method of clay exfoliation, which includes clay intercalation by lower molecular weight PMR monomer under conditions of low and high shear and sonication, clay treatments by aliphatic and aromatic surfactants, and clay dispersion in primary, higher molecular weight PMR resin. Clay spacing, thermal, and mechanical properties were evaluated and compared with the best results available in literature for PMR polyimide systems.

Using social media to engage adolescents and young adults with their health

PubMed Central

Wong, Charlene A.; Merchant, Raina M.; Moreno, Megan A.

2015-01-01

We focus on the potential of social media related to the health of adolescent and young adults, who are nearly ubiquitous social media users but difficult to engage with their health and relatively low healthcare utilizers. Opportunities to better engage adolescents and young adults through social media exist in healthcare delivery, health education and health policy. However, challenges remain for harnessing social media, including making a clear value proposition and developing evidence-based frameworks for measuring the impact of social media on health. PMID:25984444

Thailand's Work and Health Transition.

PubMed

Kelly, Matthew; Strazdins, Lyndall; Dellora, Tarie; Khamman, Suwanee; Seubsman, Sam-Ang; Sleigh, Adrian C

2010-09-01

Thailand has experienced a rapid economic transition from agriculture to industry and services, and from informal to formal employment. It has much less state regulation and worker representation relative to developed nations, who underwent these transitions more slowly and sequentially, decades earlier. We examine the strengthening of Thai government policy and legislation affecting worker's health, responding to international norms, a new democratic constitution, fear of foreign importer embargos and several fatal workplace disasters. We identify key challenges remaining for Thai policy makers, including legislation enforcement and the measurement of impacts on worker's mental and physical health.

Current treatments of acne: Medications, lights, lasers, and a novel 650-μs 1064-nm Nd: YAG laser.

PubMed

Gold, Michael H; Goldberg, David J; Nestor, Mark S

2017-09-01

The treatment of acne, especially severe acne, remains a challenge to dermatologists. Therapies include retinoids, antibiotics, hormones, lights, lasers, and various combinations of these modalities. Acne is currently considered a chronic rather than an adolescent condition. The appropriate treatment depends on the patient and the severity of disease. The purpose of this study was to review current therapies for acne of all severities and to introduce the 650-μs 1064-nm laser for the treatment of acne. © 2017 Wiley Periodicals, Inc.

Myocarditis.

PubMed

Fung, Gabriel; Luo, Honglin; Qiu, Ye; Yang, Decheng; McManus, Bruce

2016-02-05

Viral myocarditis remains a prominent infectious-inflammatory disease for patients throughout the lifespan. The condition presents several challenges including varied modes of clinical presentation, a range of timepoints when patients come to attention, a diversity of approaches to diagnosis, a spectrum of clinical courses, and unsettled perspectives on therapeutics in different patient settings and in the face of different viral pathogens. In this review, we examine current knowledge about viral heart disease and especially provide information on evolving understanding of mechanisms of disease and efforts by investigators to identify and evaluate potential therapeutic avenues for intervention. © 2016 American Heart Association, Inc.

The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management

PubMed Central

Mokomane, Margaret; Kasvosve, Ishmael; de Melo, Emilia; Pernica, Jeffrey M.; Goldfarb, David M.

2017-01-01

Acute diarrhoeal diseases remain a leading cause of global morbidity and mortality particularly among young children in resource-limited countries. Recent large studies utilizing case–control design, prospective sampling and more sensitive and broad diagnostic techniques have shed light on particular pathogens of importance and highlighted the previously under recognized impact of these infections on post-acute illness mortality and growth. Vaccination, particularly against rotavirus, has emerged as a key effective means of preventing significant morbidity and mortality from childhood diarrhoeal disease. Other candidate vaccines against leading diarrhoeal pathogens, such as enterotoxigenic Escherichia coli and Shigella spp., also hold significant promise in further ameliorating the burden of enteric infections in children. Large studies are also currently underway evaluating novel and potential easy-to-implement water, sanitation and hygiene (WASH) preventive strategies. Given the ongoing global burden of this illness, the paucity of new advances in case management over the last several decades remains a challenge. The increasing recognition of post-acute illness mortality and growth impairment has highlighted the need for interventions that go beyond management of dehydration and electrolyte disturbances. The few trials of novel promising interventions such as probiotics have mainly been conducted in high-income settings. Trials of antimicrobials have also been primarily conducted in high-income settings or in travellers from high-income settings. Bloody diarrhoea has been shown to be a poor marker of potentially treatable bacterial enteritis, and rising antimicrobial resistance has also made empiric antimicrobial therapy more challenging in many settings. Novel effective and sustainable interventions and diagnostic strategies are clearly needed to help improve case management. Diarrhoeal disease and other enteric infections remain an unmet challenge in global child health. Most promising recent developments have been focused around preventive measures, in particular vaccination. Further advances in prevention and case management including the possible use of targeted antimicrobial treatment are also required to fully address this critical burden on child health and human potential. PMID:29344358

Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals.

PubMed

Le Conte, Philippe; Thibergien, Séverin; Obellianne, Jean Batiste; Montassier, Emmanuel; Potel, Gilles; Roy, Pierre Marie; Batard, Eric

2017-08-30

Sepsis management in the Emergency Department remains a daily challenge. The Surviving Sepsis Campaign (SSC) has released three-hour bundle. The implementation of these bundles in European Emergency Departments remains poorly described. The main objective was to assess the compliance with the Severe Sepsis Campaign 3-h bundle (blood culture, lactate dosage, first dose of antibiotics and 30 ml/kg fluid challenge). Secondary objectives were the analysis of the delay of severe sepsis recognition and description of the population. In accordance with STROBE statement, we performed a retrospective study in two French University Hospital Emergency Departments from February to August 2015. Patients admitted during the study period were screened using the electronic files of the hospital databases. Patient's files were reviewed and included in the study if they met severe sepsis criteria. Demographics, comorbities, treatments were recorded. Delays from admission to severe sepsis diagnosis, fluid loading onset and antibiotics administration were calculated. One hundred thirty patients were included (76 men, mean age 71 ± 14 years). Blood culture, lactate dosage, antibiotics and 30 ml/kg fluid loading were performed within 3 hours in % [95% confidence interval] 100% [96-100%], 62% [54-70%], 49% [41-58%] and 19% [13-27%], respectively. 25 patients out of 130 (19% [13-27%]) fulfilled each criteria of the 3-h bundle. The mean fluid loading volume was 18 ± 11 ml/kg. Mean delay between presentation and severe sepsis diagnosis was 200 ± 263 min, from diagnosis to fluid challenge and first antibiotic dose, 10 ± 27 min and 20 ± 55 min, respectively. Compliance with SSC 3-h bundle and delay between admission and sepsis recognition have to be improved. If confirmed by other studies, an improvement program might be deployed.

Challenges and opportunities for managing aquatic mercury pollution in altered landscapes.

PubMed

Hsu-Kim, Heileen; Eckley, Chris S; Achá, Dario; Feng, Xinbin; Gilmour, Cynthia C; Jonsson, Sofi; Mitchell, Carl P J

2018-03-01

The environmental cycling of mercury (Hg) can be affected by natural and anthropogenic perturbations. Of particular concern is how these disruptions increase mobilization of Hg from sites and alter the formation of monomethylmercury (MeHg), a bioaccumulative form of Hg for humans and wildlife. The scientific community has made significant advances in recent years in understanding the processes contributing to the risk of MeHg in the environment. The objective of this paper is to synthesize the scientific understanding of how Hg cycling in the aquatic environment is influenced by landscape perturbations at the local scale, perturbations that include watershed loadings, deforestation, reservoir and wetland creation, rice production, urbanization, mining and industrial point source pollution, and remediation. We focus on the major challenges associated with each type of alteration, as well as management opportunities that could lessen both MeHg levels in biota and exposure to humans. For example, our understanding of approximate response times to changes in Hg inputs from various sources or landscape alterations could lead to policies that prioritize the avoidance of certain activities in the most vulnerable systems and sequestration of Hg in deep soil and sediment pools. The remediation of Hg pollution from historical mining and other industries is shifting towards in situ technologies that could be less disruptive and less costly than conventional approaches. Contemporary artisanal gold mining has well-documented impacts with respect to Hg; however, significant social and political challenges remain in implementing effective policies to minimize Hg use. Much remains to be learned as we strive towards the meaningful application of our understanding for stakeholders, including communities living near Hg-polluted sites, environmental policy makers, and scientists and engineers tasked with developing watershed management solutions. Site-specific assessments of MeHg exposure risk will require new methods to predict the impacts of anthropogenic perturbations and an understanding of the complexity of Hg cycling at the local scale.

Reconstruction of structure and function in tissue engineering of solid organs: Toward simulation of natural development based on decellularization.

PubMed

Zheng, Chen-Xi; Sui, Bing-Dong; Hu, Cheng-Hu; Qiu, Xin-Yu; Zhao, Pan; Jin, Yan

2018-04-27

Failure of solid organs, such as the heart, liver, and kidney, remains a major cause of the world's mortality due to critical shortage of donor organs. Tissue engineering, which uses elements including cells, scaffolds, and growth factors to fabricate functional organs in vitro, is a promising strategy to mitigate the scarcity of transplantable organs. Within recent years, different construction strategies that guide the combination of tissue engineering elements have been applied in solid organ tissue engineering and have achieved much progress. Most attractively, construction strategy based on whole-organ decellularization has become a popular and promising approach, because the overall structure of extracellular matrix can be well preserved. However, despite the preservation of whole structure, the current constructs derived from decellularization-based strategy still perform partial functions of solid organs, due to several challenges, including preservation of functional extracellular matrix structure, implementation of functional recellularization, formation of functional vascular network, and realization of long-term functional integration. This review overviews the status quo of solid organ tissue engineering, including both advances and challenges. We have also put forward a few techniques with potential to solve the challenges, mainly focusing on decellularization-based construction strategy. We propose that the primary concept for constructing tissue-engineered solid organs is fabricating functional organs based on intact structure via simulating the natural development and regeneration processes. Copyright © 2018 John Wiley & Sons, Ltd.

NASA's Earth Observing Data and Information System - Near-Term Challenges

NASA Technical Reports Server (NTRS)

Behnke, Jeanne; Mitchell, Andrew; Ramapriyan, Hampapuram

2018-01-01

NASA's Earth Observing System Data and Information System (EOSDIS) has been a central component of the NASA Earth observation program since the 1990's. EOSDIS manages data covering a wide range of Earth science disciplines including cryosphere, land cover change, polar processes, field campaigns, ocean surface, digital elevation, atmosphere dynamics and composition, and inter-disciplinary research, and many others. One of the key components of EOSDIS is a set of twelve discipline-based Distributed Active Archive Centers (DAACs) distributed across the United States. Managed by NASA's Earth Science Data and Information System (ESDIS) Project at Goddard Space Flight Center, these DAACs serve over 3 million users globally. The ESDIS Project provides the infrastructure support for EOSDIS, which includes other components such as the Science Investigator-led Processing systems (SIPS), common metadata and metrics management systems, specialized network systems, standards management, and centralized support for use of commercial cloud capabilities. Given the long-term requirements, and the rapid pace of information technology and changing expectations of the user community, EOSDIS has evolved continually over the past three decades. However, many challenges remain. Challenges addressed in this paper include: growing volume and variety, achieving consistency across a diverse set of data producers, managing information about a large number of datasets, migration to a cloud computing environment, optimizing data discovery and access, incorporating user feedback from a diverse community, keeping metadata updated as data collections grow and age, and ensuring that all the content needed for understanding datasets by future users is identified and preserved.

Vaccinology in the third millennium: scientific and social challenges

PubMed Central

Poland, Gregory A.; Whitaker, Jennifer A.; Poland, Caroline M.; Ovsyannikova, Inna G.; Kennedy, Richard B.

2016-01-01

The epidemiology of deaths due to vaccine-preventable diseases has been significantly and positively altered through the use of vaccines. Despite this, significant challenges remain in vaccine development and use in the third millennium. Both new (Ebola, Chikungunya, West Nile) and re-emerging diseases (measles, mumps, influenza) require the development of new or next-generation vaccines. The global aging of the population, and accumulating numbers of immunocompromised persons, will require new vaccine and adjuvant development to protect large segments of the population. After vaccine development, significant challenges remain globally in the cost and efficient use and acceptance of vaccines by the public. This article raises issues in these two areas and suggests a way forward that will benefit current and future generations. PMID:27039875

Paleobiological Perspectives on Early Microbial Evolution

PubMed Central

Knoll, Andrew H.

2015-01-01

Microfossils, stromatolites, and chemical biosignatures indicate that Earth became a biological planet more than 3.5 billion years ago, making most of life's history microbial. Proterozoic rocks preserve a rich record of cyanobacteria, including derived forms that differentiate multiple cell types. Stromatolites, in turn, show that microbial communities covered the seafloor from tidal flats to the base of the photic zone. The Archean record is more challenging to interpret, particularly on the question of cyanobacterial antiquity, which remains to be resolved. In the late Neoproterozoic Era, increasing oxygen and radiating eukaryotes altered the biosphere, with planktonic algae gaining ecological prominence in the water column, whereas seaweeds and, eventually, animals spread across shallow seafloors. From a microbial perspective, however, animals, algae, and, later, plants simply provided new opportunities for diversification, and, to this day, microbial metabolisms remain the only essential components of biogeochemical cycles. PMID:26134315

Artificial activation of toxin-antitoxin systems as an antibacterial strategy.

PubMed

Williams, Julia J; Hergenrother, Paul J

2012-06-01

Toxin-antitoxin (TA) systems are unique modules that effect plasmid stabilization via post-segregational killing of the bacterial host. The genes encoding TA systems also exist on bacterial chromosomes, and it has been speculated that these are involved in a variety of cellular processes. Interest in TA systems has increased dramatically over the past 5 years as the ubiquitous nature of TA genes on bacterial genomes has been revealed. The exploitation of TA systems as an antibacterial strategy via artificial activation of the toxin has been proposed and has considerable potential; however, efforts in this area remain in the early stages and several major questions remain. This review investigates the tractability of targeting TA systems to kill bacteria, including fundamental requirements for success, recent advances, and challenges associated with artificial toxin activation. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Challenge of Controlling the COPD Epidemic Chronic Obstructive Pulmonary Disease: Unmet Needs.

PubMed

Polverino, Francesca; Celli, Bartolome

2018-05-17

Many unmet needs still remain in the assessment and treatment of patients with chronic obstructive pulmonary disease (COPD), particularly in relation to its under- and misdiagnosis, which lead to under- and mistreatment. This paucity of knowledge about the importance and presence of COPD, as well as its treatment, is seen with patients and carers as well as healthcare providers. This review considers the areas of key educational need, including the clinical characteristics of COPD, factors contributing to the disease, effective diagnosis, and clinical management of patients, and the implementation of treatment guidelines. As COPD remains the third most frequent cause of death in the world, we must continue to expand the scope and reach of our efforts to improve outcomes in this debilitating disease. Copyright © 2018. Published by Elsevier Inc.

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

PubMed

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

2017-11-16

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

Evaluation of carbon nanotube probes in critical dimension atomic force microscopes.

PubMed

Choi, Jinho; Park, Byong Chon; Ahn, Sang Jung; Kim, Dal-Hyun; Lyou, Joon; Dixson, Ronald G; Orji, Ndubuisi G; Fu, Joseph; Vorburger, Theodore V

2016-07-01

The decreasing size of semiconductor features and the increasing structural complexity of advanced devices have placed continuously greater demands on manufacturing metrology, arising both from the measurement challenges of smaller feature sizes and the growing requirement to characterize structures in more than just a single critical dimension. For scanning electron microscopy, this has resulted in increasing sophistication of imaging models. For critical dimension atomic force microscopes (CD-AFMs), this has resulted in the need for smaller and more complex tips. Carbon nanotube (CNT) tips have thus been the focus of much interest and effort by a number of researchers. However, there have been significant issues surrounding both the manufacture and use of CNT tips. Specifically, the growth or attachment of CNTs to AFM cantilevers has been a challenge to the fabrication of CNT tips, and the flexibility and resultant bending artifacts have presented challenges to using CNT tips. The Korea Research Institute for Standards and Science (KRISS) has invested considerable effort in the controlled fabrication of CNT tips and is collaborating with the National Institute of Standards and Technology on the application of CNT tips for CD-AFM. Progress by KRISS on the precise control of CNT orientation, length, and end modification, using manipulation and focused ion beam processes, has allowed us to implement ball-capped CNT tips and bent CNT tips for CD-AFM. Using two different generations of CD-AFM instruments, we have evaluated these tip types by imaging a line/space grating and a programmed line edge roughness specimen. We concluded that these CNTs are capable of scanning the profiles of these structures, including re-entrant sidewalls, but there remain important challenges to address. These challenges include tighter control of tip geometry and careful optimization of scan parameters and algorithms for using CNT tips.

Enrolling African-American and Latino patients with asthma in comparative effectiveness research: Lessons learned from 8 patient-centered studies.

