Challenges and strategies for coping with scleroderma: implications for a scleroderma-specific self-management program.

PubMed

Milette, Katherine; Thombs, Brett D; Maiorino, Kristina; Nielson, Warren R; Körner, Annett; Peláez, Sandra

2018-05-09

The purpose of this study was to explore challenges faced by patients with systemic sclerosis, also called scleroderma, in coping with their disease and the strategies they used to face those challenges. Five focus groups were held with scleroderma patients (4 groups, n = 34) and health care professionals who have experience treating scleroderma (1 group, n = 8). Participants' discussions were recorded, transcribed and analyzed using thematic analysis. Participants reported challenges accessing information (e.g., knowledgeable specialists), dealing with negative emotions (e.g., stress due to misunderstandings with loved ones), and accessing resources (e.g., helpful products or devices). Strategies for overcoming challenges were also discussed (e.g., advocating for own needs). When faced with significant challenges while coping with scleroderma, patients develop strategies to manage better and improve their quality of life. To help them cope, patients would benefit from easier access to supportive interventions, including tailored scleroderma self-management programs. Although the challenges experienced by patients with scleroderma are unique, findings from this study might help better understand patients' perspectives regarding coping and disease management for other chronic diseases as well. Implications for Rehabilitation People living with rare diseases, including the rare autoimmune disease scleroderma, face unique challenges and often do not have access to disease-specific educational or other support resources. People with scleroderma report that they face challenges in accessing information, including knowledgeable healthcare providers; managing difficult social interactions and negative emotions; and accessing resources. Strategies employed by scleroderma patients to overcome these challenges include seeking connections to other people with scleroderma or scleroderma patient organizations, actively seeking out local resources, and learning to communicate and advocate more effectively. Rehabilitation professionals can support people with scleroderma by providing them with information on connecting with scleroderma patient organizations or by facilitating local patient support networks.

Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management.

PubMed

Grani, Giorgio; Lamartina, Livia; Durante, Cosimo; Filetti, Sebastiano; Cooper, David S

2018-06-01

Follicular thyroid cancer is the second most common differentiated thyroid cancer histological type and has been overshadowed by its more common counterpart-papillary thyroid cancer-despite its unique biological behaviour and less favourable outcomes. In this Review, we comprehensively review the literature on follicular thyroid cancer to provide an evidence-based guide to the management of these tumours, to highlight the lack of evidence behind guideline recommendations, and to identify changes and challenges over the past decades in diagnosis, prognosis, and treatment. We highlight that correct identification of cancer in indeterminate cytological samples is challenging and ultrasonographic features can be misleading. Despite certain unique aspects of follicular thyroid cancer presentation and prognosis, no specific recommendations exist for follicular thyroid cancer and Hürthle cell carcinoma in evidence-based guidelines. Efforts should be made to stimulate additional research in this field. Copyright © 2018 Elsevier Ltd. All rights reserved.

Three Essays on Information Technology Security Management in Organizations

ERIC Educational Resources Information Center

Gupta, Manish

2011-01-01

Increasing complexity and sophistication of ever evolving information technologies has spurred unique and unprecedented challenges for organizations to protect their information assets. Companies suffer significant financial and reputational damage due to ineffective information technology security management, which has extensively been shown to…

Biodiversity and management of the Madrean Archipelago: The Sky Islands of southwestern United States and northwestern Mexico

Treesearch

Leonard H. DeBano; Peter H. Ffolliott; Alfredo Ortega-Rubio; Gerald J. Gottfried; Robert H. Hamre; Carleton B. Edminster

1995-01-01

This conference brought together scientists and managers from government, universities, and private organizations to examine the biological diversity and management challenges of the unique "sky island" ecosystems of the mountains of the southwestern United States and northwestern Mexico. Session topics included: floristic resources, plant ecology,...

Space station operations management

NASA Technical Reports Server (NTRS)

Cannon, Kathleen V.

1989-01-01

Space Station Freedom operations management concepts must be responsive to the unique challenges presented by the permanently manned international laboratory. Space Station Freedom will be assembled over a three year period where the operational environment will change as significant capability plateaus are reached. First Element Launch, Man-Tended Capability, and Permanent Manned Capability, represent milestones in operational capability that is increasing toward mature operations capability. Operations management concepts are being developed to accomodate the varying operational capabilities during assembly, as well as the mature operational environment. This paper describes operations management concepts designed to accomodate the uniqueness of Space Station Freedoom, utilizing tools and processes that seek to control operations costs.

Followership: An Essential Ingredient of Leadership

DTIC Science & Technology

2015-06-12

takes a different approach to followers then Army doctrine, in his book Leadership. Followers are sorted in four categories. There are top managers ...unique challenges and ways of interacting with each. Top managers are identified as those who are “key players” within an organization. These are...

Improving Information Products for System 2 Decision Support

ERIC Educational Resources Information Center

Gibson, Neal

2010-01-01

The creation, maintenance, and management of Information Product (IP) systems that are used by organizations for complex decisions represent a unique set of challenges. These challenges are compounded when the purpose of such a systems is also for knowledge creation and dissemination. Information quality research to date has focused mainly upon…

Challenge theme 7: Information support for management of border security and environmental protection: Chapter 9 in United States-Mexican Borderlands: Facing tomorrow's challenges through USGS science

USGS Publications Warehouse

Parcher, Jean W.; Page, William R.

2013-01-01

Historically, international borders were located far from the major political and economic capitals of their countries and rarely received adequate planning or infrastructure development. Today, as a result of global economics and increased movement of goods between nations, border regions play a much greater role in commerce, tourism, and transportation. For example, Mexico is the second largest destination for United States exports (Woodrow Wilson Center Mexico Institute, 2009). The rapid population and economic growth along the United States–Mexican border, undocumented human border crossings, and the unique natural diversity of resources in the Borderlands present challenges for border security and environmental protection. Assessing risks and implementing sustainable growth policies to protect the environment and quality of life greatly increase in complexity when the issues cross an international border, where social services, environmental regulations, lifestyles, and cultural beliefs are unique for each country. Shared airsheds, water and biological resources, national security issues, and disaster management needs require an integrated binational approach to assess risks and develop binational management strategies.

Options for pest and disease control in organic pecan

USDA-ARS?s Scientific Manuscript database

Although organic pecans typically command a higher wholesale and retail price, their production presents a unique set of challenges. Among these are issues of pest and disease management - it is not simply a modification of the conventional, pest and disease management paradigm. Despite these pest ...

A Case Study: Leadership Style and Practice Leveraging Knowledge Management in Multigenerational Professional Learning Communities

ERIC Educational Resources Information Center

Giles-Weeks, Veda

2014-01-01

Age related demographic changes, within public school organizations are resulting in leadership challenges in leveraging organizational knowledge across four unique generational cohorts. Competitive success within schools has linkages to organizational cohesiveness and knowledge management (KM). Generational cohorts maintain values affecting…

An Analysis of the Impact of Financial Factors on the Well-Being of Military Officers

DTIC Science & Technology

2015-12-01

34 Figure 18. Job Fields of Participants ...........................................................................34 Figure 19...financial environment as their civilian counterparts, but with some unique challenges and unique benefits. Benefits include relative job stability...instruction goes on to state that personal financial management services shall support the commander, promote readiness and retention , include education

Guidelines for Perioperative Management of the Diabetic Patient

PubMed Central

Surani, Salim R.

2015-01-01

Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes. PMID:26078998

FHWA and USGS cooperate to provide environmental engineering/science curricula developed for the stochastic empirical loading and dilution model (SELDM) to universities and colleges.

DOT National Transportation Integrated Search

2016-01-01

Managers and engineers at the Federal Highway Administration (FHWA) and State Departments of Transportation (DOTs) indicate that they need researchers, employees, consultants, and regulators who understand the unique challenges involved in managing a...

Health Services Management Education On-Site at a Military Medical Center

ERIC Educational Resources Information Center

Williams, Stephen J.; Poss, W. Bradley; Cupp, Craig L.

2014-01-01

A cooperative educational program with the U.S. military is described to illustrate a unique opportunity that confronted a graduate healthcare management program. The resulting degree program supported the military's operational medical mission but also presented interesting and unexpected challenges resulting from the wars in Iraq and…

Important Hawaiian tree species in need of genetic conservation

Treesearch

Robert D. Hauff

2017-01-01

Resource managers in Hawaii face unique forest conservation challenges. Invasive species continue to inundate the remote island archipelago, directly threatening its forest resources. Hawaii has the largest number (> 400) of endangered plants in the United States, and managers use genetic approaches to preserve these small populations which are often island...

Perceptions of ESL Program Management in Canadian Higher Education: A Qualitative Case Study

ERIC Educational Resources Information Center

Eaton, Sarah Elaine

2017-01-01

ESL programs at post-secondary institutions must often generate revenue in addition to teaching students English. Institutions often impose explicit expectations on these programs to generate profit, creating unique challenges for those who administer them. This qualitative case study investigated challenges faced by ESL program directors at one…

Counselling in Primary Care: Past, Present, and Future.

ERIC Educational Resources Information Center

Eatock, John

2000-01-01

Presents a brief history of the growth of counseling in primary care. Discusses the challenges for primary care counselors and counseling, as well as the need for coordination, regulation and management. Also discusses the imperative for research support and the unique nature of counseling in primary care including challenges to its survival. (MKA)

Management and Prevention of Dystocia.

PubMed

Funnell, Bethany J; Hilton, W Mark

2016-07-01

Dystocia is an inevitable challenge in the livestock industries, particularly with primiparous female animals. Prevention and appropriate management will decrease cow and calf morbidity and mortality, which will improve the economic status of the beef or dairy operation. Early identification and proper intervention improves outcomes, and the use of selection tools to decrease the potential for dystocia will have positive returns. Assisted reproductive technologies present a unique set of challenges to the calving process that both the producer and practitioner should be prepared to address. Published by Elsevier Inc.

Y2K compliance countdown.

PubMed

Arlotto, P W

1999-01-01

The new century brings unique challenges--especially Y2K compliance. This article presents nurse managers and executives with an overview of the issues and action steps to keep their organizations on track.

Fire Management in the Inter Galatic Interface or 30 Years of Fire Management at Merritt Island National Wildlife Refuge/Kennedy Space Center, Florida

Treesearch

Frederic W. Adrian

2006-01-01

Prescribed burning is essential on Merritt Island National Wildlife Refuge. Not only is it needed to manage the volatile fuels, but also to manage the complex system of fire maintained habitats found here. Fire management on the Refuge presents unique challenges. In addition to the restraints to prescribed burning that are common to many prescribed burning programs,...

DUF6 Guide

Science.gov Websites

and the environment. The Guide provides basic information about the properties of uranium compounds understand the unique challenges involved in managing DOE's inventory of depleted UF6 in a safe and efficient

Cultural Sensitivity and Challenges in Management of the Transgender Patient With ESRD in Transplantation.

PubMed

Hoch, Deborah Ann; Bulman, Maya; McMahon, Dorn W

2016-03-01

Transgender patients with end-stage renal disease (ESRD) present with specific challenges during the transplant evaluation, perioperative management, and postoperative phase of care. Demographic information, health-care records, chosen name, and gender identity along with documentation of specific health-care needs can become a challenge when gender assigned at birth is incongruent with the patients gender identity. Medical care involves addressing the end-organ disease as well as addressing those aspects of care specific to the transgender patient. This review article provides information on defining transgender, the impact of ESRD, and transgender in the transplant process and considerations in the throughout phases of care. Current recommendations for management of this unique population are provided. © 2016, NATCO.

Chemical, Electrical, and Radiation Injuries.

PubMed

Friedstat, Jonathan; Brown, David A; Levi, Benjamin

2017-07-01

This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries and provide recommendations for management. Copyright © 2017 Elsevier Inc. All rights reserved.

Native American  student perspectives of challenges in natural resource higher education

Treesearch

Breanna Gervais; Chase R. Voirin; Chris Beatty; Grace Bulltail; Stephanie Cowherd; Shawn Defrance; Breana Dorame; Raymond Gutteriez; Jessica Lackey; Candy Lupe; April B. Negrette; Natalya C. Robbins Sherman; Ruth Swaney; Kevin Tso; Marvin Victor; Royale Wilson; Kimberly Yazzie; Jonathan W. Long; Serra J. Hoagland

2017-01-01

Native Americans have vital interests in promoting forest management decisions based on sound science and consistent with cultural values to sustain and conserve tribal natural resources. Advancing the next generation of natural resource professionals into key positions is essential to advance the self-determination of tribes; yet, there are unique challenges Native...

The Health Challenges of Urban Latino College Students as Revealed through Student Journaling

ERIC Educational Resources Information Center

Rowland, Amy L.

2008-01-01

Because of the unique health risks faced by the Hispanic population and the notoriously poor health habits of college students, this study examines the health challenges faced by Latino college students enrolled at an urban commuter institution. A thematic analysis reveals the top themes for males and females as healthy eating, weight management,…

Wilderness stewardship challenges in the uKhahlamba Drakensberg Park World Heritage Site

Treesearch

Sonja Krüger

2007-01-01

The location of the uKhahlamba Drakensberg Park wilderness areas along an international border and within a World Heritage Site and Transfrontier Conservation Area, provides unique opportunities and challenges for the stewardship of these areas. Although the wilderness areas were proclaimed more than 30 years ago, wilderness-specific planning, management and monitoring...

Self-Management for Children with High-Functioning Autism Spectrum Disorders

ERIC Educational Resources Information Center

Wilkinson, Lee A.

2008-01-01

Supporting children with autism spectrum disorders in the general education classroom presents a unique challenge to the teachers and schools that serve them. This article addresses the utility of self-management as a proactive strategy for increasing the task engagement and compliant behavior of high-functioning students with autism. The author…

Mitigation in riparian areas: Questions, concerns and recommendations

Treesearch

Tony Barron

1996-01-01

The management of seven thousand acres in the Rio Grande Valley State Park presents a unique management challenge and opportunity. The Open Space Division defines a riparian area as "any area of land influenced directly by permanent water". The influence of permanent water or water flows produces visible vegetation and visible vegetative characteristics on...

The Challenges of Teaching Strategic Management: Working toward Successful Inclusion of the Resource-Based View

ERIC Educational Resources Information Center

Schneider, Marguerite; Lieb, Pamela

2004-01-01

The industrial organization economics (IOE) and resource-based view (RBV) schools contribute uniquely to the strategic management curriculum. However, presentation of the RBV is often inadequate or ineffective, in part due to faculty habit, students' conceptualization of knowledge as objective and readily transferable, and course pedagogy. We…

A concept for performance management for Federal science programs

USGS Publications Warehouse

Whalen, Kevin G.

2017-11-06

The demonstration of clear linkages between planning, funding, outcomes, and performance management has created unique challenges for U.S. Federal science programs. An approach is presented here that characterizes science program strategic objectives by one of five “activity types”: (1) knowledge discovery, (2) knowledge development and delivery, (3) science support, (4) inventory and monitoring, and (5) knowledge synthesis and assessment. The activity types relate to performance measurement tools for tracking outcomes of research funded under the objective. The result is a multi-time scale, integrated performance measure that tracks individual performance metrics synthetically while also measuring progress toward long-term outcomes. Tracking performance on individual metrics provides explicit linkages to root causes of potentially suboptimal performance and captures both internal and external program drivers, such as customer relations and science support for managers. Functionally connecting strategic planning objectives with performance measurement tools is a practical approach for publicly funded science agencies that links planning, outcomes, and performance management—an enterprise that has created unique challenges for public-sector research and development programs.

Analysis of the Effectiveness of F-15E Risk Management during Peacetime Operations

DTIC Science & Technology

2015-06-18

of aircraft or life . These results were compared with existing risk management programs in the form of unit worksheet assessments. This study found...Force risk management program across all fixed-wing aircraft. Rotary wing aircraft will have their own unique challenges . However, for all its...the loss of aircraft or life . These results were compared with existing risk management programs in the form of unit worksheet assessments. This

Meeting the Needs of GLB Youth in Residential Care Settings: A Framework for Assessing the Unique Needs of a Vulnerable Population

ERIC Educational Resources Information Center

Block, Rebecca G.; Matthews, John D.

2006-01-01

This article explores uses for strengths-based assessment of gay, lesbian and bisexual youth in residential care. Gay, lesbian and bisexual (GLB) youth face unique challenges such as stigma management and disclosure. In addition, GLB youth are also at increased risk for drug use, suicide and unprotected sex. Consequently, the needs of GLB youth…

EPA LABORATORIES IMPLEMENT EMS PROGRAM

EPA Science Inventory

This paper highlights the breadth and magnitude of carrying out an effective Environmental Management System (EMS) program at the U.S. EPA's research and development laboratories. Federal research laboratories have unique operating challenges compared to more centralized industr...

Unique research challenges for high-speed civil transports

NASA Technical Reports Server (NTRS)

Jackson, Charlie M., Jr.; Morris, E. K., Jr.

1988-01-01

Market growth and technological advances are expected to lead to a generation of long-range transports that cruise at supersonic or even hypersonic speeds. Current NASA/industry studies will define the market windows in terms of time frame, Mach number, and technology requirements for these aircraft. Initial results indicate that, for the years 2000 to 2020, economically attractive vehicles could have a cruise speed up to Mach 6. The resulting research challenges are unique. They must be met with technologies that will produce commercially successful and environmentally compatible vehicles where none have existed. Several important areas of research were identified for the high-speed civil transports. Among these are sonic boom, takeoff noise, thermal management, lightweight structures with long life, unique propulsion concepts, unconventional fuels, and supersonic laminar flow.

Unique research challenges for high-speed civil transports

NASA Technical Reports Server (NTRS)

Jackson, Charlie M., Jr.; Morris, Charles E. K., Jr.

1987-01-01

Market growth and technological advances are expected to lead to a generation of long-range transports that cruise at supersonic or even hypersonic speeds. Current NASA/industry studies will define the market windows in terms of time frame, Mach number, and technology requirements for these aircraft. Initial results indicate that, for the years 2000 to 2020, economically attractive vehicles could have a cruise speed up to Mach 6. The resulting research challenges are unique. They must be met with technologies that will produce commercially successful and environmentally compatible vehicles where none have existed. Several important areas of research were identified for the high-speed civil transports. Among these are sonic boom, takeoff noise, thermal management, lightweight structures with long life, unique propulsion concepts, unconventional fuels, and supersonic laminar flow.

Get Organized! Time Management for School Leaders

ERIC Educational Resources Information Center

Buck, Frank

2008-01-01

Too often, time-management books target the business executive. Although it is true that those in the educational arena share many of the same challenges, it is also true that schools are unique places. This book is written for school leaders. Its scenarios specifically address the day-to-day situations school leaders face on a regular basis. This…

School Business Management in the 21st Century.

ERIC Educational Resources Information Center

Association of School Business Officials International, Reston, VA.

As society's fundamental characteristics change, schools and school leaders must be prepared to modify the educational enterprise to meet the new and unique needs of adults and youngsters in the 21st century. To anticipate and control change, the school business manager must be able to project future trends, issues, and challenges. In this volume,…

Managing rumor and gossip in operating room settings.

PubMed

Blakeley, J A; Ribeiro, V; Hughes, A

1996-07-01

The unique features of the operating room (OR) make it an ideal setting for the proliferation of gossip and rumor. Although not always negative, these "grapevine" communications can reduce productivity and work satisfaction. Hence, OR managers need to understand these forms of communication and prevent or control their negative consequences. The authors offer suggestions for undertaking this challenge.

Challenges of managing disease in tall orchard trees – pecan scab, a case study

USDA-ARS?s Scientific Manuscript database

Managing disease in tall orchard trees presents unique issues not found in relatively shorter horticultural and agronomic crops, simply due to height. Pecan scab (caused by Fusicladium effusum [G. Winter] Seyran et al.) is used as an example of a major disease of one of the tallest orchard crops in ...

Best Practices for Emergency Rerouting : Research and Findings Manual

DOT National Transportation Integrated Search

2012-09-01

Michigan is a geographically diverse state with some metropolitan or urban centers and vast rural areas : that attract recreational and tourist activities. Each of the States seven MDOT regions present unique : incident management challenges as we...

Tourette syndrome in children and adolescents: special considerations.

PubMed

Eapen, Valsamma; Crncec, Rudi

2009-12-01

Tourette syndrome (TS) affects people of all ages, with onset in early childhood and continuing through the different stages of the life cycle into adolescence and adults. This review focuses on barriers to diagnosis and challenges in the management of young patients with TS. Barriers to identification occur at multiple levels, including detection in the community setting (including schools), parents' help-seeking behavior, and cultural influences on such behavior, as well as diagnosis by the medical provider. Challenges to management include unfamiliarity of primary care providers, inconsistencies in the diagnosis and management plan, and failure to recognize comorbid conditions, as well as inadequate knowledge and lack of resources to effectively deal with comorbidities. In addition to the complexities posed by pharmacological interactions, there are unique psychosocial challenges experienced by young people with TS and their families. Effective communication and collaboration between families, health care providers, and school personnel, as well as supportive communities, are essential components of comprehensive management.

Closing the Gap: Supporting Patients’ Transition to Self-Management after Hospitalization

PubMed Central

Pollack, Ari H; Backonja, Uba; Miller, Andrew D.; Mishra, Sonali R.; Khelifi, Maher; Kendall, Logan; Pratt, Wanda

2016-01-01

Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs. PMID:27500285

The key to successful management of STS operations: An integrated production planning system

NASA Technical Reports Server (NTRS)

Johnson, W. A.; Thomasen, C. T.

1985-01-01

Space Transportation System operations managers are being confronted with a unique set of challenges as a result of increasing flight rates, the demand for flight manifest/production schedule flexibility and an emphasis on continued cost reduction. These challenges have created the need for an integrated production planning system that provides managers with the capability to plan, schedule, status and account for an orderly flow of products and services across a large, multi-discipline organization. With increased visibility into the end-to-end production flow for individual and parallel missions in process, managers can assess the integrated impact of changes, identify and measure the interrelationships of resource, schedule, and technical performance requirements and prioritize productivity enhancements.

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.

Traffic incident management in hazardous materials spills in incident clearance.

DOT National Transportation Integrated Search

2009-01-01

Hazardous materials spills provide unique challenges to traffic incident clearance. When hazardous materials are present, not only do response personnel have to deal with typical traffic incident issues, they also must deal with potential chemical ha...

Whole-School Management Issues Concerning the PE Department: "A Natural Division of Labour?"

ERIC Educational Resources Information Center

Williams, Gareth Mark; Williams, Dean

2013-01-01

Utilising the labour ideas of Adam Smith and Emile Durkheim as a theoretical basis, the main objective of this study was to investigate the perception that Heads of Physical Education (HoPE) face unique management and leadership challenges. Results showed that HoPE believe that they are overburdened with tasks primarily involving the delegation of…

Potential for a small, tracked vehicle in small tree management activities

Treesearch

Jeff Halbrook; Harry Lee

2002-01-01

Small diameter timber offers unique challenges for resource managers. Soil disturbance, residual stand damage, and high equipment capital are often associated with using large logging equipment to extract this timber. In an ongoing project at the University of Idaho, an All Season Vehicle (ASV) RC 30 has been modified for use as a low impact skidding device. Several...

Privatized managed care and forensic mental health services.

PubMed

Packer, I K

1998-01-01

Managed care for mental health services, which began in the private, commercial sector, has spread over the past few years to the public mental health sector as well. Recently, states have begun considering whether to include the forensic population within their privatized managed care systems. This article explores some of the complexities and special challenges unique to forensic services and notes some of the problems that might be incurred if the forensic population were included in a managed care system.

Cultural and Family Challenges to Managing Type 2 Diabetes in Immigrant Chinese Americans

PubMed Central

Chesla, Catherine A.; Chun, Kevin M.; Kwan, Christine M.L.

2009-01-01

OBJECTIVE Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. RESEARCH DESIGN AND METHODS This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the inclusion criteria reviewed and confirmed the themes developed from the initial couples. RESULTS Cultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities. CONCLUSIONS Culturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients' and families' disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted. PMID:19628812

Cultural and family challenges to managing type 2 diabetes in immigrant Chinese Americans.

PubMed

Chesla, Catherine A; Chun, Kevin M; Kwan, Christine M L

2009-10-01

Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the inclusion criteria reviewed and confirmed the themes developed from the initial couples. Cultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities. Culturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients' and families' disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted.

Quality, Safety and Patient Centered Care--A Dream Come True in the Mountains of Northern Pakistan. An Award winning project of "2015 Quality, Safety & Patient Centered Care Award" at, Chicago USA.

PubMed

Jassani, Kashif; Essani, Rozina Roshan; Abbas, Syed Nadeem Husain

2016-01-01

Northern Pakistan remains very challenging terrain due to harsh weather all year round presenting an infrastructura, human resource and supply chain challenge of its own. Many times the facility had to move to different locations on emergency and ad hoc basis due to landslides, earthquakes affecting continuity of care. Providing quality healthcare to often resource constraint hard-to-reach areas has always been AKHS,P's unique forte. Breaking barriers for catchment population to access quality healthcare, AKHS,P embarked on an initiative of implementing, achieving and sustaining ISO 9001:2008 Quality Management System international standards certification. This article shares the unique experience of AKHS,P in achieving and sustaining ISO 9001:2008 International Quality Management System Certification. After untiring efforts and the hard work of ground staff; AKHS,P achieved ISO 9001:2008 International Quality Management System Certification as well as 1st Surveillance Audit which itself proved that AKHS,P sustained quality systems and ensured continuous quality improvement in the Mountains of Northern Pakistan.

Management of epilepsy during pregnancy: an update

PubMed Central

Patel, Sima I.; Pennell, Page B.

2015-01-01

The clinical management of women with epilepsy on antiepileptic drugs (AEDs) during pregnancy presents unique challenges. The goal of treatment is optimal seizure control with minimal in utero fetal exposure to AEDs in an effort to reduce the risk of structural and neurodevelopmental teratogenic effects. This paper reviews the following key issues pertaining to women with epilepsy during pregnancy: AED pharmacokinetics; clinical management of AEDs; seizure frequency; major congenital malformation; neurodevelopmental outcomes; perinatal complications; and breast feeding. PMID:27006699

Intelligent Transportation Systems (ITS) in the NPS : 2005 baseline inventory and preliminary program assessment

DOT National Transportation Integrated Search

2006-01-19

This report presents the current status of Intelligent Transportation Systems (ITS) within the 398 national parks managed by the National Park Service (NPS), discusses the potential of ITS to address the often unique transportation challenges faced b...

Adapting Project Management Practices to Research-Based Projects

NASA Technical Reports Server (NTRS)

Bahr, P.; Baker, T.; Corbin, B.; Keith, L.; Loerch, L.; Mullenax, C.; Myers, R.; Rhodes, B.; Skytland, N.

2007-01-01

From dealing with the inherent uncertainties in outcomes of scientific research to the lack of applicability of current NASA Procedural Requirements guidance documentation, research-based projects present challenges that require unique application of classical project management techniques. If additionally challenged by the creation of a new program transitioning from basic to applied research in a technical environment often unfamiliar with the cost and schedule constraints addressed by project management practices, such projects can find themselves struggling throughout their life cycles. Finally, supplying deliverables to a prime vehicle customer, also in the formative stage, adds further complexity to the development and management of research-based projects. The Biomedical Research and Countermeasures Projects Branch at NASA Johnson Space Center encompasses several diverse applied research-based or research-enabling projects within the newly-formed Human Research Program. This presentation will provide a brief overview of the organizational structure and environment in which these projects operate and how the projects coordinate to address and manage technical requirements. We will identify several of the challenges (cost, technical, schedule, and personnel) encountered by projects across the Branch, present case reports of actions taken and techniques implemented to deal with these challenges, and then close the session with an open forum discussion of remaining challenges and potential mitigations.

Morphology supporting function: attenuation correction for SPECT/CT, PET/CT, and PET/MR imaging

PubMed Central

Lee, Tzu C.; Alessio, Adam M.; Miyaoka, Robert M.; Kinahan, Paul E.

2017-01-01

Both SPECT, and in particular PET, are unique in medical imaging for their high sensitivity and direct link to a physical quantity, i.e. radiotracer concentration. This gives PET and SPECT imaging unique capabilities for accurately monitoring disease activity for the purposes of clinical management or therapy development. However, to achieve a direct quantitative connection between the underlying radiotracer concentration and the reconstructed image values several confounding physical effects have to be estimated, notably photon attenuation and scatter. With the advent of dual-modality SPECT/CT, PET/CT, and PET/MR scanners, the complementary CT or MR image data can enable these corrections, although there are unique challenges for each combination. This review covers the basic physics underlying photon attenuation and scatter and summarizes technical considerations for multimodal imaging with regard to PET and SPECT quantification and methods to address the challenges for each multimodal combination. PMID:26576737

Understanding Family Caregiver Communication to Provide Family-Centered Cancer Care.

PubMed

Wittenberg, Elaine; Buller, Haley; Ferrell, Betty; Koczywas, Marianna; Borneman, Tami

2017-12-01

To describe a family caregiver communication typology and demonstrate identifiable communication challenges among four caregiver types: Manager, Carrier, Partner, and Lone. Case studies based on interviews with oncology family caregivers. Each caregiver type demonstrates unique communication challenges that can be identified. Recognition of a specific caregiver type will help nurses to adapt their own communication to provide tailored support. Family-centered cancer care requires attention to the communication challenges faced by family caregivers. Understanding the challenges among four family caregiver communication types will enable nurses to better address caregiver burden and family conflict. Copyright © 2017 Elsevier Inc. All rights reserved.

Enhancing moist forest restoration opportunities in riparian systems

Treesearch

Theresa Benavidez Jain; Russell T. Graham

2004-01-01

In northern Rocky Mountain moist forests, riparian systems contain many attributes that create unique biophysical conditions that alter disturbances and microenvironments; thus creating distinct forest structures, species composition, and management challenges. For example, browsing, limited opening size, competition from surrounding ground vegetation, high soil...

Teaching Leaders

ERIC Educational Resources Information Center

DeAngelis, Lisa; Penney, Sherry

2015-01-01

In an age of instantaneous information sharing and increased interdependence, today's leaders must learn to work collaboratively, leveraging the strengths, skills, and experiences of those around them, in order to address the challenges they face. The Center for Collaborative Leadership is uniquely situated in the College of Management at the…

Best management practices for establishment of salt-tolerant grasses on roadsides : final report.

DOT National Transportation Integrated Search

2017-07-01

Roadsides are a unique growing environment for turf grasses and can be a challenge to establish and maintain. The University of Minnesota turf grass research program has been investigating low-input turf grasses that are better adapted for roadsides ...

Challenges of space medical operations and life sciences management

NASA Technical Reports Server (NTRS)

Haddad, S. G.

1992-01-01

The Kennedy Space Center (KSC) has been the premier launch and landing site for America's space program since the early 1960s. Visitors are cognizant of space vehicles, processing facilities and launch pads which are treasured national resources. However, most are unaware of the unique organization which supports launch and landing activities and manages the center's occupational medicine, environmental health, ecological and environmental monitoring functions, as well as human and plant research programs. Management of this multifaceted organization can be complex because funding its different functions comes from a number of sources. Additionally the diverse disciplines of personnel present a special challenge in maintaining professional competencies while assuring efficiency in cyclical operations. This article explains the organization's structure and reviews some of its accomplishments.

Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension.

PubMed

Chisholm, Peter; Anpalahan, Mahesan

2017-04-01

Both hypertension and orthostatic hypotension (OH) are strongly age-associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well-established treatments. Not infrequently, they both coexist, further compounding the management. This review provides comprehensive information on OH, including pathophysiology, diagnostic workup and treatment, with a view to provide a practical guide to its management. Special references are made to patients with supine hypertension and postprandial hypotension and older hypertensive patients. © 2016 Royal Australasian College of Physicians.

Restorative and periodontal challenges in adults with dystrophic epidermolysis bullosa.

PubMed

Puliyel, Divya; Chiu, Ching Hsiu Ketty; Habibian, Mina

2014-05-01

Oral manifestations of dystrophic epidermolysis bullosa (DEB) include blistering of the oral mucosa, scarring, limited mouth opening, decreased mobility of the tongue, restrictions in oral functions and a high incidence of caries. Adult oral health management is challenging and requires unique strategies, which have not been well described in the published literature. We present a case of DEB focusing on the obstacles encountered during restorative and periodontal care and recommendations for appropriate treatment.

Soft Tissue Management in Facial Trauma

PubMed Central

Braun, Tara L.; Maricevich, Renata S.

2017-01-01

The management of soft tissue injury after facial trauma poses unique challenges to the plastic surgeon, given the specialized nature of facial tissue and the aesthetic importance of the face. The general principles of trauma management and wound care are applied in all cases. The management of severe injuries to the face is discussed in relation to the location and the mechanism of injury. Facial transplants have arisen in the past decade for the management of catastrophic soft tissue defects, although high morbidity and mortality after these non-life-saving operations must be considered in patient selection. PMID:28496386

The Rural School Principalship: Unique Challenges, Opportunities.

ERIC Educational Resources Information Center

Hill, Jonathan

1993-01-01

Presents findings based on author's research and experience as principal in California's Mojave Desert. Five basic characteristics distinguish the rural principalship: lack of an assistant principal or other support staff; assumption of other duties, including central office tasks, teaching, or management of another site; less severe student…

Control of pestivirus infections in the management of wildlife populations

USDA-ARS?s Scientific Manuscript database

The lack of host-specificity allow pestiviruses to infect domestic livestock as well as captive and free-ranging wildlife, posing unique challenges to different stakeholders. While current control measures for bovine viral diarrhea virus (BVDV) are focused only on cattle, increased attention on the ...

Exploring challenges to telehealth communication by specialists in poison information.

PubMed

Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara

2012-01-01

The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.

Challenges and Opportunities for Learning Biology in Distance-Based Settings

ERIC Educational Resources Information Center

Hallyburton, Chad L.; Lunsford, Eddie

2013-01-01

The history of learning biology through distance education is documented. A review of terminology and unique problems associated with biology instruction is presented. Using published research and their own teaching experience, the authors present recommendations and best practices for managing biology in distance-based formats. They offer ideas…

Trauma to the Pediatric Temporomandibular Joint.

PubMed

Bae, Sam S; Aronovich, Sharon

2018-02-01

Management of pediatric condylar fractures presents a unique challenge because the developing mandible provides limited available bone for fixation and primary teeth preclude the use of typical closed reduction techniques. The available literature is reviewed with regard to closed and open treatment approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

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

ERIC Educational Resources Information Center

Gedro, Julie

2010-01-01

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

A View from the Mountain Top: The Purple Mountain Observatory Library, China

ERIC Educational Resources Information Center

Zhang, Jian

2012-01-01

This paper discusses the author's experience directing the Purple Mountain Observatory Library, Chinese Academy of Sciences (CAS) in Nanjing, China. Routine collection development, management and preservation issues are described, and the unique challenges and opportunities involved in operating a remote observatory library are highlighted.

Towards a sustained, comprehensive, intensive approach to broadening participation in the geosciences - Diversity: The Business Case?

EPA Science Inventory

Understanding perceptions and managing expectations are learnable skills that do not necessarily come with project funding. Finding life balance as one moves through a STEM career path poses unique challenges that require a certain skill set that is not always intuitive. Some of ...

Wood and fish residuals composting in Alaska

Treesearch

David Nicholls; Thomas Richard; Jesse A. Micales

2002-01-01

The unique climates and industrial mix in southeast and south central Alaska are challenges being met by the region's organics recyclers. OMPOSTING wood residuals in Alaska has become increasingly important in recent years as wood processors and other industrial waste managers search for environmentally sound and profitable outlets. Traditionally, Alaska?s...

Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice

PubMed Central

Iyngkaran, Pupalan; Toukhsati, Samia R.; Harris, Melanie; Connors, Christine; Kangaharan, Nadarajan; Ilton, Marcus; Nagel, Tricia; Moser, Debra K.; Battersby, Malcolm

2016-01-01

Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region. PMID:27397492

Consensus in the Management of Multiple Myeloma in India at Myeloma State of the Art 2016 Conference.

PubMed

Yanamandra, Uday; Khattry, Navin; Kumar, Shaji; Raje, Noopur; Jain, Arihant; Jagannath, Sundar; Menon, Hari; Kumar, Lalit; Varma, Neelam; Varma, Subhash; Saikia, Tapan; Malhotra, Pankaj

2017-03-01

The science of multiple myeloma (MM) and related plasma cell disorders is rapidly evolving with increased understanding of the disease biology and recent approval of the newer drugs widening the therapeutic armamentarium. Despite multiple international guidelines regarding the management of this disease, the practice of managing MM is not uniform amongst Indian physicians. There are challenges in management which are unique to the Indian patients. This review discusses these challenges and the consensus of the nation-wide experts in dealing with the same. We also briefly highlighted the perspective of international experts as discussed in the Myeloma State of the Art conference held in September 2016 at PGI, Chandigarh. An I ndian M yeloma A cademic G roup e (IMAGe) group was formed to strengthen the research, create awareness about myeloma and related disorders and form consensus guidelines/ recommendations that can be adapted to the Indian Scenario.

Oncology disease management.

PubMed

Fetterolf, Donald E; Terry, Rachel

2007-02-01

Oncologic conditions are ubiquitous medical illnesses that present a particular challenge for medical management programs designed to address quality and cost issues in patient populations. Disease management strategies represent a reasonable and effective approach for employers and health plans in their arsenal of health management strategies. Multiple reasons exist for the development of specialized disease management programs that deal with cancer patients, some unique to this group of individuals. Health plans and/or employers have solid justification for addressing these issues directly through programs developed specifically to work with cancer patients. Whether developed within a health plan, or "carved out" to an external vendor, proper evaluation of outcomes is essential.

Overview of Contemporary Issues of Forest Research and Management in China

NASA Astrophysics Data System (ADS)

He, Hong S.; Shifley, Stephen R.; Thompson, Frank R.

2011-12-01

With 207 million ha of forest covering 22% of its land area, China ranks fifth in the world in forest area. Rapid economic growth, climate change, and forest disturbances pose new, complex challenges for forest research and management. Progress in meeting these challenges is relevant beyond China, because China's forests represent 34% of Asia's forests and 5% of the worlds' forests. To provide a broader understanding of these management challenges and of research and policies that address them, we organized this special issue on contemporary forest research and management issues in China. At the national level, papers review major forest types and the evolution of sustainable forestry, the development of China's forest-certification efforts, the establishment of a forest inventory system, and achievements and challenges in insect pest control in China. Papers focused on Northern China address historical, social, and political factors that have shaped the region's forests; the use of forest landscape models to assess how forest management can achieve multiple objectives; and analysis and modeling of fuels and fire behavior. Papers addressing Central and South China describe the "Grain for Green" program, which converts low productivity cropland to grassland and woodland to address erosion and soil carbon sequestration; the potential effects of climate change on CO2 efflux and soil respiration; and relationships between climate and net primary productivity. China shares many forest management and research issues with other countries, but in other cases China's capacity to respond to forest management challenges is unique and bears watching by the rest of the world.

ST-elevation myocardial infarction in a young adult secondary to giant coronary aneurysm thrombosis: an important sequela of Kawasaki disease and a management challenge.

PubMed

Potter, Elizabeth L; Meredith, Ian T; Psaltis, Peter James

2016-01-20

Thrombosis of a coronary artery aneurysm (CAA) is a rare trigger for ST-elevation myocardial infarction (STEMI) and an important cause of STEMI in young adults previously affected by Kawasaki disease. Initial management should proceed in line with standard STEMI-management guidelines advocating antiplatelet medication and emergency coronary angiography. Acute CAA thrombosis presents the interventional cardiologist with unique challenges during attempted percutaneous revascularisation. In the absence of consensus guidelines, experiential reporting can therefore be of great value. We report on a 36-year-old Vietnamese woman presenting with an inferior STEMI secondary to two giant thrombosed aneurysms of the right coronary artery. Coronary wiring and thrombus aspiration temporarily improved coronary flow but recurrent thrombus with distal embolisation resulted in ventricular fibrillation and cardiogenic shock. Emergency surgical revascularisation subsequently provided a definitive and successful outcome. We discuss the challenges of percutaneous coronary intervention in this scenario and review previous reports to give an overview of principles of decision-making and management. 2016 BMJ Publishing Group Ltd.

Design and high-volume manufacture of low-cost molded IR aspheres for personal thermal imaging devices

NASA Astrophysics Data System (ADS)

Zelazny, A. L.; Walsh, K. F.; Deegan, J. P.; Bundschuh, B.; Patton, E. K.

2015-05-01

The demand for infrared optical elements, particularly those made of chalcogenide materials, is rapidly increasing as thermal imaging becomes affordable to the consumer. The use of these materials in conjunction with established lens manufacturing techniques presents unique challenges relative to the cost sensitive nature of this new market. We explore the process from design to manufacture, and discuss the technical challenges involved. Additionally, facets of the development process including manufacturing logistics, packaging, supply chain management, and qualification are discussed.

Opportunities and challenges of big data for the social sciences: The case of genomic data.

PubMed

Liu, Hexuan; Guo, Guang

2016-09-01

In this paper, we draw attention to one unique and valuable source of big data, genomic data, by demonstrating the opportunities they provide to social scientists. We discuss different types of large-scale genomic data and recent advances in statistical methods and computational infrastructure used to address challenges in managing and analyzing such data. We highlight how these data and methods can be used to benefit social science research. Copyright © 2016 Elsevier Inc. All rights reserved.

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Bilateral tuberculous otitis media: An unique presentation.

PubMed

Bhatkar, Dhiraj; Utpat, Ketaki; Desai, Unnati; Joshi, Jyotsna M

2017-10-01

Tuberculous otitis media (TOM) is an uncustomary variety of tuberculosis (TB) usually seen secondary to pulmonary tuberculosis or associated with it. It is characterized by indolent and heterogeneous presentations. Diagnosis warrants clinical, radiological, and microbiological amalgamation. It is hence challenging and frequently delayed leading to disabling complications. Opportunate suspicion, timely diagnosis and appropriate antituberculosis therapy are the key to successful management. We report a unique case of bilateral TOM occurring in an immunocompetent adult. Copyright © 2016 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

The state of the system and steps toward resilience of distrubance-dependent oak forests

Treesearch

Tricia G. Knoot; Lisa A. Schulte; John C. Tyndall; Brian J. Palik

2010-01-01

Current ecological, economic, and social conditions present unique challenges to natural resource managers seeking to maintain the resilience of disturbance-dependent ecosystems, such as oak (Quercus spp.) forests. Oak-dominated ecosystems throughout the U.S. have historically been perpetuated through periodic disturbance, such as fire, but more...

Psychotropic Medication Management for Youth in State Care: Consent, Oversight, and Policy Considerations

ERIC Educational Resources Information Center

Naylor, Michael W.; Davidson, Christine V.; Ortega-Piron, D. Jean; Bass, Arin; Gutierrez, Alice; Hall, Angela

2007-01-01

The use of psychotropic medications in youth with emotional disturbances in state custody is increasing and presents unique challenges concerning consent and oversight. We examine various means that state child welfare agencies use to provide consent for and oversight of psychotropic medications for children in state custody and describe benefits…

Managing Water Quality in Wetlands with Foresty BMP's

Treesearch

Bob Rummer

2004-01-01

Forested wetlands are uniquely critical areas in forest operations that present special challenges to protect water quality. These locations are a direct interface between the impacts of forest operations and water. BMP's are designed to minimize nonpoint source pollution, but much of the science behind current guidelines is based on an understanding of erosion...

Improving Compliance with Diabetes Management in Young Adolescents with Attention-Deficit/Hyperactivity Disorder Using Behavior Therapy

ERIC Educational Resources Information Center

Sanchez, Lisa M.; Chronis, Andrea M.; Hunter, Scott J.

2006-01-01

Medical adherence to complex diabetes regimens can be challenging, particularly for adolescents, and therefore represents the most common reason for referral to behavioral psychologists among this population. Attention-deficit/hyperactivity disorder (ADHD), when present in children and adolescents with diabetes, presents unique barriers to…

More than a Game: Learning about Climate Change through Role-Play

ERIC Educational Resources Information Center

Paschall, Melissa; Wustenhagen, Rolf

2012-01-01

Educating management students on the connections between business and climate change is essential both to their careers and to society's ability to solve the climate challenge. To impart deep and lasting learning on this topic, the authors developed a multischool negotiation simulation that is unique in its intensiveness, cross-sector design, and…

Multiscale socioeconomic assessment across large ecosystems: lessons from practice

Treesearch

Rebecca J. McLain; Ellen M. Donoghue; Jonathan Kusel; Lita Buttolph; Susan Charnley

2008-01-01

Implementation of ecosystem management projects has created a demand for socioeconomic assessments to predict or evaluate the impacts of ecosystem policies. Social scientists for these assessments face challenges that, although not unique to such projects, are more likely to arise than in smaller scale ones. This article summarizes lessons from our experiences with...

Comparison of environmental and egg microbiology associated with conventional and free range laying hen management

USDA-ARS?s Scientific Manuscript database

Eggs from alternative production practices are a growing niche in the market. Meeting consumer requests for greater diversity in retail egg options has resulted in some unique challenges such as understanding the food safety implications of eggs from alternative production practices. A study was c...

A Social-ecological framework for urban stewardship network research to promote sustainable and resilient cities

Treesearch

Michele Romolini; R. Patrick Bixler; Morgan Grove

2016-01-01

To realize more sustainable and resilient urban social-ecological systems, there is great need for active engagement from diverse public agencies, non-profit organizations, businesses, natural resource managers, scientists, and other actors. Cities present unique challenges and opportunities for sustainability and resilience, as issues and organizations are frequently...

Professional Development for Cross-Border Managers: New Growth Opportunities for Executive Education

ERIC Educational Resources Information Center

Scalberg, Ernest J.

2013-01-01

The need of business enterprises for professionals trained for the challenges of cross-border assignments will increase exponentially through the decade. Business schools will be hard pressed to deliver programs with the scope, scale, and effectiveness necessary to address the unique competencies required for cross-cultural understanding and…

Solutions to Challenges Facing a University Digital Library and Press

PubMed Central

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

2000-01-01

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

The pressing energy innovation challenge of the US National Laboratories

NASA Astrophysics Data System (ADS)

Anadon, Laura Diaz; Chan, Gabriel; Bin-Nun, Amitai Y.; Narayanamurti, Venkatesh

2016-10-01

Accelerating the development and deployment of energy technologies is a pressing challenge. Doing so will require policy reform that improves the efficacy of public research organizations and strengthens the links between public and private innovators. With their US$14 billion annual budget and unique mandates, the US National Laboratories have the potential to critically advance energy innovation, yet reviews of their performance find several areas of weak organizational design. Here, we discuss the challenges the National Laboratories face in engaging the private sector, increasing their contributions to transformative research, and developing culture and management practices to better support innovation. We also offer recommendations for how policymakers can address these challenges.

Critical pedagogy in a health service management development programme: can "critically thinking" managers change the NHS management culture?

PubMed

Sambrook, Sally

2009-01-01

Management development programmes available to NHS managers focus on a performance orientation and sustain a culture of managerial and medical domination. This paper aims to question whether it is possible to consider NHS management development from a critical (empowerment culture) perspective. Features of the critical management studies approach (CMS) are identified. A new MSc is evaluated against these characteristics, examining the teaching and learning processes and students' perceptions of the programme. The aim is to develop critical thinkers who can return to their organizations and challenge existing power structures and practices to change local cultures and enhance health services. Empirical research employed anonymous student questionnaires and a focus group. Student evaluations suggest the MSc can deliver a critical pedagogy and help managers understand issues of power and empowerment, challenge dominant cultures, innovate and effect small, local changes in the NHS culture. There is a need to continue evaluating the programme and include other stakeholders. Longitudinal research should assess the impact of the managers' changed values, attitudes and behaviours on colleagues, clients and the local cultures. The paper identifies some of the tensions of developing "critical" health service managers, and the problems they encounter back in the "uncritical" NHS context, as well as some of the challenges in "facilitating" a critical curriculum. It questions the ethics of developing (or not) a critical perspective in a local context unfamiliar with CMS. Management development in the NHS largely ignores critical pedagogy. This paper makes a small and unique contribution to understanding how developing "critically thinking" managers can challenge the dominant culture. However, the limitations of such a small-scale study and ethical implications are noted.