PubMed

Kramer, C Bradley; LeRoy, Lisa; Donahue, Sara; Apter, Andrea J; Bryant-Stephens, Tyra; Elder, John P; Hamilton, Winifred J; Krishnan, Jerry A; Shelef, Deborah Q; Stout, James W; Sumino, Kaharu; Teach, Stephen J; Federman, Alex D

2016-12-01

African-American and Latino patients are often difficult to recruit for asthma studies. This challenge is a barrier to improving asthma care and outcomes for these populations. We sought to examine the recruitment experiences of 8 asthma comparative effectiveness studies that specifically targeted African-American and Latino patients, and identify the solutions they developed to improve recruitment. Case report methodology was used to gather and evaluate information on study design, recruitment procedures and outcomes from study protocols and annual reports, and in-depth interviews with each research team. Data were analyzed for themes, commonalities, and differences. There were 4 domains of recruitment challenges: individual participant, institutional, research team, and study intervention. Participants had competing demands for time and some did not believe they had asthma. Institutional challenges included organizational policies governing monetary incentives and staff hiring. Research team challenges included ongoing training needs of recruitment staff, and intervention designs often were unappealing to participants because of inconveniences. Teams identified a host of strategies to address these challenges, most importantly engagement of patients and other stakeholders in study design and troubleshooting, and flexibility in data collection and intervention application to meet the varied needs of patients. Asthma researchers may have greater success with recruitment by addressing uncertainty among patients about asthma diagnosis, engaging stakeholders in all aspects of study design and implementation, and maximizing flexibility of study and intervention protocols. However, even with such efforts, engagement of African-American and Latino patients in asthma research may remain low. Greater investment in research on engaging these populations in asthma research may ultimately be needed to improve their asthma care and outcomes. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Responding to a cVDPV1 outbreak in Ukraine: Implications, challenges and opportunities.

PubMed

Khetsuriani, Nino; Perehinets, Ihor; Nitzan, Dorit; Popovic, Dragoslav; Moran, Thomas; Allahverdiyeva, Vusala; Huseynov, Shahin; Gavrilin, Eugene; Slobodianyk, Liudmyla; Izhyk, Olha; Sukhodolska, Anna; Hegazi, Sahar; Bulavinova, Katerina; Platov, Sergei; O'Connor, Patrick

2017-08-24

The European Region, certified polio-free in 2002, remains at risk of wild poliovirus reintroduction and emergence of circulating vaccine-derived polioviruses (cVDPV) until global polio eradication is achieved, as demonstrated by the cVDPV1 outbreak in Ukraine in 2015. We reviewed epidemiologic, clinical and virology data on cVDPV cases, surveillance and immunization coverage data, and reports of outbreak-related surveys, country missions, and expert group meetings. In Ukraine, 3-dose polio vaccine coverage declined from 91% in 2008 to 15% by mid-2015. In summer, 2015, two unrelated children from Zakarpattya province were paralyzed by a highly divergent cVDPV1. The isolates were 20 and 26 nucleotide divergent from prototype Sabin strain (with 18 identical mutations) consistent with their common origin and ∼2-year evolution. Outbreak response recommendations developed with international partner support included conducting three nationwide supplementary immunization activities (SIAs) with tOPV, strengthening surveillance and implementing communication interventions. SIAs were conducted during October 2015-February 2016 (officially reported coverage, round 1-64.4%, round 2-71.7%, and round 3-80.7%). Substantial challenges to outbreak response included lack of high-level support, resistance to OPV use, low perceived risk of polio, widespread vaccine hesitancy, anti-vaccine media environment, economic crisis and military conflict. Communication activities improved caregiver awareness of polio and confidence in vaccination. Surveillance was enhanced but did not consistently meet applicable performance standards. Post-outbreak assessments concluded that cVDPV1 transmission in Ukraine has likely stopped following the response, but significant gaps in population immunity and surveillance remained. Chronic under-vaccination in Ukraine resulted in the accumulation of children susceptible to polioviruses and created favorable conditions for VDPV1 emergence and circulation, leading to the outbreak. Until programmatic gaps in immunization and surveillance are addressed, Ukraine will remain at high-risk for VDPV emergence and circulation, as well as at risk for other vaccine-preventable diseases. Published by Elsevier Ltd.

Benefits of exercise therapy in peripheral arterial disease.

PubMed

Osinbowale, Olusegun O; Milani, Richard V

2011-01-01

Peripheral arterial disease (PAD) is a common disorder caused largely by atherosclerosis. Although it is associated with increased morbidity and cardiovascular mortality, PAD remains underdiagnosed. Traditional PAD care has involved cardiovascular risk factor modification, use of antiplatelet agents, and revascularization. For those individuals who are eligible and willing to perform exercise therapy (ET), a significant benefit may be recognized. Despite this, ET faces several challenges to implementation. Notably, the lack of reimbursement by third party payers remains the major challenge to routine use of ET. Copyright © 2011 Elsevier Inc. All rights reserved.

Revisiting adaptations of neotropical katydids (Orthoptera: Tettigoniidae) to gleaning bat predation

PubMed Central

ter Hofstede, Hannah; Voigt-Heucke, Silke; Lang, Alexander; Römer, Heinrich; Page, Rachel; Faure, Paul; Dechmann, Dina

2017-01-01

All animals have defenses against predators, but assessing the effectiveness of such traits is challenging. Neotropical katydids (Orthoptera: Tettigoniidae) are an abundant, ubiquitous, and diverse group of large insects eaten by a variety of predators, including substrate-gleaning bats. Gleaning bats capture food from surfaces and usually use prey-generated sounds to detect and locate prey. A number of Neotropical katydid signaling traits, such as the emission of ultrasonic frequencies, substrate vibration communication, infrequent calling, and ultrasound-evoked song cessation are thought to have evolved as defenses against substrate-gleaning bats. We collected insect remains from hairy big-eared bat (Micronycteris hirsuta) roosts in Panama. We identified insect remains to order, species, or genus and quantified the proportion of prey with defenses against predatory bats based on defenses described in the literature. Most remains were from katydids and half of those were from species with documented defenses against substrate-gleaning bats. Many culled remains were from insects that do not emit mate-calling songs (e.g. beetles, dragonflies, cockroaches, and female katydids), indicating that eavesdropping on prey signals is not the only prey-finding strategy used by this bat. Our results show that substrate-gleaning bats can occasionally overcome katydid defenses. PMID:28261664

Revisiting adaptations of neotropical katydids (Orthoptera: Tettigoniidae) to gleaning bat predation.

PubMed

Ter Hofstede, Hannah; Voigt-Heucke, Silke; Lang, Alexander; Römer, Heinrich; Page, Rachel; Faure, Paul; Dechmann, Dina

2017-01-01

All animals have defenses against predators, but assessing the effectiveness of such traits is challenging. Neotropical katydids (Orthoptera: Tettigoniidae) are an abundant, ubiquitous, and diverse group of large insects eaten by a variety of predators, including substrate-gleaning bats. Gleaning bats capture food from surfaces and usually use prey-generated sounds to detect and locate prey. A number of Neotropical katydid signaling traits, such as the emission of ultrasonic frequencies, substrate vibration communication, infrequent calling, and ultrasound-evoked song cessation are thought to have evolved as defenses against substrate-gleaning bats. We collected insect remains from hairy big-eared bat ( Micronycteris hirsuta ) roosts in Panama. We identified insect remains to order, species, or genus and quantified the proportion of prey with defenses against predatory bats based on defenses described in the literature. Most remains were from katydids and half of those were from species with documented defenses against substrate-gleaning bats. Many culled remains were from insects that do not emit mate-calling songs (e.g. beetles, dragonflies, cockroaches, and female katydids), indicating that eavesdropping on prey signals is not the only prey-finding strategy used by this bat. Our results show that substrate-gleaning bats can occasionally overcome katydid defenses.

The use of Leptodyctium riparium (Hedw.) Warnst in the estimation of minimum postmortem interval.

PubMed

Lancia, Massimo; Conforti, Federica; Aleffi, Michele; Caccianiga, Marco; Bacci, Mauro; Rossi, Riccardo

2013-01-01

The estimation of the postmortem interval (PMI) is still one of the most challenging issues in forensic investigations, especially in cases in which advanced transformative phenomena have taken place. The dating of skeletal remains is even more difficult and sometimes only a rough determination of the PMI is possible. Recent studies suggest that plant analysis can provide a reliable estimation for skeletal remains dating, when traditional techniques are not applicable. Forensic Botany is a relatively recent discipline that includes many subdisciplines such as Palynology, Anatomy, Dendrochronology, Limnology, Systematic, Ecology, and Molecular Biology. In a recent study, Cardoso et al. (Int J Legal Med 2010;124:451) used botanical evidence for the first time to establish the PMI of human skeletal remains found in a forested area of northern Portugal from the growth rate of mosses and shrub roots. The present paper deals with a case in which the study of the growth rate of the bryophyte Leptodyctium riparium (Hedw.) Warnst, was used in estimating the PMI of some human skeletal remains that were found in a wooded area near Perugia, in Central Italy. © 2012 American Academy of Forensic Sciences.

Facebook Groups for the Management of Chronic Diseases.

PubMed

Partridge, Stephanie R; Gallagher, Patrick; Freeman, Becky; Gallagher, Robyn

2018-01-17

The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group "champions"; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations. ©Stephanie R Partridge, Patrick Gallagher, Becky Freeman, Robyn Gallagher. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.01.2018.

Decision Neuroscience: Neuroeconomics

PubMed Central

Smith, David V.; Huettel, Scott A.

2012-01-01

Few aspects of human cognition are more personal than the choices we make. Our decisions – from the mundane to the impossibly complex – continually shape the courses of our lives. In recent years, researchers have applied the tools of neuroscience to understand the mechanisms that underlie decision making, as part of the new discipline of decision neuroscience. A primary goal of this emerging field has been to identify the processes that underlie specific decision variables, including the value of rewards, the uncertainty associated with particular outcomes, and the consequences of social interactions. Recent work suggests potential neural substrates that integrate these variables, potentially reflecting a common neural currency for value, to facilitate value comparisons. Despite the successes of decision neuroscience research for elucidating brain mechanisms, significant challenges remain. These include building new conceptual frameworks for decision making, integrating research findings across disparate techniques and species, and extending results from neuroscience to shape economic theory. To overcome these challenges, future research will likely focus on interpersonal variability in decision making, with the eventual goal of creating biologically plausible models for individual choice. PMID:22754602

The Enduring Challenge of Determining Pneumonia Etiology in Children: Considerations for Future Research Priorities.

PubMed

Feikin, Daniel R; Hammitt, Laura L; Murdoch, David R; O'Brien, Katherine L; Scott, J Anthony G

2017-06-15

Pneumonia kills more children each year worldwide than any other disease. Nonetheless, accurately determining the causes of childhood pneumonia has remained elusive. Over the past century, the focus of pneumonia etiology research has shifted from studies of lung aspirates and postmortem specimens intent on identifying pneumococcal disease to studies of multiple specimen types distant from the lung that are tested for multiple pathogens. Some major challenges facing modern pneumonia etiology studies include the use of nonspecific and variable case definitions, poor access to pathologic lung tissue and to specimens from fatal cases, poor diagnostic accuracy of assays (especially when testing nonpulmonary specimens), and the interpretation of results when multiple pathogens are detected in a given individual. The future of childhood pneumonia etiology research will likely require integrating data from complementary approaches, including applications of advanced molecular diagnostics and vaccine probe studies, as well as a renewed emphasis on lung aspirates from radiologically confirmed pneumonia and postmortem examinations. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

The Future of the Small Rural Grocery Store: A Qualitative Exploration.

PubMed

Pinard, Courtney A; Fricke, Hollyanne E; Smith, Teresa M; Carpenter, Leah R; Yaroch, Amy L

2016-11-01

Rural communities face unique challenges to and opportunities for offering more healthful foods and are often understudied in comparison to their urban counterparts. The purpose of this study was to conduct a qualitative assessment of rural storeowners' perceptions of their communities, their business practices, and factors that influences their viability, sustainability, and ability to support healthy food choices. We conducted interviews with storeowners (N = 15) in small stores in rural Nebraska and explored perceptions of business practices, role in the community, and consumer demand for more healthful foods. The storeowners reported strategies they employ to remain competitive, such as selling alcohol and tobacco, focusing on customer service, and ensuring quality of products. Manufacturer and distributor agreements often put constraints on their business models. Key challenges reported included a dwindling population and competition with larger chains in neighboring towns set in a sparsely populated landscape. Goals for the future included expanding equipment, largely to offer more prepared foods. This study adds to the literature around food access in rural communities, and can inform future implementation strategies to work with storeowners to improve healthy food access.

Animal models of post-ischemic forced use rehabilitation: methods, considerations, and limitations

PubMed Central

2013-01-01

Many survivors of stroke experience arm impairments, which can severely impact their quality of life. Forcing use of the impaired arm appears to improve functional recovery in post-stroke hemiplegic patients, however the mechanisms underlying improved recovery remain unclear. Animal models of post-stroke rehabilitation could prove critical to investigating such mechanisms, however modeling forced use in animals has proven challenging. Potential problems associated with reported experimental models include variability between stroke methods, rehabilitation paradigms, and reported outcome measures. Herein, we provide an overview of commonly used stroke models, including advantages and disadvantages of each with respect to studying rehabilitation. We then review various forced use rehabilitation paradigms, and highlight potential difficulties and translational problems. Lastly, we discuss the variety of functional outcome measures described by experimental researchers. To conclude, we outline ongoing challenges faced by researchers, and the importance of translational communication. Many stroke patients rely critically on rehabilitation of post-stroke impairments, and continued effort toward progression of rehabilitative techniques is warranted to ensure best possible treatment of the devastating effects of stroke. PMID:23343500

Multiagent Work Practice Simulation: Progress and Challenges

NASA Technical Reports Server (NTRS)

Clancey, William J.; Sierhuis, Maarten; Shaffe, Michael G. (Technical Monitor)

2001-01-01

Modeling and simulating complex human-system interactions requires going beyond formal procedures and information flows to analyze how people interact with each other. Such work practices include conversations, modes of communication, informal assistance, impromptu meetings, workarounds, and so on. To make these social processes visible, we have developed a multiagent simulation tool, called Brahms, for modeling the activities of people belonging to multiple groups, situated in a physical environment (geographic regions, buildings, transport vehicles, etc.) consisting of tools, documents, and a computer system. We are finding many useful applications of Brahms for system requirements analysis, instruction, implementing software agents, and as a workbench for relating cognitive and social theories of human behavior. Many challenges remain for representing work practices, including modeling: memory over multiple days, scheduled activities combining physical objects, groups, and locations on a timeline (such as a Space Shuttle mission), habitat vehicles with trajectories (such as the Shuttle), agent movement in 3D space (e.g., inside the International Space Station), agent posture and line of sight, coupled movements (such as carrying objects), and learning (mimicry, forming habits, detecting repetition, etc.).

Multiagent Work Practice Simulation: Progress and Challenges

NASA Technical Reports Server (NTRS)

Clancey, William J.; Sierhuis, Maarten

2002-01-01

Modeling and simulating complex human-system interactions requires going beyond formal procedures and information flows to analyze how people interact with each other. Such work practices include conversations, modes of communication, informal assistance, impromptu meetings, workarounds, and so on. To make these social processes visible, we have developed a multiagent simulation tool, called Brahms, for modeling the activities of people belonging to multiple groups, situated in a physical environment (geographic regions, buildings, transport vehicles, etc.) consisting of tools, documents, and computer systems. We are finding many useful applications of Brahms for system requirements analysis, instruction, implementing software agents, and as a workbench for relating cognitive and social theories of human behavior. Many challenges remain for representing work practices, including modeling: memory over multiple days, scheduled activities combining physical objects, groups, and locations on a timeline (such as a Space Shuttle mission), habitat vehicles with trajectories (such as the Shuttle), agent movement in 3d space (e.g., inside the International Space Station), agent posture and line of sight, coupled movements (such as carrying objects), and learning (mimicry, forming habits, detecting repetition, etc.).

Protection of SAAO observing site against light and dust pollution

NASA Astrophysics Data System (ADS)

Sefako, Ramotholo; Väisänen, Petri

2016-10-01

The South African Astronomical Observatory (SAAO) observing station near Sutherland, Northern Cape in South Africa, is one of the darkest sites in the world for optical and IR astronomy. The SAAO hosts and operates several facilities, including the Southern African Large Telescope (SALT) and a number of international robotic telescopes. To ensure that the conditions remain optimal for astronomy, legislation called the Astronomy Geographic Advantage (AGA) Act, of 2007, was enacted. The Act empowers the Department of Science and Technology (DST) to regulate issues that pose a threat to optical and/or radio astronomy in areas declared Astronomy Advantage Areas in South Africa. For optical astronomy, the main challenges are those posed by light and dust pollution as result of wind energy developments, and petroleum gas and oil exploration/exploitation in the area. We give an update of possible threats to the quality of the night skies at SAAO, and the challenges relating to the AGA Act implementation and enforcement. We discuss measures that are put in place to protect the Observatory, including a study to quantify the threat by a planned wind energy facility.

Step-up training for colorectal and gastric ESD and the challenge of ESD training in the proximal colon: results from a German Center.

PubMed

Ebigbo, Alanna; Probst, Andreas; Römmele, Christoph; Messmann, Helmut

2018-05-01

The endoscopic submucosal dissection (ESD) of cancerous and precancerous lesions in the gastrointestinal (GI) tract is an effective but difficult-to-learn procedure, especially for Western endoscopists. We developed a step-up training protocol and evaluated its outcome on a single endoscopist using specific performance measures. The training protocol included a 12-month period of 50 observational and supervised ESD cases as well as 24 animal procedures. After completion of the protocol, ESD competency was evaluated in the first 30 independent ESD cases. Majority of lesions were located in the stomach and rectum. Performance measures included R0-resection rate, complication rate and resection speed. R0 resection rate was 93 %, complication rate was 7 % and median resection speed was 6,77 cm 2 /h. 1 case of delayed perforation with subsequent hemicolectomy occurred in the descending colon. The ESD step-up training protocol used in this study on a single endoscopist showed excellent outcomes for lesions in the rectum and stomach. However, ESD training in the upper colon remains a challenge.

Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies.

PubMed

Chao, Tiffany E; Mandigo, Morgan; Opoku-Anane, Jessica; Maine, Rebecca

2016-01-01

Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed. A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training. LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.

The effectiveness of a four-hour challenge course on leadership efficacy and work efficacy

Treesearch

Theresa Odello; Eddie Hill; Edwin Gomez

2008-01-01

This study examines the effects of participation in a 4-hour challenge course on leadership efficacy and work efficacy of college students. The findings of this research indicate that both leadership and work efficacy increased significantly after participation in a challenge course and that increased levels of the participants' self-efficacy remained 6 weeks...

Progress in Application of the Neurosciences to an Understanding of Human Learning: The Challenge of Finding a Middle-Ground Neuroeducational Theory

ERIC Educational Resources Information Center

Anderson, O. Roger

2014-01-01

Modern neuroscientific research has substantially enhanced our understanding of the human brain. However, many challenges remain in developing a strong, brain-based theory of human learning, especially in complex environments such as educational settings. Some of the current issues and challenges in our progress toward developing comprehensive…

Access in Scotland: Access to Higher Education for People from Less Advantaged Backgrounds in Scotland

ERIC Educational Resources Information Center

Blackburn, Lucy Hunter; Kadar-Satat, Gitit; Riddell, Sheila; Weedon, Elisabet

2016-01-01

Access to universities across the United Kingdom remains a challenge despite improvements in recent years. Those challenges are still more marked in Scotland than in the other nations, as this report shows. This report lays bare the extent of the challenge. Scotland has a different approach to higher education. It no longer charges tuition fees,…

Pharmaceutical care in community pharmacies: practice and research in the US.

PubMed

Christensen, Dale B; Farris, Karen B

2006-01-01

To describe the state of community pharmacy, including patient care services, in the US. Chain pharmacies, including traditional chains, mass merchandisers, and supermarkets, comprise more than 50% of community pharmacies in the US. Dispensing of drugs remains the primary focus, yet the incidence of patients being counseled on medications appears to be increasing. More than 25% of independent community pharmacy owners report providing some patient clinical care services, such as medication counseling and chronic disease management. Most insurance programs pay pharmacists only for dispensing services, yet there are a growing number of public and private initiatives that reimburse pharmacists for cognitive services. Clinical care opportunities exist in the new Medicare prescription drug benefit plan, as it requires medication therapy management services for specific enrollees. The private market approach to healthcare delivery in the US, including pharmacy services, precludes national and statewide strategies to change the basic business model. To date, most pharmacies remain focused on dispensing prescriptions. With lower dispensing fees and higher operating costs, community pharmacies are focused on increasing productivity and efficiency through technology and technicians. Pharmacists remain challenged to establish the value of their nondispensing-related pharmaceutical care services in the private sector. As the cost of suboptimal drug therapy becomes more evident, medication therapy management may become a required pharmacy benefit in private drug insurance plans. Pharmacy school curricula, as well as national and state pharmacy associations, continually work to train and promote community pharmacists for these roles. Practice research is driven primarily by interested academics and, to a lesser degree, by pharmacy associations. Efficient dispensing of prescriptions is the primary focus of community pharmacies in the US. Some well designed practice-based research has been conducted, but there is no national research agenda or infrastructure. Reimbursement for cognitive services remains an infrequent, but growing, activity.

Radio Frequency Identification (RFID) in Space

NASA Technical Reports Server (NTRS)

Bacon, John B.

2011-01-01

The ISS has some significant inventory management challenges. RFID solves many of these, and was deployed 8/2011. Significant issues (some unique to spacecraft) remain. NASA is interested and investing in technologies that will help to overcome the remaining issues.

RECENT ADVANCES IN QUANTITATIVE NEUROPROTEOMICS

PubMed Central

Craft, George E; Chen, Anshu; Nairn, Angus C

2014-01-01

The field of proteomics is undergoing rapid development in a number of different areas including improvements in mass spectrometric platforms, peptide identification algorithms and bioinformatics. In particular, new and/or improved approaches have established robust methods that not only allow for in-depth and accurate peptide and protein identification and modification, but also allow for sensitive measurement of relative or absolute quantitation. These methods are beginning to be applied to the area of neuroproteomics, but the central nervous system poses many specific challenges in terms of quantitative proteomics, given the large number of different neuronal cell types that are intermixed and that exhibit distinct patterns of gene and protein expression. This review highlights the recent advances that have been made in quantitative neuroproteomics, with a focus on work published over the last five years that applies emerging methods to normal brain function as well as to various neuropsychiatric disorders including schizophrenia and drug addiction as well as of neurodegenerative diseases including Parkinson’s disease and Alzheimer’s disease. While older methods such as two-dimensional polyacrylamide electrophoresis continued to be used, a variety of more in-depth MS-based approaches including both label (ICAT, iTRAQ, TMT, SILAC, SILAM), label-free (label-free, MRM, SWATH) and absolute quantification methods, are rapidly being applied to neurobiological investigations of normal and diseased brain tissue as well as of cerebrospinal fluid (CSF). While the biological implications of many of these studies remain to be clearly established, that there is a clear need for standardization of experimental design and data analysis, and that the analysis of protein changes in specific neuronal cell types in the central nervous system remains a serious challenge, it appears that the quality and depth of the more recent quantitative proteomics studies is beginning to shed light on a number of aspects of neuroscience that relates to normal brain function as well as of the changes in protein expression and regulation that occurs in neuropsychiatric and neurodegenerative disorders. PMID:23623823

Recent advances in quantitative neuroproteomics.

PubMed

Craft, George E; Chen, Anshu; Nairn, Angus C

2013-06-15

The field of proteomics is undergoing rapid development in a number of different areas including improvements in mass spectrometric platforms, peptide identification algorithms and bioinformatics. In particular, new and/or improved approaches have established robust methods that not only allow for in-depth and accurate peptide and protein identification and modification, but also allow for sensitive measurement of relative or absolute quantitation. These methods are beginning to be applied to the area of neuroproteomics, but the central nervous system poses many specific challenges in terms of quantitative proteomics, given the large number of different neuronal cell types that are intermixed and that exhibit distinct patterns of gene and protein expression. This review highlights the recent advances that have been made in quantitative neuroproteomics, with a focus on work published over the last five years that applies emerging methods to normal brain function as well as to various neuropsychiatric disorders including schizophrenia and drug addiction as well as of neurodegenerative diseases including Parkinson's disease and Alzheimer's disease. While older methods such as two-dimensional polyacrylamide electrophoresis continued to be used, a variety of more in-depth MS-based approaches including both label (ICAT, iTRAQ, TMT, SILAC, SILAM), label-free (label-free, MRM, SWATH) and absolute quantification methods, are rapidly being applied to neurobiological investigations of normal and diseased brain tissue as well as of cerebrospinal fluid (CSF). While the biological implications of many of these studies remain to be clearly established, that there is a clear need for standardization of experimental design and data analysis, and that the analysis of protein changes in specific neuronal cell types in the central nervous system remains a serious challenge, it appears that the quality and depth of the more recent quantitative proteomics studies is beginning to shed light on a number of aspects of neuroscience that relates to normal brain function as well as of the changes in protein expression and regulation that occurs in neuropsychiatric and neurodegenerative disorders. Copyright © 2013. Published by Elsevier Inc.

Environment Industry, Industry Study, Spring 2008

DTIC Science & Technology

2008-01-01

challenge is deforestation of the Amazon rainforest due to illegal logging, cattle ranching, commercial agriculture and settlement/ subsistence farming...Since the Amazon accounts for thirty percent of all remaining tropical forest in the world, the challenge is immense.24 Understandably, Brazil is a

Magnetron sputtering for the production of EUV mask blanks

NASA Astrophysics Data System (ADS)

Kearney, Patrick; Ngai, Tat; Karumuri, Anil; Yum, Jung; Lee, Hojune; Gilmer, David; Vo, Tuan; Goodwin, Frank

2015-03-01

Ion Beam Deposition (IBD) has been the primary technique used to deposit EUV mask blanks since 1995 when it was discovered it could produce multilayers with few defects. Since that time the IBD technique has been extensively studied and improved and is finally approaching usable defectivities. But in the intervening years, the defectivity of magnetron sputtering has been greatly improved. This paper evaluates the suitability of a modern magnetron tool to produce EUV mask blanks and the ability to support HVM production. In particular we show that the reflectivity and uniformity of these tools are superior to current generation IBD tools, and that the magnetron tools can produce EUV films with defect densities comparable to recent best IBD tool performance. Magnetron tools also offer many advantages in manufacturability and tool throughput; however, challenges remain, including transitioning the magnetron tools from the wafer to mask formats. While work continues on quantifying the capability of magnetron sputtering to meet the mask blank demands of the industry, for the most part the remaining challenges do not require any fundamental improvements to existing technology. Based on the recent results and the data presented in this paper there is a clear indication that magnetron deposition should be considered for the future of EUV mask blank production.

Evolution of information-driven HIV/AIDS policies in China.

PubMed

Sun, Xinhua; Lu, Fan; Wu, Zunyou; Poundstone, Katharine; Zeng, Gang; Xu, Peng; Zhang, Dapeng; Liu, Kangmai; Liau, Adrian

2010-12-01

As China continues to commit to universal access to HIV/AIDS prevention, treatment and care services, its HIV/AIDS policies have become increasingly information driven. We review China's key national-level HIV/AIDS policies and discuss policy gaps and challenges ahead. We conducted a desk review of key national-level policies that have had a major impact on China's HIV/AIDS epidemic, and examined recent epidemiological data relevant to China's HIV response. National-level policies that have had a major impact on China's HIV/AIDS response include: 'Four Frees and One Care'; 5-year action plans; and HIV/AIDS regulation. These landmark policies have facilitated massive scaling up of services over the past decade. For example, the number of drug users provided with methadone maintenance treatment significantly increased from 8116 in 2005 to 241 975 in 2009; almost a 30-fold increase. The 'Four Frees and One Care' policy has increased the number of people living with AIDS on anti-retroviral treatment from some 100 patients in 2003 to over 80 000 in 2009. However, stigma and discrimination remains major obstacles for people living with HIV/AIDS trying to access services. China's current national policies are increasingly information driven and responsive to changes in the epidemic. However, gaps remain in policy implementation, and new policies are needed to meet emerging challenges.

Biomarkers to guide clinical therapeutics in rheumatology?

PubMed

Robinson, William H; Mao, Rong

2016-03-01

The use of biomarkers in rheumatology can help identify disease risk, improve diagnosis and prognosis, target therapy, assess response to treatment, and further our understanding of the underlying pathogenesis of disease. Here, we discuss the recent advances in biomarkers for rheumatic disorders, existing impediments to progress in this field, and the potential of biomarkers to enable precision medicine and thereby transform rheumatology. Although significant challenges remain, progress continues to be made in biomarker discovery and development for rheumatic diseases. The use of next-generation technologies, including large-scale sequencing, proteomic technologies, metabolomic technologies, mass cytometry, and other single-cell analysis and multianalyte analysis technologies, has yielded a slew of new candidate biomarkers. Nevertheless, these biomarkers still require rigorous validation and have yet to make their way into clinical practice and therapeutic development. This review focuses on advances in the biomarker field in the last 12 months as well as the challenges that remain. Better biomarkers, ideally mechanistic ones, are needed to guide clinical decision making in rheumatology. Although the use of next-generation techniques for biomarker discovery is making headway, it is imperative that the roadblocks in our search for new biomarkers are overcome to enable identification of biomarkers with greater diagnostic and predictive utility. Identification of biomarkers with robust diagnostic and predictive utility would enable precision medicine in rheumatology.

Optimal Surgical Management of Severe Ischemic Mitral Regurgitation: To Repair or to Replace?

PubMed Central

Perrault, Louis P.; Moskowitz, Alan J.; Kron, Irving L.; Acker, Michael A.; Miller, Marissa A.; Horvath, Keith A.; Thourani, Vinod H.; Argenziano, Michael; D'Alessandro, David A.; Blackstone, Eugene H.; Moy, Claudia S.; Mathew, Joseph P.; Hung, Judy; Gardner, Timothy J.; Parides, Michael K.

2013-01-01

Background Ischemic mitral regurgitation (MR), a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results This paper describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic (CT) Surgical Trials Network. This paper addresses challenges in selecting a feasible primary endpoint, characterizing the target population (including the degree of MR), and analytical challenges in this high mortality disease. Conclusions The paper concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life and cardiac physiology in therapeutic decision-making. PMID:22054660

HIV pre-exposure prophylaxis and health and community systems in the Global South: Thailand case study.

PubMed

Colby, Donn; Srithanaviboonchai, Kriengkrai; Vanichseni, Suphak; Ongwandee, Sumet; Phanuphak, Nittaya; Martin, Michael; Choopanya, Kachit; Chariyalertsak, Suwat; van Griensven, Frits

2015-01-01

Pre-exposure prophylaxis (PrEP) is recommended by the World Health Organization as an effective method of HIV prevention for individuals at risk for infection. In this paper, we describe the unique role that Thailand has played in the global effort to combat the HIV epidemic, including its role in proving the efficacy of PrEP, and discuss the opportunities and challenges of implementing PrEP in a middle-income country. Thailand was one of the first countries in the world to successfully reverse a generalized HIV epidemic. Despite this early success, HIV prevalence has remained high among people who inject drugs and has surged among men who have sex with men (MSM) and transgender women (TGW). Two pivotal trials that showed that the use of oral antiretroviral medication as PrEP can reduce HIV transmission were conducted partially or entirely at Thai sites. Demonstration projects of PrEP, as well as clinical trials of alternative PrEP regimens, began or will begin in 2014-2015 in Thailand and will provide additional data and experience on how to best implement PrEP for high-risk individuals in the community. Financing of drug costs, the need for routine laboratory monitoring and lack of awareness about PrEP among at-risk groups all present challenges to the wider implementation of PrEP for HIV prevention in Thailand. Although significant challenges to wider use remain, PrEP holds promise as a safe and highly effective method to be used as part of a combined HIV prevention strategy for MSM and TGW in Thailand.

Drug Use and Multiple Sex Partners among Homeless Ex-Offenders: Secondary Findings from an Experimental Study

PubMed Central

Nyamathi, Adeline M.; Zhang, Sheldon; Wall, Sarah; Hall, Elizabeth A.; Salem, Benissa E.; Farabee, David; Faucette, Mark; Yadav, Kartik

2016-01-01

Background Transitioning into society after release from incarceration presents real challenges for male offenders; in California, up to 60% return to prison within three years following release. The risk for ongoing drug use and having sex with multiple sex partners is a significant challenge for ex-offenders preparing to enter the community. Objectives The aims are to describe drug use and sexual behavior (sex with multiple partners) prior to incarceration and six and 12 months following study enrollment using data obtained as part of a randomized controlled trial (RCT). Methods This is a planned secondary analysis of data obtained as part of an RCT designed to study the effects of intensive peer coaching and nurse case management, intensive peer coaching, and brief nurse counseling on hepatitis A and B vaccination adherence compared to a usual care control treatment that also included brief peer coaching and brief nurse counseling. Self-report data from subjects enrolled at one residential drug treatment facility in Los Angeles were captured at three time points: baseline, and six- and 12-month follow up. Results Findings showed substantive and significant reductions in drug use and engaging in sex with multiple partners six months following enrollment into the study compared to the baseline data, but results did not differ by study condition. At 12-month follow up, drug use and sex with multiple partners increased, but remained less than at baseline levels. Discussion Sustaining reductions in drug use and engaging in sex with multiple partners remains a challenge following incarceration. PMID:27124254

How could Health Information Exchange Better Meet the Needs of Care Practitioners?

PubMed Central

Kaushal, R.; Vest, J.R.

2014-01-01

Summary Background Health information exchange (HIE) has the potential to improve the quality of healthcare by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high. Objectives We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners. Methods We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State. Results The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows. Conclusions Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable. PMID:25589903

The Contribution of Upper Body Movements to Dynamic Balance Regulation during Challenged Locomotion

PubMed Central

Boström, Kim J.; Dirksen, Tim; Zentgraf, Karen; Wagner, Heiko

2018-01-01

Recent studies suggest that in addition to movements between ankle and hip joints, movements of the upper body, in particular of the arms, also significantly contribute to postural control. In line with these suggestions, we analyzed regulatory movements of upper and lower body joints supporting dynamic balance regulation during challenged locomotion. The participants walked over three beams of varying width and under three different verbally conveyed restrictions of arm posture, to control the potential influence of arm movements on the performance: The participants walked (1) with their arms stretched out perpendicularly in the frontal plane, (2) spontaneously, i.e., without restrictions to the arm movements, and (3) with their hands on their thighs. After applying an inverse-dynamics analysis to the measured joint kinematics, we investigated the contribution of upper and lower body joints to balance regulation in terms of torque amplitude and variation. On the condition with the hands on the thighs, the contribution of the upper body remains significantly lower than the contribution of the lower body irrespective of beam widths. For spontaneous arm movements and for outstretched arms we find that the upper body (including the arms) contributes to the balancing to a similar extent as the lower body. Moreover, when the task becomes more difficult, i.e., for narrower beam widths, the contribution of the upper body increases, while the contribution of the lower body remains nearly constant. These findings lend further support to the hypothetical existence of an “upper body strategy” complementing the ankle and hip strategies especially during challenging dynamic balance tasks. PMID:29434544

Challenges in Accommodating Volume Change of Si Anodes for Li-Ion Batteries

PubMed Central

Ko, Minseong; Chae, Sujong; Cho, Jaephil

2015-01-01

Si has been considered as a promising alternative anode for next-generation Li-ion batteries (LIBs) because of its high theoretical energy density, relatively low working potential, and abundance in nature. However, Si anodes exhibit rapid capacity decay and an increase in the internal resistance, which are caused by the large volume changes upon Li insertion and extraction. This unfortunately limits their practical applications. Therefore, managing the total volume change remains a critical challenge for effectively alleviating the mechanical fractures and instability of solid-electrolyte-interphase products. In this regard, we review the recent progress in volume-change-accommodating Si electrodes and investigate their ingenious structures with significant improvements in the battery performance, including size-controlled materials, patterned thin films, porous structures, shape-preserving shell designs, and graphene composites. These representative approaches potentially overcome the large morphologic changes in the volume of Si anodes by securing the strain relaxation and structural integrity in the entire electrode. Finally, we propose perspectives and future challenges to realize the practical application of Si anodes in LIB systems. PMID:27525208

De-escalating Antibiotic Use in the Inpatient Setting: Strategies, Controversies, and Challenges.