Helicopter winchmens' experiences with pain management in challenging environments.

PubMed

van der Velde, J; Linehan, L; Cusack, S

2013-02-01

We conducted a survey of Irish Coast Guard Search and Rescue Helicopter winchmen to establish if their pain management scope of practice was adequate for their working environment. We surveyed 17 SAR personnel. 88% of winchmen have experienced scenarios where they were unable to reduce pain scores below 6/10. In seeking solutions within current Irish Prehospital Clinical Practice Guidelines, repeated descriptions of operations in extreme weather and sea conditions were given which were entirely incompatible with the dexterity required to break a glass ampoule and draw up solution, let alone site an intravenous (IV) line or administer a drug via intramuscular (IM) injection. Irish Coast Guard Search and Rescue Helicopter winchmen encounter polytrauma patients in extreme pain in uniquely challenging environments. Novel solutions to pain management within this tightly governed system are urgently required.

Mergers and acquisitions in professional organizations: a complex adaptive systems approach.

PubMed

Walls, M E; McDaniel, R R

1999-09-01

Nurse managers face unique challenges as they cope with mergers and acquisitions among health care organizations. These challenges can be better understood if it is recognized that health care institutions are professional organizations and that the transformations required are extremely difficult. These difficulties are caused, in part, by the institutionalized nature of professional organizations, and this nature is explicated. Professional organizations are stubborn. They are repositories of expertise and values that are societal in origin and difficult to change. When professional organizations are understood as complex adaptive systems, complexity theory offers insight that provide strategies for managing mergers and acquisitions that may not be apparent when more traditional conceptualizations of professional organizations are used. Specific managerial techniques consistent with both the institutionalized characteristics and the complex adaptive systems characteristics of professional organizations are offered to nurse managers.

Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium

PubMed Central

Wilson, M E; Pandey, S K; Thakur, J

2003-01-01

Paediatric cataract blindness presents an enormous problem to developing countries in terms of human morbidity, economic loss, and social burden. Managing cataracts in children remains a challenge: treatment is often difficult, tedious, and requires a dedicated team effort. To assure the best long term outcome for cataract blind children, appropriate paediatric surgical techniques need to be defined and adopted by ophthalmic surgeons of developing countries. The high cost of operative equipment and the uneven world distribution of ophthalmologists, paediatricians, and anaesthetists create unique challenges. This review focuses on issues related to paediatric cataract management that are appropriate and suitable for ophthalmic surgeons in the developing world. Practical guidelines and recommendations have also been provided for ophthalmic surgeons and health planners dealing with childhood cataract management in the developing world. PMID:12488254

Community-based telemonitoring for hypertension management: practical challenges and potential solutions.

PubMed

Hovey, Lauren; Kaylor, Mary Beth; Alwan, Majd; Resnick, Helaine E

2011-10-01

Older adults residing in rural areas often lack convenient, patient-centered, community-based approaches to facilitate receipt of routine care to manage common chronic conditions. Without adequate access to appropriate disease management resources, the risk of seniors' experiencing acute events related to these common conditions increases substantially. Further, poorly managed chronic conditions are costly and place seniors at increased risk of institutionalization and permanent loss of independence. Novel, telehealth-based approaches to management of common chronic conditions like hypertension may not only improve the health of older adults, but may also lead to substantial cost savings associated with acute care episodes and institutionalization. The aim of this report is to summarize practical considerations related to operations and logistics of a unique community-based telemonitoring pilot study targeting rural seniors who utilize community-based senior centers. This article reviews the technological challenges encountered during the study and proposes solutions relevant to future research and implementation of telehealth in community-based, congregate settings.

Total Quality Management: A Unique Challenge For Behavioral Science Researchers,

DTIC Science & Technology

Quality Management (TQM) programs in industry and government. The essence of TQM involves respect for personal choice and the participation of every level of workers in decisions which impact the organization. Typically, structured questionnaires developed by behavioral scientists are designed to be easy to summarize and generally lack any mechanism for personal comments, ideas, and suggestions. New open-ended, interactive, and iterative survey methodologies are needed to enhance creativity, encourage feedback, and foster a sense of participation. Total Quality

CALFED--An experiment in science and decisionmaking

USGS Publications Warehouse

Taylor, Kimberly A.; Jacobs, Katharine L.; Luoma, Samuel N.

2003-01-01

The CALFED Bay-Delta Program faces a challenging assignment: to develop a collaborative state-federal management plan for the complex river system and involve multiple stakeholders (primarily municipal, agricultural, and environmental entities) whose interests frequently are in direct conflict. Although many resource-management issues involve multiple stakeholders and conflict is integral to their discussion, the CALFED experience is unique because of its shared state and federal roles, the magnitude and significance of stakeholder participation, and the complexity of the scientific issues involved.

Just-in-Time Training for High-Risk Low-Volume Therapies: An Approach to Ensure Patient Safety.

PubMed

Helman, Stephanie; Lisanti, Amy Jo; Adams, Ann; Field, Cynthia; Davis, Katherine Finn

2016-01-01

High-risk low-volume therapies are those therapies that are practiced infrequently and yet carry an increased risk to patients because of their complexity. Staff nurses are required to competently manage these therapies to treat patients' unique needs and optimize outcomes; however, maintaining competence is challenging. This article describes implementation of Just-in-Time Training, which requires validation of minimum competency of bedside nurses managing high-risk low-volume therapies through direct observation of a return-demonstration competency checklist.

Anaesthetic significance and management of a child with neonatal purpura fulminans

PubMed Central

Tiwari, Akhilesh Kumar; Tomar, Gaurav Singh; Tayal, Swapnil; Chadha, Madhur; Kapoor, Mukul

2012-01-01

Protein C deficiency is a rare autosomal-dominant disorder of varying severity. Patients with homozygous and compound heterozygous protein C deficiency present with neonatal purpura fulminans (NPF). Other presentations usually include disseminated intravascular coagulation and venous thromboembolism. This disorder usually poses a unique anaesthetic challenge to the anaesthesiologist, requiring special precautions to prevent various intra- and post-operative complications. We hereby report the successful anaesthetic management of a 1-month-old infant who presented with NPF. PMID:22923829

Implementing the new HEDIS hypertension performance measure.

PubMed

Sennett, C

2000-04-01

There is a problem with blood pressure control in the United States--a problem with significant implications for the health and welfare of the populace. This problem is bigger than managed care, but managed care organizations have both unique opportunities and unique obligations to address it. NCQA has responded to this problem, and to the opportunity for better care implicit in it, by introducing into HEDIS a measure that focuses on hypertension control. This measure will add pressure to health plans to address the problem of hypertension control, but it also will create the opportunity for positive recognition for those plans that succeed. The HEDIS hypertension measure is well grounded in both the science of medicine and the science of measurement. But HEDIS measurement alone will not create change. To effect change will require analysis of the problems that limit the delivery of effective care to patients with hypertension. It will require measurement of the success of the key processes of care upon which effective care depends. And it will require response--rational, focused, and operationally effective. These, in turn, will challenge key managers in health plans. Medical directors will have to influence provider behavior. Pharmacy directors will have to leverage pharmacy resources to support efforts to change provider and enrollee behaviors. And QA directors will have to manage a challenging set of measurement activities, from which plans' efforts to improve will be launched. The next few years will not be easy--demands for improvement increase annually, and resources are every year more scarce. Yet the goal is worth the struggle--to transform an industry that the public perceives to be interested in limiting care into one that the public turns to for assurance that care represents high value. Responding effectively to the HEDIS hypertension measure creates a unique opportunity for managed care--to demonstrate to the public that managed care is leading national efforts to improve quality for 50 million Americans needlessly at risk for heart disease and stroke, and in doing so, to demonstrate its commitment to health maintenance--the very foundation of managed care.

Use of decision support systems as a drought management tool

USGS Publications Warehouse

Frevert, D.; Lins, H.; ,

2005-01-01

Droughts present a unique challenge to water managers throughout the world and the current drought in the western United States is taxing facilities to the limit. Coping with this severe drought requires state of the art decision support systems including efficient and accurate hydrologic process models, detailed hydrologic data bases and effective river systems management modeling frameworks. This paper will outline a system of models developed by the Bureau of Reclamation, the US Geological Survey, the University of Colorado and a number of other governmental and university partners. The application of the technology to drought management in several key western river basins will be discussed.

Glaucoma and Corneal Transplant Procedures

PubMed Central

Al-Mahmood, Ammar M.; Al-Swailem, Samar A.; Edward, Deepak P.

2012-01-01

Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence reported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available; surgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen following deep anterior lamellar keratoplasty. Descemet's striping-automated endothelial keratoplasty is also associated with postprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and the management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma following different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular pressure monitoring in this group of patients. PMID:22315661

Newborn screening progress in developing countries--overcoming internal barriers.

PubMed

Padilla, Carmencita D; Krotoski, Danuta; Therrell, Bradford L

2010-04-01

Newborn screening is an important public health measure aimed at early identification and management of affected newborns thereby lowering infant morbidity and mortality. It is a comprehensive system of education, screening, follow-up, diagnosis, treatment/management, and evaluation that must be institutionalized and sustained within public health systems often challenged by economic, political, and cultural considerations. As a result, developing countries face unique challenges in implementing and expanding newborn screening that can be grouped into the following categories: (1) planning, (2) leadership, (3) medical support, (4) technical support, (5) logistical support, (6) education, (7) protocol and policy development, (8) administration, (9) evaluation, and (10) sustainability. We review some of the experiences in overcoming implementation challenges in developing newborn screening programs, and discuss recent efforts to encourage increased newborn screening through support networking and information exchange activities in 2 regions-the Asia Pacific and the Middle East/North Africa. Copyright 2010 Elsevier Inc. All rights reserved.

Cold Plasmas for Biofilm Control: Opportunities and Challenges.

PubMed

Gilmore, Brendan F; Flynn, Padrig B; O'Brien, Séamus; Hickok, Noreen; Freeman, Theresa; Bourke, Paula

2018-06-01

Bacterial biofilm infections account for a major proportion of chronic and medical device associated infections in humans, yet our ability to control them is compromised by their inherent tolerance to antimicrobial agents. Cold atmospheric plasma (CAP) represents a promising therapeutic option. CAP treatment of microbial biofilms represents the convergence of two complex phenomena: the production of a chemically diverse mixture of reactive species and intermediates, and their interaction with a heterogeneous 3D interface created by the biofilm extracellular polymeric matrix. Therefore, understanding these interactions and physiological responses to CAP exposure are central to effective management of infectious biofilms. We review the unique opportunities and challenges for translating CAP to the management of biofilms. Copyright © 2018. Published by Elsevier Ltd.

Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?

PubMed Central

Rao, Durga Prasada; Rao, Venkateswara A

2010-01-01

The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with “what is new?” in obstetric anaesthesia. PMID:21224967

Sink or SLIM: A Local Response to Promote Global Sustainable Change through Education, Partnerships, and Workforce Development

ERIC Educational Resources Information Center

de Roode, Alexander F.; Sakamoto, Clyde M.; Six, Janet

2009-01-01

Maui's unique geographic location, culture, economy, and ecology provide a year-round sustainable living laboratory for the development of sustainable solutions to local and global challenges. Maui Community College's mission, goals, and actions are guided by the Native Hawaiian reverence for the ahupuaa, the traditional land management practice…

Leadership in Social Work: Where Are We?

ERIC Educational Resources Information Center

Sullivan, W. Patrick

2016-01-01

This article provides an overview of the status of leadership in social work, with an emphasis on unique functions and challenges leaders face in the field. Included in this review is a consideration of the concept of leadership as distinct from management, a historical review of the development of leadership as a specialty within social work, and…

Diagnosis of Urinary Tract Infections in Children

PubMed Central

2016-01-01

Urinary tract infections (UTIs) are a common occurrence in children. The management and laboratory diagnosis of these infections pose unique challenges that are not encountered in adults. Important factors, such as specimen collection, urinalysis interpretation, culture thresholds, and antimicrobial susceptibility testing, require special consideration in children and will be discussed in detail in the following review. PMID:27053673

Managing Educational Reforms during Times of Transition: The Role of Leadership

ERIC Educational Resources Information Center

Moccia, Salvatore

2016-01-01

Being the leader of a university is a unique and diverse challenge ever since universities have been described by Cohen and Marchin (1974) as "organized anarchies" with high inertia, unclear technologies and problematic goals. This could be in part due to the fact of the temporary status of their roles amplifying a sort of conflict of…

Predicting Burnout and Job Satisfaction in Workplace Counselors: The Influence of Role Stressors, Job Challenge, and Organizational Knowledge

ERIC Educational Resources Information Center

Kirk-Brown, Andrea; Wallace, Debra

2004-01-01

The present study examines the antecedents of burnout and job satisfaction among counselors employed in workplace settings. Workplace counselors face the unique demands of managing dual client relationships (individual and organization) within the counseling setting. Antecedents of the job-related outcomes of burnout and satisfaction are likely to…

Serving Those Who Have Served--Managing Veteran and Military Student Best Practices

ERIC Educational Resources Information Center

Brown, Patricia A.; Gross, Charles

2011-01-01

An increasing number of veterans and military students are seeking to complete degrees online and through enrollment at campuses across the nation. Their increased numbers present some unique challenges and opportunities. Post 9/11, Chapter 33 GI Bill funding is enticing more institutions to look at the veteran and military population as a…

Principles of Tendon Reconstruction Following Complex Trauma of the Upper Limb

PubMed Central

Chattopadhyay, Arhana; McGoldrick, Rory; Umansky, Elise; Chang, James

2015-01-01

Reconstruction of tendons following complex trauma to the upper limb presents unique clinical and research challenges. In this article, the authors review the principles guiding preoperative assessment, surgical reconstruction, and postoperative rehabilitation and management of the upper extremity. Tissue engineering approaches to address tissue shortages for tendon reconstruction are also discussed. PMID:25685101

Social and ethical issues in environmental risk management.

PubMed

Oughton, Deborah H

2011-07-01

The recognition of the social and ethical aspects of radiation risk management has been an important part of international projects following the Chernobyl accident of 1986. This study comments on the science and policy issues in environmental risk assessment, including the social and ethical dimensions of emergency preparedness and remediation experiences gained from the Chernobyl accident. While the unique situation of Fukushima, combined with an earthquake and tsunami, raises its own social and political challenges, it is hoped that some of the lessons learnt from Chernobyl will be relevant to long-term management of the Fukushima site. Copyright © 2011 SETAC.

Management of Herpes Simplex Virus Keratitis in the Pediatric Population.

PubMed

Vadoothker, Saujanya; Andrews, Laura; Jeng, Bennie H; Levin, Moran Roni

2018-05-14

Herpes simplex virus (HSV) keratitis is a highly prevalent and visually-disabling disease in both the pediatric and adult population. While many studies have investigated the treatment of HSV keratitis in adult patients, few have focused on managing this condition in children. Children are at particularly high risk for visual morbidity due to unique challenges in diagnosis and treatment, and the often more aggressive disease course that results in corneal scarring, and subsequently amblyopia. This review presents the pathogenesis and most current recommendations for the medical and surgical management of HSV keratitis in the pediatric population.

Ventilatory Management and Extubation Criteria of the Neurological/Neurosurgical Patient

PubMed Central

Souter, M. J.; Manno, Edward M.

2013-01-01

Approximately 200 000 patients per year will require mechanical ventilation secondary to neurological injury or disease. The associated mortality, morbidity, and costs are significant. The neurological patient presents a unique set of challenges to airway management, mechanical ventilation, and defining extubation readiness. Neurological injury and disease can directly or indirectly involve the process involved with respiration or airway control. This article will review the basics of airway management and mechanical ventilation in the neurological patient. The current state of the literature evaluating extubation criteria in the neurological patient will also be reviewed. PMID:23983886

Managing childhood chronic illness: parent perspectives and implications for parent-provider relationships.

PubMed

Kratz, Lyn; Uding, Nancy; Trahms, Cristine M; Villareale, Nanci; Kieckhefer, Gail M

2009-12-01

When children have special health care needs, parents assume the roles of care coordinator, medical expert, and systems advocate as well as their typical parenting roles. They face many challenges in managing their child's chronic condition in the context of everyday life. Health care providers are uniquely positioned to assist parents in meeting those challenges and to promote parent competency and confidence in their child's care. The data for this analysis were collected during classes for parents of children with chronic conditions who took part in a randomized controlled study of a curriculum's effectiveness. During facilitated discussions, parents discussed challenges they faced and generated strategies they found helpful. Qualitative data analysis revealed dominant themes across subject areas. Challenges included social isolation, strained relationships and ongoing frustrations with health care and educational systems. Helpful strategies focused on being prepared, connecting with peers, becoming an advocate, developing partnerships and caring for one's self. Implications for health care providers include: understanding common challenges parents face; promoting parent-to-parent connections; and building partnerships with parents and their children with special needs.

SHM reliability and implementation - A personal military aviation perspective

NASA Astrophysics Data System (ADS)

Lindgren, Eric A.

2016-02-01

Structural Health Monitoring has been proposed as a solution to address the needs of military aviation to reduce the time and cost to perform nondestructive inspections. While the potential to realize significant benefits exist, there are considerations that have to be addressed before such systems can be integrated into military platforms. Some considerations are pervasive to all aviation, such as how to assess the reliability and reproducible capability of these systems. However, there are other challenges unique to military aviation that must be overcome before these types of systems can be used. This presentation and paper are intended as a complement to the review of the outcome of the SAE G-11 SHM committee special workshop on SHM reliability in April of 2015. It will address challenges unique to military aviation that stem from different approaches to managing structural integrity (i.e. safety), frequency of use, design differences, various maintenance practices, and additional descriptions addressing differences in the execution of inspections. The objective of this presentation is to improve the awareness of the research and development community to the different and unique requirements found in military aviation, including the differences between countries, services, and aircraft type. This information should assist the research and development community in identifying and attacking key challenges. It is not intended to be comprehensive overview of all stakeholders' perspectives, but to serve as a launch point for additional discussion and exploration of opportunities to realize the potential of Structural Health Monitoring to assist in the management of military aviation assets. The views expressed in this publication are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the United States Government.

Advances and challenges in hair restoration of curly Afrocentric hair.

PubMed

Rogers, Nicole E; Callender, Valerie D

2014-04-01

Although the biochemical composition of hair is similar among racial and ethnic groups, the hair structure between them varies, and individuals with curly hair pose specific challenges and special considerations when a surgical option for alopecia is considered. Hair restoration in this population should therefore be approached with knowledge on the clinical characteristics of curly hair, hair grooming techniques that may influence the management, unique indications for the procedure, surgical instrumentation used, and the complications that may arise. Copyright © 2014 Elsevier Inc. All rights reserved.

Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group.

PubMed

Huo, Yong; Thompson, Peter; Buddhari, Wacin; Ge, Junbo; Harding, Scott; Ramanathan, Letchuman; Reyes, Eugenio; Santoso, Anwar; Tam, Li-Wah; Vijayaraghavan, Govindan; Yeh, Hung-I

2015-03-15

Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

User applications unique to mobile satellites

NASA Technical Reports Server (NTRS)

Castiel, David

1990-01-01

As AMSC enters the market with its mobile satellite services, it faces a sophisticated user group that has already experimented with a wide range of communications services, including cellular radio and Ku-band satellite messaging. AMSC's challenge is to define applications unique to the capabilities of its dedicated L band satellite and consistent with the provisions outlined in its FCC license. Through a carefully researched approach to its three main markets (aeronautical, land mobile, and maritime) AMSC is discovering a wellspring of interest in corporate and general aviation, trucking companies, pipeline monitoring and control companies, maritime management firms, telecommunications companies, and government agencies. A general overview is provided of AMSC's FCC license and corporate history, and the specific applications unique to each user group is discussed.

Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

PubMed

Klaess, Cynthia C; Jungquist, Carla R

2018-06-01

Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use. The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management. A questionnaire survey design was used. Respondents represented 35 states and 2 countries. The participants were 146 respondents from ASPMN membership (1,485 members). The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes. Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted. Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges.

PubMed

Juengst, Shannon B; Kumar, Raj G; Wagner, Amy K

2017-01-01

Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.

Social work management in emerging health care systems.

PubMed

Kenney, J J

1990-02-01

An overview of the health care industry's trend toward multihealth systems is presented and specific adaptive strategies for social work managers in health care are suggested. The challenges to social work leaders during this transition from largely free-standing, privately owned health care institutions to corporately owned, horizontally and vertically integrated delivery systems are discussed in terms of identity, style, and substance. Directors of social work departments in multihealth corporations will need to resolve issues of institutional versus corporate identity as well as those of corporate versus professional identity. A multioptional management style that incorporates networking and political expertise should be cultivated. Substantive demands in the areas of management information systems, productivity, quality assurance, and budgeting also must be addressed. The emergence of multihealth systems poses major challenges and unique opportunities to the social work profession. Awareness of managerial strategies and critical content areas can help social work leaders enhance the role and contribution of social work in these exciting and complex health care delivery systems.

Are leaders portable?

PubMed

Groysberg, Boris; McLean, Andrew N; Nohria, Nitin

2006-05-01

Does management talent transfer from one company to another? The market certainly seems to think so. Stock prices spike when companies announce new CEOs from a talent generator like General Electric. But how do these executives perform over the long term? The authors studied the careers of 20 former GE executives who went on to lead other major organizations, with strikingly uneven results. Even the best management talent, the authors found, is transferable only if it maps to the challenges of the new environment. More specifically, the authors identified five types of skills that may or may not transfer to a new job: general management human capital, or the skills to gather, cultivate, and deploy financial, technical, and human resources; strategic human capital, or individuals' expertise in cost cutting, growth, or cyclical markets; industry human capital, meaning the technical and regulatory knowledge unique to an industry; relationship human capital, or the extent to which a manager's effectiveness can be attributed to his or her experience working with colleagues or as part of a team; and company-specific human capital, or the knowledge about routines and procedures, corporate culture and informal structures, and systems and processes that are unique to a company. The GE executives' performance as CEOs depended on whether their new organizations were able to leverage each type of skill. The authors'findings challenge the conventional wisdom on human capital, which holds that there are two types of skill: general management, which is readily transferable, and company specific, which is not. In fact, they argue, other types of management capabilities can make a significant contribution to performance, and company-specific skills can be an asset in a new job.

Factors that attract and repel visitation to urban recreation sites: a framework for research

Treesearch

David Klenosky; Cherie LeBlanc; Christine Vogt; Herbert Schroeder

2008-01-01

The mix of natural features and manmade elements in urban and metropolitan areas presents unique challenges for resource managers and planners. While some elements of the urban landscape (e.g., forested areas, parks, water features, and museums) may attract or encourage visitation, others (e.g., industrial and commercial activity, odors, noises, crime, litter, and...

Logging utilization research in the Pacific Northwest: residue prediction and unique research challenges

Treesearch

Erik C. Berg; Todd A. Morgan; Eric A. Simmons; Stanley J. Zarnoch

2015-01-01

Logging utilization research results have informed land managers of changes in utilization of forest growing stock for more than 40 years. The logging utilization residue ratio- growing stock residue volume/mill delivered volume- can be applied to historic or projected timber harvest volumes to predict woody residue volumes at varied spatial scales. Researchers at the...

Woody biomass utilization trends, barriers, and strategies: Perspectives of U.S. Forest Service managers

Treesearch

Shiloh Sundstrom; Max Nielsen-Pincus; Cassandra Moseley; Sarah McCaffrey

2012-01-01

The use of woody biomass is being promoted across the United States as a means of increasing energy independence, mitigating climate change, and reducing the cost of hazardous fuels reduction treatments and forest restoration projects. The opportunities and challenges for woody biomass use on the national forest system are unique. In addition to making woody biomass...

Cascabel prescribed fire long-term watershed study: an opportunity to monitor climate change

Treesearch

Gerald Gottfried; Daniel Neary; Peter Ffolliott; Karen Koestner

2012-01-01

Experimental watershed studies can provide answers to new challenges facing land managers and society including the impacts of fires and climate change on upstream and regional hydrology. The Cascabel Watersheds long-term prescribed fire study provides a unique opportunity to monitor climate change because of its location in an oak savanna situated between deserts or...

Improving Classroom Engagement among High School Students with Disruptive Behavior: Evaluation of the Class Pass Intervention

ERIC Educational Resources Information Center

Collins, Tai A.; Cook, Clayton R.; Dart, Evan H.; Socie, Diana G.; Renshaw, Tyler L.; Long, Anna C.

2016-01-01

Off-task and disruptive classroom behaviors have a negative impact on the learning environment and present a unique challenge for teachers to address. The aim of this study was to evaluate the Class Pass Intervention (CPI) as a behavior management strategy for secondary students with disruptive classroom behavior. The CPI consists of providing…

Improving School Experiences for Adolescents with Type 1 Diabetes

ERIC Educational Resources Information Center

Kise, Saori S.; Hopkins, Amanda; Burke, Sandra

2017-01-01

Background: Diabetes mellitus (diabetes) is one of the most common metabolic diseases in children worldwide and the incidence of type 1 diabetes (T1D) is growing. T1D is complicated to manage and adolescents with diabetes face unique, age-specific challenges. The purpose of this article is to discuss ways in which schools can create a positive…

Strategies Used by Intellectually Gifted Students to Cope with Stress during Their Participation in a High School International Baccalaureate Program

ERIC Educational Resources Information Center

Shaunessy, Elizabeth; Suldo, Shannon M.

2010-01-01

Individuals respond to threats to affiliation and achievement needs through drawing on a repertoire of coping strategies specific to a given situation. Gifted adolescents in college-preparatory high school programs may be faced with novel stressors, and may have unique coping strategies to manage these challenges. The current study considers…

What great managers do.

PubMed

Buckingham, Marcus

2005-03-01

Much has been written about the qualities that make a great manager, but most of the literature overlooks a fundamental question: What does a great manager actually do? While there are countless management styles, one thing underpins the behavior of all great managers. Above all, an exceptional manager comes to know and value the particular quirks and abilities of her employees. She figures out how to capitalize on her staffers' strengths and tweaks her environment to meet her larger goals. Such a specialized approach may seem like a lot of work. But in fact, capitalizing on each person's uniqueness can save time. Rather than encourage employees to conform to strict job descriptions that may include tasks they don't enjoy and aren't good at, a manager who develops positions for his staff members based on their unique abilities will be rewarded with behaviors that are far more efficient and effective than they would be otherwise. This focus on individuals also makes employees more accountable. Because staffers are evaluated on their particular strengths and weaknesses, they are challenged to take responsibility for their abilities and to hone them. Capitalizing on a person's uniqueness also builds a stronger sense of team. By taking the time to understand what makes each employee tick, a great manager shows that he sees his people for who they are. This personal investment not only motivates individuals but also galvanizes the entire team. Finally, this approach shakes up existing hierarchies, which leads to more creative thinking. To take great managing from theory to practice, the author says, you must know three things about a person: her strengths, the triggers that activate those strengths, and how she learns. By asking the right questions, squeezing the right triggers, and becoming aware of your employees' learning styles, you will discover what motivates each person to excel.

Social defense: an evolutionary-developmental model of children's strategies for coping with threat in the peer group.

PubMed

Martin, Meredith J; Davies, Patrick T; MacNeill, Leigha A

2014-04-29

Navigating the ubiquitous conflict, competition, and complex group dynamics of the peer group is a pivotal developmental task of childhood. Difficulty negotiating these challenges represents a substantial source of risk for psychopathology. Evolutionary developmental psychology offers a unique perspective with the potential to reorganize the way we think about the role of peer relationships in shaping how children cope with the everyday challenges of establishing a social niche. To address this gap, we utilize the ethological reformulation of the emotional security theory as a guide to developing an evolutionary framework for advancing an understanding of the defense strategies children use to manage antagonistic peer relationships and protect themselves from interpersonal threat (Davies and Sturge-Apple, 2007). In this way, we hope to illustrate the value of an evolutionary developmental lens in generating unique theoretical insight and novel research directions into the role of peer relationships in the development of psychopathology.

Anesthetic management during cardiopulmonary bypass: a systematic review.

PubMed

Barry, Aaron E; Chaney, Mark A; London, Martin J

2015-04-01

Cardiopulmonary bypass (CPB) required for cardiac surgery presents unique challenges to the cardiac anesthesiologist responsible for providing the 3 most basic facets of any anesthetic: amnesia, analgesia, and muscle relaxation. Unique pathophysiologic changes during CPB result in pharmacokinetic alterations that impact the serum and tissue concentrations of IV and volatile anesthetics. Similarly, CPB causes pharmacodynamic alterations that impact anesthetic efficacy. The clinical significance of these alterations represents a "moving target" as practice evolves and the technology of CPB circuitry advances. In addition, perfusionists choose, modify, and maintain the CPB circuitry and membrane oxygenator. Thus, their significance may not be fully appreciated by the anesthesiologist. These issues have a profound impact on the anesthetic state of the patient. The delivery and maintenance of anesthesia during CPB present unique challenges. The perfusionist may be directly responsible for the delivery of anesthetic during CPB, a situation unique to the cardiac suite. In addition, monitors of anesthetic depth-assessment of clinical signs, hemodynamic indicators, the bispectral index monitor, end-tidal anesthetic concentration, or twitch monitoring-are often absent, unreliable, or directly impacted by the unique pathophysiology associated with CPB. The magnitude of these challenges is reflected in the higher incidence of intraoperative awareness during cardiac surgery. Further complicating matters are the lack of specific clinical guidelines and varying international policies regarding medical device specifications that add further layers of complexity and introduce practice variability both within institutions and among nations. We performed a systematic survey of the literature to identify where anesthetic practice during CPB is evidence based (or not), identify gaps in the literature to guide future investigations, and explore the implications of evolving surgical practice, perfusion techniques, and national policies that impact amnesia, analgesia, and muscle relaxation during CPB.

The use of social media for campus safety.

PubMed

Haupt, Brittany; Kapucu, Naim; Morgan, Jeffrey

As public safety communication evolved, each disaster or emergency presented unique challenges for emergency managers and others response to disasters. Yet, a foundational focus is the timely dissemination of accurate information to keep communities informed and able to prepare, mitigate, respond, and recover. For the campus community, the increase in bomb threats, active shooter incidents, and geographic-based natural disasters call for the discovery of reliable and cost-effective solutions for emergency information management. Social media is becoming a critical asset in this endeavor. This article examines the evolution of public safety communication, the unique setting of the campus community, and social media's role in campus disaster resilience. In addition, an exploratory study was done to better understand the perception of social media use for public safety within the campus community. The findings provide practical recommendations for campus emergency management professions; however, future research is needed to provide specific, actionable ways to achieve these goals as well as understand how diverse universities utilize a variety of platforms.

Total centralisation and optimisation of an oncology management suite via Citrix®

NASA Astrophysics Data System (ADS)

James, C.; Frantzis, J.; Ripps, L.; Fenton, P.

2014-03-01

The management of patient information and treatment planning is traditionally an intra-departmental requirement of a radiation oncology service. Epworth Radiation Oncology systems must support the transient nature of Visiting Medical Officers (VMOs). This unique work practice created challenges when implementing the vision of a completely paperless solution that allows for a responsive and efficient service delivery. ARIA® and EclipseTM (Varian Medical Systems, Palo Alto, CA, USA) have been deployed across four dedicated Citrix® (Citrix Systems, Santa Clara, CA, USA) servers allowing VMOs to access these applications remotely. A range of paperless solutions were developed within ARIA® to facilitate clinical and organisational management whilst optimising efficient work practices. The IT infrastructure and paperless workflow has enabled VMOs to securely access the VarianTM (Varian Medical Systems, Palo Alto, CA, USA) oncology software and experience full functionality from any location on multiple devices. This has enhanced access to patient information and improved the responsiveness of the service. Epworth HealthCare has developed a unique solution to enable remote access to a centralised oncology management suite, while maintaining a secure and paperless working environment.

Reconstructive and Oncoplastic Surgery for Giant Phyllodes Tumors: A Single Center’s Experience

PubMed Central

Pitsinis, Vassilis; Moussa, Osama; Hogg, Fiona; McCaskill, Jane

2017-01-01

Phyllodes tumors are biphasic fibroepithelial neoplasms of the breast. While the surgical management of these relatively uncommon tumors has been addressed in the literature, few reports have commented on the surgical approach to tumors greater than ten centimetres in diameter – the giant phyllodes tumor. We report a case of giant breast tumors and discuss the techniques utilized for pre-operative diagnosis, tumor removal, and breast reconstruction. A review of the literature on the surgical management of phyllodes tumors was performed. Management of the large phyllodes tumors presents the surgeon with unique challenges. The majority of these tumors can be managed by simple mastectomy but reconstruction and even oncoplastic conservative management is for selective consideration. PMID:28713717

Sheep (Ovis aries) as a Model for Cardiovascular Surgery and Management before, during, and after Cardiopulmonary Bypass

PubMed Central

DiVincenti, Louis; Westcott, Robin; Lee, Candice

2014-01-01

Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veterinarians, technicians, and researchers developing and implementing protocols with this model. PMID:25255065

The Journey of Harmless Bullet: The Perioperative Care of Penetrating Cardiac Injury

PubMed Central

Abou-Leila, Ahmad; Voronov, Gennadiy

2017-01-01

Traumatic injuries to the heart contribute significantly to trauma are associated with high mortality. Cardiac gunshot wounds (GSW) are considered more lethal compared to other injuries and present several unique challenges to the anesthesia management and perioperative care. We are reporting a rare case of a trauma victim who survived a GSW to the heart. We will discuss the perioperative care of penetrating cardiac injuries, the role of the anesthesia team in resuscitation, safe anesthesia induction, cardiopulmonary bypass management, and the essential role of intraoperative transesophageal echocardiogram imaging. PMID:28928592

Mycobacterium chimaera Infections Associated With Contaminated Heater-Cooler Devices for Cardiac Surgery: Outbreak Management.

PubMed

Marra, Alexandre R; Diekema, Daniel J; Edmond, Michael B

2017-08-15

The global outbreak of Mycobacterium chimaera infections associated with heater-cooler devices (HCDs) presents several important, unique challenges for the infection prevention community. The primary focus of this article is to assist hospitals in establishing a rapid response for identification, notification, and evaluation of exposed patients, and management of HCDs with regard to placement and containment, environmental culturing, and disinfection. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Diagnosis and management of premalignant penile lesions

PubMed Central

Shabbir, Majid; Minhas, Suks; Muneer, Asif

2011-01-01

Diagnosing premalignant penile lesions from benign penile dermatoses presents a unique challenge. The rarity of these conditions and the low incidence of penile cancer mean that the majority of our knowledge is based on small, non-randomized, retrospective studies. The introduction of specialist penile cancer centres in the UK has resulted in the centralization of expertise and resources, and has furthered our understanding of the biological behaviour and management of this rare malignancy. We review the current trends in the approach to diagnosing and treating various premalignant penile conditions. PMID:21904571

Platelet rich fibrin (Prf) and β-tricalcium phosphate with coronally advanced flap for the management of grade-II furcation defect.

PubMed

Sambhav, Jain; Rohit, Rai; Ranjana, Mohan; Shalabh, Mehrotra

2014-07-01

Multirooted teeth offer unique and challenging problems due to the furcation area, creates situations in which routine periodontal procedures are somewhat limited and special procedures are generally required. The present case was showing the management of grade II furcation defect by platelet rich fibrin (PRF) and β-Tricalcium phosphate with coronally advanced flap. Platelet rich fibrin and β-Tricalcium phosphate with coronally advanced flap have been shown to be a promising and successful approach for the treatment of furcation defect. Its gaining clinical attachment significantly manages both the gingival recession and furcation involvement simultaneously.

Superficial Vein Thrombophlebitis in a Football Athlete.

PubMed

Schleich, Kevin T; Smoot, M Kyle

2016-03-01

A 22-year-old professional football player presented to a preparticipation physical examination with a 2-week history of left leg discomfort extending from the groin to the knee over the previous 2 weeks. He was found to have superficial vein thrombophlebitis (SVT) of the left great saphenous vein extending from the knee to within approximately 1.6 cm of the saphenofemoral junction. There is paucity in the literature regarding the management of SVT, particularly in actively training athletes. This case addresses the considerations of anticoagulation management for SVT as well as the unique challenge of managing anticoagulation therapy in an athlete that is actively training.

Principles of Wound Management and Wound Healing in Exotic Pets.

PubMed

Mickelson, Megan A; Mans, Christoph; Colopy, Sara A

2016-01-01

The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing. Copyright © 2016 Elsevier Inc. All rights reserved.

Principles of Wound Management and Wound Healing in the Exotic Pets

PubMed Central

Mickelson, Megan A.; Mans, Christoph; Colopy, Sara A.

2015-01-01

Synopsis The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regards to the animal’s temperament and behavior, unique anatomy and small size, and tendency towards secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately impact wound healing. This article summarizes the general phases of wound healing, factors that impact healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing. PMID:26611923

Generation SMH (shaking my head): Work-Life Balance and Generational Realities

NASA Astrophysics Data System (ADS)

Jones, M. B.

2012-12-01

Many Federal Agencies have 'workforce development' programs that focus on preparing the next generation of scientists and engineers at the graduate and undergraduate level. Several of the science Agencies (e.g., NASA, NOAA, EPA, etc.), have programs that support students in many of the diverse disciplines that are unique to those Agency missions. While financial support certainly is critical to assist students in the STEM and other fields, professional development is just as important to equip students with a balanced arsenal of tactics to be successful professionals in the STEM workforce of today. Finding life balance as one moves through a STEM career path poses unique challenges that require a certain skill set that is not always intuitive. Some of those challenges include: selecting grad or post doc positions (negotiating to a family's advantage); balancing work and family commitments; and dealing with employer/advisor perceptions and expectations. For current and future generations in STEM, many of the above mentioned challenges require additional skill in negotiating interactions with individuals from other generations. Understanding perceptions and managing expectations are learnable skills that do not necessarily come with project funding.

Tank-automotive robotics

NASA Astrophysics Data System (ADS)

Lane, Gerald R.

1999-07-01

To provide an overview of Tank-Automotive Robotics. The briefing will contain program overviews & inter-relationships and technology challenges of TARDEC managed unmanned and robotic ground vehicle programs. Specific emphasis will focus on technology developments/approaches to achieve semi- autonomous operation and inherent chassis mobility features. Programs to be discussed include: DemoIII Experimental Unmanned Vehicle (XUV), Tactical Mobile Robotics (TMR), Intelligent Mobility, Commanders Driver Testbed, Collision Avoidance, International Ground Robotics Competition (ICGRC). Specifically, the paper will discuss unique exterior/outdoor challenges facing the IGRC competing teams and the synergy created between the IGRC and ongoing DoD semi-autonomous Unmanned Ground Vehicle and DoT Intelligent Transportation System programs. Sensor and chassis approaches to meet the IGRC challenges and obstacles will be shown and discussed. Shortfalls in performance to meet the IGRC challenges will be identified.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana.

PubMed

Mupara, Lucia U; Lubbe, Johanna C

2016-01-01

Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.

Managing large energy and mineral resources (EMR) projects in challenging environments

NASA Astrophysics Data System (ADS)

Chanmeka, Arpamart

The viability of energy mineral resources (EMR) construction projects is contingent upon the state of the world economic climate. Oil sands projects in Alberta, Canada exemplify large EMR projects that are highly sensitive to fluctuations in the world market. Alberta EMR projects are constrained by high fixed production costs and are also widely recognized as one of the most challenging construction projects to successfully deliver due to impacts from extreme weather conditions, remote locations and issues with labor availability amongst others. As indicated in many studies, these hardships strain the industry's ability to execute work efficiently, resulting in declining productivity and mounting cost and schedule overruns. Therefore, to enhance the competitiveness of Alberta EMR projects, project teams are targeting effective management strategies to enhance project performance and productivity by countering the uniquely challenging environment in Alberta. The main purpose of this research is to develop industry wide benchmarking tailored to the specific constraints and challenges of Alberta. Results support quantitative assessments and identify the root causes of project performance and ineffective field productivity problems in the heavy industry sector capital projects. Customized metrics produced from the data collected through a web-based survey instrument were used to quantitatively assess project performance in the following dimensions: cost, schedule, change, rework, safety, engineering and construction productivity and construction practices. The system enables the industry to measure project performance more accurately, get meaningful comparisons, while establishing credible norms specific to Alberta projects. Data analysis to identify the root cause of performance problems was conducted. The analysis of Alberta projects substantiated lessons of previous studies to create an improved awareness of the abilities of Alberta-based companies to manage their unique projects. This investigation also compared Alberta-based projects with U.S. projects to point out the differences in project process and management strategies under different environments. The relative impact of factors affecting construction productivity were identified and validated by the input from industry experts. The findings help improve the work processes used by companies developing projects in Alberta.

HIV is Now a Manageable Long-Term Condition, But What Makes it Unique? A Qualitative Study Exploring Views About Distinguishing Features from Multi-Professional HIV Specialists in North West England.

PubMed

Jelliman, Pauline; Porcellato, Lorna

HIV is evolving from a life-threatening infection to a long-term, manageable condition because of medical advances, radical changes in health and social care policy, and the impact of an aging population. However, HIV remains complex, presenting unique characteristics distinguishing it from other long-term conditions (LTCs). Our aim in this qualitative descriptive study was to identify and explore these features in the context of LTCs. A focus group (FG) method was used to gather the views and experiences of multi-professional HIV specialists who worked in North West England. Twenty-four staff participated in FGs (n = 3), which were audio recorded, manually transcribed, and thematically analyzed. We found four main themes: (a) stigma, (b) challenges faced by HIV specialists, (c) lack HIV-related knowledge, and (d) unique features, termed "stand alone." We concluded that these distinguishing features hindered full recognition and acceptance of HIV as an LTC. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Spermatic cord dedifferentiated liposarcoma presenting as a recurrent inguinal hernia.

PubMed

Crigger, Chad; Barnard, John; Zaslau, Stanley; Vos, Jeffrey A

2016-12-01

Paratesticular sarcomas are a rare entity and provide a unique clinical challenge due to their slow growing, often painless natural course. Adding to this challenge is the complex anatomy of the scrotum that allows these masses to mimic other conditions, including inguinal hernia, cysts, or fluid collections. We report such a case and our approach to an 83-year-old male with dedifferentiated liposarcoma of the spermatic cord with a history of inguinal hernia. In doing so, we highlight the need for thorough evaluation of scrotal masses and the management of these rare, though well-described, tumors.

Information technology challenges of biodiversity and ecosystems informatics

USGS Publications Warehouse

Schnase, J.L.; Cushing, J.; Frame, M.; Frondorf, A.; Landis, E.; Maier, D.; Silberschatz, A.

2003-01-01

Computer scientists, biologists, and natural resource managers recently met to examine the prospects for advancing computer science and information technology research by focusing on the complex and often-unique challenges found in the biodiversity and ecosystem domain. The workshop and its final report reveal that the biodiversity and ecosystem sciences are fundamentally information sciences and often address problems having distinctive attributes of scale and socio-technical complexity. The paper provides an overview of the emerging field of biodiversity and ecosystem informatics and demonstrates how the demands of biodiversity and ecosystem research can advance our understanding and use of information technologies.

Aspirin and Nonsteroidal Antiinflammatory Drugs Hypersensitivity and Management.

PubMed

Modena, Brian; White, Andrew A; Woessner, Katharine M

2017-11-01

Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) are widely used in the United States and throughout the world for a variety of indications. Several unique hypersensitivity syndromes exist to this class of medications, making them one of the common reasons for consultation to the allergist. The lack of any laboratory-based diagnostic studies to assist in identifying the culprits in these reactions make evaluation of aspirin and NSAID hypersensitivity challenging. Identifying patients appropriate for oral challenge and/or desensitization protocols is the standard pragmatic approach to this issue when it arises. Copyright © 2017 Elsevier Inc. All rights reserved.

Challenges and Strategies for Breeding Resistance in Capsicum annuum to the Multifarious Pathogen, Phytophthora capsici

PubMed Central

Barchenger, Derek W.; Lamour, Kurt H.; Bosland, Paul W.

2018-01-01

Phytophthora capsici is the most devastating pathogen for chile pepper production worldwide and current management strategies are not effective. The population structure of the pathogen is highly variable and few sources of widely applicable host resistance have been identified. Recent genomic advancements in the host and the pathogen provide important insights into the difficulties reported by epidemiological and physiological studies published over the past century. This review highlights important challenges unique to this complex pathosystem and suggests strategies for resistance breeding to help limit losses associated with P. capsici. PMID:29868083

Pain management in the geriatric population.

PubMed

Borsheski, Robert; Johnson, Quinn L

2014-01-01

Pain is a highly prevalent and clinically important problem in the elderly. Unfortunately, due to difficulties in assessing pain in geriatric patients, the complexities of multiple comorbidities, and the high prevalence of polypharmacy, many practitioners are reluctant to treat pain aggressively in this unique patient population. Safe and effective treatment therefore, requires a working knowledge of the physiologic changes associated with aging, the challenges of accurately assessing pain, the unique effects of common therapeutic agents upon the elderly as well as the importance of adjunctive therapies. The following review is intended to provide the practitioner with practical knowledge for safer and more effective treatment of pain.

Return to Play After Shoulder Surgery in Throwers.

PubMed

Thorsness, Robert; Alland, Jeremy A; McCulloch, Colin B; Romeo, Anthony

2016-10-01

The throwing athlete's shoulder is a unique, complex entity with challenges in diagnosis and management. The shoulders in these athletes possess unique biomechanics and pathologic conditions. Unfortunately, return to play outcomes are often poor when specifically evaluating overhead athletes, especially with regard to SLAP repair. It is imperative for the surgeon to be cautious when indicating these athletes for surgery, because although they may demonstrate improvements in pain and general function, subtle changes in accuracy or velocity as a result of surgery can significantly affect the success of an overhead throwing athlete at the competitive level. Copyright © 2016 Elsevier Inc. All rights reserved.

Forest stand dynamics of shortleaf pine in the Ozarks

Treesearch

David R. Larsen

2007-01-01

Much has been written on the management of shortleaf pine in the Ozarks (Brinkman et al. 1965, Brinkman 1967, Brinkman and Smith 1968, Seidel and Rogers 1965, Seidel and Rogers 1966). In large portions of the Ozarks, shortleaf pine does not grow in pure stands but rather in mixes with various oak species. These mixes present unique challenges in finding the set of...

Research Suggestions in the Design of a Global Graduate Business Program Delivered by Online Learning

ERIC Educational Resources Information Center

Puderbaugh, Amy

2015-01-01

The purpose of this paper was to examine the unique areas of concern when establishing an eLearning program in the field of global business. A survey of eLearning and a global management subject matter appears. This paper identifies potential challenges in program design and raises practical concerns for future research. [For the full proceedings,…

Microbial control of wood-boring insects attacking forest and shade trees

Treesearch

Ann E. Hajek; Leah S. Bauer

2007-01-01

Wood-boring insect pests that feed on the bark, phloem, or xylem (wood) of living trees pose unique management challenges because their immature stages live in cryptic, often inaccessible, habitats within host trees. The eggs of wood borers are laid in or on tree trunks, branches, terminal shoots, or roots. After the eggs hatch, neonates tunnel in and feed on internal...

When caretaking competes with care giving: a qualitative study of full-time working mothers who are nurse managers.

PubMed

Firmin, Michael W; Bailey, Megan

2008-10-01

The purpose of this study was to explore the motivations and stresses associated with full-time working mothers who practice as nurse managers. Full-time work outside the home for mothers has been recognized as a circumstance which may present certain benefits and risks to family life. Nursing management is recognized as a high-stress occupation, which may be filled by mothers who work full time. Little is known about the specific needs and stresses of full-time nurse managers who are caring for children at home. In-depth interviews were conducted with 13 mothers who worked as nurse managers. Participants expressed challenges in several areas including balancing/separating work and home, self-imposed advancement inhibitions, and constant giving. Challenges were offset by assets, which included complimentary roles, health insurance, added income, and professional and personal fulfilment. Participants 'wanted it all', including the conveniences of part-time employment and the benefits of full-time employment. Full-time nurse managers with children at home experience unique tensions which characterize their work and home environments. Employers may assist nurses by adopting flexible scheduling, educational and child-care support and assistance in negotiating work and home roles.