PubMed

Daniel Markley, J; Bernard, Shaina; Bearman, Gonzalo; Stevens, Michael P

2017-04-01

Antibiotic de-escalation (ADE) is widely accepted as an integral strategy to curtail the global antibiotic resistance crisis. However, there is significant uncertainty regarding the ideal ADE strategy and its true impact on antibiotic resistance. Rapid diagnostic testing has the potential to enhance ADE strategies. Herein, we aim to discuss the current strategies, controversies, and challenges of ADE in the inpatient setting. A consensus definition of ADE remains elusive at this time. Preliminary studies utilizing rapid diagnostic tests including matrix-assisted laser desorption/ionization time of flight (MALDI-TOF), procalcitonin, and other molecular techniques have demonstrated the potential to support ADE strategies. In the absence of evidence-based, highly specific ADE protocols, the likelihood that individual providers will make consistent, often challenging, decisions to de-escalate antibiotic therapy is low. Antimicrobial stewardship programs should support local physicians with ADE and develop innovative ways to integrate ADE into the broader construct of antimicrobial stewardship programs. The evolving field of rapid diagnostics has significant potential to improve ADE strategies, but more research is needed to fully realize this goal.

Blind prediction of noncanonical RNA structure at atomic accuracy.

PubMed

Watkins, Andrew M; Geniesse, Caleb; Kladwang, Wipapat; Zakrevsky, Paul; Jaeger, Luc; Das, Rhiju

2018-05-01

Prediction of RNA structure from nucleotide sequence remains an unsolved grand challenge of biochemistry and requires distinct concepts from protein structure prediction. Despite extensive algorithmic development in recent years, modeling of noncanonical base pairs of new RNA structural motifs has not been achieved in blind challenges. We report a stepwise Monte Carlo (SWM) method with a unique add-and-delete move set that enables predictions of noncanonical base pairs of complex RNA structures. A benchmark of 82 diverse motifs establishes the method's general ability to recover noncanonical pairs ab initio, including multistrand motifs that have been refractory to prior approaches. In a blind challenge, SWM models predicted nucleotide-resolution chemical mapping and compensatory mutagenesis experiments for three in vitro selected tetraloop/receptors with previously unsolved structures (C7.2, C7.10, and R1). As a final test, SWM blindly and correctly predicted all noncanonical pairs of a Zika virus double pseudoknot during a recent community-wide RNA-Puzzle. Stepwise structure formation, as encoded in the SWM method, enables modeling of noncanonical RNA structure in a variety of previously intractable problems.

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

PubMed

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

2017-06-01

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

Integrated mixed methods policy analysis for sustainable food systems: trends, challenges and future research.

PubMed

Cuevas, Soledad

Agriculture is a major contributor to greenhouse gas emissions, an important part of which is associated to deforestation and indirect land use change. Appropriate and coherent food policies can play an important role in aligning health, economic and environmental goals. From the point of view of policy analysis, however, this requires multi-sectoral, interdisciplinary approaches which can be highly complex. Important methodological advances in the area are not exempted from limitations and criticism. We argue that there is scope for further developments in integrated quantitative and qualitative policy analysis combining existing methods, including mathematical modelling and stakeholder analysis. We outline methodological trends in the field, briefly characterise integrated mixed methods policy analysis and identify contributions, challenges and opportunities for future research. In particular, this type of approach can help address issues of uncertainty and context-specific validity, incorporate multiple perspectives and help advance meaningful interdisciplinary collaboration in the field. Substantial challenges remain, however, such as the integration of key issues related to non-communicable disease, or the incorporation of a broader range of qualitative approaches that can address important cultural and ethical dimensions of food.

History of Neurosurgery in Palestine.

PubMed

Darwazeh, Rami; Darwazeh, Mazhar; Sun, Xiaochuan

2017-08-01

Palestinian neurosurgery started with Dr. Antone Tarazi as the first Palestinian neurosurgeon. Before that, there was no organized neurosurgery specialty, and general surgeons performed neurosurgical procedures. Here we review the history of neurosurgery and neurosurgical applications in Palestine, evaluate some limitations of the current system, and discuss major challenges to improving this system. We collected information from various sources in either English or Arabic. The development of neurosurgery and neurosurgical training in Palestine began in 1960 with the first center established in Jerusalem, which provided much-needed neurosurgical services and training in the fields of neurosurgery and neurology. Palestine has produced a number of its own neurosurgeons and has promoted further progress by establishing the Palestinian Neurosurgical Society in 2014. Today, there are 34 neurosurgeons (including 1 female neurosurgeon) and 17 residents providing expert care in 17 centers across Palestine, along with 1 neurosurgical residency program. Neurosurgery in Palestine has faced many challenges, some of which have been overcome. However, there remain many challenges, which will require much time and effort to surmount. Political stabilization is a significant factor in the progress of neurosurgery in Palestine. Copyright © 2017 Elsevier Inc. All rights reserved.

Fishes in a changing world: learning from the past to promote sustainability of fish populations.

PubMed

Gordon, T A C; Harding, H R; Clever, F K; Davidson, I K; Davison, W; Montgomery, D W; Weatherhead, R C; Windsor, F M; Armstrong, J D; Bardonnet, A; Bergman, E; Britton, J R; Côté, I M; D'agostino, D; Greenberg, L A; Harborne, A R; Kahilainen, K K; Metcalfe, N B; Mills, S C; Milner, N J; Mittermayer, F H; Montorio, L; Nedelec, S L; Prokkola, J M; Rutterford, L A; Salvanes, A G V; Simpson, S D; Vainikka, A; Pinnegar, J K; Santos, E M

2018-03-01

Populations of fishes provide valuable services for billions of people, but face diverse and interacting threats that jeopardize their sustainability. Human population growth and intensifying resource use for food, water, energy and goods are compromising fish populations through a variety of mechanisms, including overfishing, habitat degradation and declines in water quality. The important challenges raised by these issues have been recognized and have led to considerable advances over past decades in managing and mitigating threats to fishes worldwide. In this review, we identify the major threats faced by fish populations alongside recent advances that are helping to address these issues. There are very significant efforts worldwide directed towards ensuring a sustainable future for the world's fishes and fisheries and those who rely on them. Although considerable challenges remain, by drawing attention to successful mitigation of threats to fish and fisheries we hope to provide the encouragement and direction that will allow these challenges to be overcome in the future. © 2018 The Authors. Journal of Fish Biology published by John Wiley & Sons Ltd on behalf of The Fisheries Society of the British Isles.

Navigating the patent landscapes for nanotechnology: English gardens or tangled grounds?

PubMed

Sylvester, Douglas J; Bowman, Diana M

2011-01-01

The patent landscape, like a garden, can tell you much about its designers and users: their motivations, biases, and general interests. While both patent landscapes and gardens may appear to the casual observer as refined and ordered, an in-depth exploration of the terrain is likely to reveal unforeseen challenges including, for example, alien species, thickets, and trolls. As this chapter illustrates, patent landscapes are dynamic and have been forced to continually evolve in response to technological innovation. While emerging technologies such as biotechnology and information communication technology have challenged the traditional patent landscape, the overarching framework and design have largely remained intact. But will this always be the case? The aim of this chapter is to highlight how nanotechnology is challenging the existing structures and underlying foundation of the patent landscape and the implications thereof for the technology, industry, and public more generally. The chapter concludes by asking the question whether the current patent landscape will be able to withstand the ubiquitous nature of the technology, or whether nanotechnology will be a catalyst for governments and policy makers for overhauling the current landscape design.

Organic contaminant transport and fate in the subsurface: Evolution of knowledge and understanding

NASA Astrophysics Data System (ADS)

Essaid, Hedeff I.; Bekins, Barbara A.; Cozzarelli, Isabelle M.

2015-07-01

Toxic organic contaminants may enter the subsurface as slightly soluble and volatile nonaqueous phase liquids (NAPLs) or as dissolved solutes resulting in contaminant plumes emanating from the source zone. A large body of research published in Water Resources Research has been devoted to characterizing and understanding processes controlling the transport and fate of these organic contaminants and the effectiveness of natural attenuation, bioremediation, and other remedial technologies. These contributions include studies of NAPL flow, entrapment, and interphase mass transfer that have advanced from the analysis of simple systems with uniform properties and equilibrium contaminant phase partitioning to complex systems with pore-scale and macroscale heterogeneity and rate-limited interphase mass transfer. Understanding of the fate of dissolved organic plumes has advanced from when biodegradation was thought to require oxygen to recognition of the importance of anaerobic biodegradation, multiple redox zones, microbial enzyme kinetics, and mixing of organic contaminants and electron acceptors at plume fringes. Challenges remain in understanding the impacts of physical, chemical, biological, and hydrogeological heterogeneity, pore-scale interactions, and mixing on the fate of organic contaminants. Further effort is needed to successfully incorporate these processes into field-scale predictions of transport and fate. Regulations have greatly reduced the frequency of new point-source contamination problems; however, remediation at many legacy plumes remains challenging. A number of fields of current relevance are benefiting from research advances from point-source contaminant research. These include geologic carbon sequestration, nonpoint-source contamination, aquifer storage and recovery, the fate of contaminants from oil and gas development, and enhanced bioremediation.

A review of biomechanically informed breast image registration

NASA Astrophysics Data System (ADS)

Hipwell, John H.; Vavourakis, Vasileios; Han, Lianghao; Mertzanidou, Thomy; Eiben, Björn; Hawkes, David J.

2016-01-01

Breast radiology encompasses the full range of imaging modalities from routine imaging via x-ray mammography, magnetic resonance imaging and ultrasound (both two- and three-dimensional), to more recent technologies such as digital breast tomosynthesis, and dedicated breast imaging systems for positron emission mammography and ultrasound tomography. In addition new and experimental modalities, such as Photoacoustics, Near Infrared Spectroscopy and Electrical Impedance Tomography etc, are emerging. The breast is a highly deformable structure however, and this greatly complicates visual comparison of imaging modalities for the purposes of breast screening, cancer diagnosis (including image guided biopsy), tumour staging, treatment monitoring, surgical planning and simulation of the effects of surgery and wound healing etc. Due primarily to the challenges posed by these gross, non-rigid deformations, development of automated methods which enable registration, and hence fusion, of information within and across breast imaging modalities, and between the images and the physical space of the breast during interventions, remains an active research field which has yet to translate suitable methods into clinical practice. This review describes current research in the field of breast biomechanical modelling and identifies relevant publications where the resulting models have been incorporated into breast image registration and simulation algorithms. Despite these developments there remain a number of issues that limit clinical application of biomechanical modelling. These include the accuracy of constitutive modelling, implementation of representative boundary conditions, failure to meet clinically acceptable levels of computational cost, challenges associated with automating patient-specific model generation (i.e. robust image segmentation and mesh generation) and the complexity of applying biomechanical modelling methods in routine clinical practice.

Organic contaminant transport and fate in the subsurface: evolution of knowledge and understanding

USGS Publications Warehouse

Essaid, Hedeff I.; Bekins, Barbara A.; Cozzarelli, Isabelle M.

2015-01-01

Toxic organic contaminants may enter the subsurface as slightly soluble and volatile nonaqueous phase liquids (NAPLs) or as dissolved solutes resulting in contaminant plumes emanating from the source zone. A large body of research published in Water Resources Research has been devoted to characterizing and understanding processes controlling the transport and fate of these organic contaminants and the effectiveness of natural attenuation, bioremediation, and other remedial technologies. These contributions include studies of NAPL flow, entrapment, and interphase mass transfer that have advanced from the analysis of simple systems with uniform properties and equilibrium contaminant phase partitioning to complex systems with pore-scale and macroscale heterogeneity and rate-limited interphase mass transfer. Understanding of the fate of dissolved organic plumes has advanced from when biodegradation was thought to require oxygen to recognition of the importance of anaerobic biodegradation, multiple redox zones, microbial enzyme kinetics, and mixing of organic contaminants and electron acceptors at plume fringes. Challenges remain in understanding the impacts of physical, chemical, biological, and hydrogeological heterogeneity, pore-scale interactions, and mixing on the fate of organic contaminants. Further effort is needed to successfully incorporate these processes into field-scale predictions of transport and fate. Regulations have greatly reduced the frequency of new point-source contamination problems; however, remediation at many legacy plumes remains challenging. A number of fields of current relevance are benefiting from research advances from point-source contaminant research. These include geologic carbon sequestration, nonpoint-source contamination, aquifer storage and recovery, the fate of contaminants from oil and gas development, and enhanced bioremediation.

A House Full of Trap Doors. Identifying barriers to resilient drylands in the toolbox of pastoral development

NASA Astrophysics Data System (ADS)

Krätli, Saverio; Kaufmann, Brigitte; Roba, Hassan; Hiernaux, Pierre; Li, Wenjun; Easdale, Marcos H.; Huelsebusch, Christian

2016-04-01

The theoretical understanding of drylands and pastoral systems has long undergone a U-turn from the initial perspective rooted in classical ecology. The shift has hinged on the way to represent asymmetric variability, from a disturbance in an ecosystem that naturally tends towards uniformity and stability, to a constitutive part of a dynamic ecosystem. Operationalising the new reversed perspective, including the need to update the methodological infrastructure to plan around drylands and pastoral development, remains a challenge. Underlying assumptions about stability and uniformity, that are a legacy of equilibrium thinking, remain embedded in the toolbox of pastoral development, starting from the technical language to talk about the subject. This effectively gets in the way of operationalizing state of the art understanding of pastoral systems and the drylands. Unless these barriers are identified, unpacked and managed, even the present calls for increasing the rigour and intensity of data collection - for example as part of the ongoing global process to revise and improve agricultural data - cannot deliver a realistic representation of pastoral systems in statistics and policy making. This contribution presents the case for understanding variability as an asset, and provides a range of examples of methodological barriers, including classifications of livestock systems, scale of observation, key parameters in animal production, indicators in the measurement of ecological efficiency, concepts of ecological fragility, natural resources, and pastoral risk. The need to update this legacy is a pressing challenge for policy makers concerned with both modernisation and resilience in the drylands.

Packing of Fruit Fly Parasitoids for Augmentative Releases

PubMed Central

Montoya, Pablo; Cancino, Jorge; Ruiz, Lía

2012-01-01

The successful application of Augmentative Biological Control (ABC) to control pest fruit flies (Diptera: Tephritidae) confronts two fundamental requirements: (1) the establishment of efficient mass rearing procedures for the species to be released, and (2) the development of methodologies for the packing and release of parasitoids that permit a uniform distribution and their optimal field performance under an area-wide approach. Parasitoid distributions have been performed by ground and by air with moderate results; both options face challenges that remain to be addressed. Different devices and strategies have been used for these purposes, including paper bags and the chilled adult technique, both of which are commonly used when releasing sterile flies. However, insect parasitoids have morphological and behavioral characteristics that render the application of such methodologies suboptimal. In this paper, we discuss an alternate strategy for the augmentative release of parasitoids and describe packing conditions that favor the rearing and emergence of adult parasitoids for increased field performance. We conclude that the use of ABC, including the packaging of parasitoids, requires ongoing development to ensure that this technology remains a viable and effective control technique for pest fruit flies. PMID:26466634

Thalidomide‐induced teratogenesis: History and mechanisms

PubMed Central

2015-01-01

Nearly 60 years ago thalidomide was prescribed to treat morning sickness in pregnant women. What followed was the biggest man‐made medical disaster ever, where over 10,000 children were born with a range of severe and debilitating malformations. Despite this, the drug is now used successfully to treat a range of adult conditions, including multiple myeloma and complications of leprosy. Tragically, a new generation of thalidomide damaged children has been identified in Brazil. Yet, how thalidomide caused its devastating effects in the forming embryo remains unclear. However, studies in the past few years have greatly enhanced our understanding of the molecular mechanisms the drug. This review will look at the history of the drug, and the range and type of damage the drug caused, and outline the mechanisms of action the drug uses including recent molecular advances and new findings. Some of the remaining challenges facing thalidomide biologists are also discussed. Birth Defects Research (Part C) 105:140–156, 2015. © 2015 The Authors Birth Defects Research Part C: Embryo Today: Reviews Published by Wiley Periodicals, Inc. PMID:26043938

The revised EEMCO guidance for the in vivo measurement of water in the skin.