Polycythemia Vera Management and Challenges in the Community Health Setting

PubMed Central

Gerds, Aaron T.; Dao, Kim-Hien

2017-01-01

Patients with polycythemia vera (PV) experience shortened survival, increased risk of thromboembolic and hemorrhagic events, and burdensome symptoms. For all patients with PV, treatment with aspirin and hematocrit control with phlebotomy are recommended. In addition, patients with high-risk status or poor hematocrit control benefit from cytoreductive therapy with hydroxyurea, although approximately 1 in 4 patients develops resistance or intolerance. For patients who are resistant to or intolerant of hydroxyurea, studies have shown that ruxolitinib, a Janus kinase 1/2 inhibitor, provides hematocrit control, reduces spleen size, normalizes blood counts, and improves PV-related symptoms. For many patients, PV is managed in a community health setting, and it is important that community hematologists, oncologists, and internists are familiar with the contemporary management of PV to improve patient outcomes, including management for patients who present with unique health-care needs. This review provides an overview of current treatment options for patients with PV and discusses challenging circumstances encountered by community providers in the management of PV, including symptom assessment, identification of hydroxyurea resistance/intolerance, pregnancy, elective surgeries, concomitant immunosuppressants, and managing patients in areas with limited access to specialized hematologic care. PMID:28095380

Is pediatric IBD treatment different than in adults?

PubMed

Lev-Tzion, R; Turner, D

2012-06-01

The incidence of pediatric inflammatory bowel disease (IBD) continues to rise in most countries. Approximately 20-25% of IBD patients present before the age of 20, and their management is associated with many unique challenges. These challenges stem both from the inherent differences between children and adults, and from the differences in the nature and course of the disease. Children with IBD are more likely than adults to present with extensive disease ‑ both in Crohn's disease (CD) and ulcerative colitis (UC). Diagnosis requires a high index of suspicion, as children may present with less typical signs such as poor growth and delayed puberty. In the very young patients with inflammatory bowel disease, the pediatric clinician must consider a broader range of immunological and allergic disorders. Optimal management requires recognition of pediatric patterns of presentation, efficacy and adverse-effect profiles, and understanding monitoring aspects unique to pediatrics. These aspects include pediatric disease-related psychological issues, adherence to therapy and transition to adult care. Inadequate attention to growth, puberty or bone health in childhood can result in long-term consequences, such as impaired adult height and increased risk of fractures. Management of pediatric IBD and prevention of adverse long-term consequences relies on a variety of therapies well-known to the adult practitioner, along with therapies that are not widespread in adults, most notably exclusive enteral nutrition (EEN). The latter is as effective as corticosteroids in achieving clinical remission in children, while achieving better results than corticosteroids with regard to mucosal healing and growth. This review discusses the broad variety of issues that form the basis for management of pediatric IBD.

Managing oneself.

PubMed

Drucker, P F

1999-01-01

Throughout history, people had little need to manage their careers--they were born into their station in life or, in the recent past, they relied on their companies to chart their career paths. But times have drastically changed. Today, we must all learn to manage ourselves. What does that mean? According to Peter Drucker, it means we have to learn to develop ourselves. We have to place ourselves where we can make the greatest contribution to our organizations and communities. And we have to stay mentally alert and engaged during a 50-year working life, which means knowing how and when to change the work that we do. It may seem obvious that people achieve results by doing what they are good at and by working in ways that fit their abilities. But, Drucker says, very few people actually know--let alone take advantage of--their unique strengths. He challenges each of us to ask ourselves fundamental questions: What are my strengths? How do I perform? What are my values? Where do I belong? What should my contribution be? Don't try to change yourself, cautions Drucker. Instead, concentrate on improving the skills you have and accepting assignments that are tailored to your individual way of working. If you do that, you can transform yourself from an ordinary worker into an outstanding performer. Successful careers today are not planned out in advance. They develop when people are prepared for opportunities because they have asked themselves those questions, and they have rigorously assessed their unique characteristics. This article challenges readers to take responsibility for managing their futures, both in and out of the office.

Tolerating Uncertainty: Perceptions of the Future for Ageing Parent Carers and Their Adult Children with Intellectual Disabilities.

PubMed

Pryce, Laura; Tweed, Alison; Hilton, Amanda; Priest, Helena M

2017-01-01

Improved life expectancy means that more adults with intellectual disabilities are now living with ageing parents. This study explored older families' perceptions of the future. Semi-structured interviews were conducted with nine older parents and three adults with intellectual disabilities and analysed to produce an explanatory thematic framework. 'Tolerating uncertainty' was the major theme in participants' attempts to manage anxieties about the future, encompassing sub-themes of 'accepting the parenting role', 'facing challenges', 'being supported/isolated', 'positive meaning making', 're-evaluating as time moves on' and 'managing future thinking'. Some participants expressed preferences for their future which were in contrast to their parents' views, and provide a unique perspective that has often been neglected in prior research. This research has found commonalities in how families tolerate the uncertainty of the future, but also unique differences that require tailored interventions and prospective action by services. © 2015 John Wiley & Sons Ltd.

Oman's coral reefs: A unique ecosystem challenged by natural and man-related stresses and in need of conservation.

PubMed

Burt, J A; Coles, S; van Lavieren, H; Taylor, O; Looker, E; Samimi-Namin, K

2016-04-30

Oman contains diverse and abundant reef coral communities that extend along a coast that borders three environmentally distinct water bodies, with corals existing under unique and often stressful environmental conditions. In recent years Oman's reefs have undergone considerable change due to recurrent predatory starfish outbreaks, cyclone damage, harmful algal blooms, and other stressors. In this review we summarize current knowledge of the biology and status of corals in Oman, particularly in light of recent stressors and projected future threats, and examine current reef management practices. Oman's coral communities occur in marginal environmental conditions for reefs, and hence are quite vulnerable to anthropogenic effects. We recommend a focus on developing conservation-oriented coral research to guide proactive management and expansion of the number and size of designated protected areas in Oman, particularly those associated with critical coral habitat. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

ISO 50001 for US Commercial Buildings - Current Status and Opportunities

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

Liu, Jingjing; Sheaffer, Paul

''ISO 50001: 2011 Energy management systems – Requirements with guidance for use'' is a voluntary International Standard which provides organizations a proven framework to manage energy and continuously improve their energy performance. Implementing ISO 50001 in the commercial building sector has its unique opportunities and challenges in comparison with the industrial sector. The energy footprint of a portfolio of commercial buildings can be just as significant as a large industrial facility in comparison. There are many energy-saving opportunities in commercial buildings that can be addressed without capital investments, and the perceived risks for making energy improvements can be lower thanmore » in the industrial sector. In addition, the energy-consuming systems in commercial buildings are limited in types and have many similarities across buildings, which makes it much easier to standardize many ISO 50001 required processes, 5 procedures and documents to simplify implementation. There are also some sector-unique challenges, such as less familiar with ISO systems and the certification process. Another challenge arises from the complexity in some buildings’ ownership, tenancy, and O&M responsibilities. This whitepaper discusses these opportunities and issues in detail. The paper also recommends the characteristics of organizations in the commercial building sector that can benefit the most from adopting the ISO 50001 standard – namely the “suitable market”. Eight segments (education, food sales, retail, inpatient health care, hospitality, office buildings, laboratories and data centers) within the commercial building sector are highlighted.« less

Digital games as an effective approach for cancer management: Opportunities and challenges.

PubMed

Ghazisaeidi, Marjan; Safdari, Reza; Goodini, Azadeh; Mirzaiee, Mahboobeh; Farzi, Jebraeil

2017-01-01

Cancer is one of the most preventable and common chronic diseases that have economic, social and psychological burden for patients, families, and the society. Cancer can be monitored by new information technology. Digital games as a uniquely powerful interaction tool support optimal care management program operation in all dimensions. The aim of this review article is to describe opportunities and challenges of this new modern technology on the delivery of cancer care services in cancer management domains for cancer care improvement. This study was un-systematic (narrative) review article. In this research, 50 full-text papers and reports had been retrieved, studied exactly, and arranged based on study aims. We searched papers based on specific and relevant keywords in research databases including PubMed, ScienceDirect, Scopus, and Google scholar. In cancer management domain, digital games are as an effective medium for health education and intervention, disease self-management training, attention distraction to relieve pain, enhance clinical outcomes, improvements in lifestyles, and physical and psychosocial activity promotion when active participation and behavior rehearsal are required for cancer patient. In spite of potential benefits of new technology, sometimes people confront various challenges such as social isolation, unusual anxiety, and disorder in physiological times of body, low physical activities, decrease academic performance, increase aggressive behavior, and physical pain. These problems can be partly overcome by proper planning, good design, and usage of suitable and continuous monitoring.

Experience of Implementing ISO 15189 Accreditation at a University Laboratory

PubMed Central

2015-01-01

The present article summarizes the authors’ experience with the implementation of a quality management system based on ISO 17025 and ISO 15189 standards at university laboratories. The accreditation of the analytical procedures at the Universidad Mariano Gálvez represented a challenge due to the unique nature of an educational institution and the difference in nature to the standards implemented. Sample handling and care of the patient were combined to achieve an integrated management system. We explain the development of the management system, the obstacles and benefits of the system and concluding that it is possible to design a management system based on ISO 15189 for the university lab that allowed delivering results assuring technical competence to patient care and welfare. PMID:27683499

[Health management in private health insurance].

PubMed

Ziegenhagen, D J; Schilling, M K

2000-09-01

German private health insurance faces new challenges. The classical tools of cost containment are no longer sufficient to keep up with ever increasing expenses for health care, and international competitors with managed care experience from their home markets are on the point of entering business in Germany. Although the American example of managed care is not fully compatible with customer demands and state regulations, some elements of this approach will gradually be introduced. First agreements were signed with networks or individual preferred providers in outpatient care and rehabilitation medicine. Insurance companies become more and more interested in supporting evidence based guidelines and programmes for disease and case management. The pros and cons of various other health management tools are discussed against the specific background of the quite unique German health care system.

Obesity management in Prader-Willi syndrome.

PubMed

Salehi, Parisa; Leavitt, Anne; Beck, Anita E; Chen, Maida L; Roth, Christian L

2015-03-01

Prader-Willi Syndrome (PWS) is one of the most common genetic causes of obesity. The phenotype of obesity in PWS is unique and characterized by hyperphagia, earlier meal initiation, delayed meal termination, reduced energy expenditure, abnormal gut hormone profiles, as well as irregular responses to food in areas of the brain associated with satiety and reward. Management of obesity is necessary to avoid major morbidity. The relentless food-seeking behavior associated with PWS such as stealing, hoarding food, eating inedibles, and lying about eating, can cause turmoil both inside and outside of the home. Management is challenging for both patients and caretakers, but at this time there are limited medical therapies available besides dietary restriction and behavior management. However, current research shows promise for discovery of additional treatment options for hyperphagia and obesity management in PWS.

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.

Challenges of Fracture Management for Adults With Osteogenesis Imperfecta.

PubMed

Gil, Joseph A; DeFroda, Steven F; Sindhu, Kunal; Cruz, Aristides I; Daniels, Alan H

2017-01-01

Osteogenesis imperfecta is caused by qualitative or quantitative defects in type I collagen. Although often considered a disease with primarily pediatric manifestations, more than 25% of lifetime fractures are reported to occur in adulthood. General care of adults with osteogenesis imperfecta involves measures to preserve bone density, regular monitoring of hearing and dentition, and maintenance of muscle strength through physical therapy. Surgical stabilization of fractures in these patients can be challenging because of low bone mineral density, preexisting skeletal deformities, or obstruction by instrumentation from previous surgeries. Additionally, unique perioperative considerations exist when operatively managing fractures in patients with osteogenesis imperfecta. To date, there is little high-quality literature to help guide the optimal treatment of fractures in adult patients with osteogenesis imperfecta. [Orthopedics. 2017; 40(1):e17-e22.]. Copyright 2016, SLACK Incorporated.

Teachers' perspectives on the challenges of teaching physical education in urban schools: the student emotional filter.

PubMed

McCaughtry, Nate; Barnard, Sara; Martin, Jeffrey; Shen, Bo; Kulinna, Pamela Hodges

2006-12-01

The purpose of this study was to analyze how the challenges of urban schools influence physical education teachers' emotional understanding and connections with their students and the implications on their teaching. Sixty-one elementary physical educators from an urban school district in the midwestern U.S. were interviewed multiple times (N = 136) over 3 years using interpretive methodology. Teachers reported five unique challenges that significantly shaped their thinking about students and their careers, along with strategies they used to overcome or manage those challenges. The challenges were: (a) insufficient instructional resources, (b) implementing culturally relevant pedagogy, (c) dealing with community violence, (d) integrating more games in curricula, and (e) teaching in a culture of basketball. Implications centered on the guilt-inducing nature of urban teaching, developing an informed and realistic vision of urban physical education, and the role of teacher preparation and professional development.

Big Data: the challenge for small research groups in the era of cancer genomics

PubMed Central

Noor, Aisyah Mohd; Holmberg, Lars; Gillett, Cheryl; Grigoriadis, Anita

2015-01-01

In the past decade, cancer research has seen an increasing trend towards high-throughput techniques and translational approaches. The increasing availability of assays that utilise smaller quantities of source material and produce higher volumes of data output have resulted in the necessity for data storage solutions beyond those previously used. Multifactorial data, both large in sample size and heterogeneous in context, needs to be integrated in a standardised, cost-effective and secure manner. This requires technical solutions and administrative support not normally financially accounted for in small- to moderate-sized research groups. In this review, we highlight the Big Data challenges faced by translational research groups in the precision medicine era; an era in which the genomes of over 75 000 patients will be sequenced by the National Health Service over the next 3 years to advance healthcare. In particular, we have looked at three main themes of data management in relation to cancer research, namely (1) cancer ontology management, (2) IT infrastructures that have been developed to support data management and (3) the unique ethical challenges introduced by utilising Big Data in research. PMID:26492224

Designing health care risk management on-line:meeting regulators' concerns for fixed-hour curriculum.

PubMed

Hyer, Kathryn; Taylor, Heidi H; Nanni, Kennith

2004-01-01

This paper describes the experience of creating a continuing professional education on-line risk management program that is designed to meet Florida's educational requirements for licensure as a risk manager in health-care settings and details the challenges faced when the in-class didactic program of 15 eight-hour sessions is reformatted as an on-line program. Structuring instructor/learner interactivity remains a challenge, especially if the program allows learner control and is a key feature in marketing the program. The article presents the dilemmas for state regulators as they work to determine if the on-line program meets legislative intent and statutory requirements because the learning platform does not have a clock function that accumulates time for each learner. While some details reflect the uniqueness of the 120-hour educational requirements for risk managers in Florida, the experience of the authors provides insight into the development of continuing professional education distance learning programs that are multidisciplinary and move primarily from a time-based format into a curriculum that uses time as only one dimension of the evaluation of learning.

Managing the culturally diverse medical practice team: twenty-five strategies.

PubMed

Hills, Laura

2014-01-01

A common misconception is that the phrase workplace diversity means meeting certain quotas in employee race or gender categories. In fact, diversity is much more than that. This article explores the unique benefits and challenges of managing a culturally diverse medical practice team and offers practice managers 25 practical strategies. It describes the two types of diversity training that are beneficial to practice managers and the kinds of policies, practices, and procedures that foster and promote diversity. This article also explores ethnocentrism, racism, ageism, sexism, stereotyping, and other potentially divisive issues among a diverse medical practice team. It provides an assessment instrument practice managers can use to evaluate their own diversity management skills. Finally, this article defines specifically what is meant by the term diversity and explores the top 10 diversity issues in workplaces today.

Challenges of self-management when living with multiple chronic conditions

PubMed Central

Liddy, Clare; Blazkho, Valerie; Mill, Karina

2014-01-01

Abstract Objective To explore the perspectives of patients who live with multiple chronic conditions as they relate to the challenges of self-management. Data sources On September 30, 2013, we searched MEDLINE, EMBASE, and CINAHL using relevant key words including chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self-care, self-management, perspective, and perception. Study selection Three reviewers assessed and extracted the data from the included studies after study quality was rated. Qualitative thematic synthesis method was then used to identify common themes. Twenty-three articles met the inclusion criteria, with most coming from the United States. Synthesis Important themes raised by people living with multiple chronic conditions related to their ability to self-manage included living with undesirable physical and emotional symptoms, with pain and depression highlighted. Issues with conflicting knowledge, access to care, and communication with health care providers were raised. The use of cognitive strategies, including reframing, prioritizing, and changing beliefs, was reported to improve people’s ability to self-manage their multiple chronic conditions. Conclusion This study provides a unique view into patients’ perspectives of living with multiple chronic conditions, which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with patients’ perspectives on living with multiple chronic conditions. This might be achieved by ensuring a more patient-centred approach is adopted by providers and health service organizations. PMID:25642490

Schizophrenia and sleep disorders: links, risks, and management challenges.

PubMed

Kaskie, Rachel E; Graziano, Bianca; Ferrarelli, Fabio

2017-01-01

Schizophrenia is a major psychiatric disorder that has a massive, long-lasting negative impact on the patients as well as society. While positive symptoms (i.e., delusions and hallucinations), negative symptoms (i.e., anhedonia, social withdrawal), and cognitive impairments are traditionally considered the most prominent features of this disorder, the role of sleep and sleep disturbances has gained increasing prominence in clinical practice. Indeed, the vast majority of patients with schizophrenia report sleep abnormalities, which tend to precede illness onset and can predict an acute exacerbation of psychotic symptoms. Furthermore, schizophrenia patients often have a comorbid sleep disorder, including insomnia, obstructive sleep apnea, restless leg syndrome, or periodic limb movement disorder. Despite accumulating data, the links between sleep disorders and schizophrenia have not been thoroughly examined, in part because they are difficult to disentangle, as numerous factors contribute to their comorbidity, including medication status. Additionally, sleep disorders are often not the primary focus of clinicians treating this population, despite studies suggesting that comorbid sleep disorders carry their own unique risks, including worsening of psychotic symptoms and poorer quality of life. There is also limited information about effective management strategies for schizophrenia patients affected by significant sleep disturbances and/or sleep disorders. To begin addressing these issues, the present review will systematically examine the literature on sleep disorders and schizophrenia, focusing on studies related to 1) links between distinct sleep disorders and schizophrenia; 2) risks unique to patients with a comorbid sleep disorder; and 3) and management challenges and strategies.

Improving Voluntary Environmental Management Programs: Facilitating Learning and Adaptation

NASA Astrophysics Data System (ADS)

Genskow, Kenneth D.; Wood, Danielle M.

2011-05-01

Environmental planners and managers face unique challenges understanding and documenting the effectiveness of programs that rely on voluntary actions by private landowners. Programs, such as those aimed at reducing nonpoint source pollution or improving habitat, intend to reach those goals by persuading landowners to adopt behaviors and management practices consistent with environmental restoration and protection. Our purpose with this paper is to identify barriers for improving voluntary environmental management programs and ways to overcome them. We first draw upon insights regarding data, learning, and adaptation from the adaptive management and performance management literatures, describing three key issues: overcoming information constraints, structural limitations, and organizational culture. Although these lessons are applicable to a variety of voluntary environmental management programs, we then present the issues in the context of on-going research for nonpoint source water quality pollution. We end the discussion by highlighting important elements for advancing voluntary program efforts.

Management of Concurrent Pregnancy and Acute Lymphoblastic Malignancy in Teenaged Patients: Two Illustrative Cases and Review of the Literature

PubMed Central

Johnson, Liza-Marie; Church, Christopher L.; Gomez-Garcia, Wendy C.; Popescu, Marcela I.; Margolin, Judith F.; Ribeiro, Raul C.

2014-01-01

The usual age range of acute lymphoblastic malignancies (acute lymphoblastic leukemia and advanced-stage lymphoblastic lymphoma) includes teenagers and young adults (<22 years of age) and coincides with the age of fertility. Concurrence of acute lymphoblastic malignancy with pregnancy is therefore most likely to happen during the younger childbearing ages. However, the therapeutic challenges posed by the dual diagnosis of lymphoblastic malignancy and pregnancy have not specifically been studied in the context of age, and management guidelines for pregnant young patients are lacking. Inconsistency in defining the legal decision-making rights of pregnant teenaged patients adds a further level of complexity in this age group. Management of this challenging combination in the young patient therefore entails unique ethical considerations. Here we present two illustrative cases of teenage pregnancy complicated by acute lymphoblastic malignancy, review the available literature, and offer suggestions for the therapeutic management of such cases in adolescent and young adult patients. Importantly, practical management recommendations are provided in the context of clinical ethics principles that are universally applicable, including in developing countries, where the highest incidence of adolescent pregnancies has been documented. PMID:25538861

Crew Exploration Vehicle Environmental Control and Life Support Fire Protection Approach

NASA Technical Reports Server (NTRS)

Lewis, John F.; Barido, Richard; Tuan, George C.

2007-01-01

As part of preparing for the Crew Exploration Vehicle (CEV), the National Aeronautics and Space Administration (NASA) worked on developing the requirements to manage the fire risk. The new CEV poses unique challenges to current fire protection systems. The size and configuration of the vehicle resembles the Apollo capsule instead of the current Space Shuttle or the International Space Station. The smaller free air volume and fully cold plated avionic bays of the CEV requires a different approach in fire protection than the ones currently utilized. The fire protection approach discussed in this paper incorporates historical lessons learned and fire detection and suppression system design philosophy spanning from Apollo to the International Space Station. Working with NASA fire and materials experts, this approach outlines the best requirements for both the closed out area of the vehicle, such as the avionics bay, and the crew cabin area to address the unique challenges due to the size and configuration of the CEV.

System Definition of the James Webb Space Telescope (JWST) Integrated Science Instrument Module (ISIM)

NASA Technical Reports Server (NTRS)

Lundquist, Ray; Aymergen, Cagatay; VanCampen, Julie; Abell, James; Smith, Miles; Driggers, Phillip

2008-01-01

The Integrated Science Instrument Module (ISIM) for the James Webb Space Telescope (JWST) provides the critical functions and the environment for the four science instruments on JWST. This complex system development across many international organizations presents unique challenges and unique solutions. Here we describe how the requirement flow has been coordinated through the documentation system, how the tools and processes are used to minimize impact to the development of the affected interfaces, how the system design has matured, how the design review process operates, and how the system implementation is managed through reporting to ensure a truly world class scientific instrument compliment is created as the final product.

Construction of the GAMCIT gamma-ray burst detector (G-056)

NASA Technical Reports Server (NTRS)

Coward, Michael H.; Grunsfeld, John M.; Mccall, Benjamin J.; Ratner, Albert

1995-01-01

The GAMCIT (Gamma-ray Astrophysics Mission, California Institute of Technology) payload is a Get-Away-Special payload designed to search for high-energy gamma-ray bursts and any associated optical transients. This paper presents details on the development and construction of the GAMCIT payload. In addition, this paper will reflect upon the unique challenges involved in bringing the payload close to completion, as the project has been designed, constructed, and managed entirely by undergraduate members of the Caltech SEDS (Students for the Exploration and Development of Space). Our experience will definitely be valuable to other student groups interested in undertaking a challenge such as a Get-Away-Special payload.

Cystic fibrosis, common variable immunodeficiency and Aspergers syndrome: an immunological and behavioural challenge.

PubMed

Chotirmall, S H; Low, T B; Hassan, T; Branagan, P; Kernekamp, C; Flynn, M G; Gunaratnam, C; McElvaney, N G

2011-06-01

Cystic fibrosis (CF) is of particular importance in Ireland as the Irish population has both the highest incidence (2.98/10,000) and the highest carrier rate (1 in 19) in the world. Primary immunodeficiency has not been previously reported as co-existing with CF. We report a unique case of CF associated with a primary immunodeficiency syndrome--common variable immunodeficiency (CVID). Our patient has CF, CVID and the additional comorbidity of Aspergers syndrome. The challenges inherent in diagnosing and treating such a case are outlined herein and the successful management of this case is evidenced by the well-preserved lung function of our patient.

Diversity: The business case for and benefits of

NASA Astrophysics Data System (ADS)

Jones, M. B.

2013-05-01

Many Federal Agencies have 'workforce development' programs that focus on preparing the next generation of scientists and engineers at the graduate and undergraduate level. Several of the science Agencies (e.g., NASA, NOAA, EPA, etc.), have programs that support students in many of the diverse disciplines that are unique to those Agency missions. While financial support certainly is critical to assist students in the STEM and other fields, professional development is just as important to equip students with a balanced arsenal of tactics to be successful professionals in the STEM workforce of today. Understanding perceptions and managing expectations are learnable skills that do not necessarily come with project funding. Finding life balance as one moves through a STEM career path poses unique challenges that require a certain skill set that is not always intuitive. Some of those challenges include: selecting grad or post doc positions (negotiating to a family's advantage); balancing work and family commitments; and dealing with employer/advisor perceptions and expectations. Since the scientific enterprise requires multiple perspectives to flourish (e.g., peer review), many of the above mentioned challenges require additional skill in negotiating interactions with individuals from a variety of backgrounds… with as many perspectives.

Public access management as an adaptive wildlife management tool

USGS Publications Warehouse

Ouren, Douglas S.; Watts, Raymond D.

2005-01-01

One key issue in the Black Mesa – Black Canyon area is the interaction between motorized vehicles and. The working hypothesis for this study is that early season elk movement onto private lands and the National Park is precipitated by increased use of Off Highway Vehicles (OHV’s). Data on intensity of motorized use is extremely limited. In this study, we monitor intensity of motorized vehicle and trail use on elk movements and habitat usage and analyze interactions. If management agencies decide to alter accessibility, we will monitor wildlife responses to changes in the human-use regime. This provides a unique opportunity for adaptive management experimentation based on coordinated research and monitoring. The products from this project will provide natural resource managers across the nation with tools and information to better meet these resource challenges.

A guide to wound managment in palliative care.

PubMed

Naylor, Wayne A

2005-11-01

Wound management in palliative patients is often a very challenging area of care. There are many unique issues that can combine to produce complicated wound management scenarios, including the types of wounds and wound symptoms most commonly affecting palliative care patients, as well as the presence of concurrent disease and associated treatment. Problems exist with the availability of suitable dressings and balancing life expectancy with the goals of wound care. A significant, and possibly under-recognized, issue is the emotional and social distress experienced by these patients, which can be directly attributed to their wound. These problems must all be recognized and addressed in order to manage wounds effectively in this patient population. This article aims to explore these issues and offer advice on the management of wound-related symptoms, with the ultimate goal of improving patients' quality of life.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana

PubMed Central

Mupara, Lucia U.; Lubbe, Johanna C.

2016-01-01

Background Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. Design A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. Results The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. Conclusions The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana. PMID:26899774

Acute liver failure with thyrotoxicosis treated with liver transplantation.

PubMed

Cascino, Matthew D; McNabb, Brian; Gardner, David G; Woeber, Kenneth A; Fox, Alyson N; Wang, Bruce; Fix, Oren K

2013-01-01

We describe a young woman with previously undiagnosed thyrotoxicosis who presented with acute liver failure (ALF). We present a case report and review the relevant literature. An extensive evaluation excluded possible causes of ALF other than thyrotoxicosis. The management of thyrotoxicosis posed several unique challenges in the setting of ALF, particularly because we did not want to use potentially hepatotoxic thionamides. The patient was treated with prednisone and propranolol and was started on potassium iodide when she was listed for liver transplantation. She underwent an uncomplicated liver transplant and subsequent thyroidectomy and is doing well. This well-characterized case describes thyrotoxicosis as a possible cause of ALF after thoroughly excluding other possible causes and illustrates the challenges of simultaneously managing both disorders. To our knowledge, this is the first report of ALF possibly resulting from untreated thyrotoxicosis that was successfully treated with liver transplantation.

Groundwater and human development: challenges and opportunities in livelihoods and environment.

PubMed

Shah, T

2005-01-01

At less than 1000 km3/year, the world's annual use of groundwater is 1.5% of renewable water resource but contributes a lion's share of water-induced human welfare. Global groundwater use however has increased manifold in the past 50 years; and the human race has never had to manage groundwater use on such a large scale. Sustaining the massive welfare gains groundwater development has created without ruining the resource is a key water challenge facing the world today. In exploring this challenge, we have focused a good deal on conditions of resource occurrence but less so on resource use. I offer a typology of five groundwater demand systems as Groundwater Socio-ecologies (GwSE), each embodying a unique pattern of interactions between socio-economic and ecological variables, and each facing a distinct groundwater governance challenge. During the past century, a growing corpus of experiential knowledge has accumulated in the industrialized world on managing groundwater in various uses and contexts. A daunting global groundwater issue today is to apply this knowledge intelligently to by far the more formidable challenge that has arisen in developing regions of Asia and Africa, where groundwater irrigation has evolved into a colossal anarchy supporting billions of livelihoods but threatening the resource itself.

Landscape and climate science and scenarios for Florida

USGS Publications Warehouse

Terando, Adam; Traxler, Steve; Collazo, Jaime

2014-01-01

The Peninsular Florida Landscape Conservation Cooperative (PFLCC) is part of a network of 22 Landscape Conservation Cooperatives (LCCs) that extend from Alaska to the Caribbean. LCCs are regional-applied conservation-science partnerships among Federal agencies, regional organizations, States, tribes, nongovernmental organizations (NGOs), private stakeholders, universities, and other entities within a geographic area. The goal of these conservation-science partnerships is to help inform managers and decision makers at a landscape scale to further the principles of adaptive management and strategic habitat conservation. A major focus for LCCs is to help conservation managers and decision makers respond to large-scale ecosystem and habitat stressors, such as climate change, habitat fragmentation, invasive species, and water scarcity. The purpose of the PFLCC is to facilitate planning, design, and implementation of conservation strategies for fish and wildlife species at the landscape level using the adaptive management framework of strategic habitat conservation—integrating planning, design, delivery, and evaluation. Florida faces a set of unique challenges when responding to regional and global stressors because of its unique ecosystems and assemblages of species, its geographic location at the crossroads of temperate and tropical climates, and its exposure to both rapid urbanization and rising sea levels as the climate warms. In response to these challenges, several landscape-scale science projects were initiated with the goal of informing decision makers about how potential changes in climate and the built environment could impact habitats and ecosystems of concern in Florida and the Southeast United States. In June 2012, the PFLCC, North Carolina State University, convened a workshop at the U.S. Geological Survey (USGS) Coastal and Marine Science Center in St. Petersburg to assess the results of these integrated assessments and to foster an open dialogue about science gaps and future research needs.

Dyspnea Management in Palliative Home Care: A Case Series in Malaysia

PubMed Central

Thongkhamcharoen, Rojanasak; Breaden, Katrina; Agar, Meera; Hamzah, Ednin

2012-01-01

Managing dyspnea at home is a challenging task. Although a competent palliative home care team can assist a patient to live at home with better pain control, dyspnea is usually not as well managed. In the Asian context, there are few research studies in dyspnea management in palliative home care. This paper aims to illustrate the cultural context that has an impact on dyspnea management at home and the assessment and management of dyspnea in a community palliative care setting in Malaysia. This paper reports on a study of 5 dyspneic patients suffering from both cancer-related and non–cancer-related dyspnea. Its focus is on a unique Asian cultural belief system that affects communication about prognosis and the role of family in palliative home care. In addition, this paper also describes dyspnea assessment, the barriers to morphine use, benzodiazepine prescription, oxygen therapy, and nonpharmacologic intervention in this center. PMID:23093829

Species co-occurrence analysis predicts management outcomes for multiple threats.

PubMed

Tulloch, Ayesha I T; Chadès, Iadine; Lindenmayer, David B

2018-03-01

Mitigating the impacts of global anthropogenic change on species is conservation's greatest challenge. Forecasting the effects of actions to mitigate threats is hampered by incomplete information on species' responses. We develop an approach to predict community restructuring under threat management, which combines models of responses to threats with network analyses of species co-occurrence. We discover that contributions by species to network co-occurrence predict their recovery under reduction of multiple threats. Highly connected species are likely to benefit more from threat management than poorly connected species. Importantly, we show that information from a few species on co-occurrence and expected responses to alternative threat management actions can be used to train a response model for an entire community. We use a unique management dataset for a threatened bird community to validate our predictions and, in doing so, demonstrate positive feedbacks in occurrence and co-occurrence resulting from shared threat management responses during ecosystem recovery.

A Survey Of Techniques for Managing and Leveraging Caches in GPUs

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

Mittal, Sparsh

2014-09-01

Initially introduced as special-purpose accelerators for graphics applications, graphics processing units (GPUs) have now emerged as general purpose computing platforms for a wide range of applications. To address the requirements of these applications, modern GPUs include sizable hardware-managed caches. However, several factors, such as unique architecture of GPU, rise of CPU–GPU heterogeneous computing, etc., demand effective management of caches to achieve high performance and energy efficiency. Recently, several techniques have been proposed for this purpose. In this paper, we survey several architectural and system-level techniques proposed for managing and leveraging GPU caches. We also discuss the importance and challenges ofmore » cache management in GPUs. The aim of this paper is to provide the readers insights into cache management techniques for GPUs and motivate them to propose even better techniques for leveraging the full potential of caches in the GPUs of tomorrow.« less

Defining Time: The Argument for a Paradigm Shift in Air Force Thinking

DTIC Science & Technology

2013-04-03

the ability to effectively cope with unique mental stressors and challenges needed to ensure mission readiness,” adding, “A servicemember’s family’s...nuclear sorties since it supports the higher level priority.28 In order to allow maximum flexibility , as well as the most effective ...and a continuing reduction in the Total Force planned through 2017, the Air Force must manage all of its resources effectively and efficiently

Managing military training-related environmental disturbance.

PubMed

Zentelis, Rick; Banks, Sam; Roberts, J Dale; Dovers, Stephen; Lindenmayer, David

2017-12-15

Military Training Areas (MTAs) cover at least 2 percent of the Earth's terrestrial surface and occur in all major biomes. These areas are potentially important for biodiversity conservation. The greatest challenge in managing MTAs is balancing the disturbance associated with military training and environmental values. These challenges are unique as no other land use is managed for these types of anthropogenic disturbances in a natural setting. We investigated how military training-related disturbance is best managed on MTAs. Specifically, we explored management options to maximise the amount of military training that can be undertaken on a MTA while minimising the amount of environmental disturbance. MTAs comprise of a number of ranges designed to facilitate different types of military training. We simulated military training-related environmental disturbance at different range usage rates under a typical range rotation use strategy, and compared the results to estimated ecosystem recovery rates from training activities. We found that even at relatively low simulated usage rates, random allocation and random spatial use of training ranges within an MTA resulted in environmental degradation under realistic ecological recovery rates. To avoid large scale environmental degradation, we developed a decision-making tool that details the best method for managing training-related disturbance by determining how training activities can be allocated to training ranges. Copyright © 2017 Elsevier Ltd. All rights reserved.

Membrane-based processes for wastewater nutrient recovery: Technology, challenges, and future direction.

PubMed

Xie, Ming; Shon, Ho Kyong; Gray, Stephen R; Elimelech, Menachem

2016-02-01

Wastewater nutrient recovery holds promise for more sustainable water and agricultural industries. We critically review three emerging membrane processes - forward osmosis (FO), membrane distillation (MD) and electrodialysis (ED) - that can advance wastewater nutrient recovery. Challenges associated with wastewater nutrient recovery were identified. The advantages and challenges of applying FO, MD, and ED technologies to wastewater nutrient recovery are discussed, and directions for future research and development are identified. Emphasis is given to exploration of the unique mass transfer properties of these membrane processes in the context of wastewater nutrient recovery. We highlight that hybridising these membrane processes with existing nutrient precipitation process will lead to better management of and more diverse pathways for near complete nutrient recovery in wastewater treatment facilities. Copyright © 2015 Elsevier Ltd. All rights reserved.

Linear Temporal Logic (LTL) Based Monitoring of Smart Manufacturing Systems.

PubMed

Heddy, Gerald; Huzaifa, Umer; Beling, Peter; Haimes, Yacov; Marvel, Jeremy; Weiss, Brian; LaViers, Amy

2015-01-01

The vision of Smart Manufacturing Systems (SMS) includes collaborative robots that can adapt to a range of scenarios. This vision requires a classification of multiple system behaviors, or sequences of movement, that can achieve the same high-level tasks. Likewise, this vision presents unique challenges regarding the management of environmental variables in concert with discrete, logic-based programming. Overcoming these challenges requires targeted performance and health monitoring of both the logical controller and the physical components of the robotic system. Prognostics and health management (PHM) defines a field of techniques and methods that enable condition-monitoring, diagnostics, and prognostics of physical elements, functional processes, overall systems, etc. PHM is warranted in this effort given that the controller is vulnerable to program changes, which propagate in unexpected ways, logical runtime exceptions, sensor failure, and even bit rot. The physical component's health is affected by the wear and tear experienced by machines constantly in motion. The controller's source of faults is inherently discrete, while the latter occurs in a manner that builds up continuously over time. Such a disconnect poses unique challenges for PHM. This paper presents a robotic monitoring system that captures and resolves this disconnect. This effort leverages supervisory robotic control and model checking with linear temporal logic (LTL), presenting them as a novel monitoring system for PHM. This methodology has been demonstrated in a MATLAB-based simulator for an industry inspired use-case in the context of PHM. Future work will use the methodology to develop adaptive, intelligent control strategies to evenly distribute wear on the joints of the robotic arms, maximizing the life of the system.

Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum.

PubMed

Jawhari, Badeia; Keenan, Louanne; Zakus, David; Ludwick, Dave; Isaac, Abraam; Saleh, Abdullah; Hayward, Robert

2016-10-01

Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Learner : preceptor ratios for practice-based learning across health disciplines: a systematic review.

PubMed

Loewen, Peter; Legal, Michael; Gamble, Allison; Shah, Kieran; Tkachuk, Stacey; Zed, Peter

2017-02-01

Practice-based learning is a cornerstone of developing clinical and professional competence in health disciplines. Practice-based learning systems have many interacting components, but a key facet is the number of learners per preceptor. Different learner : preceptor ratios may have unique benefits and pose unique challenges for participants. This is the first comprehensive systematic review of the topic. Our research questions were: What are the benefits and challenges of each learner : preceptor ratio in practice-based learning from the perspectives of the learners, preceptors, patients and stakeholder organisations (i.e. the placing and health care delivery organisations)? Are any ratios superior to others with respect to these characteristics and perspectives? Qualitative systematic review of published English-language literature since literature database inception, including multiple health disciplines. Seventy-three articles were included in this review. Eight learner : preceptor ratio arrangements were identified involving nursing, physiotherapy, occupational therapy, pharmacy, dietetics, speech and language therapy, and medicine. Each arrangement offers unique benefits and challenges from the perspectives of learners, preceptors, programmes and health care delivery organisations. Patient perspectives were absent. Despite important advantages of each ratio for learners, preceptors and organisations, some of which may be profession specific, the 2 : 1 and 2+ : 2+ learner : preceptor ratios appear to be most likely to successfully balance the needs of all stakeholders. Regardless of the learner : preceptor ratio chosen for its expected benefits, our results illuminate challenges that can be anticipated and managed. Patient perspectives should be incorporated into future studies of learner : preceptor ratios. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Social and Economic Analysis Branch: integrating policy, social, economic, and natural science

USGS Publications Warehouse

Schuster, Rudy; Walters, Katie D.

2015-01-01

The Fort Collins Science Center's Social and Economic Analysis Branch provides unique capabilities in the U.S. Geological Survey by leading projects that integrate social, behavioral, economic, and natural science in the context of human–natural resource interactions. Our research provides scientific understanding and support for the management and conservation of our natural resources in support of multiple agency missions. We focus on meeting the scientific needs of the Department of the Interior natural resource management bureaus in addition to fostering partnerships with other Federal and State managers to protect, restore, and enhance our environment. The Social and Economic Analysis Branch has an interdisciplinary group of scientists whose primary functions are to conduct both theoretical and applied social science research, provide technical assistance, and offer training to support the development of skills in natural resource management activities. Management and research issues associated with human-resource interactions typically occur in a unique context and require knowledge of both natural and social sciences, along with the skill to integrate multiple science disciplines. In response to these challenging contexts, Social and Economic Analysis Branch researchers apply a wide variety of social science concepts and methods which complement our rangeland/agricultural, wildlife, ecology, and biology capabilities. The goal of the Social and Economic Analysis Branch's research is to enhance natural-resource management, agency functions, policies, and decisionmaking.

Digital games as an effective approach for cancer management: Opportunities and challenges

PubMed Central

Ghazisaeidi, Marjan; Safdari, Reza; Goodini, Azadeh; Mirzaiee, Mahboobeh; Farzi, Jebraeil

2017-01-01

OBJECTIVE: Cancer is one of the most preventable and common chronic diseases that have economic, social and psychological burden for patients, families, and the society. Cancer can be monitored by new information technology. Digital games as a uniquely powerful interaction tool support optimal care management program operation in all dimensions. The aim of this review article is to describe opportunities and challenges of this new modern technology on the delivery of cancer care services in cancer management domains for cancer care improvement. METHODS: This study was un-systematic (narrative) review article. In this research, 50 full-text papers and reports had been retrieved, studied exactly, and arranged based on study aims. We searched papers based on specific and relevant keywords in research databases including PubMed, ScienceDirect, Scopus, and Google scholar. CONCLUSION: In cancer management domain, digital games are as an effective medium for health education and intervention, disease self-management training, attention distraction to relieve pain, enhance clinical outcomes, improvements in lifestyles, and physical and psychosocial activity promotion when active participation and behavior rehearsal are required for cancer patient. In spite of potential benefits of new technology, sometimes people confront various challenges such as social isolation, unusual anxiety, and disorder in physiological times of body, low physical activities, decrease academic performance, increase aggressive behavior, and physical pain. These problems can be partly overcome by proper planning, good design, and usage of suitable and continuous monitoring. PMID:28584830

Women's business: the challenge of childbirth.

PubMed

Barclay, L; Andre, C A; Glover, P A

1989-09-01

This paper was delivered as the opening address at the First National Conference of Childbirth Educators held in Melbourne, Australia, November, 1988. It is published with permission and support from the organisers. This paper develops and links insights available from anthropology, sociology, feminism and economics to the challenge facing childbirth educators. This challenge needs illumination from a number of directions before it can be understood, explained and met. The challenge described in the paper is that of re-establishing the importance and value of 'women's business'. This phrase, developed further at the beginning of the work, is from Aboriginal culture. It conveys the uniqueness of matters belonging to women. Childbirth is currently big business. Its management, whilst masquerading as scientific or medical, is clearly socio-economic. Until this is understood big business will continue to dominate women's business. The paper sets out to develop and defend these assertions and establish a role and responsibility for childbirth educators in relation to them.

Diversity dynamics: The experience of male Robert Wood Johnson Foundation nurse faculty scholars.

PubMed

Brody, Abraham A; Farley, Jason E; Gillespie, Gordon L; Hickman, Ronald; Hodges, Eric A; Lyder, Courtney; Palazzo, Steven J; Ruppar, Todd; Schiavenato, Martin; Pesut, Daniel J

Managing diversity dynamics in academic or clinical settings for men in nursing has unique challenges resulting from their minority status within the profession. The purpose of this study was to share challenges and lessons learned identified by male scholars in the Robert Wood Johnson Foundation Nurse Faculty Scholars program and suggest strategies for creating positive organizations promoting inclusive excellence. Multiple strategies including informal mentored discussions and peer-to-peer dialogue throughout the program, formal online surveys of scholars and National Advisory Committee members, and review of scholar progress reports were analyzed as part of the comprehensive evaluation plan of the program. Diversity dynamic issues include concerns with negative stereotyping, microaggression, gender intelligence, and differences in communication and leadership styles. Male nurse faculty scholars report experiencing both opportunities and challenges residing in a predominately female profession. This article attempts to raise awareness and suggest strategies to manage diversity dynamics in service of promoting the development of a culture of health that values diversity and inclusive excellence for both men and women in academic, research, and practice contexts. Copyright © 2017 Elsevier Inc. All rights reserved.

The Orbital Workshop Waste Management Compartment

NASA Technical Reports Server (NTRS)

1972-01-01

This image is a wide-angle view of the Orbital Workshop waste management compartment. The waste management facilities presented a unique challenge to spacecraft designers. In addition to collection of liquid and solid human wastes, there was a medical requirement to dry all solid human waste products and to return the residue to Earth for examination. Liquid human waste (urine) was frozen for return to Earth. Total quantities of each astronaut's liquid and solid wastes were precisely measured. Cabin air was drawn into the toilet, shown on the wall at right in this photograph, and over the waste products to generate a flow of the waste in the desired direction. The air was then filtered for odor control and antiseptic purposes prior to being discharged back into the cabin.

Hemorrhage and culture: management in the developing world and cultural implications for nursing care.

PubMed

Penney, D S

1991-01-01

In the industrialized world, technological resources and skilled personnel characterize the response to a hemorrhagic crisis. Such an efficient use of supplied technology stands in stark contrast to the responses toward a similar crisis when encountered in a developing country. In fact, attempting to manage a hemorrhage in a developing country may pose entanglements with economic, political, cultural, environmental, and medical obstacles. The uniqueness of this task and its challenges to the health professional are presented to provide nurses in advanced societies with a basic understanding of principles involved in managing hemorrhage in less-than-ideal circumstances. In addition, cultural care considerations are briefly described as they relate to the nursing role in the developing world.

Sepsis in Older Adults.

PubMed

Rowe, Theresa A; McKoy, June M

2017-12-01

Sepsis disproportionally affects older adults with more than 60% of sepsis diagnoses attributed to adults aged 65 years and older. Identifying, diagnosing, and treating sepsis in older individuals remain a challenge for clinicians, and few studies focus specifically on older adults with multiple medical comorbidities. Principles guiding management of sepsis for older adults are generally the same as in younger adults; however, unique considerations particularly pertinent to the care older adults include antimicrobial selection and dosing, delirium management, and goals of care discussions. Other factors, such as medical comorbidities, cognitive impairment, and functional status, impact outcomes more than age alone. Copyright © 2017 Elsevier Inc. All rights reserved.

Management of Unfavorable Outcomes in Head and Neck Free Flap Reconstruction: Experience-Based Lessons from the MD Anderson Cancer Center.

PubMed

Chang, Edward I; Hanasono, Matthew M; Butler, Charles E

2016-10-01

Complex head and neck reconstruction often mandates free tissue transfer to achieve the most optimal outcomes. Unfortunately, such challenging cases are not without risks of complications, the most dreaded of which is loss of the free flap. Aside from loss of the free flap, there are several other potential complications that can result following head and neck reconstruction. Certain complications are avoided with careful planning, others require significant revisions and in certain cases another free flap. This article presents the experience managing a series of unique complications following free flap head and neck reconstruction. Published by Elsevier Inc.

Making capitated Medicare work for women: policy and research challenges.

PubMed

Bierman, A S; Clancy, C M

2000-01-01

Growth in capitated Medicare has special ramifications for older women who comprise the majority of Medicare beneficiaries. Older women are more likely than men to have chronic conditions that lead to illness and disability, and they often have fewer financial and social resources to cope with these problems. Gender differences in health status have a number of important implications for the financing and delivery of care for older women under both traditional fee-for-service Medicare and capitation. The utilization of effective preventive interventions, new therapeutic interventions for the management of common chronic disorders, and more cost-effective models of chronic disease management could potentially extend the active life expectancy of older women. However, there are financial and delivery system barriers to achieving these objectives. Traditional FFS Medicare has gaps in coverage of care for chronic illness and disability that disproportionately impact women. Managed care potentially offers flexibility to allocate resources creatively, to develop new models of care, and offer enhanced benefits with lower out-of-pocket costs. However, challenges to realizing this potential under Medicare managed care with unique implications for older women include: possible gender bias in capitation payments, risk selection, inadequacy of risk adjustment models, benefit and market instability, and disenrollment patterns.

Data Management in Astrobiology: Challenges and Opportunities for an Interdisciplinary Community

PubMed Central

Suomela, Todd; Malone, Jim

2014-01-01

Abstract Data management and sharing are growing concerns for scientists and funding organizations throughout the world. Funding organizations are implementing requirements for data management plans, while scientists are establishing new infrastructures for data sharing. One of the difficulties is sharing data among a diverse set of research disciplines. Astrobiology is a unique community of researchers, containing over 110 different disciplines. The current study reports the results of a survey of data management practices among scientists involved in the astrobiology community and the NASA Astrobiology Institute (NAI) in particular. The survey was administered over a 2-month period in the first half of 2013. Fifteen percent of the NAI community responded (n=114), and additional (n=80) responses were collected from members of an astrobiology Listserv. The results of the survey show that the astrobiology community shares many of the same concerns for data sharing as other groups. The benefits of data sharing are acknowledged by many respondents, but barriers to data sharing remain, including lack of acknowledgement, citation, time, and institutional rewards. Overcoming technical, institutional, and social barriers to data sharing will be a challenge into the future. Key Words: Data management—Data sharing—Data preservation. Astrobiology 14, 451–461. PMID:24840364

DREAM: Distributed Resources for the Earth System Grid Federation (ESGF) Advanced Management

NASA Astrophysics Data System (ADS)

Williams, D. N.

2015-12-01

The data associated with climate research is often generated, accessed, stored, and analyzed on a mix of unique platforms. The volume, variety, velocity, and veracity of this data creates unique challenges as climate research attempts to move beyond stand-alone platforms to a system that truly integrates dispersed resources. Today, sharing data across multiple facilities is often a challenge due to the large variance in supporting infrastructures. This results in data being accessed and downloaded many times, which requires significant amounts of resources, places a heavy analytic development burden on the end users, and mismanaged resources. Working across U.S. federal agencies, international agencies, and multiple worldwide data centers, and spanning seven international network organizations, the Earth System Grid Federation (ESGF) has begun to solve this problem. Its architecture employs a system of geographically distributed peer nodes that are independently administered yet united by common federation protocols and application programming interfaces. However, significant challenges remain, including workflow provenance, modular and flexible deployment, scalability of a diverse set of computational resources, and more. Expanding on the existing ESGF, the Distributed Resources for the Earth System Grid Federation Advanced Management (DREAM) will ensure that the access, storage, movement, and analysis of the large quantities of data that are processed and produced by diverse science projects can be dynamically distributed with proper resource management. This system will enable data from an infinite number of diverse sources to be organized and accessed from anywhere on any device (including mobile platforms). The approach offers a powerful roadmap for the creation and integration of a unified knowledge base of an entire ecosystem, including its many geophysical, geographical, social, political, agricultural, energy, transportation, and cyber aspects. The resulting aggregation of data combined with analytics services has the potential to generate an informational universe and knowledge system of unprecedented size and value to the scientific community, downstream applications, decision makers, and the public.

USGS Science: Addressing Our Nation's Challenges

USGS Publications Warehouse

Larson, Tania M.

2009-01-01

With 6.6 billion people already living on Earth, and that number increasing every day, human influence on our planet is ever more apparent. Changes to the natural world combined with increasing human demands threaten our health and safety, our national security, our economy, and our quality of life. As a planet and a Nation, we face unprecedented challenges: loss of critical and unique ecosystems, the effects of climate change, increasing demand for limited energy and mineral resources, increasing vulnerability to natural hazards, the effects of emerging diseases on wildlife and human health, and growing needs for clean water. The time to respond to these challenges is now, but policymakers and decisionmakers face difficult choices. With competing priorities to balance, and potentially serious - perhaps irreversible - consequences at stake, our leaders need reliable scientific information to guide their decisions. As the Nation's earth and natural science agency, the USGS monitors and conducts scientific research on natural hazards and resources and how these elements and human activities influence our environment. Because the challenges we face are complex, the science needed to better understand and deal with these challenges must reflect the complex interplay among natural and human systems. With world-class expertise in biology, geology, geography, hydrology, geospatial information, and remote sensing, the USGS is uniquely capable of conducting the comprehensive scientific research needed to better understand the interdependent interactions of Earth's systems. Every day, the USGS helps decisionmakers to minimize loss of life and property, manage our natural resources, and protect and enhance our quality of life. This brochure provides examples of the challenges we face and how USGS science helps decisionmakers to address these challenges.

Treatment options for tank farms long-length contaminated equipment

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

Josephson, W.S.

1995-10-16

This study evaluated a variety of treatment and disposal technologies for mixed waste (MW) meeting the following criteria: 1. Single-Shell and Double-Shell Tank System (tank farms) equipment and other debris; 2. length greater than 12 feet; and contaminated with listed MW from the tank farms. This waste stream, commonly referred to as tank farms long-length contaminated equipment (LLCE), poses a unique and costly set of challenges during all phases of the waste management lifecycle.

Utilities Power Change: Engaging Commercial Customers in Workplace Charging

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

Lommele, Stephen; Dafoe, Wendy

As stewards of an electric grid that is available almost anywhere people park, utilities that support workplace charging are uniquely positioned to help their commercial customers be a part of the rapidly expanding network of charging infrastructure. Utilities understand the distinctive challenges of their customers, have access to technical information about electrical infrastructure, and have deep experience modeling and managing demand for electricity. This case study highlights the experiences of two utilities with workplace charging programs.

Genital and reproductive organ complications of Crohn disease: technical considerations as it relates to perianal disease, imaging features, and implications on management.

PubMed

Kammann, Steven; Menias, Christine; Hara, Amy; Moshiri, Mariam; Siegel, Cary; Safar, Bashar; Brandes, Steven; Shaaban, Akram; Sandrasegaran, Kumar

2017-06-01

A relatively large proportion of patients with Crohn disease (CD) develop complications including abscess formation, stricture, and penetrating disease. A subset of patients will have genital and reproductive organ involvement of CD, resulting in significant morbidity. These special circumstances create unique management challenges that must be tailored to the activity, location, and extent of disease. Familiarity with the epidemiology, pathogenesis, imaging features, and treatment strategies for patients with genital CD can aid imaging diagnoses and guide appropriate patient management. The purpose of this study is to illustrate the spectrum of CD in the genital tract and reproductive organs and discuss the complex management strategies in these patients as it relates to imaging. Given the impact on patient outcome and treatment planning, familiarity with the epidemiology, pathogenesis, imaging features, and treatment of patients with genital Crohn disease can aid radiologic diagnoses and guide appropriate patient management.

Implications of agricultural and wildlife policy on management and eradication of bovine tuberculosis and brucellosis in free-ranging wood bison of northern Canada.

PubMed

Nishi, J S; Stephen, C; Elkin, B T

2002-10-01

Although disease is often an important factor in the population dynamics of wild ungulates, it is largely the threat-both real and perceived-that sylvatic disease reservoirs pose to the health status of commercial livestock or game farm industry that has led governments to establish policy and legislation for disease management, trade, and movement. With respect to bovine tuberculosis and brucellosis in wildlife, policies are largely borrowed from the existing regulatory framework for domestic livestock. In this paper, we review how general policy goals for managing these reportable diseases in domestic livestock have also affected conservation and management of bison in Canada. We argue that there is a need to better integrate conservation biology with agricultural livestock policy to develop management options and better address the unique conservation challenges that diseased free-ranging bison populations present.

An academic approach to climate change emergency preparedness.

PubMed

Trask, Jeffrey A

To achieve effective emergency management and business continuity, all hazards should be considered during the planning and preparedness process. In recent years, several new hazards have attracted the attention of Emergency Management and Business Continuity practitioners. Climate change presents a unique challenge. Practitioners must rely on historical data combined with scientific projections to guide their planning and preparedness efforts. This article examines how an academic institution's emergency management programme can plan successfully for this hazard by focusing on best practices in the area of building cross-departmental and cross-jurisdictional relationships. Examples of scientific data related to the hazard of climate change will be presented along with the latest guidance from the Federal Emergency Management Agency encouraging the planning for future hazards. The article presents a functional exercise in which this hazard was prominently featured, and presents testimony from subject matter experts. Recommendations for emergency management and business continuity programmes are so provided.

Unique medical issues in adult patients with mucopolysaccharidoses.

PubMed

Mitchell, John; Berger, Kenneth I; Borgo, Andrea; Braunlin, Elizabeth A; Burton, Barbara K; Ghotme, Kemel A; Kircher, Susanne G; Molter, David; Orchard, Paul J; Palmer, James; Pastores, Gregory M; Rapoport, David M; Wang, Raymond Y; White, Klane

2016-10-01

The mucopolysaccharidoses are a group of inherited metabolic diseases caused by deficiencies in enzymes involved in the sequential degradation of glycosaminoglycans (GAGs) leading to substrate accumulation in various tissues and organs. GAG accumulation can cause growth retardation and progressive damage to respiratory, cardiovascular, musculoskeletal, nervous, gastrointestinal, auditory, and visual systems. In the past, few people with severe phenotypic mucopolysaccharidosis (MPS) reached adulthood. However, better methods for diagnosis, multi-disciplinary care, and new therapies have extended lifespan, leading to an increasing number of patients surviving beyond childhood. The growing number of adult MPS patients poses significant challenges for clinicians who may not be familiar with the clinical manifestations of MPS. In addition, as new interventions have changed the natural history of these disorders, it is difficult to anticipate both the impact on life expectancy and other complications that may occur as these patients age. Because the MPS disorders are multi-organ diseases, their management requires a coordinated multi-disciplinary approach. Here we discuss the unique pattern of medical issues and multi-organ involvement in adult patients with MPS and identify the challenges that are associated with management of MPS. This review is based on information from an expert investigator meeting with MPS specialists held October 2-4, 2014 in Dublin, Ireland, as well as on current literature searches focusing on MPS and adults. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Lurking in the Shadows: Emerging Rodent Infectious Diseases

PubMed Central

Besselsen, David G.; Franklin, Craig L.; Livingston, Robert S.; Riley, Lela K.

2013-01-01

Rodent parvoviruses, Helicobacter spp., murine norovirus, and several other previously unknown infectious agents have “emerged” in laboratory rodents relatively recently. These agents have been discovered serendipitously or through active investigation of atypical serology results, cell culture contamination, unexpected histopathology, or previously unrecognized clinical disease syndromes. The potential research impact of these agents is not fully known. Infected rodents have demonstrated immunomodulation, tumor suppression, clinical disease (particularly in immunodeficient rodents), and histopathology. Perturbations of organismal and cellular physiology also likely occur. These agents posed unique challenges to laboratory animal resource programs once discovered; it was necessary to develop specific diagnostic assays and an understanding of their epidemiology and transmission routes before attempting eradication, and then evaluate eradication methods for efficacy. Even then management approaches varied significantly, from apathy to total exclusion, and such inconsistency has hindered the sharing and transfer of rodents among institutions, particularly for genetically modified rodent models that may not be readily available. As additional infectious agents are discovered in laboratory rodents in coming years, much of what researchers have learned from experiences with the recently identified pathogens will be applicable. This article provides an overview of the discovery, detection, and research impact of infectious agents recently identified in laboratory rodents. We also discuss emerging syndromes for which there is a suspected infectious etiology, and the unique challenges of managing newly emerging infectious agents. PMID:18506061

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.

Charting a path for health sciences librarians in an integrated information environment.

PubMed

Jones, C J

1993-10-01

Changes in the health information environment present a major challenge to health sciences librarians. To successfully meet this challenge, librarians must apply the concepts of informal, self-directed, lifelong learning to their own carers. The Joint Commission on Accreditation of Healthcare Organizations is creating an integrated information environment in health care organizations. The health sciences librarian brings unique knowledge and skills to this environment. The reference technique, a methodology that closely parallels other problem-solving approaches such as the physician's diagnostic technique, equips librarians with the conceptual skills to develop creative solutions to information management problems. Each health sciences librarian must assume responsibility for extending professional skills and abilities and demonstrating them in the workplace.

Mitigating Issues Related to the Modeling of Insurgent Recruitment

NASA Astrophysics Data System (ADS)

Briscoe, Erica; Trewhitt, Ethan; Weiss, Lora; Whitaker, Elizabeth

Modeling the specific motivations and influences related to an individual's decision to become involved in insurgent warfare presents its own collection of unique challenges. The difficulty of the problem often necessitates simplifications that, while making the task more manageable, may inadvertently 'smooth away' critical aspects of the problem. Augmenting the challenge is that research into the motivations of terrorism has found there is not a definitive set of variables that serve as reliable indicators of an individual's involvement. This paper addresses techniques aimed toward mitigating issues that manifest in the modeling of insurgent recruitment so that these complications do not lessen the viability of models that are used in the prediction and evaluation of terrorist activity.

Collaborative Potential between National Estuary Programs ...

EPA Pesticide Factsheets

Estuaries are among the most productive ecosystems in the world, providing unique habitat for freshwater and marine species as well as valuable social and economic benefits. The wealth of ecosystem goods and services from estuaries has led to growth and development of human communities in adjacent areas and an increase in human activities that can adversely affect water quality and critical habitat. Managing for sustainable estuaries requires a balance of environmental concerns with community social and economic values. This has created an opportunity to leverage Environmental Protection Agency (EPA) scientific knowledge and tools with National Estuary Program (NEP) planning and management expertise to address environmental challenges in important estuarine ecosystems. The non-regulatory National Estuary Program (NEP) was outlined in the Clean Water Act to provide stakeholders an opportunity to monitor and manage ‘nationally significant’ estuaries. Currently there are 28 estuaries in the NEP, broadly distributed across the Atlantic, Pacific and Gulf Coasts, and in Puerto Rico. The local NEP management conferences must address a variety of environmental issues, from water quality and natural resources to coastal and watershed development. While the underlying objectives of each NEP are quite similar, each has unique landscapes, land uses, waterbodies, habitats, biological resources, economies and social culture. Consequently, the effects and severity of anthr

The provision of neuropsychological services in rural/regional settings: professional and ethical issues.

PubMed

Allott, Kelly; Lloyd, Susan

2009-07-01

Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.

Infectious disease in cervids of North America: data, models, and management challenges.

PubMed

Conner, Mary Margaret; Ebinger, Michael Ryan; Blanchong, Julie Anne; Cross, Paul Chafee

2008-01-01

Over the past two decades there has been a steady increase in the study and management of wildlife diseases. This trend has been driven by the perception of an increase in emerging zoonotic diseases and the recognition that wildlife can be a critical factor for controlling infectious diseases in domestic animals. Cervids are of recent concern because, as a group, they present a number of unique challenges. Their close ecological and phylogenetic relationship to livestock species places them at risk for receiving infections from, and reinfecting livestock. In addition, cervids are an important resource; revenue from hunting and viewing contribute substantially to agency budgets and local economies. A comprehensive coverage of infectious diseases in cervids is well beyond the scope of this chapter. In North America alone there are a number of infectious diseases that can potentially impact cervid populations, but for most of these, management is not feasible or the diseases are only a potential or future concern. We focus this chapter on three diseases that are of major management concern and the center of most disease research for cervids in North America: bovine tuberculosis, chronic wasting disease, and brucellosis. We discuss the available data and recent advances in modeling and management of these diseases.

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

PubMed

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

2017-10-27

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

A Randomized Clinical Trial of a Money Management Intervention for Veterans With Psychiatric Disabilities.

PubMed

Elbogen, Eric B; Hamer, Robert M; Swanson, Jeffrey W; Swartz, Marvin S

2016-10-01

The study evaluated an intervention to help veterans with psychiatric disabilities, who face a unique set of challenges concerning money management. A randomized clinical trial was conducted of a brief (one to three hours) psychoeducational, recovery-oriented money management intervention called $teps for Achieving Financial Empowerment ($AFE). Analyses revealed no main effects on outcomes of random assignment to $AFE (N=67) or a control condition consisting of usual care (N=77). Veterans who reported using $AFE skills showed significantly lower impulsive buying, more responsible spending, higher rates of engaging in vocational activities, and greater number of work hours compared with veterans in the control condition. Findings have clinical implications for case management services involving informal money management assistance. Offering veterans with psychiatric disabilities a one-time money management intervention is unlikely to lead to substantial changes. Results imply that efforts to improve psychosocial outcomes among veterans must not only teach but also increase use of money management skills.

Brilliant gamma beams for industrial applications: new opportunities, new challenges

NASA Astrophysics Data System (ADS)

Iancu, V.; Suliman, G.; Turturica, G. V.; Iovea, M.; Daito, I.; Ohgaki, H.; Matei, C.; Ur, C. A.; Balabanski, D. L.

2016-10-01

The Nuclear Physics oriented pillar of the pan-European Extreme Light Infrastructure (ELI-NP) will host an ultra-bright, energy tunable, and quasi-monochromatic gamma-ray beam system in the range of 0.2-19.5 MeV produced by laser-Compton backscattering technique. The applied research program envisioned at ELI-NP targets to use nuclear resonance fluorescence (NRF) and computed tomography to provide new opportunities for industry and society. High sensitivity NRF-based investigations can be successfully applied to safeguard applications and management of radioactive wastes as well as to uncharted fields like cultural heritage and medical imaging. Gamma-ray radioscopy and computed tomography performed at ELI-NP has the potential to achieve high resolution in industrial-sized objects provided the detection challenges introduced by the unique characteristics of the gamma beam are overcome. Here we discuss the foreseen industrial applications that will benefit from the high quality and unique characteristics of ELI-NP gamma beam and the challenges they present. We present the experimental setups proposed to be implemented for this goal, discuss their performance based on analytical calculations and numerical Monte-Carlo simulations, and comment about constrains imposed by the limitation of current scintillator detectors. Several gamma-beam monitoring devices based on scintillator detectors will also be discussed.

The Baltic Sea as a time machine for the future coastal ocean.

PubMed

Reusch, Thorsten B H; Dierking, Jan; Andersson, Helen C; Bonsdorff, Erik; Carstensen, Jacob; Casini, Michele; Czajkowski, Mikolaj; Hasler, Berit; Hinsby, Klaus; Hyytiäinen, Kari; Johannesson, Kerstin; Jomaa, Seifeddine; Jormalainen, Veijo; Kuosa, Harri; Kurland, Sara; Laikre, Linda; MacKenzie, Brian R; Margonski, Piotr; Melzner, Frank; Oesterwind, Daniel; Ojaveer, Henn; Refsgaard, Jens Christian; Sandström, Annica; Schwarz, Gerald; Tonderski, Karin; Winder, Monika; Zandersen, Marianne

2018-05-01

Coastal global oceans are expected to undergo drastic changes driven by climate change and increasing anthropogenic pressures in coming decades. Predicting specific future conditions and assessing the best management strategies to maintain ecosystem integrity and sustainable resource use are difficult, because of multiple interacting pressures, uncertain projections, and a lack of test cases for management. We argue that the Baltic Sea can serve as a time machine to study consequences and mitigation of future coastal perturbations, due to its unique combination of an early history of multistressor disturbance and ecosystem deterioration and early implementation of cross-border environmental management to address these problems. The Baltic Sea also stands out in providing a strong scientific foundation and accessibility to long-term data series that provide a unique opportunity to assess the efficacy of management actions to address the breakdown of ecosystem functions. Trend reversals such as the return of top predators, recovering fish stocks, and reduced input of nutrient and harmful substances could be achieved only by implementing an international, cooperative governance structure transcending its complex multistate policy setting, with integrated management of watershed and sea. The Baltic Sea also demonstrates how rapidly progressing global pressures, particularly warming of Baltic waters and the surrounding catchment area, can offset the efficacy of current management approaches. This situation calls for management that is (i) conservative to provide a buffer against regionally unmanageable global perturbations, (ii) adaptive to react to new management challenges, and, ultimately, (iii) multisectorial and integrative to address conflicts associated with economic trade-offs.

The Baltic Sea as a time machine for the future coastal ocean

PubMed Central

Reusch, Thorsten B. H.; Andersson, Helen C.; Bonsdorff, Erik; Carstensen, Jacob; Kuosa, Harri; Laikre, Linda; Melzner, Frank; Oesterwind, Daniel; Sandström, Annica; Schwarz, Gerald; Winder, Monika; Zandersen, Marianne

2018-01-01

Coastal global oceans are expected to undergo drastic changes driven by climate change and increasing anthropogenic pressures in coming decades. Predicting specific future conditions and assessing the best management strategies to maintain ecosystem integrity and sustainable resource use are difficult, because of multiple interacting pressures, uncertain projections, and a lack of test cases for management. We argue that the Baltic Sea can serve as a time machine to study consequences and mitigation of future coastal perturbations, due to its unique combination of an early history of multistressor disturbance and ecosystem deterioration and early implementation of cross-border environmental management to address these problems. The Baltic Sea also stands out in providing a strong scientific foundation and accessibility to long-term data series that provide a unique opportunity to assess the efficacy of management actions to address the breakdown of ecosystem functions. Trend reversals such as the return of top predators, recovering fish stocks, and reduced input of nutrient and harmful substances could be achieved only by implementing an international, cooperative governance structure transcending its complex multistate policy setting, with integrated management of watershed and sea. The Baltic Sea also demonstrates how rapidly progressing global pressures, particularly warming of Baltic waters and the surrounding catchment area, can offset the efficacy of current management approaches. This situation calls for management that is (i) conservative to provide a buffer against regionally unmanageable global perturbations, (ii) adaptive to react to new management challenges, and, ultimately, (iii) multisectorial and integrative to address conflicts associated with economic trade-offs. PMID:29750199

Linear Temporal Logic (LTL) Based Monitoring of Smart Manufacturing Systems

PubMed Central

Heddy, Gerald; Huzaifa, Umer; Beling, Peter; Haimes, Yacov; Marvel, Jeremy; Weiss, Brian; LaViers, Amy

2017-01-01

The vision of Smart Manufacturing Systems (SMS) includes collaborative robots that can adapt to a range of scenarios. This vision requires a classification of multiple system behaviors, or sequences of movement, that can achieve the same high-level tasks. Likewise, this vision presents unique challenges regarding the management of environmental variables in concert with discrete, logic-based programming. Overcoming these challenges requires targeted performance and health monitoring of both the logical controller and the physical components of the robotic system. Prognostics and health management (PHM) defines a field of techniques and methods that enable condition-monitoring, diagnostics, and prognostics of physical elements, functional processes, overall systems, etc. PHM is warranted in this effort given that the controller is vulnerable to program changes, which propagate in unexpected ways, logical runtime exceptions, sensor failure, and even bit rot. The physical component’s health is affected by the wear and tear experienced by machines constantly in motion. The controller’s source of faults is inherently discrete, while the latter occurs in a manner that builds up continuously over time. Such a disconnect poses unique challenges for PHM. This paper presents a robotic monitoring system that captures and resolves this disconnect. This effort leverages supervisory robotic control and model checking with linear temporal logic (LTL), presenting them as a novel monitoring system for PHM. This methodology has been demonstrated in a MATLAB-based simulator for an industry inspired use-case in the context of PHM. Future work will use the methodology to develop adaptive, intelligent control strategies to evenly distribute wear on the joints of the robotic arms, maximizing the life of the system. PMID:28730154

COLLABORATE©, Part IV: Ramping Up Competency-Based Performance Management.

PubMed

Treiger, Teresa M; Fink-Samnick, Ellen

The purpose of this fourth part of the COLLABORATE© article series provides an expansion and application of previously presented concepts pertaining to the COLLABORATE paradigm of professional case management practice. The model is built upon a value-driven foundation that: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. As an industry, health care continues to evolve. Terrain shifts and new influences continually surface to challenge professional case management practice. The need for top-performing and nimble professionals who are knowledgeable and proficient in the workplace continues to challenge human resource departments. In addition to care setting knowledge, professional case managers must continually invest in their practice competence toolbox to grow skills and abilities that transcend policies and processes. These individuals demonstrate agility in framing (and reframing) their professional practice to facilitate the best possible outcomes for their clients. Therefore, the continued emphasis on practice competence conveyed through the performance management cycle is an essential ingredient to performance management focused on customer service excellence and organizational improvement. Professional case management transcends professional disciplines, educational levels, and practice settings. Business objectives continue to drive work process and priorities in many practice settings. However, competencies that align with regulatory and accreditation requirements should be the critical driver for consistent, high-quality case management practice. Although there is inherent value in what various disciplines bring to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities.

Making it local: Beacon Communities use health information technology to optimize care management.

PubMed

Allen, Amy; Des Jardins, Terrisca R; Heider, Arvela; Kanger, Chatrian R; Lobach, David F; McWilliams, Lee; Polello, Jennifer M; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C; Turske, Scott A

2014-06-01

Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks--including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation--the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability.

Understanding risks and complications in the management of ankle fractures

PubMed Central

Mehta, Saurabh Sagar; Rees, Kishan; Cutler, Lucy; Mangwani, Jitendra

2014-01-01

Ankle fracture (AF) is a common injury with potentially significant morbidity associated with it. The most common age groups affected are young active patients, sustaining high energy trauma and elderly patients with comorbidities. Both these groups pose unique challenges for appropriate management of these injuries. Young patients are at risk of developing posttraumatic osteoarthritis, with a significant impact on quality of life due to pain and impaired function. Elderly patients, especially with poorly controlled diabetes and osteoporosis are at increased risk of wound complications, infection and failure of fixation. In the most severe cases, this can lead to amputation and mortality. Therefore, individualized approach to the management of AF is vital. This article highlights commonly encountered complications and discusses the measures needed to minimize them when dealing with these injuries. PMID:25298549

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Cataract and keratoconus: minimizing complications in intraocular lens calculations.

PubMed

Bozorg, Sara; Pineda, Roberto

2014-01-01

Patients with both cataract and keratoconus present unique challenges for the surgeon. Accurate keratometry (K) and axial length (AL) readings may be impossible, and uncertainty is introduced when estimating the corneal power for intraocular lens (IOL) selection. Different options on how to choose an IOL and how to manage irregular astigmatism of a keratoconic patient with cataract have been proposed and are reviewed. The stage of keratoconus and the history of the patient are both critical in determining the strategy used in treatment of cataracts.

Parent Management of the School Reintegration Needs of Children and Youth Following Moderate or Severe Traumatic Brain Injury

PubMed Central

Roscigno, Cecelia I.; Fleig, Denise K.; Knafl, Kathleen A.

2014-01-01

Purpose School reintegration following children’s traumatic brain injury (TBI) is still poorly understood from families’ perspectives. We aimed to understand how both unique and common experiences during children’s school reintegration were explained by parents to influence the family. Methods Data came from an investigation using descriptive phenomenology (2005–2007) to understand parents’ experiences in the first 5 years following children’s moderate to severe TBI. Parents (N = 42 from 37 families in the United States) participated in two 90-minute interviews (first M = 15 months; second M = 27 months). Two investigators independently coded parents’ discussions of school reintegration using content analysis to understand the unique and common factors that parents perceived affected the family. Results Parents’ school negotiation themes included: 1) legal versus moral basis for helping the child; 2) inappropriate state and local services that did not consider needs specific to TBI; and, 3) involvement in planning, implementing, and evaluating the child’s education plan. Parents perceived that coordinated and collaboration leadership with school personnel lessened families’ workload. Families who home-schooled had unique challenges. Conclusions School reintegration can add to family workload by changing roles and relationships, and by adding to parents’ perceived stress in managing of the child’s condition. PMID:24969697

Transforming Teaching Challenges into Learning Opportunities: Interdisciplinary Reflective Collaboration

ERIC Educational Resources Information Center

Callaghan, Ronel

2015-01-01

Teaching in higher education poses unique sets of challenges, especially for academics in the engineering, built sciences and information science education disciplines. This article focuses on how reflective collaboration can support academics in their quest to find unique solutions to challenges in different academic contexts. A reflective…

Solid Rocket Booster (SRB) - Evolution and Lessons Learned During the Shuttle Program

NASA Technical Reports Server (NTRS)

Kanner, Howard S.; Freeland, Donna M.; Olson, Derek T.; Wood, T. David; Vaccaro, Mark V.

2011-01-01

The Solid Rocket Booster (SRB) element integrates all the subsystems needed for ascent flight, entry, and recovery of the combined Booster and Motor system. These include the structures, avionics, thrust vector control, pyrotechnic, range safety, deceleration, thermal protection, and retrieval systems. This represents the only human-rated, recoverable and refurbishable solid rocket ever developed and flown. Challenges included subsystem integration, thermal environments and severe loads (including water impact), sometimes resulting in hardware attrition. Several of the subsystems evolved during the program through design changes. These included the thermal protection system, range safety system, parachute/recovery system, and others. Obsolescence issues occasionally required component recertification. Because the system was recovered, the SRB was ideal for data and imagery acquisition, which proved essential for understanding loads and system response. The three main parachutes that lower the SRBs to the ocean are the largest parachutes ever designed, and the SRBs are the largest structures ever to be lowered by parachutes. SRB recovery from the ocean was a unique process and represented a significant operational challenge; requiring personnel, facilities, transportation, and ground support equipment. The SRB element achieved reliability via extensive system testing and checkout, redundancy management, and a thorough postflight assessment process. Assembly and integration of the booster subsystems was a unique process and acceptance testing of reused hardware components was required for each build. Extensive testing was done to assure hardware functionality at each level of stage integration. Because the booster element is recoverable, subsystems were available for inspection and testing postflight, unique to the Shuttle launch vehicle. Problems were noted and corrective actions were implemented as needed. The postflight assessment process was quite detailed and a significant portion of flight operations. The SRBs provided fully redundant critical systems including thrust vector control, mission critical pyrotechnics, avionics, and parachute recovery system. The design intent was to lift off with full redundancy. On occasion, the redundancy management scheme was needed during flight operations. This paper describes some of the design challenges, how the design evolved with time, and key areas where hardware reusability contributed to improved system level understanding.

The Pain Associates' International Network Initiative: a novel practical approach to the challenge of chronic pain management in Europe.

PubMed

Morlion, Bart; Walch, Heribert; Yihune, Gabriel; Vielvoye-Kerkmeer, Ans; de Jong, Zuzana; Castro-Lopes, José; Stanton-Hicks, Michael

2008-01-01

Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. Epidemiological data and patient surveys have highlighted the areas of pain management that might be improved. These include a need for better understanding and documentation of the symptoms of chronic pain, standardized levels of care, improved communication among clinical personnel and with patients, and an updated education program for clinicians. For these reasons, new strategies aimed at improving the standards of pain management are needed. The Pain Associates' International Network (P.A.I.N.) Initiative was set up to devise practical methods for improving the quality of pain management for patients. These strategies have recently been put into practice through a number of activities: P.A.I.N. Workshops are meetings of international pain management professionals dedicated to discussing current management strategies and producing consensus recommendations for improving standards of care; P.A.I.N. Quality is a unique software program designed to help treating clinicians to document patient data and derive effective treatment plans; P.A.I.N. Online provides a web site forum for discussion of pain management topics; and P.A.I.N. Management is a clinician education program providing up-to-date training in pain management.

U.S. Geological Survey water-resource monitoring activities in support of the Wyoming Landscape Conservation Initiative

USGS Publications Warehouse

Soileau, Suzanna; Miller, Kirk

2013-01-01

The quality of the Nation’s water resources are vital to the health and well-being of both our communities and the natural landscapes we value. The U.S. Geological Survey investigates the occurrence, quantity, quality, distribution, and movement of surface water and groundwater and provides this information to engineers, scientists, managers, educators, and the general public. This information also supplements current (2013) and historical water data provided by the National Water Information System. The U.S. Geological Survey collects and shares data nationwide, but how those data are used is often site specific; this variety of data assists natural-resource managers in addressing unique, local, and regional challenges.

Substance Abuse Prevention, Assessment, and Treatment for Lesbian, Gay, Bisexual, and Transgender Youth.

PubMed

Aromin, Romulo Alcalde

2016-12-01

Knowing how to manage substance abuse in all youth is an important aspect of pediatric care, including providing clinically appropriate anticipatory guidance, monitoring, assessment, and treatment. Although most lesbian, gay, bisexual, and transgender (LGBT) youth do not abuse substances, as a group they experience unique challenges in self-identity development that put them at an increased risk for substance abuse. This article addresses prevention and management of substance use in LGBT youth relevant to pediatrics and allied professions as an aspect of their overall health care. It reviews basic information about substance abuse in youth and special considerations for LGBT youth. Copyright © 2016 Elsevier Inc. All rights reserved.

Pockets of opportunity: multicultural marketing strategies for BEP growth.

PubMed

Schaefer, Kelly

2003-01-01

Ranked among the 50 largest food service corporations in America, the Randolph-Sheppard Business Enterprise Program (BEP) represents a challenging and rewarding career opportunity for Americans who are legally blind. In recent years, however, the number of facilities and facility managers has declined. Multicultural consumers represent a major emerging growth market. The multicultural market is one of the most overlooked retail markets in the United States--and the one with the most buying power and growth potential. Multicultural marketing is among the least understood strategies available to facility managers, vocational rehabilitation counselors and BEP directors. Four major minority markets are discussed and marketing strategies are offered to help BEPs target and serve these unique consumers.

Trust Management in Swarm-Based Autonomic Computing Systems

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

Maiden, Wendy M.; Haack, Jereme N.; Fink, Glenn A.

2009-07-07

Reputation-based trust management techniques can address issues such as insider threat as well as quality of service issues that may be malicious in nature. However, trust management techniques must be adapted to the unique needs of the architectures and problem domains to which they are applied. Certain characteristics of swarms such as their lightweight ephemeral nature and indirect communication make this adaptation especially challenging. In this paper we look at the trust issues and opportunities in mobile agent swarm-based autonomic systems and find that by monitoring the trustworthiness of the autonomic managers rather than the swarming sensors, the trust managementmore » problem becomes much more scalable and still serves to protect the swarms. We also analyze the applicability of trust management research as it has been applied to architectures with similar characteristics. Finally, we specify required characteristics for trust management mechanisms to be used to monitor the trustworthiness of the entities in a swarm-based autonomic computing system.« less

DualTrust: A Trust Management Model for Swarm-Based Autonomic Computing Systems

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

Maiden, Wendy M.

Trust management techniques must be adapted to the unique needs of the application architectures and problem domains to which they are applied. For autonomic computing systems that utilize mobile agents and ant colony algorithms for their sensor layer, certain characteristics of the mobile agent ant swarm -- their lightweight, ephemeral nature and indirect communication -- make this adaptation especially challenging. This thesis looks at the trust issues and opportunities in swarm-based autonomic computing systems and finds that by monitoring the trustworthiness of the autonomic managers rather than the swarming sensors, the trust management problem becomes much more scalable and stillmore » serves to protect the swarm. After analyzing the applicability of trust management research as it has been applied to architectures with similar characteristics, this thesis specifies the required characteristics for trust management mechanisms used to monitor the trustworthiness of entities in a swarm-based autonomic computing system and describes a trust model that meets these requirements.« less

Technosocial Predictive Analytics in Support of Naturalistic Decision Making

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

Sanfilippo, Antonio P.; Cowell, Andrew J.; Malone, Elizabeth L.

2009-06-23

A main challenge we face in fostering sustainable growth is to anticipate outcomes through predictive and proactive across domains as diverse as energy, security, the environment, health and finance in order to maximize opportunities, influence outcomes and counter adversities. The goal of this paper is to present new methods for anticipatory analytical thinking which address this challenge through the development of a multi-perspective approach to predictive modeling as a core to a creative decision making process. This approach is uniquely multidisciplinary in that it strives to create decision advantage through the integration of human and physical models, and leverages knowledgemore » management and visual analytics to support creative thinking by facilitating the achievement of interoperable knowledge inputs and enhancing the user’s cognitive access. We describe a prototype system which implements this approach and exemplify its functionality with reference to a use case in which predictive modeling is paired with analytic gaming to support collaborative decision-making in the domain of agricultural land management.« less

Freshwater fish faunas, habitats and conservation challenges in the Caribbean river basins of north-western South America.

PubMed

Jiménez-Segura, L F; Galvis-Vergara, G; Cala-Cala, P; García-Alzate, C A; López-Casas, S; Ríos-Pulgarín, M I; Arango, G A; Mancera-Rodríguez, N J; Gutiérrez-Bonilla, F; Álvarez-León, R

2016-07-01

The remarkable fish diversity in the Caribbean rivers of north-western South America evolved under the influences of the dramatic environmental changes of neogene northern South America, including the Quechua Orogeny and Pleistocene climate oscillations. Although this region is not the richest in South America, endemism is very high. Fish assemblage structure is unique to each of the four aquatic systems identified (rivers, streams, floodplain lakes and reservoirs) and community dynamics are highly synchronized with the mono-modal or bi-modal flooding pulse of the rainy seasons. The highly seasonal multispecies fishery is based on migratory species. Freshwater fish conservation is a challenge for Colombian environmental institutions because the Caribbean trans-Andean basins are the focus of the economic development of Colombian society, so management measures must be directed to protect aquatic habitat and their connectivity. These two management strategies are the only way for helping fish species conservation and sustainable fisheries. © 2016 The Fisheries Society of the British Isles.

CT Angiography after 20 Years

PubMed Central

Rubin, Geoffrey D.; Leipsic, Jonathon; Schoepf, U. Joseph; Fleischmann, Dominik; Napel, Sandy

2015-01-01

Through a marriage of spiral computed tomography (CT) and graphical volumetric image processing, CT angiography was born 20 years ago. Fueled by a series of technical innovations in CT and image processing, over the next 5–15 years, CT angiography toppled conventional angiography, the undisputed diagnostic reference standard for vascular disease for the prior 70 years, as the preferred modality for the diagnosis and characterization of most cardiovascular abnormalities. This review recounts the evolution of CT angiography from its development and early challenges to a maturing modality that has provided unique insights into cardiovascular disease characterization and management. Selected clinical challenges, which include acute aortic syndromes, peripheral vascular disease, aortic stent-graft and transcatheter aortic valve assessment, and coronary artery disease, are presented as contrasting examples of how CT angiography is changing our approach to cardiovascular disease diagnosis and management. Finally, the recently introduced capabilities for multispectral imaging, tissue perfusion imaging, and radiation dose reduction through iterative reconstruction are explored with consideration toward the continued refinement and advancement of CT angiography. PMID:24848958

LESSONS LEARNED IN OPERATING THE HOSE-IN-HOSE SYSTEM FOR TRANSFSERRING SLUDGE AT HANFORDS K-BASINS

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

PERES MW

In May 2007, the Department of Energy and the Fluor Hanford K Basin Closure Project completed transferring sludge from the K East Basin to new containers in the K West Basin using a Hose-in-Hose system. This project presented a number of complex and unique technical, operational, and management challenges that had to be resolved to complete the required transfers and satisfy project milestones. The project team (including DOE; regulators; and Fluor management, operations, maintenance, engineering and all other support organizations) found innovative solutions to each challenge. This paper records lessons learned during the operational phase of the sludge transfer viamore » the Hose-In-Hose system. The subject is limited to the operational phase and does not cover design, development, testing or turnover. A discussion of the situation or problem encountered is provided, along with the lesson learned as applicable to a future program or project.« less

Knowledge creation through total clinical outcomes management: a practice-based evidence solution to address some of the challenges of knowledge translation.

PubMed

Lyons, John S

2009-02-01

The challenges of knowledge translation in behavioural health care are unique to this field for a variety of reasons including the fact that effective treatment is invariably embedded in a strong relationship between practitioners and the people they serve. Practitioners' knowledge gained from experience and intuition become an even more important consideration in the knowledge translation process since clinicians are, in fact, a component of most treatments. Communication of findings from science must be conceptualized with sensitivity to this reality. Considering knowledge translation as a communication process suggests the application of contemporary theories of communication which emphasize the creation of shared meaning over the transmission of knowledge from one person to the next. In this context outcomes management approaches to create a learning environment within clinical practices that facilitate the goals of knowledge transfer while respecting that the scientific enterprise is neither the sole nor primary repository of knowledge.

A shark attack treated in a tertiary care centre: Case report and review of the literature.

PubMed

Roy, Mélissa; Plant, Mathew A; Snell, Laura

2018-01-01

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

A shark attack treated in a tertiary care centre: Case report and review of the literature

PubMed Central

Roy, Mélissa; Plant, Mathew A; Snell, Laura

2018-01-01

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman’s contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries. PMID:29076325

Secure Cryptographic Key Management System (CKMS) Considerations for Smart Grid Devices

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

Abercrombie, Robert K; Sheldon, Frederick T; Aldridge, Hal

2011-01-01

In this paper, we examine some unique challenges associated with key management in the Smart Grid and concomitant research initiatives: 1) effectively model security requirements and their implementations, and 2) manage keys and key distribution for very large scale deployments such as Smart Meters over a long period of performance. This will set the stage to: 3) develop innovative, low cost methods to protect keying material, and 4) provide high assurance authentication services. We will present our perspective on key management and will discuss some key issues within the life cycle of a cryptographic key designed to achieve the following:more » 1) control systems designed, installed, operated, and maintained to survive an intentional cyber assault with no loss of critical function, and 2) widespread implementation of methods for secure communication between remote access devices and control centers that are scalable and cost-effective to deploy.« less

Test Results from a High Power Linear Alternator Test Rig

NASA Technical Reports Server (NTRS)

Birchenough, Arthur G.; Hervol, David S.; Gardner, Brent G.

2010-01-01

Stirling cycle power conversion is an enabling technology that provides high thermodynamic efficiency but also presents unique challenges with regard to electrical power generation, management, and distribution. The High Power Linear Alternator Test Rig (HPLATR) located at the NASA Glenn Research Center (GRC) in Cleveland, OH is a demonstration test bed that simulates electrical power generation from a Stirling engine driven alternator. It implements the high power electronics necessary to provide a well regulated DC user load bus. These power electronics use a novel design solution that includes active rectification and power factor control, active ripple suppression, along with a unique building block approach that permits the use of high voltage or high current alternator designs. This presentation describes the HPLATR, the test program, and the operational results.

Patients as Patches: Ecology and Epidemiology in Healthcare Environments.

PubMed

Lofgren, Eric T; Egizi, Andrea M; Fefferman, Nina H

2016-12-01

The modern healthcare system involves complex interactions among microbes, patients, providers, and the built environment. It represents a unique and challenging setting for control of the emergence and spread of infectious diseases. We examine an extension of the perspectives and methods from ecology (and especially urban ecology) to address these unique issues, and we outline 3 examples: (1) viewing patients as individual microbial ecosystems; (2) the altered ecology of infectious diseases specifically within hospitals; and (3) ecosystem management perspectives for infection surveillance and control. In each of these cases, we explore the accuracy and relevance of analogies to existing urban ecological perspectives, and we demonstrate a few of the potential direct uses of this perspective for altering research into the control of healthcare-associated infections. Infect Control Hosp Epidemiol. 2016;1507-1512.

Test Results From a High Power Linear Alternator Test Rig

NASA Technical Reports Server (NTRS)

Birchenough, Arthur G.; Hervol, David S.; Gardner, Brent G.

2010-01-01

Stirling cycle power conversion is an enabling technology that provides high thermodynamic efficiency but also presents unique challenges with regard to electrical power generation, management, and distribution. The High Power Linear Alternator Test Rig (HPLATR) located at the NASA Glenn Research Center (GRC) in Cleveland, Ohio is a demonstration test bed that simulates electrical power generation from a Stirling engine driven alternator. It implements the high power electronics necessary to provide a well regulated DC user load bus. These power electronics use a novel design solution that includes active rectification and power factor control, active ripple suppression, along with a unique building block approach that permits the use of high voltage or high current alternator designs. This report describes the HPLATR, the test program, and the operational results.

Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section

PubMed Central

Shah, Tanmay H.; Badve, Manasi S.; Olajide, Kowe O.; Skorupan, Havyn M.; Waters, Jonathan H.; Vallejo, Manuel C.

2011-01-01

Patients with Klippel-Feil Syndrome (KFS) have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-year-old female, G2P1A0 with KFS (fusion of cervical vertebrae) who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiber-optic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS) is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III) precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus. PMID:24765318

Disease management programs for CKD patients: the potential and pitfalls.

PubMed

Rocco, Michael V

2009-03-01

Disease management describes the use of a number of approaches to identify and treat patients with chronic health conditions, especially those that are expensive to treat. Disease management programs have grown rapidly in the United States in the past several years. These programs have been established for patients with chronic kidney disease (CKD), but some have been discontinued because of the high cost of the program. Disease management programs for CKD face unique challenges. Identification of patients with CKD is hampered by incomplete use of the International Classification of Diseases, Ninth Revision (ICD-9) codes for CKD by physicians and the less than universal use of estimated glomerular filtration rate from serum creatinine measurements to identify patients with an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2). CKD affects multiple organ systems. Thus, a comprehensive disease management program will need to manage each of these aspects of CKD. These multiple interventions likely will make a CKD disease management program more costly than similar disease management programs designed for patients with diabetes mellitus, congestive heart failure, or other chronic diseases. The lack of data that can be used to develop effective disease management programs in CKD makes it difficult to determine goals for the management of each organ system affected by CKD. Finally, long periods of observation will be needed to determine whether a particular disease management program is effective in not only improving patient outcomes, but also decreasing both resource use and health care dollars. This long-term observation period is contrary to how most disease management contracts are written, which usually are based on meeting goals during a 1- to 3-year period. Until these challenges are resolved, it likely will be difficult to maintain effective disease management programs for CKD.

Sustainable agricultural water management across climates

NASA Astrophysics Data System (ADS)

DeVincentis, A.

2016-12-01

Fresh water scarcity is a global problem with local solutions. Agriculture is one of many human systems threatened by water deficits, and faces unique supply, demand, quality, and management challenges as the global climate changes and population grows. Sustainable agricultural water management is paramount to protecting global economies and ecosystems, but requires different approaches based on environmental conditions, social structures, and resource availability. This research compares water used by conservation agriculture in temperate and tropical agroecosystems through data collected from operations growing strawberries, grapes, tomatoes, and pistachios in California and corn and soybeans in Colombia. The highly manipulated hydrologic regime in California has depleted water resources and incited various adaptive management strategies, varying based on crop type and location throughout the state. Operations have to use less water more efficiently, and sometimes that means fallowing land in select groundwater basins. At the opposite end of the spectrum, the largely untouched landscape in the eastern plains of Colombia are rapidly being converted into commercial agricultural operations, with a unique opportunity to manage and plan for agricultural development with sustainability in mind. Although influenced by entirely different climates and economies, there are some similarities in agricultural water management strategies that could be applicable worldwide. Cover crops are a successful management strategy for both agricultural regimes, and moving forward it appears that farmers who work in coordination with their neighbors to plan for optimal production will be most successful in both locations. This research points to the required coordination of agricultural extension services as a critical component to sustainable water use, successful economies, and protected environments.

Customized recommendations for production management clusters of North American automatic milking systems.

PubMed

Tremblay, Marlène; Hess, Justin P; Christenson, Brock M; McIntyre, Kolby K; Smink, Ben; van der Kamp, Arjen J; de Jong, Lisanne G; Döpfer, Dörte

2016-07-01

Automatic milking systems (AMS) are implemented in a variety of situations and environments. Consequently, there is a need to characterize individual farming practices and regional challenges to streamline management advice and objectives for producers. Benchmarking is often used in the dairy industry to compare farms by computing percentile ranks of the production values of groups of farms. Grouping for conventional benchmarking is commonly limited to the use of a few factors such as farms' geographic region or breed of cattle. We hypothesized that herds' production data and management information could be clustered in a meaningful way using cluster analysis and that this clustering approach would yield better peer groups of farms than benchmarking methods based on criteria such as country, region, breed, or breed and region. By applying mixed latent-class model-based cluster analysis to 529 North American AMS dairy farms with respect to 18 significant risk factors, 6 clusters were identified. Each cluster (i.e., peer group) represented unique management styles, challenges, and production patterns. When compared with peer groups based on criteria similar to the conventional benchmarking standards, the 6 clusters better predicted milk produced (kilograms) per robot per day. Each cluster represented a unique management and production pattern that requires specialized advice. For example, cluster 1 farms were those that recently installed AMS robots, whereas cluster 3 farms (the most northern farms) fed high amounts of concentrates through the robot to compensate for low-energy feed in the bunk. In addition to general recommendations for farms within a cluster, individual farms can generate their own specific goals by comparing themselves to farms within their cluster. This is very comparable to benchmarking but adds the specific characteristics of the peer group, resulting in better farm management advice. The improvement that cluster analysis allows for is characterized by the multivariable approach and the fact that comparisons between production units can be accomplished within a cluster and between clusters as a choice. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The GAMCIT gamma ray burst detector

NASA Technical Reports Server (NTRS)

Mccall, Benjamin J.; Grunsfeld, John M.; Sobajic, Srdjan D.; Chang, Chinley Leonard; Krum, David M.; Ratner, Albert; Trittschuh, Jennifer E.