PubMed

Berardesca, Enzo; Loden, Marie; Serup, Jorgen; Masson, Philippe; Rodrigues, Luis Monteiro

2018-06-20

Noninvasive quantification of stratum corneum water content is widely used in skin research and topical product development. The original EEMCO guidelines on measurements of skin hydration by electrical methods and transepidermal water loss (TEWL) by evaporimeter published in 1997 and 2001 have been revisited and updated with the incorporation of recently available technologies. Electrical methods and open-chamber evaporimeters for measurement of TEWL are still the preferred techniques to measure the water balance in the stratum corneum. The background technology and biophysics of these instruments remain relevant and valid. However, new methods that can image surface hydration and measure depth profiles of dermal water content now available. Open-chamber measurement of TEWL has been supplemented with semiopen and closed chamber probes, which are more robust to environmental influence and therefore convenient to use and more applicable to field studies. However, closed chamber methods interfere with the evaporation of water, and the methods cannot be used for continuous monitoring. Validation of methods with respect to intra- and inter-instrument variation remains challenging. No validation standard or test phantom is available. The established methods for measurement of epidermal water content and TEWL have been supplemented with important new technologies including methods that allow imaging of epidermal water distribution and water depth profiles. A much more complete and sophisticated characterization of the various aspects of the dermal water barrier has been accomplished by means of today's noninvasive techniques; however, instrument standardization and validation remain a challenge. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Lithospheric Strength and Stress State: Persistent Challenges and New Directions in Geodynamics

NASA Astrophysics Data System (ADS)

Hirth, G.

2017-12-01

The strength of the lithosphere controls a broad array of geodynamic processes ranging from earthquakes, the formation and evolution of plate boundaries and the thermal evolution of the planet. A combination of laboratory, geologic and geophysical observations provides several independent constraints on the rheological properties of the lithosphere. However, several persistent challenges remain in the interpretation of these data. Problems related to extrapolation in both scale and time (rate) need to be addressed to apply laboratory data. Nonetheless, good agreement between extrapolation of flow laws and the interpretation of microstructures in viscously deformed lithospheric mantle rocks demonstrates a strong foundation to build on to explore the role of scale. Furthermore, agreement between the depth distribution of earthquakes and predictions based on extrapolation of high temperature friction relationships provides a basis to understand links between brittle deformation and stress state. In contrast, problems remain for rationalizing larger scale geodynamic processes with these same rheological constraints. For example, at face value the lab derived values for the activation energy for creep are too large to explain convective instabilities at the base of the lithosphere, but too low to explain the persistence of dangling slabs in the upper mantle. In this presentation, I will outline these problems (and successes) and provide thoughts on where new progress can be made to resolve remaining inconsistencies, including discussion of the role of the distribution of volatiles and alteration on the strength of the lithosphere, new data on the influence of pressure on friction and fracture strength, and links between the location of earthquakes, thermal structure, and stress state.

Vaccination with canine parvovirus type 2 (CPV-2) protects against challenge with virulent CPV-2b and CPV-2c.

PubMed

Siedek, Elisabeth M; Schmidt, Holger; Sture, Gordon H; Raue, Rüdiger

2011-01-01

Mutations in canine parvovirus (CPV) field isolates have created concerns regarding the ability of vaccines containing CPV-2 to protect against infection with the newly identified antigenic types CPV-2b and CPV-2c. To address this concern, the efficacy of CPV-2 strain NL-35-D currently in use as a commercial vaccine was demonstrated against an oral challenge with CPV-2b and CPV-2c, respectively. Clinically healthy specific pathogen free Beagle dogs were either vaccinated or treated with water for injection first at 8-9 weeks of age and again at 11-12 weeks of age. All dogs were challenged either with CPV-2b or CPV-2c three weeks after the second vaccination. During the two week period following challenge, clinical signs, white blood cell counts, serology by haemagglutination inhibition (HI) and serum neutralisation tests, and virus shedding by haemagglutination test were assessed. All control dogs developed clinical signs of parvovirosis (including pyrexia and leucopenia) and shed virus. Vaccinated dogs seroconverted (HI titres > or =80), remained healthy throughout the study and shed more than 100 times less virus than controls. In conclusion, vaccination with the low passage, high titre CPV-2 strain NL-35-D cross-protects dogs against virulent challenges with CPV-2b or CPV-2c by preventing disease and substantially reducing viral shedding.

Perceptions of caring for children with disabilities: Experiences from Moshi, Tanzania

PubMed Central

McNally, Anna

2013-01-01

Background Although there exist laws, policies and standards in Tanzania that serve to protect and improve the lives of children with disabilities, the individual human experiences and feelings of the carers and parents still remain the realities of caring for children with disabilities. There is a lack of qualitative studies examining experiences in a developing context. This research aimed to fill that gap. Objectives The objective of this research was to gain an insight into how having a child with a disability impacts upon participants lives and to examine both negative and positive experiences of care through the use of qualitative methods. Method This was a qualitative, exploratory study and followed a phenomenological method. Purposive convenience sampling methods were used to recruit 14 carers in Moshi, Tanzania. Qualitative, semi-structured interviews were undertaken with all 14 participants. Results Five main themes emerged from the data which shed light on the carers experiences, namely, objective challenges in terms of financial challenges, employment issues and demands of care; subjective challenges in the form of stigma, isolation and pity; positive experiences such as the child’s progress, respect and happiness; material and financial needs; and coping mechanisms which included beliefs, support and attitudes. Conclusion The findings of this research were that objective challenges are common and more significant than subjective challenges. Positive experiences were not as easily identified by the participants as the challenges faced. However, having analysed the data, carers do not experience their roles as entirely negative. They simply need the resources to deal with objective challenges which in a developing context are not easily attainable. PMID:28729981

Dissociation between history and challenge in patients with physical urticaria.

PubMed

Komarow, Hirsh D; Arceo, Sarah; Young, Michael; Nelson, Celeste; Metcalfe, Dean D

2014-01-01

Physical urticaria is a subtype of chronic urticaria induced by a physical stimulus. To evaluate the consistency between a history of physical urticaria and results of challenge testing. Seventy-six subjects, ages 3 to 77 years old, were referred with the diagnosis of a physical urticaria and were evaluated by using challenge testing directed toward the presenting diagnosis, yet included other stimuli based on history. The majority of subjects were tested to 3 or more stimuli, thus 294 provocation tests were performed. Fifty-seven subjects were surveyed for the status of their physical urticaria at least 1 year after initial evaluation. Of the 76 subjects with a positive history of a physical urticaria, 38% (n = 29) were challenge negative to the presenting diagnosis. Eight subjects within the challenge negative group reacted positively to additional testing, thus 28% (n = 21) remained negative to all challenge testing, which allowed discontinuation of medications and avoidance behavior. A negative challenge result was less likely with subjects who presented with cold-induced urticaria (25%), delayed pressure urticaria (25%), and dermatographism (29%), yet more common with cholinergic (65%) and solar urticaria (67%). A 1-year follow-up survey of 57 subjects was consistent with initial results. Nineteen of this subgroup were rechallenged for the presenting diagnosis, and the outcome was unchanged in 17 subjects and, in 2 subjects the urticaria had resolved. The diagnosis by history of a physical urticaria should be verified by testing whenever possible and particularly if the condition is judged as severe and thus requires both significant life-style changes and pharmacologic intervention. Published by Elsevier Inc.

Reframing University Engagement

ERIC Educational Resources Information Center

Manners, Paul

2013-01-01

In "Universities without Walls: Engaging Our World," Janice Reid provided an excellent survey of the traditions and perspectives that underpin university engagement, and pointed to some of the challenges that remain in genuinely "mainstreaming" this work. In this commentary, Paul Manners offers a further challenge: that those…

Work-related factors influencing home care nurse intent to remain employed.

PubMed

Tourangeau, Ann E; Patterson, Erin; Saari, Margaret; Thomson, Heather; Cranley, Lisa

Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment. The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization. A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed. Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits. Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits, (c) ensuring manageable workloads to facilitate improved work-life balance, and (d) ensuring leaders are accessible and competent.

Implantable brain computer interface: challenges to neurotechnology translation.

PubMed

Konrad, Peter; Shanks, Todd

2010-06-01

This article reviews three concepts related to implantable brain computer interface (BCI) devices being designed for human use: neural signal extraction primarily for motor commands, signal insertion to restore sensation, and technological challenges that remain. A significant body of literature has occurred over the past four decades regarding motor cortex signal extraction for upper extremity movement or computer interface. However, little is discussed regarding postural or ambulation command signaling. Auditory prosthesis research continues to represent the majority of literature on BCI signal insertion. Significant hurdles continue in the technological translation of BCI implants. These include developing a stable neural interface, significantly increasing signal processing capabilities, and methods of data transfer throughout the human body. The past few years, however, have provided extraordinary human examples of BCI implant potential. Despite technological hurdles, proof-of-concept animal and human studies provide significant encouragement that BCI implants may well find their way into mainstream medical practice in the foreseeable future.

Application, Deactivation, and Regeneration of Heterogeneous Catalysts in Bio-Oil Upgrading

DOE PAGES

Cheng, Shouyun; Wei, Lin; Zhao, Xianhui; ...

2016-12-07

The massive consumption of fossil fuels and associated environmental issues are leading to an increased interest in alternative resources such as biofuels. The renewable biofuels can be upgraded from bio-oils that are derived from biomass pyrolysis. Catalytic cracking and hydrodeoxygenation (HDO) are two of the most promising bio-oil upgrading processes for biofuel production. Heterogeneous catalysts are essential for upgrading bio-oil into hydrocarbon biofuel. Although advances have been achieved, the deactivation and regeneration of catalysts still remains a challenge. This review focuses on the current progress and challenges of heterogeneous catalyst application, deactivation, and regeneration. The technologies of catalysts deactivation, reduction,more » and regeneration for improving catalyst activity and stability are discussed. Some suggestions for future research including catalyst mechanism, catalyst development, process integration, and biomass modification for the production of hydrocarbon biofuels are provided.« less

Application, Deactivation, and Regeneration of Heterogeneous Catalysts in Bio-Oil Upgrading

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

Cheng, Shouyun; Wei, Lin; Zhao, Xianhui

The massive consumption of fossil fuels and associated environmental issues are leading to an increased interest in alternative resources such as biofuels. The renewable biofuels can be upgraded from bio-oils that are derived from biomass pyrolysis. Catalytic cracking and hydrodeoxygenation (HDO) are two of the most promising bio-oil upgrading processes for biofuel production. Heterogeneous catalysts are essential for upgrading bio-oil into hydrocarbon biofuel. Although advances have been achieved, the deactivation and regeneration of catalysts still remains a challenge. This review focuses on the current progress and challenges of heterogeneous catalyst application, deactivation, and regeneration. The technologies of catalysts deactivation, reduction,more » and regeneration for improving catalyst activity and stability are discussed. Some suggestions for future research including catalyst mechanism, catalyst development, process integration, and biomass modification for the production of hydrocarbon biofuels are provided.« less

Implementation Challenges for Sintered Silicon Carbide Fiber Bonded Ceramic Materials for High Temperature Applications

NASA Technical Reports Server (NTRS)

Singh, M.

2011-01-01

During the last decades, a number of fiber reinforced ceramic composites have been developed and tested for various aerospace and ground based applications. However, a number of challenges still remain slowing the wide scale implementation of these materials. In addition to continuous fiber reinforced composites, other innovative materials have been developed including the fibrous monoliths and sintered fiber bonded ceramics. The sintered silicon carbide fiber bonded ceramics have been fabricated by the hot pressing and sintering of silicon carbide fibers. However, in this system reliable property database as well as various issues related to thermomechanical performance, integration, and fabrication of large and complex shape components has yet to be addressed. In this presentation, thermomechanical properties of sintered silicon carbide fiber bonded ceramics (as fabricated and joined) will be presented. In addition, critical need for manufacturing and integration technologies in successful implementation of these materials will be discussed.

New technologies, human-microbe interactions, and the search for previously unrecognized pathogens.

PubMed

Relman, David A

2002-12-01

Evidence suggests that a significant number of clinically important microbial pathogens remain unrecognized. Observations from the natural world, from patterns of disease in human populations, from the bedside, and from the clinical laboratory all contribute to this body of evidence. A variety of acute and chronic neurologic syndromes illustrate this point; despite features of infection, most cases of aseptic meningitis, encephalitis, and cerebral vasculitis cannot be assigned a microbiologic diagnosis. The development and clinical application of molecular methods have led to the discovery of novel members of the endogenous normal flora as well as putative disease agents. Current challenges include the establishment of criteria for disease causation and further characterization of the human microbiome during states of health. These challenges and the goal of understanding microbial contributions to inflammatory disease may be addressed effectively through the thoughtful integration of modern technologies and clinical insight.

Damage prognosis: the future of structural health monitoring.

PubMed

Farrar, Charles R; Lieven, Nick A J

2007-02-15

This paper concludes the theme issue on structural health monitoring (SHM) by discussing the concept of damage prognosis (DP). DP attempts to forecast system performance by assessing the current damage state of the system (i.e. SHM), estimating the future loading environments for that system, and predicting through simulation and past experience the remaining useful life of the system. The successful development of a DP capability will require the further development and integration of many technology areas including both measurement/processing/telemetry hardware and a variety of deterministic and probabilistic predictive modelling capabilities, as well as the ability to quantify the uncertainty in these predictions. The multidisciplinary and challenging nature of the DP problem, its current embryonic state of development, and its tremendous potential for life-safety and economic benefits qualify DP as a 'grand challenge' problem for engineers in the twenty-first century.

Providing care for critically ill surgical patients: challenges and recommendations.

PubMed

Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

2013-07-01

Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

Text mining for adverse drug events: the promise, challenges, and state of the art.

PubMed

Harpaz, Rave; Callahan, Alison; Tamang, Suzanne; Low, Yen; Odgers, David; Finlayson, Sam; Jung, Kenneth; LePendu, Paea; Shah, Nigam H

2014-10-01

Text mining is the computational process of extracting meaningful information from large amounts of unstructured text. It is emerging as a tool to leverage underutilized data sources that can improve pharmacovigilance, including the objective of adverse drug event (ADE) detection and assessment. This article provides an overview of recent advances in pharmacovigilance driven by the application of text mining, and discusses several data sources-such as biomedical literature, clinical narratives, product labeling, social media, and Web search logs-that are amenable to text mining for pharmacovigilance. Given the state of the art, it appears text mining can be applied to extract useful ADE-related information from multiple textual sources. Nonetheless, further research is required to address remaining technical challenges associated with the text mining methodologies, and to conclusively determine the relative contribution of each textual source to improving pharmacovigilance.

Reprint of "EXOSOME LEVELS IN HUMAN BODY FLUIDS: A TUMOR MARKER BY THEMSELVES?"

PubMed

Cappello, Francesco; Logozzi, Mariantonia; Campanella, Claudia; Bavisotto, Celeste Caruso; Marcilla, Antonio; Properzi, Francesca; Fais, Stefano

2017-02-15

Despite considerable research efforts, the finding of reliable tumor biomarkers remains challenging and unresolved. In recent years a novel diagnostic biomedical tool with high potential has been identified in extracellular nanovesicles or exosomes. They are released by the majority of the cells and contain detailed molecular information on the cell of origin including tumor hallmarks. Exosomes can be isolated from easy accessible body fluids, and most importantly, they can at once provide with several biomarkers, with different levels of specificity. Recent clinical evidence shows that the levels of exosomes released into body fluids may by themselves represent a predictive/diagnostic of tumors, discriminating cancer patients from healthy subjects. The aim of this review is to highlight these latest challenging findings to provide novel and groundbreaking ideas for successful tumor early diagnosis and follow-up. Copyright © 2016 Elsevier B.V. All rights reserved.

Preliminary identification of potential markets for off-grid electrification: tool development and a case study of Ghana

NASA Astrophysics Data System (ADS)

Descoqs, Benoit; Bhattacharyya, Subhes

2018-02-01

With more than one billion people lacking access to electricity in the world, ensuring universal access to electricity by 2030 remains a major challenge which cannot be left to the government initiatives alone. Access to local information and identification of potential areas for investment can be a challenge for investors. This paper provides a tool for preliminary assessment of potential markets for off-grid electrification in developing countries and applies this to Ghana to demonstrate its applicability. A multi-criteria approach is used to rank the districts according to the overall potential and the best markets and least favourable areas for investment are identified. The tool offers flexibility to include new inputs to the analysis and the factor weights can be adjusted as appropriate. The case study shows that the tool can effectively identify potential areas from a list of candidates and offers support to analysts.

Multiple Sclerosis: Immunopathology and Treatment Update

PubMed Central

Dargahi, Narges; Katsara, Maria; Tselios, Theodore; Androutsou, Maria-Eleni; Matsoukas, John

2017-01-01

The treatment of multiple sclerosis (MS) has changed over the last 20 years. All immunotherapeutic drugs target relapsing remitting MS (RRMS) and it still remains a medical challenge in MS to develop a treatment for progressive forms. The most common injectable disease-modifying therapies in RRMS include β-interferons 1a or 1b and glatiramer acetate. However, one of the major challenges of injectable disease-modifying therapies has been poor treatment adherence with approximately 50% of patients discontinuing the therapy within the first year. Herein, we go back to the basics to understand the immunopathophysiology of MS to gain insights in the development of new improved drug treatments. We present current disease-modifying therapies (interferons, glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod, mitoxantrone), humanized monoclonal antibodies (natalizumab, ofatumumab, ocrelizumab, alemtuzumab, daclizumab) and emerging immune modulating approaches (stem cells, DNA vaccines, nanoparticles, altered peptide ligands) for the treatment of MS. PMID:28686222

Diabetic mastopathy: a diagnostic challenge in breast sonography.