1993-01-01

The GAMCIT payload is a Get-Away-Special payload designed to search for high-energy gamma-ray bursts and any associated optical transients. This paper presents details on the design of the GAMCIT payload, in the areas of battery selection, power processing, electronics design, gamma-ray detection systems, and the optical imaging of the transients. The paper discusses the progress of the construction, testing, and specific design details of the payload. In addition, this paper discusses the unique challenges involved in bringing this payload to completion, as the project has been designed, constructed, and managed entirely by undergraduate students. Our experience will certainly be valuable to other student groups interested in taking on a challenging project such as a Get-Away-Special payload.

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

PubMed

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

2014-03-01

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

NAPS as an Alertness Management Strategy

NASA Technical Reports Server (NTRS)

Rosekind, Mark R.; Smith, Roy M.; Miller, Donna L.; Co, Elizabeth L.; Gregory, Kevin B.; Gander, Philippa H.; Lebacqz, J. Victor

2001-01-01

Today, 24-hour operations are necessary to meet the demands of our society and the requirements of our industrialized global economy. These around-the-clock demands pose unique physiological challenges for the humans who remain central to safe and productive operations. Optimal alertness and performance are critical factors that are increasingly challenged by unusual, extended, or changing work/rest schedules. Technological advancements and automated systems can exacerbate the challenges faced by the human factor in these environments. Shift work, transportation demands, and continuous operations engender sleep loss and circadian disruption. Both of these physiological factors can lead to increased sleepiness, decreased performance, and a reduced margin of safety. These factors can increase vulnerability to incidents and accidents in operational settings. The consequences can have both societal effects (e.g., major destructive accidents such as Three Mile Island, Exxon Valdez, Bhopal) and personal effects (e.g., an accident driving home after a night shift).

Making It Local: Beacon Communities Use Health Information Technology to Optimize Care Management

PubMed Central

Allen, Amy; Des Jardins, Terrisca R.; Heider, Arvela; Kanger, Chatrian R.; Lobach, David F.; McWilliams, Lee; Polello, Jennifer M.; Schachter, Abigail A.; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C.; Turske, Scott A.

2014-01-01

Abstract Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks—including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation—the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability. (Population Health Management 2014;17:149–158) PMID:24476558

Long-term ecology resolves the timing, region of origin and process of establishment for a disputed alien tree

PubMed Central

Wilmshurst, Janet M.; McGlone, Matt S.; Turney, Chris S.M.

2015-01-01

Alien plants are a pervasive environmental problem, particularly on islands where they can rapidly transform unique indigenous ecosystems. However, often it is difficult to confidently determine whether a species is native or alien, especially if establishment occurred before historical records. This can present a management challenge: for example, should such taxa be eradicated or left alone until their region of origin and status are clarified? Here we show how combining palaeoecological and historical records can help resolve such dilemmas, using the tree daisy Olearia lyallii on the remote New Zealand subantarctic Auckland Islands as a case study. The status of this tree as native or introduced has remained uncertain for the 175 years since it was first discovered on the Auckland Islands, and its appropriate management is debated. Elsewhere, O. lyallii has a highly restricted distribution on small sea bird-rich islands within a 2° latitudinal band south of mainland New Zealand. Analysis of palaeoecological and historical records from the Auckland Islands suggest that O. lyallii established there c. 1807 when these islands were first exploited by European sealers. Establishment was facilitated by anthropogenic burning and clearing and its subsequent spread has been slow, limited in distribution and probably human-assisted. Olearia lyallii has succeeded mostly in highly disturbed sites which are also nutrient enriched from nesting sea birds, seals and sea spray. This marine subsidy has fuelled the rapid growth of O. lyallii and allowed this tree to be competitive against the maritime communities it has replaced. Although endemic to the New Zealand region, our evidence suggests that O. lyallii is alien to the Auckland Islands. Although such ‘native’ aliens can pose unique management challenges on islands, in this instance we suggest that ongoing monitoring with no control is an appropriate management action, as O. lyallii appears to pose minimal risk to ecological integrity. PMID:26311733

Sustainable Approaches for Materials Management in Remote ...

EPA Pesticide Factsheets

Remote, economically challenged areas in the Commonwealth of the Northern Marianas Islands (CNMI) and American Samoa in the US Pacific island territories face unique challenges with respect to solid waste management. These islands are remote and isolated, with some islands supporting only small populations, thus limiting options for pooling resources among communities in the form of regional waste management facilities, as is common on the US mainland. This isolation also results in greater costs for waste management compared to those encountered in the mainland US, a consequence of, among other factors, more expensive construction and maintenance costs because of the necessary transport of facility components (e.g., landfill liner materials) and the decreased attractiveness of waste recovery for recycling because of lower commodity prices after off-island transportation. Adding to these economic limitations, the gross domestic product and per capita income of the Pacific territories is less than half what it is in parts of the US. The first section of this report outlines a snapshot of the current state of solid waste management overall in the US Pacific island territories, primarily based on site visits.. Steps involved in this work included a review of selected existing published information related to the subject; site visits to Guam, Saipan, Tinian, Rota, Tutuila, and Apia; an assessment of the technical and economic feasibility of different solid waste

Challenges in the management of support and care programmes for child-headed households in South Africa.

PubMed

Human, Sarie P; van Rensburg, Gisela H

2011-10-01

The present study reports on data collected in a larger study on 'A situational analysis of child-headed households in South Africa'. The purpose of this study was to explore the management and control of available and required services, resources and safety nets for children in child-headed households. The significance of having a better understanding of the challenges, limitations but importance for government structures to manage and control programmes will enhance the implementation and maintenance of focused and sustainable support structures and programmes which will effectively address the needs of child-headed households. An exploratory and descriptive, quantitative survey was conducted to provide information on government structures at a national level and the nine provinces in South Africa. The population consisted of the Departments of Social Development, Education, Health and Agriculture, at both national and provincial levels. The main findings included a lack of clarity regarding the concept and definition of a child-headed household, lack of empirical data, a diversity of needs and challenges in terms of location and geographical distribution of available infrastructure and support systems; programmes that are not inclusive and integrated; and contradictions in the stipulations and implementation of existing policies and capacity and human resources shortages. It was concluded that the magnitude, uniqueness and complexity of the phenomenon necessitate effective and sound scientific management principles. This is achieved by providing legal clarity of the concept; developing relevant policies and ensuring effective implementation thereof; rigorous monitoring and evaluation based on comprehensive empirical data; and protecting the rights and safety of these children and ensuring an enabling environment for all stakeholders to address needs and challenges. The role of the nurse manager is to ensure a holistic approach to children living in child-headed households by acting as a facilitator, advocate, leader, coordinator and consultant. © 2011 Blackwell Publishing Ltd.

The Challenges Of Investigating And Remediating Port Hope's Small-Scale Urban Properties - 13115

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

Veen, Walter van; Case, Glenn; Benson, John

2013-07-01

An important component of the Port Hope Project, the larger of the two projects comprising the Port Hope Area Initiative (PHAI), is the investigation of all 4,800 properties in the Municipality of Port Hope for low level radioactive waste (LLRW) and the remediation of approximately 10% of these. Although the majority of the individual properties are not expected to involve technically sophisticated remediation programs, the large number of property owners and individually unique properties are expected to present significant logistic challenges that will require a high degree of planning, organization and communication. The protocol and lessons learned described will bemore » of interest to those considering similar programs. Information presented herein is part of a series of papers presented by the PHAI Management Office (PHAI MO) at WM Symposium '13 describing the history of the Port Hope Project and current project status. Other papers prepared for WM Symposium '13 address the large-scale site cleanup and the construction of the long-term waste management facility (LTWMF) where all of the LLRW will be consolidated and managed within an engineered, above-ground mound. (authors)« less

Temporary wetlands: Challenges and solutions to conserving a ‘disappearing’ ecosystem

USGS Publications Warehouse

Calhoun, Aram J.K.; Mushet, David M.; Bell, Kathleen P.; Boix, Dani; Fitzsimons, James A.; Isselin-Nondedeu, Francis

2017-01-01

Frequent drying of ponded water, and support of unique, highly specialized assemblages of often rare species, characterize temporary wetlands, such as vernal pools, gilgais, and prairie potholes. As small aquatic features embedded in a terrestrial landscape, temporary wetlands enhance biodiversity and provide aesthetic, biogeochemical, and hydrologic functions. Challenges to conserving temporary wetlands include the need to: (1) integrate freshwater and terrestrial biodiversity priorities; (2) conserve entire ‘pondscapes’ defined by connections to other aquatic and terrestrial systems; (3) maintain natural heterogeneity in environmental gradients across and within wetlands, especially gradients in hydroperiod; (4) address economic impact on landowners and developers; (5) act without complete inventories of these wetlands; and (6) work within limited or non-existent regulatory protections. Because temporary wetlands function as integral landscape components, not singly as isolated entities, their cumulative loss is ecologically detrimental yet not currently part of the conservation calculus. We highlight approaches that use strategies for conserving temporary wetlands in increasingly human-dominated landscapes that integrate top-down management and bottom-up collaborative approaches. Diverse conservation activities (including education, inventory, protection, sustainable management, and restoration) that reduce landowner and manager costs while achieving desired ecological objectives will have the greatest probability of success in meeting conservation goals.

Recent Development in Big Data Analytics for Business Operations and Risk Management.

PubMed

Choi, Tsan-Ming; Chan, Hing Kai; Yue, Xiaohang

2017-01-01

"Big data" is an emerging topic and has attracted the attention of many researchers and practitioners in industrial systems engineering and cybernetics. Big data analytics would definitely lead to valuable knowledge for many organizations. Business operations and risk management can be a beneficiary as there are many data collection channels in the related industrial systems (e.g., wireless sensor networks, Internet-based systems, etc.). Big data research, however, is still in its infancy. Its focus is rather unclear and related studies are not well amalgamated. This paper aims to present the challenges and opportunities of big data analytics in this unique application domain. Technological development and advances for industrial-based business systems, reliability and security of industrial systems, and their operational risk management are examined. Important areas for future research are also discussed and revealed.

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

PubMed

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

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

Conservative Management for Stable High Ankle Injuries in Professional Football Players.

PubMed

Knapik, Derrick M; Trem, Anthony; Sheehan, Joseph; Salata, Michael J; Voos, James E

High ankle "syndesmosis" injuries are common in American football players relative to the general population. At the professional level, syndesmotic sprains represent a challenging and unique injury lacking a standardized rehabilitation protocol during conservative management. PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE databases were searched using the terms syndesmotic injuries, American football, conservative management, and rehabilitation. Clinical review. Level 3. When compared with lateral ankle sprains, syndesmosis injuries result in significantly prolonged recovery times and games lost. For stable syndesmotic injuries, conservative management features a brief period of immobilization and protected weightbearing followed by progressive strengthening exercises and running, and athletes can expect to return to competition in 2 to 6 weeks. Further research investigating the efficacy of dry needling and blood flow restriction therapy is necessary to evaluate the benefit of these techniques in the rehabilitation process. Successful conservative management of stable syndesmotic injuries in professional American football athletes requires a thorough understanding of the anatomy, injury mechanisms, diagnosis, and rehabilitation strategies utilized in elite athletes.

Diagnosis and management of Duchenne muscular dystrophy, part 3: primary care, emergency management, psychosocial care, and transitions of care across the lifespan

PubMed Central

Birnkrant, David J; Bushby, Katharine; Bann, Carla M; Apkon, Susan D; Blackwell, Angela; Colvin, Mary K; Cripe, Linda; Herron, Adrienne R; Kennedy, Annie; Kinnett, Kathi; Naprawa, James; Noritz, Garey; Poysky, James; Street, Natalie; Trout, Christina J; Weber, David R; Ward, Leanne M

2018-01-01

Improvements in the function, quality of life, and longevity of patients with Duchenne muscular dystrophy (DMD) have been achieved through a multidisciplinary approach to management across a range of health-care specialties. In part 3 of this update of the DMD care considerations, we focus on primary care, emergency management, psychosocial care, and transitions of care across the lifespan. Many primary care and emergency medicine clinicians are inexperienced at managing the complications of DMD. We provide a guide to the acute and chronic medical conditions that these first-line providers are likely to encounter. With prolonged survival, individuals with DMD face a unique set of challenges related to psychosocial issues and transitions of care. We discuss assessments and interventions that are designed to improve mental health and independence, functionality, and quality of life in critical domains of living, including health care, education, employment, interpersonal relationships, and intimacy. PMID:29398641

Recommendations for the management of food allergies in a preschool/childcare setting and prevention of anaphylaxis.

PubMed

Ford, Lara S; Turner, Paul J; Campbell, Dianne E

2014-07-01

Food allergy and anaphylaxis occur most commonly in children under five, the majority of whom attend preschool and early childcare. Children under five differ significantly from school-aged children, as do their care environments, yet specific strategies for managing food allergies in early childcare settings are generally lacking in existing guidelines and legislation. In this review, we outline the scope of the problem, the unique challenges encountered in the preschool environment and existing policy and legislation in Australia, the US, Canada and the UK. We outline the management guidelines and resources available from specialist societies, and the evidence base for specific management strategies including voluntary versus legislative approaches, staff training and education, banning of foods, and availability of multiple and generic adrenaline auto-injectors. We call for greater uniformity and consistency of policy in regards to the recognition and management of infants and children with food allergy in the preschool environment and specific programmes and policies tailored to this environment.

Sustaining the rural workforce: nursing perspectives on worklife challenges.

PubMed

Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary

2009-01-01

Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.

When doctor becomes patient: challenges and strategies in caring for physician-patients.

PubMed

Domeyer-Klenske, Amy; Rosenbaum, Marcy

2012-01-01

The current study was aimed at exploring the challenges that arise in the doctor-patient relationship when the patient is also a physician and identifying strategies physicians use to meet these challenges. No previous research has systematically investigated primary care physicians' perspectives on caring for physician-patients. Family medicine (n=15) and general internal medicine (n=14) physicians at a large Midwestern university participated in semi-structured interviews where they were asked questions about their experiences with physician-patients and the strategies they used to meet the unique needs of this patient population. Thematic analysis was used to identify common responses. Three of the challenges most commonly discussed by physician participants were: (1) maintaining boundaries between relationships with colleagues or between roles as physician/colleague/friend, (2) avoiding assumptions about patient knowledge and health behaviors, and (3) managing physician-patients' access to informal consultations, personal test results, and opinions from other colleagues. We were able to identify three main strategies clinicians use in addressing these perceived challenges: (1) Ignore the physician-patient's background, (2) Acknowledge the physician-patient's background and negotiate care, and (3) Allow care to be driven primarily by the physician-patient. It is important that primary care physicians understand the challenges inherent in treating physicians and develop a strategy with which they are comfortable addressing them. Explicitly communicating with the physician-patient to ensure boundaries are maintained, assumptions about the physician-patient are avoided, and physician-patient access is properly managed are key to providing quality care to physician-patients.

Colorectal cancer: complexities and challenges in managed care.

PubMed

Minkoff, Neil B

2007-08-01

Managed care weighs advances and associated costs to determine whether the combination of longer life at sometimes significantly increased cost represents value. The price of treatment is only 1 factor. To review treatment decision processes for oncologic agents in managed care environments. Price can be exceptionally high for individuals. But if the population size is low, the per-member-per-month (PMPM) impact can be almost negligible, unlike treatments that have moderate costs but are used ubiquitously. Cancer therapies have, for the most part, escaped managed care's notice. For 2007, the national Cancer Institute projects that antineoplastic agents will consume almost a quarter of the overall drug spend. The Medicare population is a unique concern with regard to cancer. Traditionally, Medicare reimbursement of chemotherapeutic agents was based on average wholesale price (AWP) discounting, not the oncologist's purchasing cost. This allowed oncologists to use reimbursement for infusions to support their medical practices. The proposed plan of the Center for Medicare & Medicaid Services (CMS) to use average sales price (ASP) plus 6% to reimburse for drugs used in the office setting leads to significant problems. Pharmacy and therapeutics committees will also face challenges: fewer data are available for some agents because they have become available through the U.S. Food and drug administration's Fast Track, Priority review, or accelerated approval processes. Oncology disease management programs must reach out to patients and not necessarily deal with oncology issues directly, but address tangential issues that impact care, especially depression and pain management.

The management of hodgkin lymphomas in pregnancies.

PubMed

Moshe, Yakir; Bentur, Ohad Shimshon; Lishner, Michael; Avivi, Irit

2017-11-01

Hodgkin lymphoma is the most common hematological malignancy in pregnancy. Its management presents several unique challenges, as decisions have to take both maternal and fetal risks into consideration. Using three hypothetical cases, we review current evidence and guidelines and suggest our recommendations for managing pregnant Hodgkin lymphoma patients. The opportunity for a prompt and accurate diagnosis should not be missed; this may be achieved by vigilance to suggestive symptoms, performance of biopsy which is not contraindicated during pregnancy and use of MRI for staging. Most patients should receive treatment with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) after completion of the first trimester. Bridging therapy with corticosteroids or vinblastine should be considered during the first trimester. In most cases of early disease, the addition of chemotherapy cycles to the treatment plan seems preferable to radiation therapy. Diagnosis at relapse raises unique dilemmas regarding second-line chemotherapeutic regimens and timing of consolidation with high-dose therapy and autologous stem cell transplantation, an approach which is contraindicated during pregnancy. Considering the excellent outcomes of Hodgkin lymphoma outside pregnancy, every effort should be made to strive toward a curative treatment plan while balancing the multiple issues and dilemmas which arise when treating this malignancy in a pregnant patient. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Roles, skills, and competencies of middle managers in occupational therapy.

PubMed

Guo, Kristina L; Calderon, Ana

2007-01-01

This article describes the most essential roles, skills, and competencies needed by middle managers in occupational therapy organizations. Middle-level managers are responsible for a specific segment of the organization. They are uniquely positioned to foster changes in the department. Because of the challenges in the health care environment, it is important to discuss the roles that middle managers need to bring out the viability and growth of their departments and organization. These roles include planner, strategic planner, coordinator, leader, problem solver, and negotiator. To conduct these roles, skills and competencies that are closely linked to the effective performance of those roles are also described. Skills include human relations, marketing, and conceptual skills. Competencies include being able to manage attention, meaning, trust, and self, as well as being competent when conducting utilization reviews, program evaluations, documentation of services for quality and reimbursement purposes, and fiscal management. With these outlined roles, skills, and competencies, middle managers should be able to promote the mission of their organizations, support their employees, and navigate successfully in the competitive and ever-changing health care environment.

Specimen Sample Preservation for Cell and Tissue Cultures

NASA Technical Reports Server (NTRS)

Meeker, Gabrielle; Ronzana, Karolyn; Schibner, Karen; Evans, Robert

1996-01-01

The era of the International Space Station with its longer duration missions will pose unique challenges to microgravity life sciences research. The Space Station Biological Research Project (SSBRP) is responsible for addressing these challenges and defining the science requirements necessary to conduct life science research on-board the International Space Station. Space Station will support a wide range of cell and tissue culture experiments for durations of 1 to 30 days. Space Shuttle flights to bring experimental samples back to Earth for analyses will only occur every 90 days. Therefore, samples may have to be retained for periods up to 60 days. This presents a new challenge in fresh specimen sample storage for cell biology. Fresh specimen samples are defined as samples that are preserved by means other than fixation and cryopreservation. The challenge of long-term storage of fresh specimen samples includes the need to suspend or inhibit proliferation and metabolism pending return to Earth-based laboratories. With this challenge being unique to space research, there have not been any ground based studies performed to address this issue. It was decided hy SSBRP that experiment support studies to address the following issues were needed: Fixative Solution Management; Media Storage Conditions; Fresh Specimen Sample Storage of Mammalian Cell/Tissue Cultures; Fresh Specimen Sample Storage of Plant Cell/Tissue Cultures; Fresh Specimen Sample Storage of Aquatic Cell/Tissue Cultures; and Fresh Specimen Sample Storage of Microbial Cell/Tissue Cultures. The objective of these studies was to derive a set of conditions and recommendations that can be used in a long duration microgravity environment such as Space Station that will permit extended storage of cell and tissue culture specimens in a state consistent with zero or minimal growth, while at the same time maintaining their stability and viability.

Challenges for Engineering Design, Construction, and Maintenance of Infrastructure in Afghanistan

DTIC Science & Technology

2010-11-01

applied engineering expertise that collectively can solve challenging infra- structure problems. USACE-ERDC’s researchers and engineers are field...Development Center (ERDC) possesses a unique combination of basic research and applied engineering expertise that collectively can solve challenging...restoration, and other projects. The USACE Engineer Research and Development Center (ERDC) possesses a unique combination of basic research and applied

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

Kizilyalli, Isik; Evans, Craig; Matocha, Kevin

The ARPA-E model is unique in that the agency does not just provide teams funding. Throughout the lifetime of an ARPA-E award, ARPA-E Program Directors and Tech-to-Market Advisors also provide teams with expert advice through quarterly reviews and onsite visits. This hands-on approach helps ensure teams can meet ambitious milestones, target and tackle problems early on, and advance their technologies towards commercialization. Program Director Dr. Isik Kizilyalli explains the importance of this active project management approach in helping teams identify and overcome barriers. In this video, Energy Storage Systems (ESS) from the GRIDS program and Monolith Semiconductors from the SWITCHESmore » program discuss how ARPA-E’s active project management approach helped them find solutions to technical challenges.« less

Emotional intelligence skills for maintaining social networks in healthcare organizations.

PubMed

Freshman, Brenda; Rubino, Louis

2004-01-01

For healthcare organizations to survive in these increasingly challenging times, leadership and management must face mounting interpersonal concerns. The authors present the boundaries of internal and external social networks with respect to leadership and managerial functions: Social networks within the organization are stretched by reductions in available resources and structural ambiguity, whereas external social networks are stressed by interorganizational competitive pressures. The authors present the development of emotional intelligence skills in employees as a strategic training objective that can strengthen the internal and external social networks of healthcare organizations. The authors delineate the unique functions of leadership and management with respect to the application of emotional intelligence skills and discuss training and future research implications for emotional intelligence skill sets and social networks.

Skylab

NASA Image and Video Library

1972-05-01

This image is a wide-angle view of the Orbital Workshop waste management compartment. The waste management facilities presented a unique challenge to spacecraft designers. In addition to collection of liquid and solid human wastes, there was a medical requirement to dry all solid human waste products and to return the residue to Earth for examination. Liquid human waste (urine) was frozen for return to Earth. Total quantities of each astronaut's liquid and solid wastes were precisely measured. Cabin air was drawn into the toilet, shown on the wall at right in this photograph, and over the waste products to generate a flow of the waste in the desired direction. The air was then filtered for odor control and antiseptic purposes prior to being discharged back into the cabin.

Pediatric facial fractures as a result of gunshot injuries: an examination of associated injuries and trends in management.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Paik, Angie M; Lee, Edward S; Granick, Mark S

2014-03-01

Facial fractures are relatively uncommon in the pediatric population, especially those inflicted as a result of interpersonal violence in the form of gunshot injuries. Few studies have examined the unique management of such high-energy injuries in the pediatric population. Oftentimes the resultant damage to soft tissue and bony structures is so great that it challenges the previously accepted standards in the management of pediatric facial fractures. This study will examine a level 1 trauma center's experience with these unique injuries. A retrospective review of all facial fractures occurring in a pediatric population (those 18 years of age or younger) as a result of gunshot wounds in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Descriptive information was collected regarding each case as well as information regarding concomitant injuries, treatment modalities, and selected outcomes. During this time period, there were 3147 facial fractures treated at our institution, 353 of which were in pediatric patients. Of these, 17 were the results of gunshot wounds. Three patients were excluded due to insufficient data, leaving a total of 14 patients. The average age of patients was 16.5 (range 14-18); all patients were African-American males. The most common fracture was that of the mandible (n = 10), with 2 of those patients exhibiting panfacial fractures. The average Glasgow Coma Scale on admission was 13.5 (range 3-15). Six of the patients were intubated in the emergency department. The most common concomitant injury was a skull fracture (n = 3), followed by cervical spine fractures (n = 2) and intracranial hemorrhages (n = 2). All patients were admitted to the hospital for reasons other than fracture management. Seven patients ultimately went to the operating room for fracture management. The treatment modalities employed were conservative management with closed techniques (n = 11), rigid internal fixation (n = 2), and the use of an external fixator device (n = 1). Minimal to no soft-tissue debridement was performed in 10 of the 14 patients, 2 of which presented between 6 months and 10 years post-injury with soft-tissue complications related to retained material. The mean hospital length of stay was 8.2 days (range 1-18 days). One patient expired. Pediatric facial fractures as a result of gunshot wounds represent a unique and fortunately rare entity that presents a challenge to all disciplines involved in treatment. In our patients, there was a tendency towards conservative management, with only 3 patients undergoing some form of fixation and only 7 undergoing some form of operative debridement. Concomitant injuries and the high-energy nature of gunshot wounds often preclude traditional management with rigid fixation to ensure adequate bony healing. However, it is important to adequately debride devitalized soft tissue and remove all foreign material to avoid future soft tissue-related complications.

Mandibular second molar exhibiting a unique "Y-" and "J-" "shaped" root canal anatomy diagnosed using cone-beam computed tomographic scanning: A case report.

PubMed

Parashar, Saumya-Rajesh; Kowsky, R Dinesh; Natanasabapathy, Velmurugan

2017-01-01

This article aims to report a unique case with aberrant root canal anatomy exhibiting "Y-" and "J"-shaped canal pattern in a mandibular second molar. Anatomic complexities may pose challenges for endodontic treatment. Before performing endodontic treatment, the clinician should be aware of the internal anatomy of the tooth being treated and should recognize anatomic aberrations if present. Presence of unusual anatomy may call for modifications in treatment planning. This report describes in detail about a mandibular second molar tooth associated with two paramolar tubercles having a peculiar "Y-" and "J-"shaped canal anatomy detected with the aid of cone beam computed tomography, which has never been reported in the dental literature. The proposed treatment protocol for the endodontic management of the same has also been discussed.

Concomitant weekly cisplatin and thoracic radiotherapy for Pancoast tumors of the lung: pilot experience of the San Antonio Cancer Institute.

PubMed

Barnes, Jonathan B; Johnson, Scott B; Dahiya, Rajiv S; Temes, R Thomas; Herman, Terence S; Thomas, Charles R

2002-02-01

Pancoast (superior sulcus tumors) comprise a subset of non-small-cell lung cancers that have a unique clinical presentation by virtue of the locoregional pattern of disease progression. We herein report a brief report on our group's pilot experience in managing these challenging lung neoplasms with an aggressive concomitant modality approach. These results and those of the recent Southwest Oncology-lead Intergroup prospective phase 2 trial (SWOG-9416/INT-0160) support the use of concomitant chemoradiation followed by an attempt at surgical resection.

Transosseous fixation of pediatric displaced mandibular fractures with polyglactin resorbable suture--a simplified technique.

PubMed

Chandan, Sanjay; Halli, Rajshekhar; Joshi, Samir; Chhabaria, Gaurav; Setiya, Sneha

2013-11-01

Management of pediatric mandibular fractures presents a unique challenge to surgeons in terms of its numerous variations compared to adults. Both conservative and open methods have been advocated with their obvious limitations and complications. However, conservative modalities may not be possible in grossly displaced fractures, which necessitate the open method of fixation. We present a novel and simplified technique of transosseous fixation of displaced pediatric mandibular fractures with polyglactin resorbable suture, which provides adequate stability without any interference with tooth buds and which is easy to master.

Is There a Doctor Onboard? Medical Emergencies at 40,000 Feet.

PubMed

Donner, Howard J

2017-05-01

It is estimated 2.75 billion people travel aboard commercial airlines every year and 44,000 in-flight medical emergencies occur worldwide each year. Wilderness medicine requires a commonsense and improvisational approach to medical issues. A sudden call for assistance in the austere and unfamiliar surroundings of an airliner cabin may present the responding medical professional with a "wilderness medicine" experience. From resource management to equipment, this article sheds light on the unique conditions, challenges, and constraints of the flight environment. Copyright © 2017 Elsevier Inc. All rights reserved.

Managing residual limb hyperhidrosis in wounded warriors.

PubMed

Pace, Sarah; Kentosh, Joshua

2016-06-01

Residual limb dermatologic problems are a common concern among young active traumatic amputee patients who strive to maintain an active lifestyle. Hyperhidrosis of residual limbs is a recognized inciting factor that often contributes to residual limb dermatoses and is driven by the design of the prosthetic liner covering the residual limb. Treatment of hyperhidrosis in this population presents a unique challenge. Several accepted treatments of hyperhidrosis can offer some relief but have been limited by lack of results or side-effect profiles. Microwave thermal ablation has presented an enticing potential for residual limb hyperhidrosis.

HIV Infection and Older Americans: The Public Health Perspective

PubMed Central

Buchacz, Kate; Gebo, Kelly A.; Mermin, Jonathan

2012-01-01

HIV disease is often perceived as a condition affecting young adults. However, approximately 11% of new infections occur in adults aged 50 years or older. Among persons living with HIV disease, it is estimated that more than half will be aged 50 years or older in the near future. In this review, we highlight issues related to HIV prevention and treatment for HIV-uninfected and HIV-infected older Americans, and outline unique considerations and emerging challenges for public health and patient management in these 2 populations. PMID:22698038

Scalable Clinical Decision Support for Individualized Cancer Risk Management | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

We will build a scalable clinical decision support (CDS) platform that helps clinicians and patients select cancer screening strategies that are best suited to each individual. This kind of CDS is important because increased evidence supports personalizing cancer screening decisions according to each individual's unique cancer risks. While a highly desired goal, individualizing screening at a population scale requires the implementation of patient-specific risk assessments for several types of cancer. This is quite challenging in today's overwhelmed primary care environment.

Development and Execution of End-of-Mission Operations Case Study of the UARS and ERBS End-of-Mission Plans

NASA Technical Reports Server (NTRS)

Hughes, John; Marius, Julio L.; Montoro, Manuel; Patel, Mehul; Bludworth, David

2006-01-01

This Paper is a case study of the development and execution of the End-of-Mission plans for the Earth Radiation Budget Satellite (ERBS) and the Upper Atmosphere Research Satellite (UARS). The goals of the End-of-Mission Plans are to minimize the time the spacecraft remains on orbit and to minimize the risk of creating orbital debris. Both of these Missions predate the NASA Management Instructions (NMI) that directs missions to provide for safe mission termination. Each spacecrafts had their own unique challenges, which required assessing End-of-Mission requirements versus spacecraft limitations. Ultimately the End-of- Mission operations were about risk mitigation. This paper will describe the operational challenges and the lessons learned executing these End-of-Mission Plans

Development, risk, and resilience of transgender youth.

PubMed

Stieglitz, Kimberly A

2010-01-01

Transgender youth face unique and complex issues as they confront cultural expectations of gender expression and how these fit with what is natural for them. Striving for balance, learning to cope, questioning, and eventually becoming comfortable with one's gender identity and sexual orientation are of paramount importance for healthy growth and development. Ineffective management of intense challenges over time without adequate social support places youth at risk for a number of unhealthy behaviors, including risk behaviors associated with acquiring HIV. This article explores early foundations of gender identity development, challenges in the development of transgender youth, and the limited data that exist on transgender youth and HIV risks. The concept of resilience is introduced as a counterbalancing area for assessment and intervention in practice and future research with transgender youth.

Employee health surveillance in the health care industry.

PubMed

Hood, Joyce; Larrañaga, Michael

2007-10-01

This article provides an overview of the fundamental and inherent challenges in developing a health surveillance program for a health care facility. These challenges are similar to those facing individuals responsible for developing health surveillance programs for multiple industries because several "mini-industries" exist within hospitals. Hazards can range from those that are regulated by the Occupational Safety and Health Administration to those that are unregulated but pose a threat to health care workers. Occupational hazards that are unique to the health care industry also exist. A health surveillance program can be developed with focused assessment and a strong occupational safety and health program. Implementation can occur within a health care setting with the buy-in of the many stakeholders involved, especially supervisors managing departments where chemical and other hazards are present.

Future implications of eHealth interventions for chronic pain management in underserved populations.

PubMed

DeMonte, Colette M; DeMonte, William D; Thorn, Beverly E

2015-01-01

Many underserved communities, especially those in rural settings, face unique challenges that make high quality healthcare less accessible. The implementation of eHealth technologies has become a potentially valuable option to disseminate interventions. The authors' work in rural Alabama Federally Qualified Health Centers provide insights into the access to technology as well as the likelihood of utilizing eHealth technology in underserved communities. This paper will review current challenges related to digital dissemination of behavioral health interventions for chronic pain. Two major concerns are the lack of technological resources and the lack of appropriate materials for patients who may have low levels of reading, health and/or digital literacy. We will propose some recommendations to address common barriers faced by those providing care.

Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events.

PubMed

Lansdowne, Krystal; Scully, Christopher G; Galeotti, Loriano; Schwartz, Suzanne; Marcozzi, David; Strauss, David G

2015-06-01

In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high-priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. Triage in CBRN scenarios presents unique challenges for first responders because the effects of CBRN agents and the clinical presentations of casualties at each triage stage can vary. The uniqueness of a CBRN event can render standard patient monitoring medical device and conventional triage algorithms ineffective. Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications ("medical apps") for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events.

Fuzzy Multicriteria Decision Analysis for Adaptive Watershed Management

NASA Astrophysics Data System (ADS)

Chang, N.

2006-12-01

The dramatic changes of societal complexity due to intensive interactions among agricultural, industrial, and municipal sectors have resulted in acute issues of water resources redistribution and water quality management in many river basins. Given the fact that integrated watershed management is more a political and societal than a technical challenge, there is a need for developing a compelling method leading to justify a water-based land use program in some critical regions. Adaptive watershed management is viewed as an indispensable tool nowadays for providing step-wise constructive decision support that is concerned with all related aspects of the water consumption cycle and those facilities affecting water quality and quantity temporally and spatially. Yet the greatest challenge that decision makers face today is to consider how to leverage ambiguity, paradox, and uncertainty to their competitive advantage of management policy quantitatively. This paper explores a fuzzy multicriteria evaluation method for water resources redistribution and subsequent water quality management with respect to a multipurpose channel-reservoir system--the Tseng- Wen River Basin, South Taiwan. Four fuzzy operators tailored for this fuzzy multicriteria decision analysis depict greater flexibility in representing the complexity of various possible trade-offs among management alternatives constrained by physical, economic, and technical factors essential for adaptive watershed management. The management strategies derived may enable decision makers to integrate a vast number of internal weirs, water intakes, reservoirs, drainage ditches, transfer pipelines, and wastewater treatment facilities within the basin and bring up the permitting issue for transboundary diversion from a neighboring river basin. Experience gained indicates that the use of different types of fuzzy operators is highly instructive, which also provide unique guidance collectively for achieving the overarching goals of sustainable development on a regional scale.

Injuries to the Aorta, Aortic Annulus, and Left Ventricle During Transcatheter Aortic Valve Replacement: Management and Outcomes.

PubMed

Langer, Nathaniel B; Hamid, Nadira B; Nazif, Tamim M; Khalique, Omar K; Vahl, Torsten P; White, Jonathon; Terre, Juan; Hastings, Ramin; Leung, Diana; Hahn, Rebecca T; Leon, Martin; Kodali, Susheel; George, Isaac

2017-01-01

The experience with transcatheter aortic valve replacement is increasing worldwide; however, the incidence of potentially catastrophic cardiac or aortic complications has not decreased. In most cases, significant injuries to the aorta, aortic valve annulus, and left ventricle require open surgical repair. However, the transcatheter aortic valve replacement patient presents a unique challenge as many patients are at high or prohibitive surgical risk and, therefore, an open surgical procedure may not be feasible or appropriate. Consequently, prevention of these potentially catastrophic injuries is vital, and practitioners need to understand when open surgical repair is required and when alternative management strategies can be used. The goal of this article is to provide an overview of current management and prevention strategies for major complications involving the aorta, aortic valve annulus, and left ventricle. © 2016 American Heart Association, Inc.

Collaborative eHealth Meets Security: Privacy-Enhancing Patient Profile Management.

PubMed

Sanchez-Guerrero, Rosa; Mendoza, Florina Almenarez; Diaz-Sanchez, Daniel; Cabarcos, Patricia Arias; Lopez, Andres Marin

2017-11-01

Collaborative healthcare environments offer potential benefits, including enhancing the healthcare quality delivered to patients and reducing costs. As a direct consequence, sharing of electronic health records (EHRs) among healthcare providers has experienced a noteworthy growth in the last years, since it enables physicians to remotely monitor patients' health and enables individuals to manage their own health data more easily. However, these scenarios face significant challenges regarding security and privacy of the extremely sensitive information contained in EHRs. Thus, a flexible, efficient, and standards-based solution is indispensable to guarantee selective identity information disclosure and preserve patient's privacy. We propose a privacy-aware profile management approach that empowers the patient role, enabling him to bring together various healthcare providers as well as user-generated claims into an unique credential. User profiles are represented through an adaptive Merkle Tree, for which we formalize the underlying mathematical model. Furthermore, performance of the proposed solution is empirically validated through simulation experiments.

Economic credentialing: the propriety of managing physician costs through privileging.

PubMed

Dahl, B A

1999-01-01

Hospital executives face the unique task of managing the costs of an institution in which they have no direct managerial authority over the primary cost drivers, namely, the physicians who practice in the hospital. Perhaps the most controversial method of controlling physician costs consists of the application of economic factors to the credentialing process. Using the credentialing process as a technique to exert fiscal control over physicians affords hospital executives and their governing boards a tremendous cost-management opportunity. The legal propriety of economic credentialing remains unsettled. Many commentators, relying on limited case law, conclude that hospitals can engage in economic credentialing. Nevertheless, hospitals should exercise care when employing an economic rationale to restrict privileges lest they stir up legal challenges. Moreover, if hospitals use economic credentialing to limit medicaid patients' access to hospitals by excluding these patients' physicians from the hospital, the federal government may have the last word on the propriety of the practice.

Progression of understanding for the role of Epstein-Barr virus and management of nasopharyngeal carcinoma.

PubMed

Nakanishi, Yosuke; Wakisaka, Naohiro; Kondo, Satoru; Endo, Kazuhira; Sugimoto, Hisashi; Hatano, Miyako; Ueno, Takayoshi; Ishikawa, Kazuya; Yoshizaki, Tomokazu

2017-09-01

Nasopharyngeal carcinoma (NPC) is very common in southern China and Southeast Asia. In regions where NPC is endemic, undifferentiated subtypes constitute most cases and are invariably associated with Epstein-Barr virus (EBV) infection, whereas the differentiated subtype is more common in other parts of the world. Undifferentiated NPC is a unique malignancy with regard to its epidemiology, etiology, and clinical presentation. Clinically, NPC is highly invasive and metastatic, but sensitive to both chemotherapy and radiotherapy (RT). Overall prognosis has dramatically improved over the past three decades because of advances in management, including the improvement of RT technology, the broader application of chemotherapy, and more accurate disease staging. Despite the excellent local control with modern RT, distant failure remains a challenging problem. Advances in molecular technology have helped to elucidate the molecular pathogenesis of NPC. This article reviews the contribution of EBV gene products to NPC pathogenesis and the current management of NPC.

International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents.

PubMed

Strapazzon, Giacomo; Reisten, Oliver; Argenone, Fabien; Zafren, Ken; Zen-Ruffinen, Greg; Larsen, Gordon L; Soteras, Inigo

2018-06-01

Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Treatment of Young Adults with Acute Lymphoblastic Leukemia.

PubMed

Kansagra, Ankit; Litzow, Mark

2017-06-01

Young adults with acute lymphoblastic leukemia are a distinctive category of patients, with substantial difference in disease biology and response to therapy; hence, they pose unique challenges and issues beyond those faced by children and older adults. Despite inferior survival compared to children, there is growing evidence to suggest that young adults have improved outcomes when treated with pediatric-based approaches. With better supportive care and toxicity management and multidisciplinary team and approach, we have made great improvement in outcomes of young adults with ALL. However, despite significant progress, patients with persistence of minimal residual disease have a poor prognosis. This review discusses current controversies in the management of young adults with ALL, outcomes following pediatric and adult protocols, and the role of allogeneic stem cell transplantation. We also explore recent advances in disease monitoring and highlight our approach to incorporation of novel therapies in the management of young adults with ALL.

Aquatics Systems Branch: transdisciplinary research to address water-related environmental problems

USGS Publications Warehouse

Dong, Quan; Walters, Katie D.

2015-01-01

The Aquatic Systems Branch at the Fort Collins Science Center is a group of scientists dedicated to advancing interdisciplinary science and providing science support to solve water-related environmental issues. Natural resource managers have an increasing need for scientific information and stakeholders face enormous challenges of increasing and competing demands for water. Our scientists are leaders in ecological flows, riparian ecology, hydroscape ecology, ecosystem management, and contaminant biology. The Aquatic Systems Branch employs and develops state-of-the-science approaches in field investigations, laboratory experiments, remote sensing, simulation and predictive modeling, and decision support tools. We use the aquatic experimental laboratory, the greenhouse, the botanical garden and other advanced facilities to conduct unique research. Our scientists pursue research on the ground, in the rivers, and in the skies, generating and testing hypotheses and collecting quantitative information to support planning and design in natural resource management and aquatic restoration.

Functional crown lengthening surgery in the aesthetic zone; periodontic and prosthodontic considerations.

PubMed

Patel, Rajiv M; Baker, Paul

2015-01-01

Crown lengthening surgery aims to increase the amount of supragingival tooth tissue by resection of the soft and/or hard tissues to enable otherwise unrestorable teeth to be restored by increasing the retention and resistance forms of the teeth. Restoration of the worn dentition may require significant prosthodontic knowledge and skill. A prosthodontist should be involved from the beginning of the management of the patient. A number of key stages should be considered for correct management. Although the periodontist may guide the prosthodontist with regards to what may or may not be possible surgically, the overall treatment plan should be prosthodontically driven. Clinical Relevance: Toothwear of the anterior dentition provides a unique challenge to restore not only function but also to manage the aesthetic demands of the patient. To ensure that the correct outcome is reached, clinicians should be familiar with the normal anatomical proportions and relationships to enable planning and treatment to take place.

Operationalizing universal health coverage in Nigeria through social health insurance

PubMed Central

Okpani, Arnold Ikedichi; Abimbola, Seye

2015-01-01

Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme. PMID:26778879

Digital Object Identifiers (DOI's) usage and adoption in U.S Geological Survey (USGS)

NASA Astrophysics Data System (ADS)

Frame, M. T.; Palanisamy, G.

2013-12-01

Addressing grand environmental science challenges requires unprecedented access to easily understood data that cross the breadth of temporal, spatial, and thematic scales. From a scientist's perspective, the big challenges lie in discovering the relevant data, dealing with extreme data heterogeneity, large data volumes, and converting data to information and knowledge. Historical linkages between derived products, i.e. Publications, and associated datasets has not existed in the earth science community. The USGS Core Science Analytics and Synthesis, in collaboration with DOE's Oak Ridge National Laboratory (ORNL) Mercury Consortium (funded by NASA, USGS and DOE), established a Digital Object Identifier (DOI) service for USGS data, metadata, and other media. This service is offered in partnership through the University of California Digital Library EZID service. USGS scientists, data managers, and other professionals can generate globally unique, persistent and resolvable identifiers for any kind of digital objects. Additional efforts to assign DOIs to historical data and publications have also been underway. These DOI identifiers are being used to cite data in journal articles, web-accessible datasets, and other media for distribution, integration, and in support of improved data management practices. The session will discuss the current DOI efforts within USGS, including a discussion on adoption, challenges, and future efforts necessary to improve access, reuse, sharing, and discoverability of USGS data and information.

Assessing the challenges of multi-scope clinical research sites: an example from NIH HIV/AIDS clinical trials networks.

PubMed

Rosas, Scott R; Cope, Marie T; Villa, Christie; Motevalli, Mahnaz; Utech, Jill; Schouten, Jeffrey T

2014-04-01

Large-scale, multi-network clinical trials are seen as a means for efficient and effective utilization of resources with greater responsiveness to new discoveries. Formal structures instituted within the National Institutes of Health (NIH) HIV/AIDS Clinical Trials facilitate collaboration and coordination across networks and emphasize an integrated approach to HIV/AIDS vaccine, prevention and therapeutics clinical trials. This study examines the joint usage of clinical research sites as means of gaining efficiency, extending capacity, and adding scientific value to the networks. A semi-structured questionnaire covering eight clinical management domains was administered to 74 (62% of sites) clinical site coordinators at single- and multi-network sites to identify challenges and efficiencies related to clinical trials management activities and coordination with multi-network units. Overall, respondents at multi-network sites did not report more challenges than single-network sites, but did report unique challenges to overcome including in the areas of study prioritization, community engagement, staff education and training, and policies and procedures. The majority of multi-network sites reported that such affiliations do allow for the consolidation and cost-sharing of research functions. Suggestions for increasing the efficiency or performance of multi-network sites included streamlining standards and requirements, consolidating protocol activation methods, using a single cross-network coordinating centre, and creating common budget and payment mechanisms. The results of this assessment provide important information to consider in the design and management of multi-network configurations for the NIH HIV/AIDS Clinical Trials Networks, as well as others contemplating and promoting the concept of multi-network settings. © 2013 John Wiley & Sons Ltd.

Feline reproduction: problems and clinical challenges.

PubMed

Little, Susan

2011-07-01

Many veterinarians are closely involved with pedigree cat breeding and have become familiar with the unique characteristics of feline reproduction and breeding management. However, even veterinarians who do not have involvement with the pedigree cat fancy require a basic knowledge of the reproductive problems that are most likely to be encountered in working with non-breeding pet cats as well as stray and feral cats. This article reviews reproductive problems and challenges in both sexes - namely, ovarian remnant syndrome, mammary fibroadenomatous hyperplasia, congenital anomalies of the reproductive tract and pregnancy diagnosis in the queen, and cryptorchidism and low libido in the tom. Feline reproduction has not received the amount of investigation and attention that has been directed at canine reproduction. The result is that less data is available both for description of normal reproduction and for management of common problems. This article reviews most of the available evidence for the conditions discussed. Efforts should focus on making information more readily available to the practitioner and expanding the knowledge base in this important area of feline medicine. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

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

Caring for teens with chronic illness: risky business?

PubMed

Louis-Jacques, Jennifer; Samples, Cathryn

2011-08-01

With advances in medicine, more children with chronic illness are reaching adolescence and young adulthood. Research has shown that this group is not immune to the behavioral risks endorsed by healthy adolescents. Recent literature exploring the etiology of risk behaviors and their impact on chronic illness is presented. Risk taking may be the result of differential maturation of two distinct parts of the adolescent brain. Risk taking can be considered normal in adolescents with chronic illness, but there is some evidence that chronic illness affects normal psychosocial development. Moreover, evidence supports that chronic illness can lead to disparities in risk education and assessment because of disease focused management rather than a more comprehensive approach. Youth living with chronic illnesses face unique challenges in accomplishing the developmental tasks of adolescence. These challenges include risk behaviors, which jeopardize current and future health. The reasons for risk taking are multifactorial and require providers to make the adolescent and not the illness the center of management. More research is needed on how to improve developmentally appropriate and relevant interventions to aid in safe passage into adulthood.

In the time of significant generational diversity - surgical leadership must step up!

PubMed

Money, Samuel R; O'Donnell, Mark E; Gray, Richard J

2014-02-01

The diverse attitudes and motivations of surgeons and surgical trainees within different age groups present an important challenge for surgical leaders and educators. These challenges to surgical leadership are not unique, and other industries have likewise needed to grapple with how best to manage these various age groups. The authors will herein explore management and leadership for surgeons in a time of age diversity, define generational variations within "Baby-Boomer", "Generation X" and "Generation Y" populations, and identify work ethos concepts amongst these three groups. The surgical community must understand and embrace these concepts in order to continue to attract a stellar pool of applicants from medical school. By not accepting the changing attitudes and motivations of young trainees and medical students, we may disenfranchise a high percentage of potential future surgeons. Surgical training programs will fill, but will they contain the highest quality trainees? Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Principles and application of LIMS in mouse clinics.

PubMed

Maier, Holger; Schütt, Christine; Steinkamp, Ralph; Hurt, Anja; Schneltzer, Elida; Gormanns, Philipp; Lengger, Christoph; Griffiths, Mark; Melvin, David; Agrawal, Neha; Alcantara, Rafael; Evans, Arthur; Gannon, David; Holroyd, Simon; Kipp, Christian; Raj, Navis Pretheeba; Richardson, David; LeBlanc, Sophie; Vasseur, Laurent; Masuya, Hiroshi; Kobayashi, Kimio; Suzuki, Tomohiro; Tanaka, Nobuhiko; Wakana, Shigeharu; Walling, Alison; Clary, David; Gallegos, Juan; Fuchs, Helmut; de Angelis, Martin Hrabě; Gailus-Durner, Valerie

2015-10-01

Large-scale systemic mouse phenotyping, as performed by mouse clinics for more than a decade, requires thousands of mice from a multitude of different mutant lines to be bred, individually tracked and subjected to phenotyping procedures according to a standardised schedule. All these efforts are typically organised in overlapping projects, running in parallel. In terms of logistics, data capture, data analysis, result visualisation and reporting, new challenges have emerged from such projects. These challenges could hardly be met with traditional methods such as pen & paper colony management, spreadsheet-based data management and manual data analysis. Hence, different Laboratory Information Management Systems (LIMS) have been developed in mouse clinics to facilitate or even enable mouse and data management in the described order of magnitude. This review shows that general principles of LIMS can be empirically deduced from LIMS used by different mouse clinics, although these have evolved differently. Supported by LIMS descriptions and lessons learned from seven mouse clinics, this review also shows that the unique LIMS environment in a particular facility strongly influences strategic LIMS decisions and LIMS development. As a major conclusion, this review states that there is no universal LIMS for the mouse research domain that fits all requirements. Still, empirically deduced general LIMS principles can serve as a master decision support template, which is provided as a hands-on tool for mouse research facilities looking for a LIMS.

Budding trends in integrated pest management using advanced micro- and nano-materials: Challenges and perspectives.

PubMed

Khandelwal, Neha; Barbole, Ranjit S; Banerjee, Shashwat S; Chate, Govind P; Biradar, Ankush V; Khandare, Jayant J; Giri, Ashok P

2016-12-15

One of the most vital supports to sustain human life on the planet earth is the agriculture system that has been constantly challenged in terms of yield. Crop losses due to insect pest attack even after excessive use of chemical pesticides, are major concerns for humanity and environment protection. By the virtue of unique properties possessed by micro and nano-structures, their implementation in Agri-biotechnology is largely anticipated. Hence, traditional pest management strategies are now forestalling the potential of micro and nanotechnology as an effective and viable approach to alleviate problems pertaining to pest control. These technological innovations hold promise to contribute enhanced productivity by providing novel agrochemical agents and delivery systems. Application of these systems engages to achieve: i) control release of agrochemicals, ii) site-targeted delivery of active ingredients to manage specific pests, iii) reduced pesticide use, iv) detection of chemical residues, v) pesticide degradation, vi) nucleic acid delivery and vii) to mitigate post-harvest damage. Applications of micro and nano-technology are still marginal owing to the perception of low economic returns, stringent regulatory issues involving safety assessment and public awareness over their uses. In this review, we highlight the potential application of micro and nano-materials with a major focus on effective pest management strategies including safe handling of pesticides. Copyright © 2016 Elsevier Ltd. All rights reserved.

Laboratory information management system for membrane protein structure initiative--from gene to crystal.

PubMed

Troshin, Petr V; Morris, Chris; Prince, Stephen M; Papiz, Miroslav Z

2008-12-01

Membrane Protein Structure Initiative (MPSI) exploits laboratory competencies to work collaboratively and distribute work among the different sites. This is possible as protein structure determination requires a series of steps, starting with target selection, through cloning, expression, purification, crystallization and finally structure determination. Distributed sites create a unique set of challenges for integrating and passing on information on the progress of targets. This role is played by the Protein Information Management System (PIMS), which is a laboratory information management system (LIMS), serving as a hub for MPSI, allowing collaborative structural proteomics to be carried out in a distributed fashion. It holds key information on the progress of cloning, expression, purification and crystallization of proteins. PIMS is employed to track the status of protein targets and to manage constructs, primers, experiments, protocols, sample locations and their detailed histories: thus playing a key role in MPSI data exchange. It also serves as the centre of a federation of interoperable information resources such as local laboratory information systems and international archival resources, like PDB or NCBI. During the challenging task of PIMS integration, within the MPSI, we discovered a number of prerequisites for successful PIMS integration. In this article we share our experiences and provide invaluable insights into the process of LIMS adaptation. This information should be of interest to partners who are thinking about using LIMS as a data centre for their collaborative efforts.

BioEarth: Envisioning and developing a new regional earth system model to inform natural and agricultural resource management

DOE PAGES

Adam, Jennifer C.; Stephens, Jennie C.; Chung, Serena H.; ...

2014-04-24

Uncertainties in global change impacts, the complexities associated with the interconnected cycling of nitrogen, carbon, and water present daunting management challenges. Existing models provide detailed information on specific sub-systems (e.g., land, air, water, and economics). An increasing awareness of the unintended consequences of management decisions resulting from interconnectedness of these sub-systems, however, necessitates coupled regional earth system models (EaSMs). Decision makers’ needs and priorities can be integrated into the model design and development processes to enhance decision-making relevance and “usability” of EaSMs. BioEarth is a research initiative currently under development with a focus on the U.S. Pacific Northwest region thatmore » explores the coupling of multiple stand-alone EaSMs to generate usable information for resource decision-making. Direct engagement between model developers and non-academic stakeholders involved in resource and environmental management decisions throughout the model development process is a critical component of this effort. BioEarth utilizes a bottom-up approach for its land surface model that preserves fine spatial-scale sensitivities and lateral hydrologic connectivity, which makes it unique among many regional EaSMs. Here, we describe the BioEarth initiative and highlights opportunities and challenges associated with coupling multiple stand-alone models to generate usable information for agricultural and natural resource decision-making.« less

Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities.

PubMed

Drummond, Jennifer L; Were, Martin C; Arrossi, Silvina; Wools-Kaloustian, Kara

2017-07-01

Appropriate collection and use of health information is critical to the planning, scaling up, and improvement of cervical cancer programs. The health information systems implementation landscape is unique to each country; however, systems serving cervical cancer programs in low-resource settings share characteristics that present common challenges. In response, many programs have taken innovative approaches to generating the quality information needed for decision making. Recent advances in health information technology also provide feasible solutions to challenges. This article draws from the experiences of the authors and from current literature to describe outstanding challenges and promising practices in the implementation of cervical cancer data systems, and to make recommendations for next steps. Recommendations include engaging all stakeholders-including providers, program managers, implementing partners, and donors-in promoting national, district, and community information systems; building on existing systems and processes, as well as introducing new technologies; and evolving data collection and data systems as programs advance. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Integrating an incident management system within a continuity of operations programme: case study of the Bank of Canada.

PubMed

Loop, Carole

2013-01-01

Carrying out critical business functions without interruption requires a resilient and robust business continuity framework. By embedding an industry-standard incident management system within its business continuity structure, the Bank of Canada strengthened its response plan by enabling timely response to incidents while maintaining a strong focus on business continuity. A total programme approach, integrating the two disciplines, provided for enhanced recovery capabilities. While the value of an effective and efficient response organisation is clear, as demonstrated by emergency events around the world, incident response structures based on normal operating hierarchy can experience unique challenges. The internationally-recognised Incident Command System (ICS) model addresses these issues and reflects the five primary incident management functions, each contributing to the overall strength and effectiveness of the response organisation. The paper focuses on the Bank of Canada's successful implementation of the ICS model as its incident management and continuity of operations programmes evolved to reflect current best practices.

Temporal and Location Based RFID Event Data Management and Processing

NASA Astrophysics Data System (ADS)

Wang, Fusheng; Liu, Peiya

Advance of sensor and RFID technology provides significant new power for humans to sense, understand and manage the world. RFID provides fast data collection with precise identification of objects with unique IDs without line of sight, thus it can be used for identifying, locating, tracking and monitoring physical objects. Despite these benefits, RFID poses many challenges for data processing and management. RFID data are temporal and history oriented, multi-dimensional, and carrying implicit semantics. Moreover, RFID applications are heterogeneous. RFID data management or data warehouse systems need to support generic and expressive data modeling for tracking and monitoring physical objects, and provide automated data interpretation and processing. We develop a powerful temporal and location oriented data model for modeling and queryingRFID data, and a declarative event and rule based framework for automated complex RFID event processing. The approach is general and can be easily adapted for different RFID-enabled applications, thus significantly reduces the cost of RFID data integration.

Heart failure in sub-Saharan Africa: A clinical approach.

PubMed

Kraus, S; Ogunbanjo, G; Sliwa, K; Ntusi, N A B

2016-01-01

Despite medical advances, heart failure (HF) remains a global health problem and sub-Saharan Africa (SSA) is no exception, with decompensated HF being the most common primary diagnosis for patients admitted to hospital with heart disease. In SSA the in-hospital mortality rate of decompensated HF is up to 8.3%. HF is a clinical syndrome that is caused by a diverse group of aetiologies, each requiring unique management strategies, highlighting the need for diagnostic certainty and a broad understanding of the complex pathophysiology of this condition. While there are a number of advanced medical, device and surgical interventions being tailored for HF internationally, the fundamental basic principles of HF management, such as patient education, effective management of congestion and initiation of disease-modifying medical therapies, remain a challenge on our continent. This review addresses both the epidemiology of HF in SSA and principles of management that focus specifically on symptom relief, prevention of hospitalisation and improving survival in this population.

An application of digital network technology to medical image management.

PubMed

Chu, W K; Smith, C L; Wobig, R K; Hahn, F A

1997-01-01

With the advent of network technology, there is considerable interest within the medical community to manage the storage and distribution of medical images by digital means. Higher workflow efficiency leading to better patient care is one of the commonly cited outcomes [1,2]. However, due to the size of medical image files and the unique requirements in detail and resolution, medical image management poses special challenges. Storage requirements are usually large, which implies expenses or investment costs make digital networking projects financially out of reach for many clinical institutions. New advances in network technology and telecommunication, in conjunction with the decreasing cost in computer devices, have made digital image management achievable. In our institution, we have recently completed a pilot project to distribute medical images both within the physical confines of the clinical enterprise as well as outside the medical center campus. The design concept and the configuration of a comprehensive digital image network is described in this report.

Endonasal management of pediatric congenital transsphenoidal encephaloceles: nuances of a modified reconstruction technique. Technical note and report of 3 cases.

PubMed

Zeinalizadeh, Mehdi; Sadrehosseini, Seyed Mousa; Habibi, Zohreh; Nejat, Farideh; Silva, Harley Brito da; Singh, Harminder

2017-03-01

OBJECTIVE Congenital transsphenoidal encephaloceles are rare malformations, and their surgical treatment remains challenging. This paper reports 3 cases of transsphenoidal encephalocele in 8- to 24-month-old infants, who presented mainly with airway obstruction, respiratory distress, and failure to thrive. METHODS The authors discuss the surgical management of these lesions via a minimally invasive endoscopic endonasal approach, as compared with the traditional transcranial and transpalatal approaches. A unique endonasal management algorithm for these lesions is outlined. The lesions were repaired with no resection of the encephalocele sac, and the cranial base defects were reconstructed with titanium mesh plates and vascular nasoseptal flaps. RESULTS Reduction of the encephalocele and reconstruction of the skull base was successfully accomplished in all 3 cases, with favorable results. CONCLUSIONS The described endonasal management algorithm for congenital transsphenoidal encephaloceles is a safe, viable alternative to traditional transcranial and transpalatal approaches, and avoids much of the morbidity associated with these open techniques.

Applying Content Management to Automated Provenance Capture

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

Schuchardt, Karen L.; Gibson, Tara D.; Stephan, Eric G.

2008-04-10

Workflows and data pipelines are becoming increasingly valuable in both computational and experimen-tal sciences. These automated systems are capable of generating significantly more data within the same amount of time than their manual counterparts. Automatically capturing and recording data prove-nance and annotation as part of these workflows is critical for data management, verification, and dis-semination. Our goal in addressing the provenance challenge was to develop and end-to-end system that demonstrates real-time capture, persistent content management, and ad-hoc searches of both provenance and metadata using open source software and standard protocols. We describe our prototype, which extends the Kepler workflow toolsmore » for the execution environment, the Scientific Annotation Middleware (SAM) content management software for data services, and an existing HTTP-based query protocol. Our implementation offers several unique capabilities, and through the use of standards, is able to pro-vide access to the provenance record to a variety of commonly available client tools.« less

ARCUS Project Managers and the Intangible Infrastructure of Large Interdisciplinary Arctic Research Networks

NASA Astrophysics Data System (ADS)

Myers, B.; Wiggins, H. V.; Turner-Bogren, E. J.; Warburton, J.

2017-12-01

Project Managers at the Arctic Research Consortium of the U.S. (ARCUS) lead initiatives to convene, communicate with, and connect the Arctic research community across challenging disciplinary, geographic, temporal, and cultural boundaries. They regularly serve as the organizing hubs, archivists and memory-keepers for collaborative projects comprised of many loosely affiliated partners. As leading organizers of large open science meetings and other outreach events, they also monitor the interdisciplinary landscape of community needs, concerns, opportunities, and emerging research directions. However, leveraging the ARCUS Project Manager role to strategically build out the intangible infrastructure necessary to advance Arctic research requires a unique set of knowledge, skills, and experience. Drawing on a range of lessons learned from past and ongoing experiences with collaborative science, education and outreach programming, this presentation will highlight a model of ARCUS project management that we believe works best to support and sustain our community in its long-term effort to conquer the complexities of Arctic research.

Human factors in waste management - potential and reality

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

Thompson, J.S.

There is enormous potential for human factors contributions in the realm of waste management. The reality, however, is very different from the potential. This is particularly true for low-level and low-level mixed-waste management. The hazards are less severe; therefore, health and safety requirements (including human factors) are not as rigorous as for high-level waste. High-level waste management presents its own unique challenges and opportunities. Waste management is strongly driven by regulatory compliance. When regulations are flexible and open to interpretation and the environment is driven so strongly by regulatory compliance, standard practice is to drop {open_quotes}nice to have{close_quotes} features, likemore » a human factors program, to save money for complying with other requirements. The challenge is to convince decision makers that human factors can help make operations efficient and cost-effective, as well as improving safety and complying with regulations. A human factors program should not be viewed as competing with compliance efforts; in fact, it should complement them and provide additional cost-effective means of achieving compliance with other regulations. Achieving this synergy of human factors with ongoing waste management operations requires educating program and facility managers and other technical specialists about human factors and demonstrating its value {open_quotes}through the back door{close_quotes} on existing efforts. This paper describes ongoing projects at Los Alamos National Laboratory (LANL) in support of their waste management groups. It includes lessons learned from hazard and risk analyses, safety analysis reports, job and task analyses, operating procedure development, personnel qualification/certification program development, and facility- and job-specific training program and course development.« less

Taking it one day at a time: African American women aging with HIV and co-morbidities.

PubMed

Warren-Jeanpiere, Lari; Dillaway, Heather; Hamilton, Pilar; Young, Mary; Goparaju, Lakshmi

2014-07-01

Self-managing HIV/AIDS presents challenges for anyone infected. These challenges may be further complicated for older HIV-infected African American women who acquired the disease at younger ages and now have co-morbidities. Little is known regarding how women's age identity, social responsibilities, co-morbidities, and romantic relationship status influence their HIV self-management. Five focus groups were conducted in Washington DC, with HIV-positive African American women aged 52-65. Topics included HIV and co-morbidity self-management, social support needs, medication adherence, and future plans for old age. A constant comparison approach was applied during data analysis. Co-morbidities, including diabetes and hypertension, were perceived to be more difficult to self-manage than HIV. This difficulty was not attributed to aging but to daily struggles such as lack of income and/or health insurance, an inflexible work schedule, and loneliness. Social responsibilities, including caring for family, positively impacted participants' ability to self-manage HIV by serving as motivation to stay healthy in order to continue to help family members. In contrast, inflexible work schedules negatively impacted women's ability to sustain medication adherence. Overall, this study demonstrates that HIV and co-morbidity self-management are inextricably linked. We can no longer afford to view engagement in HIV care as a single-disease issue and hope to attain optimal health and well-being in our HIV-affected populations. Optimal HIV self-management must be framed within a larger context that simultaneously addresses HIV and co-morbidities, while considering how social and cultural factors uniquely intersect to influence older African American women's self-management strategies.

Ethically sustainable governance in the biobanking of eggs and embryos for research.

PubMed

Stroud, Karla; O'Doherty, Kieran C

2015-12-01

Biobanking of human tissues is associated with a range of ethical, legal, and social (ELS) challenges. These include difficulties in operationalising informed consent protocols, protecting donors' privacy, managing the return of incidental findings, conceptualising ownership of tissues, and benefit sharing. Though largely unresolved, these challenges are well documented and debated in academic literature. One common response to the ELS challenges of biobanks is a call for strong and independent governance of biobanks. Theorists who argue along these lines suggest that since fully informed consent to a single research project is often not feasible, research participants should be given the additional protection of being allowed to consent to the governance framework of the biobank. Such governance therefore needs to be transparent and ethically sustainable. In this paper we review the governance challenges of establishing and maintaining human tissue biobanks. We then discuss how the creation of a biobank for eggs and embryos, in particular, may introduce additional or unique challenges beyond those presented by the biobanking of other human tissues. Following previous work on biobank governance, we argue that ethically sustainable governance needs to be participatory, adaptive, and trustworthy.

Imaging X-Ray Polarimetry Explorer (IXPE) Risk Management

NASA Technical Reports Server (NTRS)

Alexander, Cheryl; Deininger, William D.; Baggett, Randy; Primo, Attina; Bowen, Mike; Cowart, Chris; Del Monte, Ettore; Ingram, Lindsey; Kalinowski, William; Kelley, Anthony;

Quantitative Approaches to Group Research: Suggestions for Best Practices

ERIC Educational Resources Information Center

McCarthy, Christopher J.; Whittaker, Tiffany A.; Boyle, Lauren H.; Eyal, Maytal

2017-01-01

Rigorous scholarship is essential to the continued growth of group work, yet the unique nature of this counseling specialty poses challenges for quantitative researchers. The purpose of this proposal is to overview unique challenges to quantitative research with groups in the counseling field, including difficulty in obtaining large sample sizes…

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

PubMed

Javadi, Dena; Tran, Nhan; Ghaffar, Abdul

2018-05-24

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

Medical management of epileptic seizures: challenges and solutions.

PubMed

Sarma, Anand K; Khandker, Nabil; Kurczewski, Lisa; Brophy, Gretchen M

2016-01-01

Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical-psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and "pseudoseizure" patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.

Environmental ethics and professional practice: A case study of an environmental challenge for century 2000

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

Malone, C.

1995-12-01

Objective resolution of environmental issues involves questions of facts and values, and, for environmental issues to be resolved ethically, a proper synthesis of environmental facts with questions of ethics must occur. In this case study, the proposal by the U.S. Department of Energy (DOE) to use the Yucca Mountain site in southwest Nevada as a deep geologic repository for the permanent disposal of the nation`s high-level nuclear waste is examined in part in the context of the {open_quotes}Code of Ethics and Standards of Practice for Environmental Professionals{close_quotes} adopted by the National Association of Environmental Professionals (NAEP). Current plans are thatmore » a repository at the Yucca Mountain site would begin functioning in 2010 and would be sealed after about 150 years. The requirement that a geologic repository must isolate nuclear waste from the environment for at least 10,000 years poses unique challenges to environmental professionals. This case study also analyzes the challenges in terms of the implications of a new federal Executive Order on Ecosystem Management and corresponding internal orders within all federal agencies to conform to the Executive Order. The imposition of the principles and practices of ecosystem-based resource management on federal agencies provides an opportunity to also address, in the context of the DOE Yucca Mountain Project, (1) the ecosystem approach to environmental management, (2) concepts of holistic resource management planning, and (3) the concepts of sustainability and biodiversity. Within this framework there are important implications for environmental ethics and professional practice that must remain at the forefront of concerns of the NAEP over the next two decades.« less

Parent management of the school reintegration needs of children and youth following moderate or severe traumatic brain injury.

PubMed

Roscigno, Cecelia I; Fleig, Denise K; Knafl, Kathleen A

2015-01-01

School reintegration following children's traumatic brain injury (TBI) is still poorly understood from families' perspectives. We aimed to understand how both unique and common experiences during children's school reintegration were explained by parents to influence the family. Data came from an investigation using descriptive phenomenology (2005-2007) to understand parents' experiences in the first five years following children's moderate to severe TBI. Parents (N = 42 from 37 families in the United States) participated in two 90-min interviews (first M = 15 months; second M = 27 months). Two investigators independently coded parents' discussions of school reintegration using content analysis to understand the unique and common factors that parents perceived affected the family. Parents' school negotiation themes included the following: (1) legal versus moral basis for helping the child; (2) inappropriate state and local services that did not consider needs specific to TBI; and (3) involvement in planning, implementing and evaluating the child's education plan. Parents perceived that coordinated and collaboration leadership with school personnel lessened families' workload. Families who home-schooled had unique challenges. School reintegration can add to family workload by changing roles and relationships and by adding to parents' perceived stress in managing of the child's condition. Moderate to severe traumatic brain injury is assumed to be the primary cause of children's morbidities post-injury. Despite laws in the United States meant to facilitate children's school reintegration needs, parents often perceived that policies and practices differed from the intentions of laws and added to the family workload and stress. The school environment of the child (physical, cultural or psychological setting) plays an important long-term role in shaping family roles, relationships and management of the child's condition.

Thriving on Chaos: The Development of a Surgical Information System

PubMed Central

Olund, Steven R.

1988-01-01

Hospitals present unique challenges to the computer industry, generating a greater quantity and variety of data than nearly any other enterprise. This is complicated by the fact that a hospital is not one homogenous organization, but a bundle of semi-independent groups with unique data requirements. Therefore hospital information systems must be fast, flexible, reliable, easy to use and maintain, and cost-effective. The Surgical Information System at Rush Presbyterian-St. Luke's Medical Center, Chicago is such system. It uses a Sequent Balance 21000 multi-processor superminicomputer, running industry standard tools such as the Unix operating system, a 4th generation programming language (4GL), and Structured Query Language (SQL) relational database management software. This treatise illustrates a comprehensive yet generic approach which can be applied to almost any clinical situation where access to patient data is required by a variety of medical professionals.

Successful Coproduction in Water Management and Climate Science

NASA Astrophysics Data System (ADS)

Kaatz, L.

2017-12-01

Frequently described as the "canary in the coal mine," the water sector has been one of the first to experience and begin preparing for the impacts of climate change. Water utilities have lead the way in developing and testing climate information in practice with the end goal of building resiliency and avoiding catastrophic disasters. A key aspect of this leadership is strong, collaborative partnerships resulting in the coproduction of knowledge and actionable science. In this session we will hear from the decision-maker perspective regarding what effective partnerships in real-world applications look like using examples from the Water Utility Climate Alliances (WUCA), and the experience and outcomes of a unique decade-long partnership between Denver Water and the National Center for Atmospheric Research. The lessons learned and challenges encountered in these examples of coproduction are not unique to WUCA, Denver Water nor the water sector, rather they are applicable across sectors and may inform future coproduction efforts.

Characteristic patterns of lip prints in Egyptian population sample at Dakahlia Governorate.

PubMed

Ragab, Ahmed Refat; El-Dakroory, Sahar Abd El-Aziz; Rahman, Rania Hamed Abdel

2013-03-01

Human identification is one of the most challenging sciences. Recently, study of lip prints has become slightly fashionable in forensic field. The aim of the present work is to determine the pattern of lip prints and evaluate its uniqueness in a sample of Egyptian population. The study included 955 subjects (2-65 years old). Lip prints were taken by direct rolling methods against hard background and each lip print was divided into six areas to be examined by magnifying hand lens. Thereafter, they were scanned and examined by the Microsoft office picture manager program. The results revealed that the lip print for each individual was unique and the complete vertical pattern was the commonest type among males and females living in Dakahlia Governorate, Egypt. Sex could not be differentiated from the lip print. It can be concluded that lip print analysis is an ancillary tool for personal identification especially in criminal investigations.

The why, what, and how of management innovation.

PubMed

Hamel, Gary

2006-02-01

For organizations like GE, P&G, and Visa, management innovation is the secret to success. But what is management innovation? Why is it so important? And how can other companies learn to become management innovators? This article from expert Gary Hamel answers those questions. A management breakthrough can deliver a strong advantage to the innovating company and produce a major shift in industry leadership. Few companies, however, have been able to come up with a formal process for fostering management innovation. The biggest challenge seems to be generating truly unique ideas. Four components can help: a big problem that demands fresh thinking, creative principles or paradigms that can reveal new approaches, an evaluation of the conventions that constrain novel thinking, and examples and analogies that help redefine what can be done. No doubt there are existing management processes in your organization that exacerbate the big problems you're hoping to solve. So how can you learn to identify them? Start by asking a series of questions for each one. For instance, Who owns the process? What are its objectives? What are the metrics for success? What are the decision-making criteria? How are decisions communicated, and to whom? After documenting these details, ask the people involved with the process to weigh in. This exploration may reveal opportunities to reinventyour management processes. A management innovation, the author says, creates long-lasting advantage when it meets at least one of three conditions: It is based on a novel principle that challenges the orthodoxy; it is systemic, involving a range of processes and methods; or it is part of a program of invention, where progress compounds over time. So far, management in this century isn't much different from management in the previous one, says Hamel. Therein lies the opportunity. You can wait for a competitor to come upon the next great management process and drive you out of business-or you can become a management innovator right now.

An Interdisciplinary Approach to Sports Concussion Evaluation and Management: The Role of a Neuropsychologist.

PubMed

Ott, Summer D; Bailey, Christopher M; Broshek, Donna K

2018-05-01

Sports neuropsychology is a rapidly emerging field that affords neuropsychologists, the opportunity to work with a diverse group of individuals in terms of age, gender, sports, ethnicity, and language and sports has a way of bringing diverse communities together. Although working with athletes can be associated with unique challenges, neuropsychological assessment with this population and being part of an interdisciplinary sports medicine team is both exciting and rewarding and can merge a passion for sports with professional interests. This paper is intended to highlight the contribution of neuropsychology to the evaluation and management of sport-related concussion as well as describe the neuropsychologist's role as an integral member of interdisciplinary sports medicine teams. Clinical model, special considerations, assessment strategy, and administrative aspects of practice are discussed.

Getting comfortable with "comfort feeding": An exploration of legal and ethical aspects of the Australian speech-language pathologist's role in palliative dysphagia care.

PubMed

Kelly, Katherine; Cumming, Steven; Kenny, Belinda; Smith-Merry, Jennifer; Bogaardt, Hans

2018-06-01

With an ageing population, speech-language pathologists (SLPs) can expect to encounter legal and ethical challenges associated with palliative and end-of-life care more frequently. An awareness of the medico-legal and ethical framework for palliative dysphagia management will better equip SLPs to work effectively in this area. This narrative review examines a range of legislation, legal, ethical and SLP literature that is currently available to orient SLPs to legal and ethical palliative dysphagia management in the Australian context. Relevant legal and ethical considerations in palliative and end-of-life care are described. SLPs have a role in palliative dysphagia management, however, this can involve unique legal and ethical challenges. The legal position on provision and cessation of nutrition and hydration differs between Australian States and Territories. Decisions by the courts have established a body of relevant case law. This article introduces SLPs to some of the important considerations for legal and ethical palliative care, but is not intended to be directive. SLPs are encouraged to explore their local options for ethical and medico-legal guidance. It is hoped that increasing SLPs awareness of many of the concepts discussed in this article enhances the provision of high-quality patient-centred care.

Identifying ecological "sweet spots" underlying cyanobacteria functional group dynamics from long-term observations using a statistical machine learning approach

NASA Astrophysics Data System (ADS)

Nelson, N.; Munoz-Carpena, R.; Phlips, E. J.

2017-12-01

Diversity in the eco-physiological adaptations of cyanobacteria genera creates challenges for water managers who are tasked with developing appropriate actions for controlling not only the intensity and frequency of cyanobacteria blooms, but also reducing the potential for blooms of harmful taxa (e.g., toxin producers, N2 fixers). Compounding these challenges, the efficacy of nutrient management strategies (phosphorus-only versus nitrogen-and-phosphorus) for cyanobacteria bloom abatement is the subject of an ongoing debate, which increases uncertainty associated with bloom mitigation decision-making. In this work, we analyze a unique long-term (17-year) dataset composed of monthly observations of cyanobacteria genera abundances, zooplankton abundances, water quality, and flow from Lake George, a bloom-impacted flow-through lake of the St. Johns River (FL, USA). Using the Random Forests machine learning algorithm, an assumption-free ensemble modeling approach, the dataset was evaluated to quantify and characterize relationships between environmental conditions and seven cyanobacteria groupings: five genera (Anabaena, Cylindrospermopsis, Lyngbya, Microcystis, and Oscillatoria) and two functional groups (N2 fixers and non-fixers). Results highlight the selectivity of nitrogen in describing genera and functional group dynamics, and potential for physical effects to limit the efficacy of nutrient management as a mechanism for cyanobacteria bloom mitigation.

ADIPSIC DIABETES INSIPIDUS: A REVIEW.

PubMed

Eisenberg, Yuval; Frohman, Lawrence A

2016-01-01

Adipsic diabetes insipidus (ADI) is a rare disorder consisting of central diabetes insipidus (CDI) and a deficient or absent thirst response to hyperosmolality. Patients with ADI experience marked morbidity and mortality. Diagnosis and management of these patients is quite challenging, even in expert hands. In this review, we aim to provide an updated overview of this difficult clinical scenario. We conducted a PubMed search for articles related to ADI. The search terms "adipsia," "adipsic," "thirst," and "diabetes insipidus" were used to identify relevant literature. ADI has been described in only approximately 100 patients. This rarity has limited the quality and quantity of literature to case reports, case series, and expert opinion. Diagnosis focuses on confirmation of CDI followed by documenting subnormal or completely absent thirst in response to a hypertonic stimulus. Among the described patients with ADI, the majority experience morbidity (e.g., severe hypernatremia, sleep apnea, venous thromboembolism [VTE], and obesity) and an increased mortality risk. Management focuses on frequent reassessment of daily prescribed water intake with fixed antidiuretic therapy (desmopressin) and comorbidity screening. The complexity of patients with ADI provides a difficult challenge for clinicians. Prompt recognition of thirst disorders in patients with CDI should lead to appropriately regimented management strategies and can result in safe outpatient care for these unique patients.

Challenges in developing physician leadership and management.

PubMed

Guthrie, M B

1999-01-01

Many of the issues confronting healthcare organizations require physician involvement and understanding, and the physician executive is a tool to achieving physician participation. Physician leaders can become the mediators between physicians and organizational management, minimizing miscommunication and maximizing agreement and understanding. Yet few doctors seem willing to stand up and speak positively for the plans and proposals that will move the institution forward, and healthcare executives are often frustrated by physician leadership that fails to articulate and implement the vision and objectives of the organization. Understanding physician leadership and exploring the challenges in managing and leading physicians require an understanding of the physician mindset--a completely different mindset than that of the typical healthcare executive. Beginning with a discussion of the unique situation faced by physicians in leadership positions, this article attempts to define the obstacles faced by both the physician and the executive in developing the role of physician executive. After reviewing the opportunities open to physician executives for improving leadership ability, the author presents the essential characteristics and core skills for effective leadership. The second half of the article suggests ways in which an organization can reemphasize physician leadership development within an organization from selection of potential candidates to creating training and networking opportunities and offering appropriate incentives.

Gastric cancer in India: epidemiology and standard of treatment.

PubMed

Servarayan Murugesan, Chandramohan; Manickavasagam, Kanagavel; Chandramohan, Apsara; Jebaraj, Abishai; Jameel, Abdul Rehman Abdul; Jain, Mayank Shikar; Venkataraman, Jayanthi

2018-04-02

India has a low incidence of gastric cancer. It ranks among the top five most common cancers. Regional diversity of incidence is of importance. It is the second most common cause of cancer related deaths among Indian men and women in the age between 15 and 44. Helicobacter pylori carcinogenesis is low in India. Advanced stage at presentation is a cause of concern. Basic and clinical research in India reveals a globally comparable standard of care and outcome. The large population, sociodemographic profile and challenges in health expenditure, however, remain a major challenge for health care policy managers. The newer formation of National Cancer Grid, integration of national databases and the creation of social identification database Aadhaar by The Unique Identification Authority of India are set to enhance the health care provision and optimal outcome.

Aging in Lebanon: Challenges and Opportunities

PubMed Central

Abdulrahim, Sawsan; Ajrouch, Kristine J.; Antonucci, Toni C.

2015-01-01

This spotlight offers a unique window into factors affecting aging in Lebanon. As a bridge between east and west, both geographically and culturally, Lebanon has the fastest growing older adult population in the Arab region, but few societal resources to address its needs. In a country with a history of political instability and war, but also a culture with strong family values, aging adults in Lebanon are vulnerable in some ways and advantaged in others. Outmigration of youth is an important determinant of the wellbeing of the elderly. While often advantaged by remittances sent by their children, older Lebanese adults have less access to instrumental social and personal support previously provided by young adults in the family. How Lebanon manages these challenges is likely to foreshadow the future aging experience for much of the Arab region. PMID:25326343

Research gaps and technology needs in development of PHM for passive AdvSMR components

NASA Astrophysics Data System (ADS)

Meyer, Ryan M.; Ramuhalli, Pradeep; Coble, Jamie B.; Hirt, Evelyn H.; Mitchell, Mark R.; Wootan, David W.; Berglin, Eric J.; Bond, Leonard J.; Henagar, Chuck H., Jr.

2014-02-01

Advanced small modular reactors (AdvSMRs), which are based on modularization of advanced reactor concepts, may provide a longer-term alternative to traditional light-water reactors and near-term small modular reactors (SMRs), which are based on integral pressurized water reactor (iPWR) concepts. SMRs are challenged economically because of losses in economy of scale; thus, there is increased motivation to reduce the controllable operations and maintenance costs through automation technologies including prognostics health management (PHM) systems. In this regard, PHM systems have the potential to play a vital role in supporting the deployment of AdvSMRs and face several unique challenges with respect to implementation for passive AdvSMR components. This paper presents a summary of a research gaps and technical needs assessment performed for implementation of PHM for passive AdvSMR components.

Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience

PubMed Central

Chan, Wing Bun; Chen, Jung Fu; Goh, Su-Yen; Vu, Thi Thanh Huyen; Isip-Tan, Iris Thiele; Mudjanarko, Sony Wibisono; Bajpai, Shailendra; Mabunay, Maria Aileen; Bunnag, Pongamorn

2017-01-01

Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia. PMID:29276400

Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience.

PubMed

Chan, Wing Bun; Chen, Jung Fu; Goh, Su-Yen; Vu, Thi Thanh Huyen; Isip-Tan, Iris Thiele; Mudjanarko, Sony Wibisono; Bajpai, Shailendra; Mabunay, Maria Aileen; Bunnag, Pongamorn

2017-01-01

Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia.

Post-Closure Challenges of U.S. Department of Energy Sites in Desert Environments of the Southwestern United States - 12095

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

Gil, April; Steckley, Deborah; Gauthier, Cassie

2012-07-01

U.S. Department of Energy (DOE) sites located in harsh desert environments of the Four Corners region of the southwestern United States require diligence and continual maintenance to ensure the remediation systems function as designed to protect human health and the environment. The geology and climate of this area create issues that are unique to these sites. Geologic formations contain naturally occurring constituents that are often the same as the residual contaminants remaining from historical milling activities at the sites. Although annual precipitation is low, when precipitation events occur they can be of extreme intensity, resulting in erosion and flooding thatmore » can quickly destroy infrastructure and rapidly change site conditions. Winds can cause sand storms and sand mounding that effect site features. These challenging environmental conditions, along with the remote locations of the sites, require active management beyond what was originally envisioned for uranium disposal sites to address concerns in a safe and cost-effective manner. The unique environment of the Four Corners region creates many challenges to the LTSM of LM sites in southwestern United States. The remediation efforts and approaches to infrastructure have to be specifically structured to work in this environment. Often, the systems and structures have to be modified based on lessons learned on how to best adapt to these difficult conditions and remote locations. These sites require continual maintenance and additional efforts compared to many other LM sites. (authors)« less

Effective, clinically feasible and sustainable: Key design features of psycho-educational and supportive care interventions to promote individualised self-management in cancer care.

PubMed

Schofield, Penelope; Chambers, Suzanne

2015-05-01

As the global burden of cancer increases healthcare services will face increasing challenges in meet the complex needs of these patients, their families and the communities in which they live. This raises the question of how to meet patient need where direct clinical contact may be constrained or not readily available. Patients and families require resources and skills to manage their illness outside of the hospital setting within their own communities. To propose a framework for the development and delivery of psycho-educational and supportive care interventions drawing on theoretical principles of behaviour change and evidence-based interventions, and based on extensive experience in developing and testing complex interventions in oncology. At the core of this intervention framework are considerations of efficiency: interventions are designed to cater for individuals' unique needs; to place minimal demands on the health system infrastructure and to be rapidly disseminated into usual care if successful. There are seven key features: 1) Targeting cancer type and stage; 2) Tailoring to unique individual needs; 3) Promotion of patient self-management of their disease and treatment side effects; 4) Efficient delivery of the intervention; 5) Training and adherence to protocol; 6) Ensuring the intervention is evidence-based; 7) Confirming stakeholder acceptability of the intervention. A case study of a randomised controlled trial which tested psycho-educational oncology interventions using this framework is presented. These interventions were designed to cater for individuals' unique needs and promote self-management while placing minimal demands on the acute health care setting. Innovative ways to realise the potentially major impact that psycho-educational and supportive care interventions can have on psychological morbidity, coping, symptoms and quality of life in serious and chronic illness are needed. This framework, which is driven by theory, evidence, and experience, is designed to ensure that interventions are effective, clinically feasible and sustainable.

Innovation in the North: are health service providers ready for the uptake of an internet-based chronic disease management platform?

PubMed

Tillotson, Sherri; Lear, Scott; Araki, Yuriko; Horvat, Dan; Prkachin, Ken; Bates, Joanna; Balka, Ellen

2009-01-01

Remote and rural regions in Canada are faced with unique challenges in the delivery of primary health services. The purpose of this study was to understand how patients and healthcare professionals in northern British Columbia might make use of the Internet to manage cardiovascular diseases. The study used a qualitative methodology. Eighteen health professionals and 6 patients were recruited for a semi-structured interview that explored their experience in managing patients with cardiovascular disease and their opinions and preferences about the use of the Internet in chronic disease management. Key findings from the data suggest that a) use of the Internet helps to maintain continuity of care while a patient moves through various stages of care, b) the Internet may possibly be used as an educational tool in chronic disease self-management, c) there is a need for policy development to support Internet-based consultation processes, and d) while health providers endorse the notion of electronic advancement in their practice, the need for secure and stable electronic systems is essential.

Autism spectrum disorders: an update on oral health management.

PubMed

Gandhi, Roopa P; Klein, Ulrich

2014-06-01

Dental professionals caring for patients with a diagnosis of autism spectrum disorder (ASD) will need to provide oral health care based on a family-centered approach that involves a comprehensive understanding of parental concerns and preferences, as well as the unique medical management, behaviors, and needs of the individual patient. With the rising prevalence of autism spectrum disorders (ASD), oral health providers will find themselves increasingly likely to care for these patients in their daily practice. The purpose of this article is to provide a comprehensive update on the medical and oral health management of patients with autism spectrum disorders. The authors conducted a literature review by searching for relevant articles written in English in the PubMed database pertaining to the medical and oral health management of autism, including caries status, preventive, behavioral, trauma, and restorative considerations. A detailed family centered approach based on parental preferences and concerns, the patient's challenging behaviors, and related comorbidities can serve to improve the treatment planning and oral health management of dental patients with ASD. Published by Mosby, Inc.

OpenFlow arbitrated programmable network channels for managing quantum metadata

DOE PAGES

Dasari, Venkat R.; Humble, Travis S.

2016-10-10

Quantum networks must classically exchange complex metadata between devices in order to carry out information for protocols such as teleportation, super-dense coding, and quantum key distribution. Demonstrating the integration of these new communication methods with existing network protocols, channels, and data forwarding mechanisms remains an open challenge. Software-defined networking (SDN) offers robust and flexible strategies for managing diverse network devices and uses. We adapt the principles of SDN to the deployment of quantum networks, which are composed from unique devices that operate according to the laws of quantum mechanics. We show how quantum metadata can be managed within a software-definedmore » network using the OpenFlow protocol, and we describe how OpenFlow management of classical optical channels is compatible with emerging quantum communication protocols. We next give an example specification of the metadata needed to manage and control quantum physical layer (QPHY) behavior and we extend the OpenFlow interface to accommodate this quantum metadata. Here, we conclude by discussing near-term experimental efforts that can realize SDN’s principles for quantum communication.« less

OpenFlow arbitrated programmable network channels for managing quantum metadata

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

Dasari, Venkat R.; Humble, Travis S.

Quantum networks must classically exchange complex metadata between devices in order to carry out information for protocols such as teleportation, super-dense coding, and quantum key distribution. Demonstrating the integration of these new communication methods with existing network protocols, channels, and data forwarding mechanisms remains an open challenge. Software-defined networking (SDN) offers robust and flexible strategies for managing diverse network devices and uses. We adapt the principles of SDN to the deployment of quantum networks, which are composed from unique devices that operate according to the laws of quantum mechanics. We show how quantum metadata can be managed within a software-definedmore » network using the OpenFlow protocol, and we describe how OpenFlow management of classical optical channels is compatible with emerging quantum communication protocols. We next give an example specification of the metadata needed to manage and control quantum physical layer (QPHY) behavior and we extend the OpenFlow interface to accommodate this quantum metadata. Here, we conclude by discussing near-term experimental efforts that can realize SDN’s principles for quantum communication.« less

The space shuttle ascent vehicle aerodynamic challenges configuration design and data base development

NASA Technical Reports Server (NTRS)

Dill, C. C.; Young, J. C.; Roberts, B. B.; Craig, M. K.; Hamilton, J. T.; Boyle, W. W.

1985-01-01

The phase B Space Shuttle systems definition studies resulted in a generic configuration consisting of a delta wing orbiter, and two solid rocket boosters (SRB) attached to an external fuel tank (ET). The initial challenge facing the aerodynamic community was aerodynamically optimizing, within limits, this configuration. As the Shuttle program developed and the sensitivities of the vehicle to aerodynamics were better understood the requirements of the aerodynamic data base grew. Adequately characterizing the vehicle to support the various design studies exploded the size of the data base to proportions that created a data modeling/management challenge for the aerodynamicist. The ascent aerodynamic data base originated primarily from wind tunnel test results. The complexity of the configuration rendered conventional analytic methods of little use. Initial wind tunnel tests provided results which included undesirable effects from model support tructure, inadequate element proximity, and inadequate plume simulation. The challenge to improve the quality of test results by determining the extent of these undesirable effects and subsequently develop testing techniques to eliminate them was imposed on the aerodynamic community. The challenges to the ascent aerodynamics community documented are unique due to the aerodynamic complexity of the Shuttle launch. Never before was such a complex vehicle aerodynamically characterized. The challenges were met with innovative engineering analyses/methodology development and wind tunnel testing techniques.

Communicating NASA's Knowledge: A Report of the Communicate Knowledge Process Team

NASA Technical Reports Server (NTRS)

1998-01-01

NASA has a unique charter in the Space Act of 1958 to 'provide for the widest practicable and appropriate dissemination of information concerning its activities and the results thereof.' As NASA approaches the new millennium, Government legislation and regulations, budgetary reductions that have necessitated downsizing the workforce, an emphasis on measurable results from Government agencies, and technological communications breakthroughs have provided the impetus for NASA to reexamine the way it communicates the knowledge that it generates. NASA has been challenged to manage knowledge as a resource that we owe to the American people.

Systems face challenges. Interview by Donald E.L. Johnson.

PubMed

Brown, F L

1991-04-01

The regional hospital system has become a mainstay in the structuring of health care during the past decade. How will it fare in the next 10 years? In the following interview with Health Care Strategic Management's editor and publisher Donald E.L. Johnson, Fred L. Brown, president and chief executive officer of Christian Health System, the St. Louis, Mo.-based umbrella organization for nine hospitals, six nursing facilities, and one retirement community, predicts a bright future for the health care system. He also discusses the strategies that are unique to the success of such a system.

Feasibility study for an innovative industrial red mud utilisation method.

PubMed

Kounalakis, Petros; Aravossis, Konstantinos; Karayianni, ChS

2016-02-01

Red mud is a high volume industrial waste, and its management poses a unique challenge. For the utilisation of red mud, an economical, energy saving, environmental friendly and widely applicable method has been found. The proposed novel method is purely chemical, and achieves the recovery of all the oxides contained in red mud totally and transforms them into high value added products. The present work shows that an investment in an industrial plant, treating red mud and turning a toxic industrial waste in commercial products, is safe and viable. © The Author(s) 2015.

Exertional Heat Stroke and American Football: What the Team Physician Needs to Know.

PubMed

Sylvester, Jillian E; Belval, Luke N; Casa, Douglas J; O'Connor, Francis G

Football is recognized as a leading contributor to sports injury secondary to the contact collision nature of the endeavor. While direct deaths from head and spine injury remain a significant contributor to the number of catastrophic injuries, indirect deaths (systemic failure) predominate. Exertional heat stroke has emerged as one of the leading indirect causes of death in high school and collegiate football. This review details for the team physician the unique challenge of exercising in the heat to the football player, and the prevention, diagnosis, management, and return-to-play issues pertinent to exertional heat illnesses.

Comparison of circummandibular wiring with resorbable bone plates in pediatric mandibular fractures.

PubMed

Saikrishna, D; Gupta, Nimish

2010-06-01

Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning as well as in their functional and nutritional needs which are different from that of adult patients. Early literature has advocated conservative closed management of pediatric fractures to prevent complications. However recent advances in maxillofacial surgery has enabled us to use biodegradable plates and screws, which overcomes the limitations of metallic plates. We present a comparison of two cases of parasymphysis fracture treated with circum-mandibular wiring and biodegradable plate fixation their outcome in terms of fracture healing and functional stability.

Airline business continuity and IT disaster recovery sites.

PubMed

Haji, Jassim

2016-01-01

Business continuity is defined as the capability of the organisation to continue delivery of products or services at acceptable predefined levels following a disruptive incident. Business continuity is fast evolving to become a critical and strategic decision for any organisation. Transportation in general, and airlines in particular, is a unique sector with a specialised set of requirements, challenges and opportunities. Business continuity in the airline sector is a concept that is generally overlooked by the airline managements. This paper reviews different risks related to airline processes and will also propose solutions to these risks based on experiences and good industry practices.

Developing a smartphone app to support the nursing community.

PubMed

Colton, Scott; Hunt, Louise

2016-02-01

Healthcare professionals are turning increasingly to the digital sector to access information they need for their work. Mobile technology, such as smartphones and tablets, provides a unique opportunity to place high-quality information directly into users' hands. This article describes the ongoing development of a smartphone app, Preparing for Caring, designed to prepare the future workforce by enabling mentors and nursing students to access supportive material during practice-based learning episodes. The article explores the rationale for designing the app and discusses the challenges and benefits of developing this resource from the perspectives of student, mentor and healthcare manager.

Posterior shoulder instability in the athletic population: Variations in assessment, clinical outcomes, and return to sport.

PubMed

DeLong, Jeffrey M; Bradley, James P

2015-12-18

Posterior instability of the shoulder is becoming an increasingly recognized shoulder injury in the athletic population. Diagnostic elements, such as etiology, directionality, and degree of instability are essential factors to assess in the unstable athletic shoulder. Concomitant injuries and associated pathologic lesions continue to be a significant challenge in the surgical management of posterior shoulder instability. Return to sport and previous level of play is ultimately the goal for every committed athlete and surgeon, thus subpopulations of athletes should be recognized as distinct entities requiring unique diagnostic, functional outcome measures, and surgical approaches.