PubMed

Moschetta, Marco; Telegrafo, Michele; Triggiani, Vincenzo; Rella, Leonarda; Cornacchia, Ilaria; Serio, Gabriella; Ianora, Amato Antonio Stabile; Angelelli, Giuseppe

2015-02-01

Our purpose was to retrospectively evaluate the incidence and morphologic features of diabetic mastopathy in a group of patients with diabetes, searching for specific sonographic characteristics of diabetic mastopathy. One hundred twenty diabetic patients underwent breast clinical examination, mammography, and sonography. All detected breast lesions were confirmed histopathologically. Breast lesions were found in 11 of the 120 patients (9%), including two cases of invasive ductal carcinomas and nine cases of diabetic mastopathy. In seven of those nine cases (77%), diabetic mastopathy appeared as a hypoechoic solid mass with irregular margins, inhomogeneous echotexture, and marked posterior shadowing. In the other two cases (23%), it appeared as a mildly inhomogeneous, hypoechoic solid mass. Diabetic mastopathy is a diagnostic challenge and needs to be suspected in all patients with diabetes mellitus. Imaging features are nonspecific and highly susggestive on breast sonography in most cases. Core-needle biopsy confirmation remains mandatory for a definitive diagnosis. © 2015 Wiley Periodicals, Inc.

Hypertrophic scarring: the greatest unmet challenge following burn injury

PubMed Central

Finnerty, Celeste C; Jeschke, Marc G; Branski, Ludwik K; Barret, Juan P.; Dziewulski, Peter; Herndon, David N

2017-01-01

Summary Improvements in acute burn care have enabled patients to survive massive burns which would have once been fatal. Now up to 70% of patients develop hypertrophic scars following burns. The functional and psychosocial sequelae remain a major rehabilitative challenge, decreasing quality of life and delaying reintegration into society. The current approach is to optimise the healing potential of the burn wound using targeted wound care and surgery in order to minimise the development of hypertrophic scarring. This approach often fails, and modulation of established scar is continued although the optimal indication, timing, and combination of therapies have yet to be established. The need for novel treatments is paramount, and future efforts to improve outcomes and quality of life should include optimisation of wound healing to attenuate or prevent hypertrophic scarring, well-designed trials to confirm treatment efficacy, and further elucidation of molecular mechanisms to allow development of new preventative and therapeutic strategies. PMID:27707499

Spiral counter-current chromatography: Design, development, application, and challenges.

PubMed

Huang, Xin-Yi; Sun, Xiao-Ming; Pei, Dong; Di, Duo-Long

2017-01-01

Depending on the rapid growth in the radial gradient of the centrifugal force, spiral counter-current chromatography can greatly improve the retention of stationary phase, especially for the aqueous two-phase systems with ultra-polar and high viscosity that are not well retained in the conventional multilayer coils counter-current chromatography. As a result, it is an attractive and alternative technology that is suited for separation of hydrophilic compounds and has led to many exciting progress in recent years. This review presents the recent advances and applications of spiral counter-current chromatography, including its major benefits and limitations, some novel methods to improve the separation efficiency and its applications in separation of real samples. In addition, the remaining challenges and future perspectives on development of spiral counter-current chromatography also are proposed in this article. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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

PubMed Central

Kim, Hyunsung

2014-01-01

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

Signal Processing for Metagenomics: Extracting Information from the Soup

PubMed Central

Rosen, Gail L.; Sokhansanj, Bahrad A.; Polikar, Robi; Bruns, Mary Ann; Russell, Jacob; Garbarine, Elaine; Essinger, Steve; Yok, Non

2009-01-01

Traditionally, studies in microbial genomics have focused on single-genomes from cultured species, thereby limiting their focus to the small percentage of species that can be cultured outside their natural environment. Fortunately, recent advances in high-throughput sequencing and computational analyses have ushered in the new field of metagenomics, which aims to decode the genomes of microbes from natural communities without the need for cultivation. Although metagenomic studies have shed a great deal of insight into bacterial diversity and coding capacity, several computational challenges remain due to the massive size and complexity of metagenomic sequence data. Current tools and techniques are reviewed in this paper which address challenges in 1) genomic fragment annotation, 2) phylogenetic reconstruction, 3) functional classification of samples, and 4) interpreting complementary metaproteomics and metametabolomics data. Also surveyed are important applications of metagenomic studies, including microbial forensics and the roles of microbial communities in shaping human health and soil ecology. PMID:20436876

Acceptance of wearable technology by people with Alzheimer's disease: issues and accommodations.

PubMed

Mahoney, Edward L; Mahoney, Diane F

2010-09-01

The increasing number of cognitively impaired older adults who exhibit wandering tendencies raises safety concerns. The purpose of the current study was to research the State-of the-Art in Wearable Technologies for persons with Alzheimer's Disease and identify challenges unique to this population and lessons learned. Inclusion criteria specified systems/devices that completed laboratory testing and were commercially available for usage by community-based Alzheimer's family caregivers. Methods included a series of Internet product searches and telephone interviews with related corporate representatives and participant's referrals. Results indicated many products in development or academic research use but only a limited number were available that met the study criteria. The interviews with key informants revealed features necessary to consider when making products to be worn by persons with cognitive impairment. In conclusion, there is no ideal solution and opportunities remain for marketplace innovations and for addressing the challenges associated with balancing safety and security.

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

PubMed

Kim, Hyunsung

2014-12-10

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

Innovative approaches to glaucoma management of Boston keratoprosthesis type 1.

PubMed

Vajaranant, Thasarat S; Liu, Jessica; Wilensky, Jacob; Cortina, M Soledad; Aref, Ahmad A

2016-09-01

Glaucoma remains a prevalent disorder and visual limiting factor after Boston keratoprosthesis type 1 implantation. Patients with glaucoma have worse initial and late visual acuity outcomes after otherwise successful keratoprosthesis implantation. Management of glaucoma in the setting of a keratoprosthesis is challenging because of relatively rapid progression and an inability to accurately measure intraocular pressure (IOP). In addition, there are no standard guidelines for glaucoma surveillance and monitoring after keratoprosthesis surgery. This report provides a review of the current literature and offers innovative strategies that will overcome the challenges in managing glaucoma in the setting of a Boston keratoprosthesis type 1 implant. The topics that will be discussed in this section include alternative methods for IOP measurement, rationales and surgical techniques for a pars plana tube placement for glaucoma drainage device, effective medical and laser treatment, the risk for IOP elevations after YAG laser, and practical guides to glaucoma surveillance and monitoring.

Telemental Health for Children and Adolescents: An Overview of Legal, Regulatory, and Risk Management Issues.

PubMed

Kramer, Gregory M; Luxton, David D

2016-04-01

The use of technology to provide telemental healthcare continues to increase; however, little has been written about the legal and regulatory issues involved in providing this form of care to children and adolescents. This article reviews existing laws and regulations to summarize the risk management issues relevant to providing telemental healthcare to children and adolescents. There are several legal and regulatory areas in which telemental health clinicians need to have awareness. These areas include: 1) Licensure, 2) malpractice liability, 3) credentialing and privileging, 4) informed consent, 5) security and privacy, and 6) emergency management. Although legal and regulatory challenges remain in providing telemental healthcare to children and adolescents, it is possible to overcome these challenges with knowledge of the issues and appropriate risk management strategies. We provide general knowledge of these key legal and regulatory issues, along with some risk management recommendations.

Lignocellulosic ethanol production by starch-base industrial yeast under PEG detoxification

PubMed Central

Liu, Xiumei; Xu, Wenjuan; Mao, Liaoyuan; Zhang, Chao; Yan, Peifang; Xu, Zhanwei; Zhang, Z. Conrad

2016-01-01

Cellulosic ethanol production from lignocellulosic biomass offers a sustainable solution for transition from fossil based fuels to renewable alternatives. However, a few long-standing technical challenges remain to be addressed in the development of an economically viable fermentation process from lignocellulose. Such challenges include the needs to improve yeast tolerance to toxic inhibitory compounds and to achieve high fermentation efficiency with minimum detoxification steps after a simple biomass pretreatment. Here we report an in-situ detoxification strategy by PEG exo-protection of an industrial dry yeast (starch-base). The exo-protected yeast cells displayed remarkably boosted vitality with high tolerance to toxic inhibitory compounds, and with largely improved ethanol productivity from crude hydrolysate derived from a pretreated lignocellulose. The PEG chemical exo-protection makes the industrial S. cerevisiae yeast directly applicable for the production of cellulosic ethanol with substantially improved productivity and yield, without of the need to use genetically modified microorganisms. PMID:26837707

Fabrication of Circuit QED Quantum Processors, Part 2: Advanced Semiconductor Manufacturing Perspectives

NASA Astrophysics Data System (ADS)

Michalak, D. J.; Bruno, A.; Caudillo, R.; Elsherbini, A. A.; Falcon, J. A.; Nam, Y. S.; Poletto, S.; Roberts, J.; Thomas, N. K.; Yoscovits, Z. R.; Dicarlo, L.; Clarke, J. S.

Experimental quantum computing is rapidly approaching the integration of sufficient numbers of quantum bits for interesting applications, but many challenges still remain. These challenges include: realization of an extensible design for large array scale up, sufficient material process control, and discovery of integration schemes compatible with industrial 300 mm fabrication. We present recent developments in extensible circuits with vertical delivery. Toward the goal of developing a high-volume manufacturing process, we will present recent results on a new Josephson junction process that is compatible with current tooling. We will then present the improvements in NbTiN material uniformity that typical 300 mm fabrication tooling can provide. While initial results on few-qubit systems are encouraging, advanced processing control is expected to deliver the improvements in qubit uniformity, coherence time, and control required for larger systems. Research funded by Intel Corporation.

The Early Anthropogenic Hypothesis: Challenges and Responses

NASA Astrophysics Data System (ADS)

Ruddiman, William F.

2007-12-01

Ruddiman (2003) proposed that late Holocene anthropogenic intervention caused CH4 and CO2 increases that kept climate from cooling and that preindustrial pandemics caused CO2 decreases and a small cooling. Every aspect of this early anthropogenic hypothesis has been challenged: the timescale, the issue of stage 11 as a better analog, the ability of human activities to account for the gas anomalies, and the impact of the pandemics. This review finds that the late Holocene gas trends are anomalous in all ice timescales; greenhouse gases decreased during the closest stage 11 insolation analog; disproportionate biomass burning and rice irrigation can explain the methane anomaly; and pandemics explain half of the CO2 decrease since 1000 years ago. Only ˜25% of the CO2 anomaly can, however, be explained by carbon from early deforestation. The remainder must have come from climate system feedbacks, including a Holocene ocean that remained anomalously warm because of anthropogenic intervention.

Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.

PubMed

Birx, Deborah; de Souza, Mark; Nkengasong, John N

2009-06-01

Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.

[Addicted colleagues: a blind spot amongst physicians?].

PubMed

Rode, Hans; de Rond, Marlies; Dam, Ingrid

2013-01-01

Physician impairment due to substance abuse or dependence is at least as prevalent as amongst non-physicians and is a real challenge. Not only for the impaired physicians themselves, but also for their colleagues, family members and patients. A 68-year-old physician describes her experiences of being an alcoholic as well as a patient with concomitant psychiatric disorders, including the hurdles she had to get over to deal with her disease and remain abstinent. Although colleagues knew what was going on, some of them took no action. The initial treatment by her general practitioner proved compromised. Addressing addiction amongst fellow physicians can be challenging and for this reason the Royal Dutch Medical Association (KNMG) has started the ABS Programme. On prompt and adequate intervention, treatment in specialised facilities has proved to be highly and durably effective. Addicted physicians who have been successfully treated should be monitored and supported, thus enabling their safe return to practice.

Text Mining for Adverse Drug Events: the Promise, Challenges, and State of the Art

PubMed Central

Harpaz, Rave; Callahan, Alison; Tamang, Suzanne; Low, Yen; Odgers, David; Finlayson, Sam; Jung, Kenneth; LePendu, Paea; Shah, Nigam H.

2014-01-01

Text mining is the computational process of extracting meaningful information from large amounts of unstructured text. Text mining is emerging as a tool to leverage underutilized data sources that can improve pharmacovigilance, including the objective of adverse drug event detection and assessment. This article provides an overview of recent advances in pharmacovigilance driven by the application of text mining, and discusses several data sources—such as biomedical literature, clinical narratives, product labeling, social media, and Web search logs—that are amenable to text-mining for pharmacovigilance. Given the state of the art, it appears text mining can be applied to extract useful ADE-related information from multiple textual sources. Nonetheless, further research is required to address remaining technical challenges associated with the text mining methodologies, and to conclusively determine the relative contribution of each textual source to improving pharmacovigilance. PMID:25151493

Germanium Based Field-Effect Transistors: Challenges and Opportunities

PubMed Central

Goley, Patrick S.; Hudait, Mantu K.

2014-01-01

The performance of strained silicon (Si) as the channel material for today’s metal-oxide-semiconductor field-effect transistors may be reaching a plateau. New channel materials with high carrier mobility are being investigated as alternatives and have the potential to unlock an era of ultra-low-power and high-speed microelectronic devices. Chief among these new materials is germanium (Ge). This work reviews the two major remaining challenges that Ge based devices must overcome if they are to replace Si as the channel material, namely, heterogeneous integration of Ge on Si substrates, and developing a suitable gate stack. Next, Ge is compared to compound III-V materials in terms of p-channel device performance to review how it became the first choice for PMOS devices. Different Ge device architectures, including surface channel and quantum well configurations, are reviewed. Finally, state-of-the-art Ge device results and future prospects are also discussed. PMID:28788569

Lignocellulosic ethanol production by starch-base industrial yeast under PEG detoxification

NASA Astrophysics Data System (ADS)

Liu, Xiumei; Xu, Wenjuan; Mao, Liaoyuan; Zhang, Chao; Yan, Peifang; Xu, Zhanwei; Zhang, Z. Conrad

2016-02-01

Cellulosic ethanol production from lignocellulosic biomass offers a sustainable solution for transition from fossil based fuels to renewable alternatives. However, a few long-standing technical challenges remain to be addressed in the development of an economically viable fermentation process from lignocellulose. Such challenges include the needs to improve yeast tolerance to toxic inhibitory compounds and to achieve high fermentation efficiency with minimum detoxification steps after a simple biomass pretreatment. Here we report an in-situ detoxification strategy by PEG exo-protection of an industrial dry yeast (starch-base). The exo-protected yeast cells displayed remarkably boosted vitality with high tolerance to toxic inhibitory compounds, and with largely improved ethanol productivity from crude hydrolysate derived from a pretreated lignocellulose. The PEG chemical exo-protection makes the industrial S. cerevisiae yeast directly applicable for the production of cellulosic ethanol with substantially improved productivity and yield, without of the need to use genetically modified microorganisms.

Modifying Science Grammatically and Conceptually

NASA Astrophysics Data System (ADS)

Kelly, B. P.

2017-12-01

Many adjectives—including normal, traditional, incremental, natural, social, system, actionable, and Arctic—are employed to distinguish types of science. How useful are those modifiers? For example, how is "Arctic" research different from other varieties? What conjunctions are useful among these types of research? In other words, do we benefit from "normal science" and "actionable science" or must we choose between them? Clarity about how we talk about science has substantial implications for how we think about science, how we integrate science with other epistemologies, and how science is regarded among policy makers. The importance of actionable science was highlighted during the last International Polar Year, and the Study of Environmental Arctic Change and others have taken up the challenge. As we make our knowledge actionable, however, we must remain clear about the essential nature of what Thomas Kuhn called normal science. Being clear about how science progresses would seem a prerequisite to the elusive challenge of integration with other ways of knowing.

The future of remote ECG monitoring systems.

PubMed

Guo, Shu-Li; Han, Li-Na; Liu, Hong-Wei; Si, Quan-Jin; Kong, De-Feng; Guo, Fu-Su

2016-09-01

Remote ECG monitoring systems are becoming commonplace medical devices for remote heart monitoring. In recent years, remote ECG monitoring systems have been applied in the monitoring of various kinds of heart diseases, and the quality of the transmission and reception of the ECG signals during remote process kept advancing. However, there remains accompanying challenges. This report focuses on the three components of the remote ECG monitoring system: patient (the end user), the doctor workstation, and the remote server, reviewing and evaluating the imminent challenges on the wearable systems, packet loss in remote transmission, portable ECG monitoring system, patient ECG data collection system, and ECG signals transmission including real-time processing ST segment, R wave, RR interval and QRS wave, etc. This paper tries to clarify the future developmental strategies of the ECG remote monitoring, which can be helpful in guiding the research and development of remote ECG monitoring.

Therapeutic Potential of Foldamers: From Chemical Biology Tools To Drug Candidates?

PubMed

Gopalakrishnan, Ranganath; Frolov, Andrey I; Knerr, Laurent; Drury, William J; Valeur, Eric

2016-11-10

Over the past decade, foldamers have progressively emerged as useful architectures to mimic secondary structures of proteins. Peptidic foldamers, consisting of various amino acid based backbones, have been the most studied from a therapeutic perspective, while polyaromatic foldamers have barely evolved from their nascency and remain perplexing for medicinal chemists due to their poor drug-like nature. Despite these limitations, this compound class may still offer opportunities to study challenging targets or provide chemical biology tools. The potential of foldamer drug candidates reaching the clinic is still a stretch. Nevertheless, advances in the field have demonstrated their potential for the discovery of next generation therapeutics. In this perspective, the current knowledge of foldamers is reviewed in a drug discovery context. Recent advances in the early phases of drug discovery including hit finding, target validation, and optimization and molecular modeling are discussed. In addition, challenges and focus areas are debated and gaps highlighted.

Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry.

PubMed

Nagarajan, P; Tetzlaff, M T; Curry, J L; Prieto, V G

Melanoma remains one of the most aggressive forms of cutaneous malignancies. While its diagnosis based on histologic parameters is usually straight forward in most cases, distinguishing a melanoma from a melanocytic nevus can be challenging in some instances, especially when there are overlapping clinical and histopathologic features. Occasionally, melanomas can histologically mimic other tumors and even demonstration of melanocytic origin can be challenging. Thus, several ancillary tests may be employed to arrive at the correct diagnosis. The objective of this review is to summarize these tests, including the well-established and commonly used ones such as immunohistochemistry, with specific emphasis on emerging techniques such as comparative genomic hybridization, fluorescence in situ hybridization and imaging mass spectrometry. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Online faculty development for creating E-learning materials.

PubMed

Niebuhr, Virginia; Niebuhr, Bruce; Trumble, Julie; Urbani, Mary Jo

2014-01-01

Faculty who want to develop e-learning materials face pedagogical challenges of transforming instruction for the online environment, especially as many have never experienced online learning themselves. They face technical challenges of learning new software and time challenges of not all being able to be in the same place at the same time to learn these new skills. The objective of the Any Day Any Place Teaching (ADAPT) faculty development program was to create an online experience in which faculty could learn to produce e-learning materials. The ADAPT curriculum included units on instructional design, copyright principles and peer review, all for the online environment, and units on specific software tools. Participants experienced asynchronous and synchronous methods, including a learning management system, PC-based videoconferencing, online discussions, desktop sharing, an online toolbox and optional face-to-face labs. Project outcomes were e-learning materials developed and participants' evaluations of the experience. Likert scale responses for five instructional units (quantitative) were analyzed for distance from neutral using one-sample t-tests. Interview data (qualitative) were analyzed with assurance of data trustworthiness and thematic analysis techniques. Participants were 27 interprofessional faculty. They evaluated the program instruction as easy to access, engaging and logically presented. They reported increased confidence in new skills and increased awareness of copyright issues, yet continued to have time management challenges and remained uncomfortable about peer review. They produced 22 new instructional materials. Online faculty development methods are helpful for faculty learning to create e-learning materials. Recommendations are made to increase the success of such a faculty development program.

Silent Bias: Challenges, Obstacles, and Strategies for Leadership Development in Academic Medicine-Lessons From Oral Histories of Women Professors at the University of Kansas.

PubMed

Pingleton, Susan K; Jones, Emily V M; Rosolowski, Tacey A; Zimmerman, Mary K

2016-08-01

Despite dramatic increases in female learners and junior faculty, a significant gap remains in female leadership in academic medicine. To assess challenges and obstacles encountered, strategies for academic success, and lessons learned for leadership development, the authors conducted an in-depth study of women full professors. The authors used a qualitative oral history approach, interviewing 87% of the cohort of female full professors at one Midwestern medical school in 2013 using a pretested, open-ended, semistructured interview guide. Interviews were videotaped and the audio recordings transcribed. Content was sorted into categories and key themes identified within each category. Participants described significant challenges: being treated with "silent bias," "being ignored," and being seen as an "other." Coping strategies included downplaying, keeping a distance, employing humor, and using symbols (e.g., white coat) to carefully present themselves. Explanations for success included intelligence, meritocracy, being even-tempered, and carefully constructing femininity. The participants recommended individual skills and actions to prepare for leadership development. Virtually all women could describe an individual mentor (sponsor), usually male, who provided essential assistance for their career success. At the same time, they stressed the importance of institutional support for diversity, especially with child care. Attaining "full professor" status is the pinnacle of academic success. Women who successfully navigated this academic ladder describe significant external and internal challenges that require multiple strategies to overcome. Leadership development entails a combination of individual support through mentors and sponsors, self-education and reflection, and organizational structural support to promote diversity.

Structural Challenges of Providing Palliative Care for Patients with Breast Cancer

PubMed Central

Khoshnazar, Tahereh Alsadat Khoubbin; Rassouli, Maryam; Akbari, Mohammad Esmaeil; Lotfi-Kashani, Farah; Momenzadeh, Syrus; Haghighat, Shahpar; Sajjadi, Moosa

2016-01-01

Introduction: To establish a palliative care system (PCS) in Iran, it is necessary to identify the potential barriers. Aim: This study aims to highlight the views of stakeholders to know the challenges of providing palliative care for women with breast cancer. Materials and Methods: Semi-structured in-depth interviews are used with purposeful sampling conducted in Tehran, Iran; from January to June 2015. Twenty participants were included in the study: nine patients with breast cancer and ten health-care providers. The interviews were analyzed using qualitative directed content analysis based on Donabedian model. Data credibility was examined using the criteria of Lincoln and Guba. Results: Based on the pattern of Avedis Donabedian model, two main categories were identified: (1) palliative care services in the health system still remain undefined and (2) lack of adequate care providers. The subcategories emerged from the main categories are: (1) Inexistent home care, (2) specialized palliative care being in high demand, lack of: (a) Rehabilitation program and guidelines, (b) treatment/training protocols, (c) inefficient insurance and out-of-pocket costs, (d) patient referral system, (e) nontransparency of job description, and (f) weakness of teamwork. Discussion: The findings of the study identify views and perceptions of patients as well as the health professionals around the challenges of providing palliative care. To establish a structured PCS, we need to meet the challenges and remove perceived barriers to, including but not limited to, building up knowledge and awareness of health professionals, educating professional, and developing updated, well-defined, and standard treatment protocols, tailored to local conditions. PMID:27803569

Responding to the Language Challenge: Kaiser Permanente's Approach

PubMed Central

Meyers, Kate; Tang, Gayle; Fernandez, Alicia

2009-01-01

Objective: To inform current debates on improving health care quality for patients with limited English proficiency by identifying the drivers and processes for one large health care delivery system's implementation of particular models, key success factors, and remaining challenges for the field. Study Design: A qualitative case study of the Kaiser Permanente (KP) San Francisco Medical Center's approach to developing linguistic access services and subsequent organizationwide initiatives. Methods: We conducted semistructured interviews with eight current and former clinical and administrative leaders from the KP San Francisco Medical Center and national headquarters. Interviews were analyzed for key themes. Results: KP San Francisco Medical Center developed linguistic and cultural services in response to a confluence of external and internal factors, including changing demographics, care quality challenges, and patient and clinician satisfaction issues. Early strategies included development of language-specific care modules focused on Chinese- and Spanish-speaking members while meeting broader linguistic access and cultural-competency needs through a centralized Multicultural Services Center. Additional approaches across KP regions have focused on improving interpreter services, optimizing use of bilingual staff, and creating a translation infrastructure to improve quality and reduce redundancy in written translation efforts. Conclusions: KP's experiences developing linguistic and cultural care and services since the 1990s provide lessons about decision-making processes and approaches that may guide other health systems, insurers, and policy makers striving to improve care quality and safety for patients with limited English proficiency. PMID:20740094

Recent progress and challenges in nanotechnology for biomedical applications: an insight into the analysis of neurotransmitters.

PubMed

Shankaran, Dhesingh Ravi; Miura, Norio

2007-01-01

Nanotechnology offers exciting opportunities and unprecedented compatibilities in manipulating chemical and biological materials at the atomic or molecular scale for the development of novel functional materials with enhanced capabilities. It plays a central role in the recent technological advances in biomedical technology, especially in the areas of disease diagnosis, drug design and drug delivery. In this review, we present the recent trend and challenges in the development of nanomaterials for biomedical applications with a special emphasis on the analysis of neurotransmitters. Neurotransmitters are the chemical messengers which transform information and signals all over the body. They play prime role in functioning of the central nervous system (CNS) and governs most of the metabolic functions including movement, pleasure, pain, mood, emotion, thinking, digestion, sleep, addiction, fear, anxiety and depression. Thus, development of high-performance and user-friendly analytical methods for ultra-sensitive detection of neurotransmitters remain a major challenge in modern biomedical analysis. Nanostructured materials are emerging as a powerful mean for diagnosis of CNS disorders because of their unique optical, size and surface characteristics. This review provides a brief outline on the basic concepts and recent advancements of nanotechnology for biomedical applications, especially in the analysis of neurotransmitters. A brief introduction to the nanomaterials, bionanotechnology and neurotransmitters is also included along with discussions on most of the patents published in these areas.

Seven challenges for metapopulation models of epidemics, including households models.

PubMed

Ball, Frank; Britton, Tom; House, Thomas; Isham, Valerie; Mollison, Denis; Pellis, Lorenzo; Scalia Tomba, Gianpaolo

2015-03-01

This paper considers metapopulation models in the general sense, i.e. where the population is partitioned into sub-populations (groups, patches,...), irrespective of the biological interpretation they have, e.g. spatially segregated large sub-populations, small households or hosts themselves modelled as populations of pathogens. This framework has traditionally provided an attractive approach to incorporating more realistic contact structure into epidemic models, since it often preserves analytic tractability (in stochastic as well as deterministic models) but also captures the most salient structural inhomogeneity in contact patterns in many applied contexts. Despite the progress that has been made in both the theory and application of such metapopulation models, we present here several major challenges that remain for future work, focusing on models that, in contrast to agent-based ones, are amenable to mathematical analysis. The challenges range from clarifying the usefulness of systems of weakly-coupled large sub-populations in modelling the spread of specific diseases to developing a theory for endemic models with household structure. They include also developing inferential methods for data on the emerging phase of epidemics, extending metapopulation models to more complex forms of human social structure, developing metapopulation models to reflect spatial population structure, developing computationally efficient methods for calculating key epidemiological model quantities, and integrating within- and between-host dynamics in models. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Ecosystem services as a common language for coastal ecosystem-based management.

PubMed

Granek, Elise F; Polasky, Stephen; Kappel, Carrie V; Reed, Denise J; Stoms, David M; Koch, Evamaria W; Kennedy, Chris J; Cramer, Lori A; Hacker, Sally D; Barbier, Edward B; Aswani, Shankar; Ruckelshaus, Mary; Perillo, Gerardo M E; Silliman, Brian R; Muthiga, Nyawira; Bael, David; Wolanski, Eric

2010-02-01

Ecosystem-based management is logistically and politically challenging because ecosystems are inherently complex and management decisions affect a multitude of groups. Coastal ecosystems, which lie at the interface between marine and terrestrial ecosystems and provide an array of ecosystem services to different groups, aptly illustrate these challenges. Successful ecosystem-based management of coastal ecosystems requires incorporating scientific information and the knowledge and views of interested parties into the decision-making process. Estimating the provision of ecosystem services under alternative management schemes offers a systematic way to incorporate biogeophysical and socioeconomic information and the views of individuals and groups in the policy and management process. Employing ecosystem services as a common language to improve the process of ecosystem-based management presents both benefits and difficulties. Benefits include a transparent method for assessing trade-offs associated with management alternatives, a common set of facts and common currency on which to base negotiations, and improved communication among groups with competing interests or differing worldviews. Yet challenges to this approach remain, including predicting how human interventions will affect ecosystems, how such changes will affect the provision of ecosystem services, and how changes in service provision will affect the welfare of different groups in society. In a case study from Puget Sound, Washington, we illustrate the potential of applying ecosystem services as a common language for ecosystem-based management.

Development of Antibody Therapeutics against Flaviviruses

PubMed Central

Sun, Haiyan; Chen, Qiang; Lai, Huafang

2017-01-01

Recent outbreaks of Zika virus (ZIKV) highlight the urgent need to develop efficacious interventions against flaviviruses, many of which cause devastating epidemics around the world. Monoclonal antibodies (mAb) have been at the forefront of treatment for cancer and a wide array of other diseases due to their specificity and potency. While mammalian cell-produced mAbs have shown promise as therapeutic candidates against several flaviviruses, their eventual approval for human application still faces several challenges including their potential risk of predisposing treated patients to more severe secondary infection by a heterologous flavivirus through antibody-dependent enhancement (ADE). The high cost associated with mAb production in mammalian cell cultures also poses a challenge for the feasible application of these drugs to the developing world where the majority of flavivirus infection occurs. Here, we review the current therapeutic mAb candidates against various flaviviruses including West Nile (WNV), Dengue virus (DENV), and ZIKV. The progress of using plants for developing safer and more economical mAb therapeutics against flaviviruses is discussed within the context of their expression, characterization, downstream processing, neutralization, and in vivo efficacy. The progress of using plant glycoengineering to address ADE, the major impediment of flavivirus therapeutic development, is highlighted. These advancements suggest that plant-based systems are excellent alternatives for addressing the remaining challenges of mAb therapeutic development against flavivirus and may facilitate the eventual commercialization of these drug candidates. PMID:29295568

Difficult to control atopic dermatitis

PubMed Central

2013-01-01

Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. “Eczema school” educational programs have been proven to be helpful. PMID:23663504

The United States Revised Uniform Anatomical Gift Act (2006): new challenges to balancing patient rights and physician responsibilities.

PubMed

Verheijde, Joseph L; Rady, Mohamed Y; McGregor, Joan L

2007-09-12

Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006) and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon. The Revised UAGA (2006) poses challenges to the Patient Self Determination Act (PSDA) embodied in advance health care directives and individual expression about the use of life support systems at the end-of-life. The challenges are predicated on the UAGA revising the default choice to presumption of donation intent and the use of life support systems to ensure medical suitability of organs for transplantation. The default choice trumps the expressed intent in an individual's advance health care directive to withhold and/or withdraw life support systems at the end-of-life. The Revised UAGA (2006) overrides advance directives on utilitarian grounds, which is a serious ethical challenge to society. The subtle progression of the Revised UAGA (2006) towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative "duty to donate". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support systems for organ donation at the end-of-life. Second, a broad based societal discussion must be initiated to decide if the Revised UAGA (2006) infringes on the PSDA and the individual's right of autonomy. The discussion should also address other ethical concerns raised by the Revised UAGA (2006), including the moral stance on 1) the interpretation of the refusal of life support systems as not applicable to organ donation and 2) the disregarding of the diversity of cultural beliefs about end-of-life in a pluralistic society.

Subacute ruminal acidosis reduces sperm quality in beef bulls.

PubMed

Callaghan, M J; McAuliffe, P; Rodgers, R J; Hernandez-Medrano, J; Perry, V E A

2016-08-01

Breeding bulls are commonly fed high-energy diets, which may induce subacute ruminal acidosis (SARA). In this experiment, 8 Santa Gertrudis bulls (age 20 ± 6 mo) were used to evaluate the extent and duration of effects of SARA on semen quality and the associated changes in circulating hormones and metabolites. The bulls were relocated and fed in yards with unrestricted access to hay and daily individual concentrate feeding for 125 d before SARA challenge. Semen was collected and assessed at 14-d intervals before the challenge to ensure acclimatization and the attainment of a stable spermiogram. The challenge treatments consisted of either a single oral dose of oligofructose (OFF; 6.5 g/kg BW) or an equivalent sham dose of water (Control). Locomotion, behavior, respiratory rate, and cardiovascular and gastrointestinal function were intensively monitored during the 24-h challenge period. Rumen fluid samples were retained for VFA, ammonia, and lactate analysis. After the challenge, semen was then collected every third day for a period of 7 wk and then once weekly until 12 wk, with associated blood collection for FSH, testosterone, inhibin, and cortisol assay. Percent normal sperm decreased in bulls dosed with OFF after the challenge period ( < 0.05) and continued to remain lower on completion of the study at 88 d after challenge. There was a corresponding increase in sperm defects commencing from 16 d after challenge. These included proximal cytoplasmic droplets ( < 0.001), distal reflex midpieces ( = 0.01), and vacuole and teratoid heads ( < 0.001). Changes in semen quality after challenge were associated with lower serum testosterone ( < 0.001) and FSH ( < 0.05). Serum cortisol in OFF bulls tended to be greater ( = 0.07) at 7 d after challenge. This study shows that SARA challenge causes a reduction in sperm quality sufficient to preclude bulls from sale as single sire breeding animals 3 mo after the event occurred.

Depression in Adults with Intellectual Disability: Symptoms and Challenging Behaviour

ERIC Educational Resources Information Center

Hurley, A. D.

2008-01-01

Background: Psychiatric evaluation of adults with intellectual disability (ID) remains complex because of limitations in verbal abilities, atypical clinical presentation and challenging behaviour. This study examines the clinical presentation of adults with depression compared with bipolar disorder, anxiety disorders and non-psychiatric control…

Communication Challenge Softball

ERIC Educational Resources Information Center

Moran, Tom; Vance, Mike

2005-01-01

Communication Challenge Softball is a developmentally appropriate game for middle school students. The game allows them to develop new communication skills using American Sign Language (signing). Traditional softball has been a part of physical education for years, and remains a popular sport played by children in community leagues throughout the…

Special Education in Arab Countries: Current Challenges

ERIC Educational Resources Information Center

Hadidi, Muna S.; Al Khateeb, Jamal M.

2015-01-01

Arab countries have undertaken various measures to develop special education programmes and services over the last three decades; nevertheless, major challenges remain regarding the expansion of these programmes and services and improving their quality. "This article provides an update on disability and special education in Arab…

Update in therapeutic strategies for Parkinson's disease.