External Tank Program Legacy of Success

NASA Technical Reports Server (NTRS)

Welzyn, Ken; Pilet, Jeff

2010-01-01

I.Goal: a) Extensive TPS damage caused by extreme hail storm. b) Repair plan required to restore TPS to minimize program manifest impacts. II. Challenges: a) Skeptical technical community - Concerned about interactions of damage with known/unknown failure modes. b) Schedule pressure to accommodate ISS program- Next tank still at MAF c)Limited ET resources. III. How d We Do It?: a) Developed unique engineering requirements and tooling to minimize repairs. b) Performed large amount of performance testing to demonstrate understanding of repairs and residual conditions. c) Effectively communicated results to technical community and management to instill confidence in expected performance.

Surgical management of Crohn's colitis.

PubMed

Moir, Christopher R

2007-08-01

Crohn's disease in childhood is changing. The incidence is increasing, colonic disease is becoming more prevalent in younger children, and colon reconstruction is more acceptable. Genetic phenotypes are influencing decisions for surgery, and targeted immunotherapy has renewed hope for more durable remissions following less extensive resections. The tasks facing the surgeon evaluating a child with Crohn's colitis include confirming the specific diagnostic subtype and selecting the correct procedure. This chapter will review the unique aspects of pediatric Crohn's colitis and the increased complexity of surgical choice for this most challenging presentation. Recent success with less extensive surgery offers renewed hope for children with intractable colonic disease.

Propulsion Health Management System Development for Affordable and Reliable Operation of Space Exploration Systems

NASA Technical Reports Server (NTRS)

Melcher, Kevin J.; Maul, William A.; Garg, Sanjay

2007-01-01

The constraints of future Exploration Missions will require unique integrated system health management capabilities throughout the mission. An ambitious launch schedule, human-rating requirements, long quiescent periods, limited human access for repair or replacement, and long communication delays, all require an integrated approach to health management that can span distinct, yet interdependent vehicle subsystems, anticipate failure states, provide autonomous remediation and support the Exploration Mission from beginning to end. Propulsion is a critical part of any space exploration mission, and monitoring the health of the propulsion system is an integral part of assuring mission safety and success. Health management is a somewhat ubiquitous technology that encompasses a large spectrum of physical components and logical processes. For this reason, it is essential to develop a systematic plan for propulsion health management system development. This paper provides a high-level perspective of propulsion health management systems, and describes a logical approach for the future planning and early development that are crucial to planned space exploration programs. It also presents an overall approach, or roadmap, for propulsion health management system development and a discussion of the associated roadblocks and challenges.

How transformational leadership appears in action with adverse events? A study for Finnish nurse manager.

PubMed

Liukka, Mari; Hupli, Markku; Turunen, Hannele

2017-12-26

The aim of this study was to determine whether elements of transformational leadership are present in nursing managers' actions following adverse events. Transformational leadership exerts a positive influence on organisational culture and patient safety. Eleven nursing managers were interviewed individually using a semi-structured format. Data were analysed using inductive content analysis. Four themes emerged relating to nursing managers' actions following adverse events: patient-centredness as a principle for common action, courage to reform operational models to prevent future adverse events, nursing staff's encouragement of open and blame-free discussion, and challenge to recognize adverse events. Nursing managers must understand their responsibilities and the importance of making it clear to staff that patient-centredness should be evident in all health care actions. Nursing managers must also recognize the need to ensure that staff treat patients' interests as the top priority. If an adverse event occurs, the situation should be discussed with the nursing staff and any unique aspects of the event must be accounted for. Nursing managers must have the skill to motivate and empower staff to find new ways to work, to prevent adverse events and to promote patient safety. © 2017 John Wiley & Sons Ltd.

Trials, tribulations, and triumphs of insider researchers

NASA Astrophysics Data System (ADS)

McBride, S.; Tilley, E. N.; Becker, J.; Orchiston, C.; Johnston, D. M.

2016-12-01

Is there merit in "insider" research? An insider researcher, in the social science context, is someone who conducts their research and provides their observations and perspectives on a project, sector or disaster setting which they are intimately familiar with. One strength of insider research is the unique insights and awareness that are gained as a consequence of the experience of working within the research setting. This could also be considered the most significant criticism of insider research, one that is fraught with bias and subjectivity. So, given their potential biases, can an insider develop worthwhile research? The trials and tribulations of an insider are many. Given the insider position, traditional observer empirical research is not ideal, so this research necessitates exploring different research theoretical perspectives, including the use of critical theory and constructivism. Constructivism-based research permits the researcher to use their unique perspectives and knowledge to `construct' knowledge through their research. However, using constructivist theoretical perspectives and methods may be a complex and challenging endeavor for those better acquainted with empirical methods. Further, ethical restrictions can create further complexities to insider research. Compounding the complexities of methodologies and theoretical perspective, an insiders' perspective can be difficult to manage, given their embedded viewpoint, and may include professional and emotional risks for the researcher. Given its many challenges, insider research is not a frequent pathway of academic examination, particularly in emergency management and natural hazards research. Triumphs of insider research endeavors become clear once ways to address methodological and ethical issues are resolved. I will explore these solutions in my presentation. Further, insider researchers laid the foundation for the contemporary emergency management discipline but this research has been largely been overlooked in the discourse. The triumph of insider research is how influential they may be to a sector; one historical piece of research assisted in the development of an entire sector. Finally, I explore my research pathway, as an insider, to research the communication lessons from the Canterbury Earthquake Sequence.

Making climate change projections relevant to water management: opportunities and challenges in the Colorado River basin (Invited)

NASA Astrophysics Data System (ADS)

Vano, J. A.

2013-12-01

By 2007, motivated by the ongoing drought and release of new climate model projections associated with the IPCC AR4 report, multiple independent studies had made estimates of future Colorado River streamflow. Each study had a unique approach, and unique estimate for the magnitude for mid-21st century streamflow change ranging from declines of only 6% to declines of as much as 45%. The differences among studies provided for interesting scientific debates, but to many practitioners this appeared to be just a tangle of conflicting predictions, leading to the question 'why is there such a wide range of projections of impacts of future climate change on Colorado River streamflow, and how should this uncertainty be interpreted?' In response, a group of scientists from academic and federal agencies, brought together through a NOAA cross-RISA project, set forth to identify the major sources of disparities and provide actionable science and guidance for water managers and decision makers. Through this project, four major sources of disparities among modeling studies were identified that arise from both methodological and model differences. These differences, in order of importance, are: (1) the Global Climate Models (GCMs) and emission scenarios used; (2) the ability of land surface hydrology and atmospheric models to simulate properly the high elevation runoff source areas; (3) the sensitivities of land surface hydrology models to precipitation and temperature changes; and (4) the methods used to statistically downscale GCM scenarios. Additionally, reconstructions of pre-instrumental streamflows provided further insights about the greatest risk to Colorado River streamflow of a multi-decadal drought, like those observed in paleo reconstructions, exacerbated by a steady reduction in flows due to climate change. Within this talk I will provide an overview of these findings and insights into the opportunities and challenges encountered in the process of striving to make climate change projections more useful to water managers and decision makers.

PS1-09: Comparing the Greatest Challenges of Long-Term Rectal Cancer Survivors with Anastomosis Versus Ostomy

PubMed Central

McMullen, Carmit; Altschuler, Andrea; Bulkley, Joanna; Grant, Marcia; Hornbrook, Mark; Krouse, Robert

2012-01-01

Background Patients surgically treated for rectal cancer receive either an intestinal ostomy (externalization of the bowel to the abdominal wall) or, more frequently, an anastomosis (reconnection) of the rectum. While the challenges of intestinal ostomies have been previously described by this research team, much less is known about the long-term challenges of living with an anastomosis. Understanding the challenges of long-term rectal cancer survivors with both types of surgeries is important for informing and improving current practice. Methods We mailed our survey to 1000 long-term (at least 5 years post-diagnosis) rectal cancer survivors in KP Northern California and KP Northwest during 2010–2011. Our overall response rate was 57.7% (577/1000). The survey contained an open-ended question that asked respondents to write about the greatest challenge they experienced after their cancer surgery. Seventy-three percent of respondents provided a response to this “greatest challenge” question. Responses were analyzed qualitatively to compare the challenges reported by patients with anastomosis vs. ostomy. Results Challenges related to managing bowel function and output were found in both groups. Ostomy patients reported challenges to managing ostomy equipment that were unique to their condition—ostomy appliance failures, skin breakdown around the ostomy, and finding suitable places to empty, clean, and reconnect their appliance. Other notable differences in the greatest challenges among ostomy and anastomosis patients included: patients with an ostomy reported a range of psychosocial challenges relating to depression, shame, stigma, and post-operative psychological trauma about having an ostomy and such psychosocial impacts were notably absent among anastomosis patients; patients with ostomies reported regret about having an ostomy, but patients with anastomosis did not report regret about the surgery they received; and, anastomosis patients mentioned more challenges from radiation after effects, including pain, fistulae, and strictures. Discussion Our findings about rectal cancer survivors with ostomies mirror previously published reports. Even in the face of impaired bowel function, rectal cancer survivors with anastomoses express little psychological distress or regret about treatment choice. The lasting effects of radiation therapy, however, are of special concern to this group.

Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies.

PubMed

Miller, Jordan; MacDermid, Joy C; Richardson, Julie; Walton, David M; Gross, Anita

2017-01-01

Previous evidence suggests self-management programs for people with chronic pain improve knowledge and self-efficacy, but result in small to negligible changes in function. The purpose of this multiple case studies design was to describe the unique responses of six participants to a new self-management program aimed at improving function, to detail each component of the program, and to explore potential explanations for the varied trajectories of each of the participants. Six participants who had been experiencing chronic pain for at least 5 years were included. All participants were enrolled 6 weeks of ChrOnic pain self-ManageMent support with pain science EducatioN and exercise (COMMENCE). Participants completed an assessment at baseline, 7 weeks (1-week follow-up), and 18 weeks (12-week follow-up). Each participant had a unique initial presentation and goals. Assessments included: function as measured by the Short Musculoskeletal Function Assessment - Dysfunction Index, how much participants are bothered by functional difficulties, pain intensity, fatigue, pain interference, cognitive and psychological factors associated with pain and disability, pain neurophysiology, self-efficacy, satisfaction, and perceived change. The self-management program was 6-weeks in length, consisting of one individual visit and one group visit per week. The program incorporated three novel elements not commonly included in self-management programs: pain neurophysiology education, individualized exercises determined by the participants' goals, and additional cognitive behavioural approaches. Participants were all satisfied with self-management support received. Change in function was variable ranging from 59% improvement to 17% decline. Two potential explanations for variances in response, attendance and social context, are discussed. Several challenges were identified by participants as barriers to attendance. A primary care self-management intervention including pain education and individualized exercise has potential to improve function for some people with chronic pain, although strategies to improve adherence and reduce barriers to participation may be needed to optimize the impact.

[Multiple chronic conditions and morbidity burden: challenges and considerations for an organizational strategy].

PubMed

Balicer, Ran; Bitterman, Haim; Shadmi, Efrat

2012-07-01

Technological advances combined with the aging of the population bring about an increasingly growing number of patients with chronic conditions and multi-morbidity. Multi-morbidity, the co-occurrence of chronic and/or non-chronic conditions in an individual, is the norm among elderly patients, and is becoming increasingly common among younger adults. The Israeli health system, like other systems worldwide, is faced with the challenges posed by the increase in complex multi-morbidity, in an era of growing fiscal constraints, a situation that can induce financial and organizational crises. To effectively cope with such circumstances, a paradigm shift is needed. Health systems need to focus on overall morbidity burden and multi-morbidity (rather than the prevailing one disease at a time approach) and on better care integration. The Israeli health system entails many of the essential elements for addressing the challenges of integrated care, including universal health coverage and advanced health information technology systems. Yet, like other health systems, there is a need for care management support mechanisms that are more effectively tailored to meet the needs of the highly multimorbid patients. This review outlines the organizational approach required to better align care for the main customers of health care in the 21st century: patients with multi-morbidity. We focus on four domains: assessment of morbidity burden according to measures that account for the interaction and synergism amongst conditions; integration across the care continuum; enhancement of primary care and self-management support approaches; and provision of uniquely tailored care management solutions for the highest risk multi-morbid patients.

NASA Space Rocket Logistics Challenges

NASA Technical Reports Server (NTRS)

Neeley, James R.; Jones, James V.; Watson, Michael D.; Bramon, Christopher J.; Inman, Sharon K.; Tuttle, Loraine

2014-01-01

The Space Launch System (SLS) is the new NASA heavy lift launch vehicle and is scheduled for its first mission in 2017. The goal of the first mission, which will be uncrewed, is to demonstrate the integrated system performance of the SLS rocket and spacecraft before a crewed flight in 2021. SLS has many of the same logistics challenges as any other large scale program. Common logistics concerns for SLS include integration of discreet programs geographically separated, multiple prime contractors with distinct and different goals, schedule pressures and funding constraints. However, SLS also faces unique challenges. The new program is a confluence of new hardware and heritage, with heritage hardware constituting seventy-five percent of the program. This unique approach to design makes logistics concerns such as commonality especially problematic. Additionally, a very low manifest rate of one flight every four years makes logistics comparatively expensive. That, along with the SLS architecture being developed using a block upgrade evolutionary approach, exacerbates long-range planning for supportability considerations. These common and unique logistics challenges must be clearly identified and tackled to allow SLS to have a successful program. This paper will address the common and unique challenges facing the SLS programs, along with the analysis and decisions the NASA Logistics engineers are making to mitigate the threats posed by each.

Correctional nursing: a study protocol to develop an educational intervention to optimize nursing practice in a unique context.

PubMed

Almost, Joan; Gifford, Wendy A; Doran, Diane; Ogilvie, Linda; Miller, Crystal; Rose, Don N; Squires, Mae

2013-06-21

Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses' scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. The context of provincial correctional facilities presents unique challenges for nurses' provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care.

Africa has unique and urgent barriers to cleft care: lessons from practitioners at the Pan-African Congress on Cleft Lip and Palate.

PubMed

Adetayo, Oluwaseun; Ford, Rachel; Martin, Mark

2012-01-01

The goals of this study were to delineate the protocols employed for managing patients with cleft lip and palate deformities, delineate the challenges facing practitioners and patients, and to determine the patient and physician barriers to cleft care delivery in the region. Survey questionnaires were administered to practitioners attending the second Pan-African Congress on Cleft Lip and Palate (PACCLIP), which took place in Ibadan, Nigeria, West Africa from February 4-7, 2007. The conference included 225 participants, representing 17 African countries Protocols for repair of cleft lip and palate deformities were varied, with Millard's and von Langenbeck's techniques being the preferred approach for the management of cleft lip and palate deformities, respectively. A large proportion of providers have limited access to core cleft care supporting teams, especially speech language pathologists, orthodontists, and audiologists. Several challenging barriers to cleft care were also identified at both the institutional and individual levels and are reported. Geographic separation in Africa presents a similar challenge due to isolationism as it does to surgeons in Europe. Specific to Africa are the increased barriers to care, and economic and financial hardship at various levels. A focus on funding, team building, infrastructural support, and patient education appear to be crucial in improving the care and lives of children with facial clefts in Africa.

Getting to More Effective Weight Management in Antipsychotic-Treated Youth: A Survey of Barriers and Preferences.

PubMed

Nicol, Ginger; Worsham, Elizabeth; Haire-Joshu, Debra; Duncan, Alexis; Schweiger, Julia; Yingling, Michael; Lenze, Eric

2016-02-01

Mentally ill youth are at risk for developing obesity, especially when they require antipsychotic treatment; moreover, they may face unique challenges in adhering to behavioral weight loss interventions. The aims of this project were to characterize the challenges families of youth with psychiatric disorders face when engaging in weight loss treatment and to gather information on attitudes and preferences for weight management interventions in this population. We devised a telephone survey to evaluate caregiver-perceived barriers/challenges to and preferences for behavioral weight loss treatment in overweight or obese mentally ill youth ages 6-18 treated with an antipsychotic agent in an outpatient setting. A total of 26 parents or primary caregivers completed the survey. The most commonly cited barriers to participation in physical activity (PA) and maintaining a healthy diet were child's dislike of PA and child's preference for energy-dense foods, respectively, which were impacted by psychiatric symptoms. Preferences for weight loss treatment included individualized, prescribed meal plans and shopping lists, and exercise support/demonstration, with a preference for Internet or cell phone applications to help with monitoring food intake and exercise. These results suggest that targets for obesity treatment in this population include individualized, specific support that takes into account the child's motivation, which is effected by psychiatric symptoms. Tools for providing support may include the use of telehealth visits and mobile device applications for self-monitoring.

Making products available among community health workers: Evidence for improving community health supply chains from Ethiopia, Malawi, and Rwanda

PubMed Central

Chandani, Yasmin; Andersson, Sarah; Heaton, Alexis; Noel, Megan; Shieshia, Mildred; Mwirotsi, Amanda; Krudwig, Kirstin; Nsona, Humphreys; Felling, Barbara

2014-01-01

Background A UNICEF review of the challenges to scaling up integrated community case management (iCCM) found that drug shortages were a common bottleneck. In many settings, little thought has gone into the design of supply chains to the community level and limited evidence exists for how to address these unique challenges. SC4CCM’s purpose was to conduct intervention research to identify proven, simple, affordable solutions that address the unique supply chain challenges faced by CHWs and to demonstrate that supply chain constraints at the community level can be overcome. Methods SC4CCM selected three countries to implement supply chain innovations and developed a theory of change (TOC) framework for the learning phase, which identified the main drivers of product availability and was used for baseline assessments, design, implementation and evaluation of interventions in Ethiopia, Malawi, and Rwanda. Interventions were developed in each country and tested over 12–24 months. Mixed–method follow up assessments were conducted in each country in 2012–2013. The Supply Chain for Community Case Management (SC4CCM) Project then simplified the TOC into a Community Health Supply Chain (CHSC) framework to enable cross country analysis Results The findings from interventions in the three countries suggest that the greatest supply chain benefits are realized when all three CHSC framework elements (data flow, product flow, and effective people) are in place and working together. The synergistic effect of these three elements on supply chain performance was most effectively demonstrated by results from the Enhanced Management and Quality Collaborative interventions in Malawi and Rwanda, respectively, which were characterized by lower mean stockout rates and higher in stock rates on day of visit, when compared to other interventions. Conclusions Many conditions are necessary to ensure continuous product availability at the community level, however a supply chain works best when three key elements (product flow, data flow, and effective people) are deliberately included as an integral part of the system design. Although these elements may be designed differently in different settings, streamlining and synchronizing them while ensuring inclusion of all components for each element improves supply chain performance and promotes product availability at the community level. PMID:25520795

Rehabilitation and education are underutilized for mild stroke and TIA sufferers.

PubMed

Faux, Steven G; Arora, Pooja; Shiner, Christine T; Thompson-Butel, Angelica G; Klein, Linda A

2018-06-01

Transient ischemic attack (TIA) and mild stroke represent a large proportion of cerebrovascular events, at high risk of being followed by recurrent, serious events. The importance of early education addressing risk management, secondary prevention and lifestyle modifications is the centerpiece of further stroke prevention. However, delivering education and rehabilitation to this population can be complex and challenging. Via synthesis of a narrative review and clinical experience, we explore the unique and inherent complexities of rehabilitation management and education provision for patients following mild stroke and TIA. A considerable proportion of TIA/mild stroke survivors have ongoing rehabilitation needs that are poorly addressed. The need for rehabilitation in these patients is often overlooked, and available assessment tools lack the sensitivity to identify common subtle impairments in cognition, mood, language and fatigue. Active and accessible education interventions need to be initiated early after the event, and integrated with ongoing rehabilitation management. Priority areas in need of future development in this field are highlighted and discussed. Implications for rehabilitation Survivors of mild stroke and TIA have ongoing unmet rehabilitation needs and require a unique approach to rehabilitation and education. Rehabilitation needs are difficult to assess and poorly addressed in this cohort, where available assessment tools lack the sensitivity required to identify subtle impairments. Education needs to be initiated early after the event and involve active engagement of the patient in order to improve stroke knowledge, mood and motivate adherence to lifestyle modifications and secondary prevention. Rehabilitation physicians are currently an underutilized resource, who should be more involved in the management of all patients following TIA or mild stroke.

Mapping water availability, cost and projected consumptive use in the eastern United States with comparisons to the west

NASA Astrophysics Data System (ADS)

Tidwell, Vincent C.; Moreland, Barbie D.; Shaneyfelt, Calvin R.; Kobos, Peter

2018-01-01

The availability of freshwater supplies to meet future demand is a growing concern. Water availability metrics are needed to inform future water development decisions. With the help of water managers, water availability was mapped for over 1300 watersheds throughout the 31 contiguous states in the eastern US complimenting a prior study of the west. The compiled set of water availability data is unique in that it considers multiple sources of water (fresh surface and groundwater, wastewater and brackish groundwater); accommodates institutional controls placed on water use; is accompanied by cost estimates to access, treat and convey each unique source of water; and is compared to projected future growth in consumptive water use to 2030. Although few administrative limits have been set on water availability in the east, water managers have identified 315 fresh surface water and 398 fresh groundwater basins (with 151 overlapping basins) as areas of concern (AOCs) where water supply challenges exist due to drought related concerns, environmental flows, groundwater overdraft, or salt water intrusion. This highlights a difference in management where AOCs are identified in the east which simply require additional permitting, while in the west strict administrative limits are established. Although the east is generally considered ‘water rich’ roughly a quarter of the basins were identified as AOCs; however, this is still in strong contrast to the west where 78% of the surface water basins are operating at or near their administrative limit. Little effort was noted on the part of eastern or western water managers to quantify non-fresh water resources.

Research and management priorities for Hawaiian forest birds

USGS Publications Warehouse

Paxton, Eben H.; Laut, Megan; Vetter, John P.; Kendall, Steve J.

2018-01-01

Hawai‘i's forest birds face a number of conservation challenges that, if unaddressed, will likely lead to the extinction of multiple species in the coming decades. Threats include habitat loss, invasive plants, non-native predators, and introduced diseases. Climate change is predicted to increase the geographic extent and intensity of these threats, adding urgency to implementation of tractable conservation strategies. We present a set of actionable research and management approaches, identified by conservation practitioners in Hawai'i, that will be critical for the conservation of Hawaiian forest birds in the coming years. We also summarize recent progress on these conservation priorities. The threats facing Hawai‘i's forest birds are not unique to Hawai‘i, and successful conservation strategies developed in Hawai‘i can serve as a model for other imperiled communities around the world, especially on islands.

An improved interim therapeutic restoration technique for management of anterior early childhood caries: report of two cases.

PubMed

Nelson, Travis

2013-01-01

Early childhood caries presents unique treatment challenges that often require advanced behavior management techniques, such as general anesthesia or procedural sedation. In some cases, use of these pharmacologic adjuncts is undesirable or not possible. The interim therapeutic restoration is a treatment method that, while sometimes employed in such cases, can often produce unsatisfactory results in primary anterior teeth. This is often due to insufficient bulk of material and lack of retention. The purpose of this report was to describe a simple alternative technique (resin modified glass ionomer strip crowns) that may be employed to deliver esthetic anterior restorations to marginally cooperative children in the dental clinic setting and to report on two cases in which it was successfully used. \\\\\\Department of Pediatric Dentistry, University of Washington, Seattle, Wash., USA. tmnelson@uw.edu

Facility design consideration for continuous mix production of class 1.3 propellant

NASA Technical Reports Server (NTRS)

Williamson, K. L.; Schirk, P. G.

1994-01-01

In November of 1989, NASA awarded the Advanced Solid Rocket Motor (ASRM) contract to Lockheed Missiles and Space Company (LMSC) for production of advanced solid rocket motors using the continuous mix process. Aerojet ASRM division (AAD) was selected as the facility operator and RUST International Corporation provided the engineering, procurement, and construction management services. The continuous mix process mandates that the mix and cast facilities be 'close-coupled' along with the premix facilities, creating unique and challenging requirements for the facility designer. The classical approach to handling energetic materials-division into manageable quantities, segregation, and isolation-was not available due to these process requirements and quantities involved. This paper provides a description of the physical facilities, the continuous mix process, and discusses the monitoring and detection techniques used to mitigate hazards and prevent an incident.

Pathways in heart failure disease management across socioeconomic spectra.

PubMed

Hebert, Kathy; Gogichaishvili, Ilia; Gopie, Stephanie; Arcement, Lee

2011-12-01

Caring for heart failure patients with a low socioeconomic status presents a unique set of challenges for health care providers. Heart failure disease management programs can integrate the use of teaching DVDs to overcome deficiencies in health literacy and take advantage of the Wal-Mart/Target $4 dollar medication program to provide life-saving medical therapy. In addition, open discussions with the patient and family regarding the costs of medications and the reality of what they can afford to pay monthly on a long term basis can guide the physician to prescribing medications by prioritizing use with a focus on evidence-based data for the medications with the highest mortality reduction. Finally, connecting inpatient visits to outpatient visits through the use of electronic medical records systems can facilitate avoidance of unnecessary repeat lab and diagnostic testing.

Interventional radiology in infancy.

PubMed

Barnacle, Alex M

2014-11-01

Interventional radiology (IR) is an emerging sub-speciality within paediatric medicine. In adult care, IR is largely centred on the management of vascular disease but in paediatric practice, IR applications are varied and increasingly innovative, making this an exciting field to be a part of. IR has a central role both in the day to day care of sick children, from long term IV access provision to feeding tube insertions, and in the acute management of critically ill infants, such as those with overwhelming liver disease, neonatal tumours and vascular malformations. Paediatric IR faces a unique set of challenges, developing or modifying techniques and equipment for use in very small patients, training professionals to take the speciality forward and, most importantly, convincing paediatricians and healthcare institutions to create opportunities for IR to make a difference. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

NASA Technical Reports Server (NTRS)

Iovine, John

2011-01-01

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

Recent trends in reproductive tourism and international surrogacy: ethical considerations and challenges for policy

PubMed Central

Deonandan, Raywat

2015-01-01

Reproductive tourism, or “cross-border reproductive care”, is the phenomenon of people crossing international borders to access reproductive technologies. One of the fastest-growing categories of cross-border reproductive care is international surrogacy, the act of infertile clients traveling internationally to engage the paid services of foreign surrogates to carry their babies to term. It is a multibillion-dollar global industry presenting unique legal, ethical, and risk-management challenges. Clients tend to be price-sensitive, middle-income individuals seeking services from surrogates who in the global market are thought to be of quite low socioeconomic status. Risks are experienced by all parties involved in the transaction, including the client’s countries of origin and destination. The risks to the surrogate evolve from the potential to exploit her economic vulnerability in order to encourage both consent and unfair pricing. Opportunities for policy development are explored. PMID:26316832

The Coffee Berry Borer (Hypothenemus hampei) Invades Hawaii: Preliminary Investigations on Trap Response and Alternate Hosts

PubMed Central

Messing, Russell H.

2012-01-01

In August 2010 the coffee berry borer, Hypothenemus hampei, was first reported to have invaded the Kona coffee growing region of Hawaii, posing a severe economic challenge to the fourth largest agricultural commodity in the State. Despite its long and widespread occurrence throughout the tropics as the most serious pest of coffee, there are still discrepancies in the literature regarding several basic aspects of berry borer biology relevant to its control. In Kona coffee plantations, we investigated the beetles’ response to several trap and lure formulations, and examined the occurrence of beetles in seeds of alternate host plants occurring adjacent to coffee farms. While traps were shown to capture significant numbers of beetles per day, and the occurrence of beetles in alternate hosts was quite rare, the unique situation of coffee culture in Hawaii will make this pest extremely challenging to manage in the Islands. PMID:26466620

Technical Tips: Performing EEGs and Polysomnograms on Children with Neurodevelopmental Disabilities

PubMed Central

Paasch, Valerie; Hoosier, Teresa M.; Accardo, Jennifer; Ewen, Joshua B.; Slifer, Keith J.

2013-01-01

Electroencephalograms (EEGs) and polysomnograms (PSGs) are critical and frequently ordered tests in the care of children with neurodevelopmental disabilities (NDD). Performing studies with this population can be very intimidating, given that the referral reasons and seizure types can be unique, and children with NDD may have any combination of behavioral or sensory challenges that can make it difficult to successfully complete a study. This article presents a variety of strategies that can be used to overcome these challenges through good preparation, patience, caregiver involvement, effective behavioral management techniques, and education about the medical aspects of EEG/PSG in NDD. This Technical Tips article features ideas and experiences from an EEG/PSG technologist, two board-certified child neurologists (one who is further certified in Clinical Neurophysiology, while the other is further certified in Sleep Medicine), and two behaviorally trained pediatric psychologists. PMID:23301283

Challenges of univentricular physiology in heterotaxy.

PubMed

Jacobs, Marshall L; Mavroudis, Constantine

2011-04-01

Patients with heterotaxy syndrome exhibit an extensive constellation of congenital cardiac malformations, making these patients a challenging group to manage surgically. Many of these patients' hearts do not lend themselves to separation of the pulmonary and systemic circulations except by some modification of the Fontan procedure. Palliative procedures early in life are directed at creating a satisfactory balance of pulmonary and systemic blood flow and at the same time ensuring unobstructed pulmonary venous return. Early conversion from parallel pulmonary and systemic circulations to superior cavopulmonary connections is important, to reduce volume work of the systemic ventricle. Heterotaxy patients are generally considered a high-risk population with respect to eventual Fontan procedure. It is important to appreciate the unique and variable anatomy of the sinus node and conduction system and the potential for occult pulmonary venous obstruction, atrioventricular valve regurgitation, and recurrent cyanosis, which may be related to the development of pulmonary arteriovenous malformations.

Preventing the repetition: Or, what Los Angeles' experience in water management can teach Atlanta about urban water disputes

NASA Astrophysics Data System (ADS)

Feldman, David L.

2009-04-01

Southern California's water history is an epic story with larger-than-life characters and ambitions and abundant hubris. Students of water policy might reasonably ask: Does this story, while unique to greater Los Angeles, hold lessons for other metropolises experiencing water conflict caused by explosive growth? We examine this question by considering similarities between the challenges facing Atlanta, Georgia, one of the nation's fastest growing cities in the 21st century, with those of Los Angeles. We focus on junctures where important decisions regarding water were made and how these decisions continue to challenge both cities' futures. Atlanta's financial, cultural, and environmental imprint on its surrounding region share remarkable similarities with Los Angeles' influence trajectory: it is the largest city in the southeast, a principal transportation and business hub, and it is embroiled in water conflict with nearby communities and adjoining states.

Recent trends in reproductive tourism and international surrogacy: ethical considerations and challenges for policy.

PubMed

Deonandan, Raywat

2015-01-01

Reproductive tourism, or "cross-border reproductive care", is the phenomenon of people crossing international borders to access reproductive technologies. One of the fastest-growing categories of cross-border reproductive care is international surrogacy, the act of infertile clients traveling internationally to engage the paid services of foreign surrogates to carry their babies to term. It is a multibillion-dollar global industry presenting unique legal, ethical, and risk-management challenges. Clients tend to be price-sensitive, middle-income individuals seeking services from surrogates who in the global market are thought to be of quite low socioeconomic status. Risks are experienced by all parties involved in the transaction, including the client's countries of origin and destination. The risks to the surrogate evolve from the potential to exploit her economic vulnerability in order to encourage both consent and unfair pricing. Opportunities for policy development are explored.

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

PubMed

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

2011-08-01

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

Waste management outlook for mountain regions: Sources and solutions.

PubMed

Semernya, Larisa; Ramola, Aditi; Alfthan, Björn; Giacovelli, Claudia

2017-09-01

Following the release of the global waste management outlook in 2015, the United Nations Environment Programme (UN Environment), through its International Environmental Technology Centre, is elaborating a series of region-specific and thematic waste management outlooks that provide policy recommendations and solutions based on current practices in developing and developed countries. The Waste Management Outlook for Mountain Regions is the first report in this series. Mountain regions present unique challenges to waste management; while remoteness is often associated with costly and difficult transport of waste, the potential impact of waste pollutants is higher owing to the steep terrain and rivers transporting waste downstream. The Outlook shows that waste management in mountain regions is a cross-sectoral issue of global concern that deserves immediate attention. Noting that there is no 'one solution fits all', there is a need for a more landscape-type specific and regional research on waste management, the enhancement of policy and regulatory frameworks, and increased stakeholder engagement and awareness to achieve sustainable waste management in mountain areas. This short communication provides an overview of the key findings of the Outlook and highlights aspects that need further research. These are grouped per source of waste: Mountain communities, tourism, and mining. Issues such as waste crime, plastic pollution, and the linkages between exposure to natural disasters and waste are also presented.

Communicating in complex situations: a normative approach to HIV-related talk among parents who are HIV+.

PubMed

Edwards, Laura L; Donovan-Kicken, Erin; Reis, Janet S

2014-01-01

Parents with HIV/AIDS are confronted with unique challenges when discussing HIV-related information with their children. Strategies for navigating these challenges effectively have not been systematically examined. In this study, we conducted in-depth interviews with 76 parents with HIV/AIDS who had children ages 10-18 years. Guided by O'Keefe and Delia's definition of a complex communication situation and Goldsmith's normative approach to interpersonal communication, we examined parents' goals for discussing HIV-related information, factors that made conversations challenging, and instances where these conversational purposes conflicted with one another. Our data reveal the following parent-adolescent communication predicaments: relaying safety information about HIV while minimizing child anxiety, modeling open family communication without damaging one's parental identity, and balancing parent-child relational needs amid living with an unpredictable health condition. Parents also described a variety of strategies for mitigating challenges when discussing HIV-related topics. Strategies parents perceived as effective included reframing HIV as a chronic, manageable illness; keeping talk educational; and embedding HIV-related topics within more general conversations. The theoretical and practical applications of these findings are discussed with regard to their relevance to health communication scholars and HIV care professionals.

YogaHome: teaching and research challenges in a yoga program with homeless adults.

PubMed

Davis-Berman, Jennifer; Farkas, Jean

2012-01-01

YogaHome is a therapeutic yoga program for homeless women. Developing and refining YogaHome provided a unique opportunity to explore the process of teaching yoga to women faced with the physical and emotional stress of living in a homeless shelter. Unique teaching and research challenges are presented and recommendations for future programs are discussed.

Acute encephalitis in the immunocompromised individual.

PubMed

Saylor, Deanna; Thakur, Kiran; Venkatesan, Arun

2015-08-01

This article describes recent advances in the diagnosis and management of encephalitis in immunocompromised individuals. Herpes simplex virus (HSV) and varicella zoster virus (VZV) are common causes of encephalitis in immunocompromised individuals, although clinical manifestations may be atypical, and thus challenging to recognize. Recently, an increased incidence of HSV and VZV central nervous system infections has been reported in association with novel immunosuppressive and immunomodulatory treatments. The free-living ameba Balamuthia mandrillaris causes granulomatous encephalitis predominantly in immunocompromised individuals and is associated with nearly uniform fatality. In the setting of organ transplantation, the recipient's immunocompromised state along with the potential for donor-transmitted infections can result in a unique epidemiology of encephalitis, including infection by human herpes virus-6 and BK virus. Recent studies utilizing next-generation sequencing techniques have identified several pathogens, including Leptospira santarosai and a neurotropic astrovirus, as causes of encephalitis in immunocompromised individuals. Diagnosis and management of encephalitis is challenging in immunocompromised individuals, in part because of atypical clinical presentations and the presence of uncommon or novel infectious agents. Unbiased techniques for pathogen discovery are likely to play an increasing role in the diagnosis of central nervous system infections in immunocompromised individuals.

Cleared for Launch - Lessons Learned from the OSIRIS-REx System Requirements Verification Program

NASA Technical Reports Server (NTRS)

Stevens, Craig; Adams, Angela; Williams, Bradley; Goodloe, Colby

2017-01-01

Requirements verification of a large flight system is a challenge. It is especially challenging for engineers taking on their first role in space systems engineering. This paper describes our approach to verification of the Origins, Spectral Interpretation, Resource Identification, Security-Regolith Explorer (OSIRIS-REx) system requirements. It also captures lessons learned along the way from developing systems engineers embroiled in this process. We begin with an overview of the mission and science objectives as well as the project requirements verification program strategy. A description of the requirements flow down is presented including our implementation for managing the thousands of program and element level requirements and associated verification data. We discuss both successes and methods to improve the managing of this data across multiple organizational interfaces. Our approach to verifying system requirements at multiple levels of assembly is presented using examples from our work at instrument, spacecraft, and ground segment levels. We include a discussion of system end-to-end testing limitations and their impacts to the verification program. Finally, we describe lessons learned that are applicable to all emerging space systems engineers using our unique perspectives across multiple organizations of a large NASA program.

Transient bradycardia induced by thiopentone sodium: a unique challenge in the management of refractory status epilepticus

PubMed Central

Sharma, Sushma; Nair, Pradeep P; Murgai, Aditya; Selvaraj, Raja J

2013-01-01

Thiopentone sodium is one of the important drugs in the armamentarium for terminating refractory status epilepticus, a neurological emergency. We report a case of thiopentone-related bradycardia during the management of the new onset refractory status epilepticus in a young man, which was circumvented by prophylactic insertion of temporary pacemaker while thiopentone infusion was continued. A systematic approach was employed to manage the status epilepticus, including infusion of thiamine and glucose followed by antiepileptic drugs. The patient was ventilated and infused with lorazepam, phenytoin, sodium valproate, levetiracetam and midazolam followed by thiopentone sodium. With the introduction of thiopentone the seizures could be controlled but the patient developed severe bradycardia and junctional rhythm. The bradycardia disappeared when thiopentone was withdrawn and reappeared when the drug was reintroduced. Propofol infusion was tried with no respite in seizures. Later thiopentone sodium was reintroduced after inserting temporary cardiac pacemaker. Seizure was controlled and patient was weaned off the ventilator. PMID:24130206

A game theory analysis of green infrastructure stormwater management policies

NASA Astrophysics Data System (ADS)

William, Reshmina; Garg, Jugal; Stillwell, Ashlynn S.

2017-09-01

Green stormwater infrastructure has been demonstrated as an innovative water resources management approach that addresses multiple challenges facing urban environments. However, there is little consensus on what policy strategies can be used to best incentivize green infrastructure adoption by private landowners. Game theory, an analysis framework that has historically been under-utilized within the context of stormwater management, is uniquely suited to address this policy question. We used a cooperative game theory framework to investigate the potential impacts of different policy strategies used to incentivize green infrastructure installation. The results indicate that municipal regulation leads to the greatest reduction in pollutant loading. However, the choice of the "best" regulatory approach will depend on a variety of different factors including politics and financial considerations. Large, downstream agents have a disproportionate share of bargaining power. Results also reveal that policy impacts are highly dependent on agents' spatial position within the stormwater network, leading to important questions of social equity and environmental justice.

Transient bradycardia induced by thiopentone sodium: a unique challenge in the management of refractory status epilepticus.

PubMed

Sharma, Sushma; Nair, Pradeep P; Murgai, Aditya; Selvaraj, Raja J

2013-10-15

Thiopentone sodium is one of the important drugs in the armamentarium for terminating refractory status epilepticus, a neurological emergency. We report a case of thiopentone-related bradycardia during the management of the new onset refractory status epilepticus in a young man, which was circumvented by prophylactic insertion of temporary pacemaker while thiopentone infusion was continued. A systematic approach was employed to manage the status epilepticus, including infusion of thiamine and glucose followed by antiepileptic drugs. The patient was ventilated and infused with lorazepam, phenytoin, sodium valproate, levetiracetam and midazolam followed by thiopentone sodium. With the introduction of thiopentone the seizures could be controlled but the patient developed severe bradycardia and junctional rhythm. The bradycardia disappeared when thiopentone was withdrawn and reappeared when the drug was reintroduced. Propofol infusion was tried with no respite in seizures. Later thiopentone sodium was reintroduced after inserting temporary cardiac pacemaker. Seizure was controlled and patient was weaned off the ventilator.

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

PubMed Central

Damiano, Diane L.; Alter, Katharine E.; Chambers, Henry

2010-01-01

Synopsis Cerebral palsy is the most prevalent physical disability in childhood and includes a group of disorders with varying manifestations and levels of capability in individuals given this diagnosis. This chapter will focus on current and future intervention strategies for improving mobility and participation over the lifespan for ambulatory children with cerebral palsy (CP). The provision and integration of physical therapy, medical and orthopedic surgery management focused primarily on the lower extremities will be discussed here. Some of the newer trends are: more intense and task-related exercise strategies, greater precision in tone identification and management, and a shift towards musculoskeletal surgery that focuses more on promoting dynamic bony alignment and less on releasing or lengthening tendons. Advances in basic and clinical science and technology development are changing existing paradigms and offering renewed hope for improved functioning for children with CP who are currently facing a lifelong disability with unique challenges at each stage in life. PMID:19643348

From disaster to development: a systematic review of community-driven humanitarian logistics.

PubMed

Bealt, Jennifer; Mansouri, S Afshin

2018-01-01

A plethora of untapped resources exist within disaster-affected communities that can be used to address relief and development concerns. A systematic review of the literature relating to community participation in humanitarian logistics activities revealed that communities are able to form ad hoc networks that have the ability to meet a wide range of disaster management needs. These structures, characterised as Collaborative Aid Networks (CANs), have demonstrated efficient logistical capabilities exclusive of humanitarian organisations. This study proposes that CANs, as a result of their unique characteristics, present alternatives to established humanitarian approaches to logistics, while also mitigating the challenges commonly faced by traditional humanitarian organisations. Furthermore, CANs offer a more holistic, long-term approach to disaster management, owing to their impact on development through their involvement in humanitarian logistics. This research provides the foundation for further theoretical analysis of effective and efficient disaster management, and details opportunities for policy and practice. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.

Diabetes insipidus in infants and children.

PubMed

Dabrowski, Elizabeth; Kadakia, Rachel; Zimmerman, Donald

2016-03-01

Diabetes insipidus, the inability to concentrate urine resulting in polyuria and polydipsia, can have different manifestations and management considerations in infants and children compared to adults. Central diabetes insipidus, secondary to lack of vasopressin production, is more common in children than is nephrogenic diabetes insipidus, the inability to respond appropriately to vasopressin. The goal of treatment in both forms of diabetes insipidus is to decrease urine output and thirst while allowing for appropriate fluid balance, normonatremia and ensuring an acceptable quality of life for each patient. An infant's obligate need to consume calories as liquid and the need for readjustment of medication dosing in growing children both present unique challenges for diabetes insipidus management in the pediatric population. Treatment modalities typically include vasopressin or thiazide diuretics. Special consideration must be given when managing diabetes insipidus in the adipsic patient, post-surgical patient, and in those undergoing chemotherapy or receiving medications that alter free water clearance. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management of infected urethral diverticulum with urethral dilation.

PubMed

Lazarou, George; Andrikopoulou, Maria; Cho, Sylvia

2015-01-01

Urethral diverticula are rare but underdiagnosed entities that may cause a variety of urinary and pelvic symptoms in women. Management can be very challenging, especially in cases of chronic infection. A 69-year-old gravida 4, para 2 woman with a history of type 2 diabetes and hypothyroidism presented with long history of a painful midline 3-cm suburethral cystic mass, recurrent urinary tract infections, dysuria, dyspareunia, and incomplete voiding. The diagnosis was consistent with an infected urethral diverticulum unresponsive to multiple courses of oral antibiotics. Given the patient's comorbidities and the persistence of infection of the diverticulum, conservative treatment with urethral dilation was performed before surgical treatment. Urethral dilation successfully alleviated the patient's symptoms; the surgical treatment was not ultimately required, and the patient continues to be completely asymptomatic well over 17 months later. We present a unique case of infected urethral diverticulum, which was conservatively treated with dilatation and resulted in resolution of all symptoms, and there is no need for further surgical management.

Decision-support information system to manage mass casualty incidents at a level 1 trauma center.

PubMed

Bar-El, Yaron; Tzafrir, Sara; Tzipori, Idan; Utitz, Liora; Halberthal, Michael; Beyar, Rafael; Reisner, Shimon

2013-12-01

Mass casualty incidents are probably the greatest challenge to a hospital. When such an event occurs, hospitals are required to instantly switch from their routine activity to conditions of great uncertainty and confront needs that exceed resources. We describe an information system that was uniquely designed for managing mass casualty events. The web-based system is activated when a mass casualty event is declared; it displays relevant operating procedures, checklists, and a log book. The system automatically or semiautomatically initiates phone calls and public address announcements. It collects real-time data from computerized clinical and administrative systems in the hospital, and presents them to the managing team in a clear graphic display. It also generates periodic reports and summaries of available or scarce resources that are sent to predefined recipients. When the system was tested in a nationwide exercise, it proved to be an invaluable tool for informed decision making in demanding and overwhelming situations such as mass casualty events.

Anesthetic Management of a Child With Unspecified Mitochondrial Disease in an Outpatient Dental Setting.

PubMed

Gordon, Taylor R; Montandon, Richard J

2017-01-01

Mitochondrial disease (MD) represents a category of metabolic disorders with a wide range of symptoms across a variety of organ systems. It occurs with an incidence of greater than 1:5000 and can be difficult to specifically diagnose because of the variety of clinical presentations and multiple genomic origins. Although phenotypically variable, MD symptoms often include hypotonia, cardiac defects, dysautonomia, and metabolic dysfunction. Mitochondrial disease presents a unique challenge in terms of anesthetic management, as many anesthetic drugs suppress mitochondrial function. Additional considerations may need to be made in order to evaluate the patient's metabolic compensation prior to surgery. This article presents an in-depth discussion of a case involving a nearly 10-year-old boy with a history of an unspecified form of MD, who presented for endodontic treatment of tooth No. 30 under deep sedation. The article also provides a thorough review of the current literature surrounding the anesthetic management of patients with MD.

Review of foreign body ingestion and esophageal food impaction management in adolescents.

PubMed

Sahn, Benjamin; Mamula, Petar; Ford, Carol A

2014-08-01

Foreign body ingestion is a common clinical scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life threatening. Initial and follow-up management strategies depend on multiple patient and ingested object-related factors. Available literature on this topic tends to focus on the small child or adult, leaving the clinician caring for adolescents to extrapolate this information to guide decision making for individual patients. This article reviews foreign body ingestion literature with important implications to the adolescent patient and raises awareness of some highly dangerous objects such as large button batteries, high-powered magnets, long sharps, narcotic packages, and super absorbent objects. An additional focus includes the management of esophageal food impaction. We highlight the unique aspects to the care of the adolescent with intentional ingestion and co-morbid psychiatric illness. The article concludes by discussing the challenges to prevention of ingestion in the at-risk patient. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

NASA's Approach to Software Assurance

NASA Technical Reports Server (NTRS)

Wetherholt, Martha

2015-01-01

NASA defines software assurance as: the planned and systematic set of activities that ensure conformance of software life cycle processes and products to requirements, standards, and procedures via quality, safety, reliability, and independent verification and validation. NASA's implementation of this approach to the quality, safety, reliability, security and verification and validation of software is brought together in one discipline, software assurance. Organizationally, NASA has software assurance at each NASA center, a Software Assurance Manager at NASA Headquarters, a Software Assurance Technical Fellow (currently the same person as the SA Manager), and an Independent Verification and Validation Organization with its own facility. An umbrella risk mitigation strategy for safety and mission success assurance of NASA's software, software assurance covers a wide area and is better structured to address the dynamic changes in how software is developed, used, and managed, as well as it's increasingly complex functionality. Being flexible, risk based, and prepared for challenges in software at NASA is essential, especially as much of our software is unique for each mission.

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

MyDiabetesMyWay: An Evolving National Data Driven Diabetes Self-Management Platform.