PubMed

Kulisevsky, Jaime; Oliveira, Lais; Fox, Susan H

2018-05-08

To review recent advances in therapeutics for motor and nonmotor symptoms of Parkinson's disease. Neuroprotection remains a large area of investigation with preliminary safety data on alpha synuclein immunotherapy and glucagon-like peptide-1 agonists. Novel Monoamine Oxidase B and Caetchol-O-methyltransferase-inhibitors for motor fluctuations have shown benefit and are recently approved for clinical use. Long-acting amantadine has also been approved to reduce dyskinesia. Alternative delivery strategies (sublingual, inhaled) dopaminergics may prove useful for rapid reversal of Parkinson's disease motor symptoms. Advanced therapies (surgery and infusional therapies) continue to be useful in subgroups of patients for motor complications with improved safety and also benefit on some nonmotor symptoms, including neuropsychiatric issues. Specific therapeutics for cognition, swallowing, sleep, and mood disorders had moderate to limited benefits. Exercise-based therapy appears beneficial at all stages of Parkinson's disease. The motor symptoms of Parkinson's disease can be reasonably treated and managed. However, therapies to slow or prevent disease progression remain a focus of research. Despite increased studies, treating nonmotor symptoms remains a challenge and an ongoing priority.

Ancient pathogen DNA in archaeological samples detected with a Microbial Detection Array.

PubMed

Devault, Alison M; McLoughlin, Kevin; Jaing, Crystal; Gardner, Shea; Porter, Teresita M; Enk, Jacob M; Thissen, James; Allen, Jonathan; Borucki, Monica; DeWitte, Sharon N; Dhody, Anna N; Poinar, Hendrik N

2014-03-06

Ancient human remains of paleopathological interest typically contain highly degraded DNA in which pathogenic taxa are often minority components, making sequence-based metagenomic characterization costly. Microarrays may hold a potential solution to these challenges, offering a rapid, affordable, and highly informative snapshot of microbial diversity in complex samples without the lengthy analysis and/or high cost associated with high-throughput sequencing. Their versatility is well established for modern clinical specimens, but they have yet to be applied to ancient remains. Here we report bacterial profiles of archaeological and historical human remains using the Lawrence Livermore Microbial Detection Array (LLMDA). The array successfully identified previously-verified bacterial human pathogens, including Vibrio cholerae (cholera) in a 19th century intestinal specimen and Yersinia pestis ("Black Death" plague) in a medieval tooth, which represented only minute fractions (0.03% and 0.08% alignable high-throughput shotgun sequencing reads) of their respective DNA content. This demonstrates that the LLMDA can identify primary and/or co-infecting bacterial pathogens in ancient samples, thereby serving as a rapid and inexpensive paleopathological screening tool to study health across both space and time.

Terrorism in Argentina.

PubMed

Muro, Marcelo; Cohen, Roberto; Maffei, Daniel; Ballesteros, Marcelo; Espinosa, Luis

2003-01-01

Major terrorist attacks in Argentina since 1990 have been limited to two bombings in Buenos Aires, which together caused 115 deaths and left at least 555 injured. Following these attacks, national, regional, and local institutions responsible for emergency response in Argentina sought to improve their planning and preparedness for terrorism-related events. In 1996, the national government enacted legislation, which launched the Sistema Federal de Emergencias (SIFEM) or Federal Emergency System under the direction of the president. Since 1997, several of Argentina's major cities have developed emergency plans for terrorism-related events, including intentional biological and chemical releases. Institutional participants in emergency preparedness for terrorism-related events include Emergency Medical Services, hospitals, and the public health system. Remaining challenges include: (1) Improving intra-agency coordination; (2) Improving intra-agency communication; and (3) Improving and expanding emergency response training programs for responders and the general population.

The common cold: potential for future prevention or cure.

PubMed

Passioti, Maria; Maggina, Paraskevi; Megremis, Spyridon; Papadopoulos, Nikolaos G

2014-02-01

The common cold is the most frequent, although generally mild, human disease. Human Rhinoviruses are the prevalent causative agents, but other viruses are also implicated. Being so common, viral colds, have significant implications on public health and quality of life, but may also be life-threatening for vulnerable groups of patients. Specific diagnosis and treatment of the common cold still remain unmet needs. Molecular diagnostic techniques allow specific detection of known pathogens as well as the identification of newly emerging viruses. Although a number of medications or natural treatments have been shown to have some effect, either on the number or on the severity of common colds, no single agent is considerably effective. Virus-specific management remains in most cases a challenging potential as many factors have to be taken into account, including the diversity of the viral genomes, the heterogeneity of affected individuals, as well as the complexity of this long standing host-virus relationship.

Drug-Induced Liver Injury: Pattern Recognition and Future Directions

PubMed Central

Haque, Tanvir; Sasatomi, Eizaburo; Hayashi, Paul H.

2016-01-01

Drug-induced liver injury (DILI) remains a significant clinical challenge and is the leading cause of acute liver failure in most countries. An aging population that uses more medications, a constant influx of newly developed drugs and a growing risk from unfamiliar herbal and dietary supplements will make DILI an increasing part of clinical practice. Currently, the most effective strategy for disease management is rapid identification, withholding the inciting agents, supportive care and having a firm understanding of the expected natural history. There are resources available to aid the clinician, including a new online “textbook” as well as causality assessment tools, but a heightened awareness of risk and the disease’s varying phenotypes and good history-taking remain cornerstones to diagnosis. Looking ahead, growing registries of cases, pharmacoepidemiology studies and translational research into the mechanisms of injury may produce better diagnostic tools, markers for risk and disease, and prevention and therapeutics. PMID:26696029

[Abdominal bloating: an up-to-date].

PubMed

Ducrotté, P

2009-10-01

Bloating is a common symptom, especially in women. In the clinical practice, it remains a therapeutic challenge. Since recently, its pathophysiology is better understood: an impaired transit of gas (particularly in the small bowel) or a visceral hypersensitivity leading to the induction of an abdominal discomfort despite a normal volume of gas are two of the main causes, far more frequent than an excessive production of gas. Moreover, bloating can be related to abnormal viscera-somatic reflexes promoting both an abdomino-phrenic dyssynergia and the relaxation of the muscles of the abdominal wall. From a therapeutic point of view, the efficacy of the gas absorbants remains to be more documented. Besides the treatment of a constipation and the avoidance of nutrients either highly fermentable or rich in fructose, other therapeutic options include prokinetics and drugs acting on visceral sensitivity. Probiotics are another promising option. In some centers, a non pharmacological therapeutic approach, mainly based on hypnosis, is discussed.

Accountable Care Organizations: what they mean for the country and for neurointerventionalists.

PubMed

Meehan, Timothy M; Harvey, H Benjamin; Duszak, Richard; Meyers, Philip M; McGinty, Geraldine; Nicola, Gregory N; Hirsch, Joshua A

2016-06-01

The Affordable Care Act is celebrating its fifth anniversary and remains one of the most significant attempts to reform healthcare in US history. Prior to the federal legislation, Accountable Care Organizations had largely been part of an academic discussion about how to control rising healthcare costs, but have since become a fixture in our national healthcare landscape. A fundamental shift is underway in the relationship between healthcare delivery and payment models. Some elements of Accountable Care Organizations may remain unfamiliar to most healthcare providers, including neurointerventional specialists. In this paper we review the fundamental concepts behind and the current forms of Accountable Care Organizations, and discuss the challenges and opportunities they present for neurointerventionalists. 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/

Opioid Dependence Treatment: Options In Pharmacotherapy

PubMed Central

Stotts, Angela L.; Dodrill, Carrie L.; Kosten, Thomas R.

2010-01-01

The development of effective treatments for opioid dependence is of great importance given the devastating consequences of the disease. Pharmacotherapies for opioid addiction include opioid agonists, partial agonists, opioid antagonists, and alpha-2-adrenergic agonists, which are targeted toward either detoxification or long-term agonist maintenance. Agonist maintenance therapy is currently the recommended treatment for opioid dependence due to its superior outcomes relative to detoxification. Detoxification protocols have limited long term efficacy and patient discomfort remains a significant therapy challenge. Buprenorphine’s effectiveness relative to methadone remains a controversy and may be most appropriate for patients in need of low doses of agonist treatment. Buprenorphine appears superior to alpha-2 agonists, however, and office-based treatment with buprenorphine in the US is gaining support. Studies of sustained-release formulations of naltrexone suggest improved effectiveness for retention and sustained abstinence, however, randomized clinical trials are needed. PMID:19538000

Dating Tips for Divergence-Time Estimation.

PubMed

O'Reilly, Joseph E; Dos Reis, Mario; Donoghue, Philip C J

2015-11-01

The molecular clock is the only viable means of establishing an accurate timescale for Life on Earth, but it remains reliant on a capricious fossil record for calibration. 'Tip-dating' promises a conceptual advance, integrating fossil species among their living relatives using molecular/morphological datasets and evolutionary models. Fossil species of known age establish calibration directly, and their phylogenetic uncertainty is accommodated through the co-estimation of time and topology. However, challenges remain, including a dearth of effective models of morphological evolution, rate correlation, the non-random nature of missing characters in fossil data, and, most importantly, accommodating uncertainty in fossil age. We show uncertainty in fossil-dating propagates to divergence-time estimates, yielding estimates that are older and less precise than those based on traditional node calibration. Ultimately, node and tip calibrations are not mutually incompatible and may be integrated to achieve more accurate and precise evolutionary timescales. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pharmacogenetics predictive of response and toxicity in acute lymphoblastic leukemia therapy.

PubMed

Mei, Lin; Ontiveros, Evelena P; Griffiths, Elizabeth A; Thompson, James E; Wang, Eunice S; Wetzler, Meir

2015-07-01

Acute lymphoblastic leukemia (ALL) is a relatively rare disease in adults accounting for no more than 20% of all cases of acute leukemia. By contrast with the pediatric population, in whom significant improvements in long term survival and even cure have been achieved over the last 30years, adult ALL remains a significant challenge. Overall survival in this group remains a relatively poor 20-40%. Modern research has focused on improved pharmacokinetics, novel pharmacogenetics and personalized principles to optimize the efficacy of the treatment while reducing toxicity. Here we review the pharmacogenetics of medications used in the management of patients with ALL, including l-asparaginase, glucocorticoids, 6-mercaptopurine, methotrexate, vincristine and tyrosine kinase inhibitors. Incorporating recent pharmacogenetic data, mainly from pediatric ALL, will provide novel perspective of predicting response and toxicity in both pediatric and adult ALL therapies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Systems modeling and simulation applications for critical care medicine

PubMed Central

2012-01-01

Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718

Tuberculosis remains a challenge despite economic growth in Panama.

PubMed

Tarajia, M; Goodridge, A

2014-03-01

Tuberculosis (TB) is a disease associated with inequality, and wise investment of economic resources is considered critical to its control. Panama has recently secured its status as an upper-middle-income country with robust economic growth. However, the prioritisation of resources for TB control remains a major challenge. In this article, we highlight areas that urgently require action to effectively reduce TB burden to minimal levels. Our conclusions suggest the need for fund allocation and a multidisciplinary approach to ensure prompt laboratory diagnosis, treatment assurance and workforce reinforcement, complemented by applied and operational research, development and innovation.

Diagnosis of Food Allergy.

PubMed

Gupta, Malika; Cox, Amanda; Nowak-Węgrzyn, Anna; Wang, Julie

2018-02-01

Food allergy diagnosis remains challenging. Most standard methods are unable to differentiate sensitization from clinical allergy. Recognizing food allergy is of utmost importance to prevent life-threatening reactions. On the other hand, faulty interpretation of tests leads to overdiagnosis and unnecessary food avoidances. Highly predictive models have been established for major food allergens based on skin prick testing and food-specific immunoglobulin E but are lacking for most other foods. Although many newer diagnostic techniques are improving the accuracy of food allergy diagnostics, an oral food challenge remains the only definitive method of confirming a food allergy. Copyright © 2017 Elsevier Inc. All rights reserved.

An overview of age estimation in forensic anthropology: perspectives and practical considerations.

PubMed

Márquez-Grant, Nicholas

2015-01-01

Information on methods of age estimation in physical anthropology, in particular with regard to age-at-death from human skeletal remains, is widely available in the literature. However, the practicalities and real challenges faced in forensic casework are not always highlighted. To provide a practitioner's perspective, regarding age estimation in forensic anthropology (both in the living as well as the dead), with an emphasis on the types of cases, the value of such work and its challenges and limitations. The paper reviews the current literature on age estimation with a focus on forensic anthropology, but it also brings the author's personal perspective derived from a number of forensic cases. Although much is known about what methods to use, but not always how to apply them, little attention has been given in the literature to the real practicalities faced by forensic anthropologists, for example: the challenges in different types of scenarios; how to report age estimations; responsibilities; and ethical concerns. This paper gathers some of these aspects into one overview which includes the value of such work and the practical challenges, not necessarily with the methods themselves, but also with regard to how these are applied in the different cases where age estimation is required.

Challenges of using new and repurposed drugs for the treatment of multidrug-resistant tuberculosis in children.

PubMed

Schaaf, H Simon; Garcia-Prats, Anthony J; McKenna, Lindsay; Seddon, James A

2018-03-01

New and repurposed antituberculosis drugs are urgently needed to more safely and effectively treat multidrug-resistant (MDR) tuberculosis (TB) in children. Multiple challenges limit timely access to new MDR-TB treatments in children. Areas covered: Diagnosis of MDR-TB in children remains a barrier, with few children with MDR-TB diagnosed and treated. Other barriers to timely access to new and repurposed drugs are discussed, and include delayed initiation of paediatric trials, limited funding for paediatric drug development, fragmented regulatory systems and operational challenges. The status of access to current repurposed and novel drugs is presented. Expert commentary: More timely initiation of paediatric trials is needed and paediatric work should happen and be funded in parallel with each phase of adult trials. Better quality data, increased regulator resources and expertise, harmonization of regulatory requirements across borders/organisations and registration fee waivers would improve registration timelines. Improved diagnosis, recording and reporting will establish better demand. Improved systems for procurement and supply chain management would reduce in-country operational barriers to getting medications to children. The challenges must be addressed to ensure timely and equitable access to new drugs and regimens that are urgently needed for effective, safe and shorter treatment of children with MDR-TB.

Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

PubMed Central

Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

2015-01-01

Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

Use of empirically supported interventions for psychopathology: can the participatory approach move us beyond the research-to-practice gap?

PubMed

Becker, Carolyn Black; Stice, Eric; Shaw, Heather; Woda, Susan

2009-04-01

Dissemination, or distribution, of empirically supported interventions (ESIs) for psychopathology remains a significant challenge. This paper reviews the principles of community-partnership research (CPR) and explores why CPR might improve distribution of psychological ESIs. Benefits of CPR include building trust, pooling resources and knowledge, and better serving a community by directly involving its members in the design and implementation of research. In addition, after establishing a community's trust using CPR, researchers are likely to be better positioned to partner with communities in the further distribution of ESIs via community networks. This paper reviews the case of dissonance-based eating disorder prevention interventions to provide an example of how CPR can facilitate the adoption and distribution of an ESI by a community, in this case, sororities. CPR also presents a number of challenges, however, because it is time consuming and does not always align with funding mechanisms and research designs used in randomized controlled trials. Further, CPR does not necessarily solve the challenge of training providers, though it may help with problem solving. Ultimately, we suggest that the benefits of CPR far outweigh the challenges, and hope that more researchers will adopt these practices so that more individuals can benefit from empirically supported psychological interventions.

Creating social spaces to tackle AIDS-related stigma: reviewing the role of church groups in Sub-Saharan Africa.

PubMed

Campbell, C; Skovdal, M; Gibbs, A

2011-08-01

An expanding body of literature explores the role of African church groups in facilitating or hindering the support of people living with AIDS and challenging or contributing to HIV/AIDS-related stigma. Treating church groups as social spaces in which HIV/AIDS-related stigma may potentially be challenged, we systematically review this literature, identifying five themes that highlight the complex and contradictory role of the church as a potential agent of health-enhancing social change. In many ways the church perpetuates HIV/AIDS-related stigma through (i) moralistic attitudes and (ii) its reinforcement of conservative gender ideologies. However some churches have managed move towards action that makes a more positive contribution to HIV/AIDS management through (iii) promoting various forms of social control for HIV prevention, (iv) contributing to the care and support of the AIDS-affected and (v) providing social spaces for challenging stigmatising ideas and practices. We conclude that church groups, including church leadership, can play a key role in facilitating or hindering the creation of supportive social spaces to challenge stigma. Much work remains to be done in developing deeper understandings of the multi-layered factors that enable some churches, but not others, to respond effectively to HIV/AIDS.

Creating Social Spaces to Tackle AIDS-Related Stigma: Reviewing the Role of Church Groups in Sub-Saharan Africa

PubMed Central

Skovdal, M.; Gibbs, A.

2012-01-01

An expanding body of literature explores the role of African church groups in facilitating or hindering the support of people living with AIDS and challenging or contributing to HIV/AIDS-related stigma. Treating church groups as social spaces in which HIV/AIDS-related stigma may potentially be challenged, we systematically review this literature, identifying five themes that highlight the complex and contradictory role of the church as a potential agent of health-enhancing social change. In many ways the church perpetuates HIV/AIDS-related stigma through (i) moralistic attitudes and (ii) its reinforcement of conservative gender ideologies. However some churches have managed move towards action that makes a more positive contribution to HIV/AIDS management through (iii) promoting various forms of social control for HIV prevention, (iv) contributing to the care and support of the AIDS-affected and (v) providing social spaces for challenging stigmatising ideas and practices. We conclude that church groups, including church leadership, can play a key role in facilitating or hindering the creation of supportive social spaces to challenge stigma. Much work remains to be done in developing deeper understandings of the multi-layered factors that enable some churches, but not others, to respond effectively to HIV/AIDS. PMID:20668927

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

PubMed

Carney, Marie

2010-07-01

The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.