PubMed

Wake, Deborah J; He, Jinzhang; Czesak, Anna Maria; Mughal, Fezan; Cunningham, Scott G

2016-09-01

MyDiabetesMyWay (MDMW) is an award-wining national electronic personal health record and self-management platform for diabetes patients in Scotland. This platform links multiple national institutional and patient-recorded data sources to provide a unique resource for patient care and self-management. This review considers the current evidence for online interventions in diabetes and discusses these in the context of current and ongoing developments for MDMW. Evaluation of MDMW through patient reported outcomes demonstrates a positive impact on self-management. User feedback has highlighted barriers to uptake and has guided platform evolution from an education resource website to an electronic personal health record now encompassing remote monitoring, communication tools and personalized education links. Challenges in delivering digital interventions for long-term conditions include integration of data between institutional and personal recorded sources to perform big data analytics and facilitating technology use in those with disabilities, low digital literacy, low socioeconomic status and in minority groups. The potential for technology supported health improvement is great, but awareness and adoption by health workers and patients remains a significant barrier. © 2016 Diabetes Technology Society.

Internship - practical education

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

Porell, A.L.; Bauman, H.F.

1989-01-01

The current emphasis on regulatory compliance with environmental laws has depleted the availability of experienced environmental scientists and engineers needed to initiate critical environmental projects. Further, projects of short duration and long-term commitments to employment situations are considered a high risk for both the employer and the employee. Martin Marietta Energy Systems, Inc., has met this challenge for federal agencies through the US Department of Energy's (DOE's) Hazardous Waste Remedial Actions Program (HAZWRAP). Through unique interdepartmental agency agreements between the DOE and the Department of Defense (DOD) and contractual arrangements between Energy Systems, DOE, and the University of Tennessee's (UT's)more » Waste Management Institute (WMI), an intern program was formulated. HAZWRAP is a DOE headquarters' program for addressing hazardous-waste issues at all DOE facilities. Energy Systems is the support contractor office responsible for developing policies and implementing plans for this program. Under this charter, HAZWRAP assembled a large staff of experienced project managers for developing remedial actions plans, while providing other federal agencies assistance in implementing their remedial actions programs. HAZWRAP project managers are currently managing remedial investigations and feasibility studies at 130 federal facilities located throughout the DOD.« less

Online social network data as sociometric markers.

PubMed

Binder, Jens F; Buglass, Sarah L; Betts, Lucy R; Underwood, Jean D M

2017-10-01

Data from online social networks carry enormous potential for psychological research, yet their use and the ethical implications thereof are currently hotly debated. The present work aims to outline in detail the unique information richness of this data type and, in doing so, to support researchers when deciding on ethically appropriate ways of collecting, storing, publishing, and sharing data from online sources. Focusing on the very nature of social networks, their structural characteristics, and depth of information, we provide a detailed and accessible account of the challenges associated with data management and data storage. In particular, the general nonanonymity of network data sets is discussed, and an approach is developed to quantify the level of uniqueness that a particular online network bestows upon the individual maintaining it. Using graph enumeration techniques, we show that comparatively sparse information on a network is suitable as a sociometric marker that allows for the identification of an individual from the global population of online users. The impossibility of anonymizing specific types of network data carries implications for ethical guidelines and research practice. At the same time, network uniqueness opens up opportunities for novel research in psychology. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The challenge of sleep management in military operations.

PubMed

Wesensten, Nancy J; Balkin, Thomas J

2013-01-01

It has long been known that short-term (days) insufficient sleep causes decrements in mental effectiveness that put individuals at increased risk of committing errors and causing accidents. More recently, it has been discovered that chronic poor sleep (over years) is associated with a variety of negative health outcomes (metabolic syndrome, obesity, degraded behavioral health). Implementing an effective sleep health program is, therefore, in the best interests of active duty personnel and their families both in the short- and long-term. Like managing physical activity or nutrition, effectively managing sleep health comes with its unique set of challenges arising from the fact that individuals who routinely do not obtain sufficient sleep are generally desensitized to feeling sleepy and are poor at judging their own performance capabilities--and individuals cannot be compelled to sleep. For these reasons, an optimally effective sleep health program requires 3 components: (1) a rigorous, evidence-based sleep education component to impart actionable knowledge about optimal sleep amounts, healthy sleep behaviors, the known benefits of sleep, the short- and long-term consequences of insufficient sleep, and to dispel myths about sleep; (2) a nonintrusive device that objectively and accurately measures sleep to empower the individual to track his/her own sleep/wake habits; and (3) a meaningful, actionable metric reflecting sleep/wake impact on daily effectiveness so that the individual sees the consequences of his/her sleep behavior and, therefore, can make informed sleep health choices.

Shared medical appointments: improving access, outcomes, and satisfaction for patients with chronic cardiac diseases.

PubMed

Bartley, Kelly Bauer; Haney, Rebecca

2010-01-01

Improving access to care, health outcomes, and patient satisfaction are primary objectives for healthcare practices. This article outlines benefits, concerns, and possible challenges of shared medical appointments (SMAs) for patients and providers. The SMA model was designed to support providers' demanding schedules by allowing patients with the same chronic condition to be seen in a group setting. By concentrating on patient education and disease management, interactive meetings provide an opportunity for patients to share both successes and struggles with others experiencing similar challenges. Studies demonstrated that SMAs improved patient access, enhanced outcomes, and promoted patient satisfaction. This article describes the potential benefits of SMAs for patients with chronic heart disease, which consumes a large number of healthcare dollars related to hospital admissions, acute exacerbations, and symptom management. Education for self-management of chronic disease can become repetitive and time consuming. The SMA model introduces a fresh and unique style of healthcare visits, allowing providers to devote more time and attention to patients and improve productivity. The SMA model provides an outstanding method for nurse practitioners to demonstrate their role as a primary care provider, by leading patients in group discussions and evaluating their current health status. Patient selection, preparation, and facilitation of an SMA are discussed to demonstrate the complementary nature of an SMA approach in a healthcare practice.

MIMI: multimodality, multiresource, information integration environment for biomedical core facilities.

PubMed

Szymanski, Jacek; Wilson, David L; Zhang, Guo-Qiang

2009-10-01

The rapid expansion of biomedical research has brought substantial scientific and administrative data management challenges to modern core facilities. Scientifically, a core facility must be able to manage experimental workflow and the corresponding set of large and complex scientific data. It must also disseminate experimental data to relevant researchers in a secure and expedient manner that facilitates collaboration and provides support for data interpretation and analysis. Administratively, a core facility must be able to manage the scheduling of its equipment and to maintain a flexible and effective billing system to track material, resource, and personnel costs and charge for services to sustain its operation. It must also have the ability to regularly monitor the usage and performance of its equipment and to provide summary statistics on resources spent on different categories of research. To address these informatics challenges, we introduce a comprehensive system called MIMI (multimodality, multiresource, information integration environment) that integrates the administrative and scientific support of a core facility into a single web-based environment. We report the design, development, and deployment experience of a baseline MIMI system at an imaging core facility and discuss the general applicability of such a system in other types of core facilities. These initial results suggest that MIMI will be a unique, cost-effective approach to addressing the informatics infrastructure needs of core facilities and similar research laboratories.

Review and Analysis of Algorithmic Approaches Developed for Prognostics on CMAPSS Dataset

NASA Technical Reports Server (NTRS)

Ramasso, Emannuel; Saxena, Abhinav

2014-01-01

Benchmarking of prognostic algorithms has been challenging due to limited availability of common datasets suitable for prognostics. In an attempt to alleviate this problem several benchmarking datasets have been collected by NASA's prognostic center of excellence and made available to the Prognostics and Health Management (PHM) community to allow evaluation and comparison of prognostics algorithms. Among those datasets are five C-MAPSS datasets that have been extremely popular due to their unique characteristics making them suitable for prognostics. The C-MAPSS datasets pose several challenges that have been tackled by different methods in the PHM literature. In particular, management of high variability due to sensor noise, effects of operating conditions, and presence of multiple simultaneous fault modes are some factors that have great impact on the generalization capabilities of prognostics algorithms. More than 70 publications have used the C-MAPSS datasets for developing data-driven prognostic algorithms. The C-MAPSS datasets are also shown to be well-suited for development of new machine learning and pattern recognition tools for several key preprocessing steps such as feature extraction and selection, failure mode assessment, operating conditions assessment, health status estimation, uncertainty management, and prognostics performance evaluation. This paper summarizes a comprehensive literature review of publications using C-MAPSS datasets and provides guidelines and references to further usage of these datasets in a manner that allows clear and consistent comparison between different approaches.

Motivational techniques to improve self-care in hemophilia: the need to support autonomy in children.

PubMed

Bérubé, Sarah; Mouillard, Florine; Amesse, Claudine; Sultan, Serge

2016-01-11

In pediatric hemophilia, caregivers are facing unique challenges to adherence and self-care in children and adolescents with hemophilia. Hemophilia treatment requires adequate prophylaxis and on-demand treatment, as well as a clear behavioral strategy to limit risk-taking in terms of physical exercise and diet. Medication adherence rates of hemophilia patients have been reported to decrease during late childhood and adolescence. In the developing child, moving safely from parent-care to self-care is one of the greatest challenges of integrative care within this domain. There is a clear need for initiatives designed to increase an individual's motivation for treatment and self-care activities. Among motivational approaches, the self-determination perspective offers a useful framework to explain how the transition to self-care can be facilitated. We discuss how motivation regarding hemophilia treatment may be increased through parental autonomy support and we offer examples of applied communication techniques to facilitate autonomy-supportive caregiving. Although it has not yet been tested in the context of hemophilia, these communication techniques could potentially help caregivers promote adherence and self-care in children. Confronted by unique challenges to adherence and self-care, caregivers of children with hemophilia should move from an exclusive focus on illness-management education to an integrative strategy, including motivation-enhancing communication. The self-determination perspective provides important proximal objectives (e.g. autonomy support) to maintain optimal adherence in adolescents as they move from parent-care to self-care. Future research initiatives should address the practice of these communication techniques and evaluate them in the context of hemophilia.

Bringing nanomedicines to market: regulatory challenges, opportunities, and uncertainties.

PubMed

Nijhara, Ruchika; Balakrishnan, Krishna

2006-06-01

Scientists and entrepreneurs who contemplate developing nanomedicine products face several unique challenges in addition to many of the traditional hurdles of product development. In this review we analyze the major physicochemical, biologic and functional characteristics of several nanomedicine products on the market and explore the question of what made them unique. What made them successful? We also focus on the regulatory challenges faced by nanomedicine product developers. Based on these analyses, we propose the factors that are most likely to contribute to the success of nanomedicine products.

Public Health Emergency Planning for Children in Chemical, Biological, Radiological, and Nuclear (CBRN) Disasters

PubMed Central

Bartenfeld, Michael T.; Peacock, Georgina; Griese, Stephanie E.

2015-01-01

Children represent nearly a quarter of the US population, but their unique needs in chemical, biological, radiological, and nuclear (CBRN) emergencies may not be well understood by public health and emergency management personnel or even clinicians. Children are different from adults physically, developmentally, and socially. These characteristics have implications for providing care in CBRN disasters, making resulting illness in children challenging to prevent, identify, and treat. This article discusses these distinct physical, developmental, and social traits and characteristics of children in the context of the science behind exposure to, health effects from, and treatment for the threat agents potentially present in CBRN incidents. PMID:25014894

Perioperative Pain Management of a Patient Taking Naltrexone HCl/Bupropion HCl (Contrave): A Case Report.

PubMed

Ninh, Allen; Kim, Sang; Goldberg, Andrew

2017-10-15

A 42-year-old obese woman (body mass index = 30.2 kg/m) presented for urgent anterior cervical diskectomy and fusion. She had been taking oral naltrexone-bupropion extended-release (Contrave, Orexigen Therapeutics Inc, La Jolla, CA) for the past 6 months and continued using it until 12 hours preoperatively. Despite discontinuation of this medication, and employing an intraoperative and postoperative multimodal analgesia strategy, immediate pain control was inadequately achieved. Patients taking opioid antagonists who present for surgery pose unique challenges to the anesthesiologist and require extensive preoperative interdisciplinary discussions and planning for pain control throughout the perioperative period.

Opioid addiction, diversion, and abuse in chronic and cancer pain.

PubMed

Kata, Vijay; Novitch, Matthew B; Jones, Mark R; Anyama, Best O; Helander, Erik M; Kaye, Alan D

2018-06-01

The primary cause of overdose death in the United States is related to pharmaceutical opioids. A few particular populations that struggle with adverse outcomes related to opioid abuse are those in palliative care, those with chronic pain, and those receiving pain treatments secondary to cancer or chemotherapy. There have been massive efforts to decrease the use of opioid abuse in patient care in a gestalt manner, but palliative care provides unique challenges in applying these reduction tactics used by other specialties. We explore behavioral interventions, provider education, alternative pain management techniques, postmarketing surveillance, and abuse-deterrent formulas as emerging methods to counteract opioid abuse in these populations.

On fertile ground: An initial evaluation of green care farms in the United States.

PubMed

Anderson, Keith A; Chapin, Kate P; Reimer, Zachary; Siffri, Gina

2017-01-01

Green care farms (GCF) provide unique opportunities to persons with disabilities to engage in meaningful and therapeutic activities in farm settings. In this pilot study, the researchers examined the feasibility and impact of the first GCF in the United States. Qualitative interviews (N = 19) and thematic analysis were conducted. GCF participants and family members were enthusiastic about participation and identified benefits such as respite and improved mood. Administrators and farmers indicated that GCF challenged the status quo of funding, programming, and farming. Administrators speculated that the future success of GCF relies upon administrative expertise, local relationships, and managing risk and liability.

Tackling the global mental health challenge: a psychosomatic medicine/consultation-liaison psychiatry perspective.

PubMed

Bauer, Amy M; Fielke, Ken; Brayley, John; Araya, Mesfin; Alem, Atalay; Frankel, Bernard L; Fricchione, Gregory L

2010-01-01

Consultation-liaison (C-L) psychiatry, informed by principles of psychosomatic medicine, is well-positioned to address the global impact of mental disorders through primary care C-L models. The authors review the international burden of mental disorders, highlighting medical comorbidity, undertreatment, and the rationale for enhancing primary-care management. C-L psychiatry fosters the skills required for global mental health work. The authors describe successful C-L models developed in a low-income country (Ethiopia) and an under-resourced region of a high-income country (Australia). C-L psychiatrists have the potential to marshal their unique skill-set to reduce the global burden of mental disorders.

Knee Dislocations in Sports Injuries

PubMed Central

Pardiwala, Dinshaw N; Rao, Nandan N; Anand, Karthik; Raut, Alhad

2017-01-01

Knee dislocations are devastating when they occur on the athletic field or secondary to motor sports. The complexity of presentation and spectrum of treatment options makes these injuries unique and extremely challenging to even the most experienced knee surgeons. An astute appreciation of the treatment algorithm is essential to plan individualized management since no two complex knee dislocations are ever the same. Moreover, attention to detail and finesse of surgical technique are required to obtain a good functional result and ensure return to play. Over the past 10 years, our service has treated 43 competitive sportsmen with knee dislocations, and this experience forms the basis for this narrative review. PMID:28966379

The Global Drug Facility: a unique, holistic and pioneering approach to drug procurement and management

PubMed Central

Ryan, Timothy

2007-01-01

Abstract In January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006–2015, which describes the actions and resources needed to reduce tuberculosis (TB) incidence, prevalence and deaths. A fundamental aim of the Global Plan is to expand equitable access to affordable high-quality anti-tuberculous drugs and diagnostics. A principal tool developed by the Stop TB Partnership to achieve this is the Global Drug Facility (GDF). This paper demonstrates the GDF’s unique, holistic and pioneering approach to drug procurement and management by analysing its key achievements. One of these has been to provide 9 million patient-treatments to 78 countries in its first 6 years of operation. The GDF recognized that the incentives provided by free or affordable anti-tuberculosis drugs are not sufficient to induce governments to improve their programmes’ standards and coverage, nor does the provision of free or affordable drugs guarantee that there is broad access to, and use of, drug treatment in cases where procurement systems are weak, regulatory hurdles exist or there are unreliable distribution and storage systems. Thus, the paper also illustrates how the GDF has contributed towards making sustained improvements in the capacity of countries worldwide to properly manage their anti-TB drugs. This paper also assesses some of the limitations, shortcomings and risks associated with the model. The paper concludes by examining the GDF’s key plans and strategies for the future, and the challenges associated with implementation. PMID:17639218

How I treat acute lymphoblastic leukemia in older adolescents and young adults

PubMed Central

Curran, Emily

2015-01-01

At the intersection between children and older adults, the care of adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) poses unique challenges and issues beyond those faced by other age groups. Although the survival of AYA patients is inferior to younger children, growing evidence suggests that AYA patients have improved outcomes, with disease-free survival rates of 60% to 70%, when treated with pediatric-based approaches. A holistic approach, incorporating a multidisciplinary team, is a key component of successful treatment of these AYA patients. With the appropriate support and management of toxicities during and following treatment, these regimens are well tolerated in the AYA population. Even with the significant progress that has been made during the last decade, patients with persistence of minimal residual disease (MRD) during intensive therapy still have a poor prognosis. With new insights into disease pathogenesis in AYA ALL and the availability of disease-specific kinase inhibitors and novel targeted antibodies, future studies will focus on individualized therapy to eradicate MRD and result in further improvements in survival. This case-based review will discuss the biology, pharmacology, and psychosocial aspects of AYA patients with ALL, highlighting our current approach to the management of these unique patients. PMID:25805810

Sensor Management for Applied Research Technologies (SMART)-On Demand Modeling (ODM) Project

NASA Technical Reports Server (NTRS)

Goodman, M.; Blakeslee, R.; Hood, R.; Jedlovec, G.; Botts, M.; Li, X.

2006-01-01

NASA requires timely on-demand data and analysis capabilities to enable practical benefits of Earth science observations. However, a significant challenge exists in accessing and integrating data from multiple sensors or platforms to address Earth science problems because of the large data volumes, varying sensor scan characteristics, unique orbital coverage, and the steep learning curve associated with each sensor and data type. The development of sensor web capabilities to autonomously process these data streams (whether real-time or archived) provides an opportunity to overcome these obstacles and facilitate the integration and synthesis of Earth science data and weather model output. A three year project, entitled Sensor Management for Applied Research Technologies (SMART) - On Demand Modeling (ODM), will develop and demonstrate the readiness of Open Geospatial Consortium (OGC) Sensor Web Enablement (SWE) capabilities that integrate both Earth observations and forecast model output into new data acquisition and assimilation strategies. The advancement of SWE-enabled systems (i.e., use of SensorML, sensor planning services - SPS, sensor observation services - SOS, sensor alert services - SAS and common observation model protocols) will have practical and efficient uses in the Earth science community for enhanced data set generation, real-time data assimilation with operational applications, and for autonomous sensor tasking for unique data collection.

How I treat acute lymphoblastic leukemia in older adolescents and young adults.

PubMed

Curran, Emily; Stock, Wendy

2015-06-11

At the intersection between children and older adults, the care of adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) poses unique challenges and issues beyond those faced by other age groups. Although the survival of AYA patients is inferior to younger children, growing evidence suggests that AYA patients have improved outcomes, with disease-free survival rates of 60% to 70%, when treated with pediatric-based approaches. A holistic approach, incorporating a multidisciplinary team, is a key component of successful treatment of these AYA patients. With the appropriate support and management of toxicities during and following treatment, these regimens are well tolerated in the AYA population. Even with the significant progress that has been made during the last decade, patients with persistence of minimal residual disease (MRD) during intensive therapy still have a poor prognosis. With new insights into disease pathogenesis in AYA ALL and the availability of disease-specific kinase inhibitors and novel targeted antibodies, future studies will focus on individualized therapy to eradicate MRD and result in further improvements in survival. This case-based review will discuss the biology, pharmacology, and psychosocial aspects of AYA patients with ALL, highlighting our current approach to the management of these unique patients. © 2015 by The American Society of Hematology.

To what extent do they sway Australian water management decision making?

NASA Astrophysics Data System (ADS)

Papas, Maureen

2016-10-01

At a time when the reliability of freshwater resources has become highly unpredictable, as a result of climate change and increased droughts frequency, the role of scientific evidence in forecasting the availability of seasonal water has become more critical. Australia is one of the driest inhabited continents. Its freshwater availability is highly variable, which poses unique problems for the management of the nation's water resources. Under Australia's federal system, water management challenges have been progressively dealt with through political institutions that rely on best available science to inform policy development. However, it could be argued that evidenced-based policy making is an impossible aim in a highly complex and uncertain political environment: that such a rational approach would be defeated by competing values and vested interests across stakeholders. This article demonstrates that, while science has a fundamental role to play in effective water resource management, the reality on the ground often diverges from the intended aim and does not always reflect efforts at reform. This article briefly reviews the Water Act 2007 (Cth) and comments on why policy makers need to manage rather than try to eliminate uncertainty to promote change.

Transitioning home: comprehensive case management for America's heroes.

PubMed

Perla, Lisa Y; Jackson, Patricia D; Hopkins, Sherry L; Daggett, Margaret C; Van Horn, Linda J

2013-01-01

The conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, have created unique challenges for rehabilitation teams, including nurse and social work case managers. Active duty service members, National Guard and Reservists have deployed in large numbers and as many as 20% have been exposed to blast injury, which can result in polytrauma and traumatic brain injury, the "signature injury" of the war, as well as psychological trauma, and painful musculoskeletal injuries. In addition, there are also documented emotional injuries associated with the constant stress of war and the frequency of exposure to the graphic scenes of war. The Departments of Defense and Veterans Affairs work closely to provide comprehensive care coordination and case management for service members and veterans who have honorably served our country. This article describes the case management collaborative between Veterans Affairs and the Department of Defense that ensures service members and veterans receive their entitled healthcare services. The complex care needs of these returning service members require astute case management in addition to clinical care. This collaboration ensures the best life-long outcomes and will be discussed in detail in this article. © 2013 Association of Rehabilitation Nurses.

Web Design for Space Operations: An Overview of the Challenges and New Technologies Used in Developing and Operating Web-Based Applications in Real-Time Operational Support Onboard the International Space Station, in Astronaut Mission Planning and Mission Control Operations

NASA Technical Reports Server (NTRS)

Khan, Ahmed

2010-01-01

The International Space Station (ISS) Operations Planning Team, Mission Control Centre and Mission Automation Support Network (MAS) have all evolved over the years to use commercial web-based technologies to create a configurable electronic infrastructure to manage the complex network of real-time planning, crew scheduling, resource and activity management as well as onboard document and procedure management required to co-ordinate ISS assembly, daily operations and mission support. While these Web technologies are classified as non-critical in nature, their use is part of an essential backbone of daily operations on the ISS and allows the crew to operate the ISS as a functioning science laboratory. The rapid evolution of the internet from 1998 (when ISS assembly began) to today, along with the nature of continuous manned operations in space, have presented a unique challenge in terms of software engineering and system development. In addition, the use of a wide array of competing internet technologies (including commercial technologies such as .NET and JAVA ) and the special requirements of having to support this network, both nationally among various control centres for International Partners (IPs), as well as onboard the station itself, have created special challenges for the MCC Web Tools Development Team, software engineers and flight controllers, who implement and maintain this system. This paper presents an overview of some of these operational challenges, and the evolving nature of the solutions and the future use of COTS based rich internet technologies in manned space flight operations. In particular this paper will focus on the use of Microsoft.s .NET API to develop Web-Based Operational tools, the use of XML based service oriented architectures (SOA) that needed to be customized to support Mission operations, the maintenance of a Microsoft IIS web server onboard the ISS, The OpsLan, functional-oriented Web Design with AJAX

The National Practice Benchmark for Oncology: 2015 Report for 2014 Data

PubMed Central

Balch, Carla; Ogle, John D.

2016-01-01

The National Practice Benchmark (NPB) is a unique tool used to measure oncology practices against others across the country in a meaningful way despite variations in practice demographics, size, and setting. In today’s challenging economic environment, each practice positions service offerings and competitive advantages to attract patients. Although the data in the NPB report are primarily reported by community oncology practices, the business structure and arrangements with regional health care systems are also reflected in the benchmark report. The ability to produce detailed metrics is an accomplishment of excellence in business and clinical management. With these metrics, a practice should be able to measure and analyze its current business practices and make appropriate changes, if necessary. In this report, we build on the foundation initially established by Oncology Metrics (acquired by Flatiron Health in 2014) over years of data collection and refine definitions to deliver the NPB, which is uniquely meaningful in the oncology market. PMID:27006357

Shrinking the Supply Chain for Implantable Coronary Stent Devices.

PubMed

Moore, Sean S; O'Sullivan, Kevin J; Verdecchia, Francesco

2016-02-01

Stenting treatments for the management of disease in the heart, arterial and venous systems, biliary ducts, urethras, ureters, oesophageal tract and prostate have made enormous technical advances since their introduction into clinical use. The progression from metallic to polymer based bio-absorbable stents, coupled with the advances in additive manufacturing techniques, present a unique opportunity to completely re-envision the design, manufacture, and supply chain of stents. This paper looks at current stenting trends and proposes a future where the stent supply chain is condensed from ~150 days to ~20 min. The Cardiologist therefore has the opportunity to become a designer, manufacturer and user with patients receiving custom stents specific to their unique pathology that will be generated, delivered and deployed in the Cath-lab. The paper will outline this potentially revolutionary development and consider the technical challenges that will need to be overcome in order to achieve these ambitious goals. A high level overview of the generating eluting stents in situ program-GENESIS-is outlined including some early experimental work.

Advanced nanocarriers based on heparin and its derivatives for cancer management.

PubMed

Yang, Xiaoye; Du, Hongliang; Liu, Jiyong; Zhai, Guangxi

2015-02-09

To obtain a satisfying anticancer effect, rationally designed nanocarriers are intensively studied. In this field, heparin and its derivatives have been widely attempted recently as potential component of nanocarriers due to their unique biological and physiochemical features, especially the anticancer activity. This review focuses on state-of-the-art nanocarriers with heparin/heparin derivatives as backbone or coating material. At the beginning, the unique advantages of heparin used in cancer nanotechnology are discussed. After that, different strategies of heparin chemical modification are reviewed, laying the foundation of developing various nanocarriers. Then a systematic summary of diverse nanoparticles with heparin as component is exhibited, involving heparin-drug conjugate, polymeric nanoparticles, nanogels, polyelectrolyte complex nanoparticles, and heparin-coated organic and inorganic nanoparticles. The application of these nanoparticles in various novel cancer therapy (containing targeted therapy, magnetic therapy, photodynamic therapy, and gene therapy) will be highlighted. Finally, future challenges and opportunities of heparin-based biomaterials in cancer nanotechnology are discussed.

Can banks offer digital keys for health care?

PubMed

Casillas, John

2013-01-01

In the quest to implement electronic health care records, health care stakeholders have uncovered an elephant in the room - how to implement patient identity and integrity solutions. Without this, linking the unique records of an individual is impossible. An inaccurate record can be dangerous for prescribing treatment. Yet many consider a unique patient identifier as an unacceptable privacy risk. Medical banking, or the convergence of banking and heath IT systems, is spawning new ideas that could impact on this difficult area. This article suggests that new forms of efficiency in payment processing may yield a common, cross-industry technology platform for managing digital identity by banks. Redefining a bank based on core competencies, the article looks at three areas: (1) the "identity theft arms race"; (2) innovations in payment processing; and (3) consumer engagement, and suggests that, as banking and health care systems converge, digital identity may become the new money. This realization may find banks fully engaged in helping health care to overcome the challenge of patient identity and integrity.

Psychotherapy of Arab patients in the West: uniqueness, empathy, and "otherness".

PubMed

Sayed, Mohamed A

2003-01-01

The study of Arab patients seeking treatment for their psychological problems in the West has previously been underrepresented in mainstream American journals. Notwithstanding various attempts that deal with Arab Americans as a minority group, there has been a paucity of scholarship dealing with Arab patients' unique characteristics related to sociopolitical, cultural, and other factors that impact the therapeutic process for those individuals who are not acculturated to the American way of life. These patients present challenges to their therapists owing to the contrasting cultural understanding and conceptualization of mental illness and therapeutic process. Therapists need to fully appreciate the relationship between culture and psychotherapy. Patients' and clinicians' awareness of differences may contribute to the ability of both sides of the therapeutic dyad to overcome some of the differences encountered when Arab patients are treated outside their cultural domain. A case vignette serves to illuminate how issues of cultural transference and countertransference can be managed for the benefit of the patient and the enlightenment of the therapist.

The role of managed care in work-related injuries.

PubMed

Shor, M J; Miller, J C

1996-10-01

Many opportunities exist today for orthopedic surgeons in the treatment and management of work-related injuries. Physicians wishing to enter or participate in this market must realize that the role of the physician in the treatment of the injured worker has expanded from one of being solely the care giver to being a patient manager, a problem solver, and a communicator. A number of years ago, many orthopedic surgeons missed out on managed care contracting for health maintenance organizations because they thought they could survive without it. They soon learned the challenges of sitting on the sidelines. Whether we like it or not, managed care for work-related injuries is here and its likelihood for going away is about zero. If your state has not yet adopted utilization management standards or managed care for workers' compensation-enabling legislation, when you wake up tomorrow they may have done so. Because of its relative embryonic development, there are exceptional opportunities for practitioners to take active roles in shaping the models that will serve employees and employers in the year 2000. Physicians who are interested in the treatment of injured workers have a unique opportunity right now to develop relationships in the managed workers' compensation arena. Payment and patient referrals for workers' compensation may turn out to be more attractive financially than many of the contracts currently in place with health maintenance organizations and other general health plans. Physicians willing to partner with employers and other players in the workers' compensation arena currently face some challenging, rewarding, and exciting opportunities. In the immortal words of Hippocrates, "Healing is a matter of time, but it is sometimes a matter of opportunity."3 It is unclear whether Hippocrates ever imagined our current level of science, practice, and organization, but it is clear the opportunities to be an active participant in the changes occurring in workers' compensation are as real today as they were in 1973 when then President Nixon passed the Health Maintenance Organization Act.

Software Health Management: A Short Review of Challenges and Existing Techniques

NASA Technical Reports Server (NTRS)

Pipatsrisawat, Knot; Darwiche, Adnan; Mengshoel, Ole J.; Schumann, Johann

2009-01-01

Modern spacecraft (as well as most other complex mechanisms like aircraft, automobiles, and chemical plants) rely more and more on software, to a point where software failures have caused severe accidents and loss of missions. Software failures during a manned mission can cause loss of life, so there are severe requirements to make the software as safe and reliable as possible. Typically, verification and validation (V&V) has the task of making sure that all software errors are found before the software is deployed and that it always conforms to the requirements. Experience, however, shows that this gold standard of error-free software cannot be reached in practice. Even if the software alone is free of glitches, its interoperation with the hardware (e.g., with sensors or actuators) can cause problems. Unexpected operational conditions or changes in the environment may ultimately cause a software system to fail. Is there a way to surmount this problem? In most modern aircraft and many automobiles, hardware such as central electrical, mechanical, and hydraulic components are monitored by IVHM (Integrated Vehicle Health Management) systems. These systems can recognize, isolate, and identify faults and failures, both those that already occurred as well as imminent ones. With the help of diagnostics and prognostics, appropriate mitigation strategies can be selected (replacement or repair, switch to redundant systems, etc.). In this short paper, we discuss some challenges and promising techniques for software health management (SWHM). In particular, we identify unique challenges for preventing software failure in systems which involve both software and hardware components. We then present our classifications of techniques related to SWHM. These classifications are performed based on dimensions of interest to both developers and users of the techniques, and hopefully provide a map for dealing with software faults and failures.

The Challenges of Career and Technical Education Concurrent Enrollment: An Administrative Perspective

ERIC Educational Resources Information Center

Haag, Patricia W.

2015-01-01

Career and technical education concurrent enrollment may pose unique challenges in programming and enrollment for program administrators, and this chapter describes the experiences and challenges of a CTE concurrent enrollment administrator.

Solid Rocket Booster (SRB) Flight System Integration at Its Best

NASA Technical Reports Server (NTRS)

Wood, T. David; Kanner, Howard S.; Freeland, Donna M.; Olson, Derek T.

2011-01-01

The Solid Rocket Booster (SRB) element integrates all the subsystems needed for ascent flight, entry, and recovery of the combined Booster and Motor system. These include the structures, avionics, thrust vector control, pyrotechnic, range safety, deceleration, thermal protection, and retrieval systems. This represents the only human-rated, recoverable and refurbishable solid rocket ever developed and flown. Challenges included subsystem integration, thermal environments and severe loads (including water impact), sometimes resulting in hardware attrition. Several of the subsystems evolved during the program through design changes. These included the thermal protection system, range safety system, parachute/recovery system, and others. Because the system was recovered, the SRB was ideal for data and imagery acquisition, which proved essential for understanding loads, environments and system response. The three main parachutes that lower the SRBs to the ocean are the largest parachutes ever designed, and the SRBs are the largest structures ever to be lowered by parachutes. SRB recovery from the ocean was a unique process and represented a significant operational challenge; requiring personnel, facilities, transportation, and ground support equipment. The SRB element achieved reliability via extensive system testing and checkout, redundancy management, and a thorough postflight assessment process. However, the in-flight data and postflight assessment process revealed the hardware was affected much more strongly than originally anticipated. Assembly and integration of the booster subsystems required acceptance testing of reused hardware components for each build. Extensive testing was done to assure hardware functionality at each level of stage integration. Because the booster element is recoverable, subsystems were available for inspection and testing postflight, unique to the Shuttle launch vehicle. Problems were noted and corrective actions were implemented as needed. The postflight assessment process was quite detailed and a significant portion of flight operations. The SRBs provided fully redundant critical systems including thrust vector control, mission critical pyrotechnics, avionics, and parachute recovery system. The design intent was to lift off with full redundancy. On occasion, the redundancy management scheme was needed during flight operations. This paper describes some of the design challenges and technical issues, how the design evolved with time, and key areas where hardware reusability contributed to improved system level understanding.

Suspected meningococcal meningitis on an aircraft carrier.

PubMed

Farr, Wesley; Gonzalez, Michele J; Garbauskas, Heather; Zinderman, Craig E; LaMar, James E

2004-09-01

A suspected case of meningococcal meningitis was diagnosed in a 24-year-old sailor onboard an aircraft carrier at sea in 2003. He was immediately confined to the ship's hospital ward under respiratory isolation precautions and was treated with intravenously administered antibiotics. His illness resolved without sequelae. A total of 99 close contacts from the ship were identified and given antibiotic prophylaxis, with directly observed therapy. British public health authorities were contacted to trace and treat persons identified as close contacts during a port call a few days before presentation. Managing a communicable disease such as meningococcal meningitis in the austere shipboard environment represents a unique challenge to military medical personnel. Successful management is possible through prompt treatment, respiratory isolation, and open communication between primary health care providers and public health officials. The identification of shipboard close contacts and other infection control procedures used by the ship's medical department are reviewed.

Space Toxicology: Human Health during Space Operations

NASA Technical Reports Server (NTRS)

Khan-Mayberry, Noreen; James, John T.; Tyl, ROchelle; Lam, Chiu-Wing

2010-01-01

Space Toxicology is a unique and targeted discipline for spaceflight, space habitation and occupation of celestial bodies including planets, moons and asteroids. Astronaut explorers face distinctive health challenges and limited resources for rescue and medical care during space operation. A central goal of space toxicology is to protect the health of the astronaut by assessing potential chemical exposures during spaceflight and setting safe limits that will protect the astronaut against chemical exposures, in a physiologically altered state. In order to maintain sustained occupation in space on the International Space Station (ISS), toxicological risks must be assessed and managed within the context of isolation continuous exposures, reuse of air and water, limited rescue options, and the need to use highly toxic compounds for propulsion. As we begin to explore other celestial bodies in situ toxicological risks, such as inhalation of reactive mineral dusts, must also be managed.

Glaucoma and cataract surgery: two roads merging into one.

PubMed

Shah, Manjool; Law, Geoffrey; Ahmed, Iqbal Ike K

2016-01-01

To discuss the increasing utilization of cataract extraction in the management of glaucoma and to highlight advances in surgical care that can promote synergistic treatment of these comorbid conditions. Recent years have demonstrated significant advances in the management of glaucoma through the use of novel microinvasive glaucoma devices. Furthermore, an increased understanding of the role of cataract surgery in the treatment of various glaucomas warrants review. Nevertheless, cataract surgery in the glaucoma patient warrants specific preoperative, intraoperative, and postoperative planning to optimize visual function and quality of life while mitigating potential risk factors for adverse events. Although the challenges of performing cataract extraction on glaucoma patients exist, the potential benefit to these patients is substantial. With attention to pre- and perioperative surgical planning and intraoperative technique, as well as with awareness and potential utilization of novel devices and treatment strategies, cataract extraction offers a unique platform for anatomical and functional improvement in this increasingly common cohort of patients.

Atrial flutter after surgical maze: incidence, diagnosis, and management.

PubMed

Dresen, William; Mason, Pamela K

2016-01-01

The prevalence of atrial fibrillation is increasing and surgical ablation is becoming more common, both as a stand-alone procedure and when performed concomitantly with other cardiac surgery. Although surgical ablation is effective, with it unique challenges arise, including iatrogenic macroreentrant tachycardias that are often highly symptomatic and difficult to manage conservatively. Postsurgical ablation, localization of the arrhythmic circuit is difficult to determine using surface ECG alone because of alterations in the atrial myocardium, and multiple different pathways are often present. Most, however, localize to the left atrium, and percutaneous catheter ablation is emerging as an effective treatment modality. Patients with complex postoperative arrhythmias should be referred to a dedicated atrial fibrillation center when possible and symptomatic arrhythmias mapped and ablated. Knowledge of the previously performed surgical lesion set is of vital importance in understanding the mechanism of the arrhythmia and increasing procedural success rates. http://links.lww.com/HCO/A31.

Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association.

PubMed

Feingold, Brian; Mahle, William T; Auerbach, Scott; Clemens, Paula; Domenighetti, Andrea A; Jefferies, John L; Judge, Daniel P; Lal, Ashwin K; Markham, Larry W; Parks, W James; Tsuda, Takeshi; Wang, Paul J; Yoo, Shi-Joon

2017-09-26

For many neuromuscular diseases (NMDs), cardiac disease represents a major cause of morbidity and mortality. The management of cardiac disease in NMDs is made challenging by the broad clinical heterogeneity that exists among many NMDs and by limited knowledge about disease-specific cardiovascular pathogenesis and course-modifying interventions. The overlay of compromise in peripheral muscle function and other organ systems, such as the lungs, also makes the simple application of endorsed adult or pediatric heart failure guidelines to the NMD population problematic. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. © 2017 American Heart Association, Inc.

Herpes zoster - typical and atypical presentations.

PubMed

Dayan, Roy Rafael; Peleg, Roni

2017-08-01

Varicella- zoster virus infection is an intriguing medical entity that involves many medical specialties including infectious diseases, immunology, dermatology, and neurology. It can affect patients from early childhood to old age. Its treatment requires expertise in pain management and psychological support. While varicella is caused by acute viremia, herpes zoster occurs after the dormant viral infection, involving the cranial nerve or sensory root ganglia, is re-activated and spreads orthodromically from the ganglion, via the sensory nerve root, to the innervated target tissue (skin, cornea, auditory canal, etc.). Typically, a single dermatome is involved, although two or three adjacent dermatomes may be affected. The lesions usually do not cross the midline. Herpes zoster can also present with unique or atypical clinical manifestations, such as glioma, zoster sine herpete and bilateral herpes zoster, which can be a challenging diagnosis even for experienced physicians. We discuss the epidemiology, pathophysiology, diagnosis and management of Herpes Zoster, typical and atypical presentations.

Central talar dome lesions: a unique surgical approach with incorporation of a talar allograft for joint reconstitution and restoration of function.

PubMed

Dobbs, Bruce M; Cazzell, Shawn M; Dini, Monara

2011-01-01

Osteochondral lesions of the talus have been documented, reported, and studied since as early as the 19th century. The evolution of classification systems has allowed surgeons to better manage osseous lesions. Most osteochondral lesions of the talus have been categorized as anterolateral, posteromedial, or central with respect to the talar dome and its articulating surface. The complexity of the aforementioned lesions each present their own set of obstacles and, hence, management. Specifically, surgery on a central talar dome lesion is complicated by poor exposure and limited access, proving to be a challenging operation. Preoperative planning, including exhaustive imaging before any talar dome surgery, is imperative. We present a case study that involves the need for a distal tibial chevron (wedge) talus, with incorporation of a cadaveric allograft to fill the defect.

When symptoms don't fit: a case series of conversion disorder in the pediatric otolaryngology practice.

PubMed

Caulley, Lisa; Kohlert, Scott; Gandy, Hazen; Olds, Janet; Bromwich, Matthew

2018-05-29

Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngology diseases in the pediatric population. In this report, the authors describe 3 cases of conversion disorder that presented to a pediatric otolaryngology-head and neck surgery practice. This report highlights a unique population of patients who have not previously been investigated. The clinical presentation and management of these cases are discussed in detail. Non-organic otolaryngology symptoms of conversion disorder in the pediatric population are reviewed. In addition, we discuss the challenges faced by clinicians in appropriately identifying and treating these patients and present an approach to management of their care. In this report, the authors highlight the importance of considering psychogenic illnesses in patients with atypical clinical presentations of otolaryngology disorders.

Scientific and social landscapes: New frameworks and forums for water management and sustainability

USGS Publications Warehouse

Turner, Christine; Karl, Herman A.

2001-01-01

The Two Decades of Water Law and Policy Reform conference examines the agenda for reforming and improving water law that has developed during the past two decades in the West, assesses what has (and has not) been accomplished by pursuing these reforms, and explores lessons and implications for future water law and policy. The papers and discussion provide analysis and lessons that can guide the new administration, Congress, federal agencies, state governments, and communities as they seek to find policy solutions to the challenges posed by the tremendous economic and demographic changes occurring in the West, in order to ensure the sustainability of the region’s unique environment. Specific sessions focus on reforms such as improving the scientific and technical basis for water management, water conservation and efficiency, protecting environmental values in meeting water demands, and creating new models of governance for water issues.

Optimal Remote Sensing with Small Unmanned Aircraft Systems and Risk Management

NASA Astrophysics Data System (ADS)

Stark, Brandon

Over the past decade, the rapid rise of Unmanned Aircraft Systems (UASs) has blossomed into a new component of the aviation industry. Though regulations within the United States lagged, the promise of the ability of Small Unmanned Aircraft Systems (SUASs), or those UAS that weigh less than 55 lbs, has driven significant advances in small scale aviation technology. The dream of a small, low-cost aerial platform that can fly anywhere and keep humans safely away from the `dull, dangerous and dirty' jobs, has encouraged many to examine the possibilities of utilizing SUAS in new and transformative ways, especially as a new tool in remote sensing. However, as with any new tool, there remains significant challenges in realizing the full potential of SUAS-based remote sensing. Within this dissertation, two specific challenges are addressed: validating the use of SUAS as a remote sensing platform and improving the safety and management of SUAS. The use of SUAS in remote sensing is a relatively new challenge and while it has many similarities to other remote sensing platforms, the dynamic nature of its operation makes it unique. In this dissertation, a closer look at the methodology of using SUAS reveals that while many view SUAS as an alternative to satellite imagery, this is an incomplete view and that the current common implementation introduces a new source of error that has significant implications on the reliability of the data collected. It can also be seen that a new approach to remote sensing with an SUAS can be developed by addressing the spatial, spectral and temporal factors that can now be more finely adjusted with the use of SUAS. However, to take the full advantage of the potential of SUAS, they must uphold the promise of improved safety. This is not a trivial challenge, especially for the integration into the National Airspace System (NAS) and for the safety management and oversight of diverse UAS operations. In this dissertation, the challenge of integrating SUAS in the NAS is addressed by presenting an analysis of enabling flight operations at night, developing a swarm safety management system for improving SUAS robustness, investigating the use of new technology on SUAS to improve air safety, and developing a novel framework to better understand human-SUAS interaction. Addressing the other side of safety, this dissertation discusses the struggle of large diverse organizations to balance acceptance, safety and oversight for UAS operations and the development of a novel implementation of a UAS Safety Management System.

Challenges and Opportunities with Empowering Baby Boomers for Personal Health Information Management Using Consumer Health Information Technologies: an Ecological Perspective

PubMed Central

LeRouge, Cynthia M.; Tao, Donghua; Ohs, Jennifer; Lach, Helen W.; Jupka, Keri; Wray, Ricardo

2014-01-01

“Baby Boomers” (adults born between the years of 1946 and 1964) make up the largest segment of the population in many countries, including the United States (about 78 million Americans) [1]. As Baby Boomers reach retirement age and beyond, many will have increasing medical needs and thus demand more health care resources that will challenge the healthcare system. Baby Boomers will likely accelerate the movement toward patient self-management and prevention efforts. Consumer Health Information Technologies (CHIT) hold promise for empowering health consumers to take an active role in health maintenance and disease management, and thus, have the potential to address Baby Boomers' health needs. Such innovations require changes in health care practice and processes that take into account Baby Boomers' personal health needs, preferences, health culture, and abilities to use these technologies. Without foundational knowledge of barriers and opportunities, Baby Boomers may not realize the potential of these innovations for improving self-management of health and health outcomes. However, research to date has not adequately explored the degree to which Baby Boomers are ready to embrace consumer health information technology and how their unique subcultures affect adoption and diffusion. This position paper describes an ecological conceptual framework for understanding and studying CHIT aimed at satisfying the personal health needs of Baby Boomers. We explore existing literature to provide a detailed depiction of our proposed conceptual framework, which focuses characteristics influencing Baby Boomers and their Personal Health Information Management (PHIM) and potential information problems. Using our ecological framework as a backdrop, we provide insight and implications for future research based on literature and underlying theories represented in our model. PMID:29546084

Challenges and Opportunities with Empowering Baby Boomers for Personal Health Information Management Using Consumer Health Information Technologies: an Ecological Perspective.

PubMed

LeRouge, Cynthia M; Tao, Donghua; Ohs, Jennifer; Lach, Helen W; Jupka, Keri; Wray, Ricardo

2014-01-01

"Baby Boomers" (adults born between the years of 1946 and 1964) make up the largest segment of the population in many countries, including the United States (about 78 million Americans) [1]. As Baby Boomers reach retirement age and beyond, many will have increasing medical needs and thus demand more health care resources that will challenge the healthcare system. Baby Boomers will likely accelerate the movement toward patient self-management and prevention efforts. Consumer Health Information Technologies (CHIT) hold promise for empowering health consumers to take an active role in health maintenance and disease management, and thus, have the potential to address Baby Boomers' health needs. Such innovations require changes in health care practice and processes that take into account Baby Boomers' personal health needs, preferences, health culture, and abilities to use these technologies. Without foundational knowledge of barriers and opportunities, Baby Boomers may not realize the potential of these innovations for improving self-management of health and health outcomes. However, research to date has not adequately explored the degree to which Baby Boomers are ready to embrace consumer health information technology and how their unique subcultures affect adoption and diffusion. This position paper describes an ecological conceptual framework for understanding and studying CHIT aimed at satisfying the personal health needs of Baby Boomers. We explore existing literature to provide a detailed depiction of our proposed conceptual framework, which focuses characteristics influencing Baby Boomers and their Personal Health Information Management (PHIM) and potential information problems. Using our ecological framework as a backdrop, we provide insight and implications for future research based on literature and underlying theories represented in our model.

Oral Rabies Vaccination in North America: Opportunities, Complexities, and Challenges

PubMed Central

Slate, Dennis; Algeo, Timothy P.; Nelson, Kathleen M.; Chipman, Richard B.; Donovan, Dennis; Blanton, Jesse D.; Niezgoda, Michael; Rupprecht, Charles E.

2009-01-01

Steps to facilitate inter-jurisdictional collaboration nationally and continentally have been critical for implementing and conducting coordinated wildlife rabies management programs that rely heavily on oral rabies vaccination (ORV). Formation of a national rabies management team has been pivotal for coordinated ORV programs in the United States of America. The signing of the North American Rabies Management Plan extended a collaborative framework for coordination of surveillance, control, and research in border areas among Canada, Mexico, and the US. Advances in enhanced surveillance have facilitated sampling of greater scope and intensity near ORV zones for improved rabies management decision-making in real time. The value of enhanced surveillance as a complement to public health surveillance was best illustrated in Ohio during 2007, where 19 rabies cases were detected that were critical for the formulation of focused contingency actions for controlling rabies in this strategically key area. Diverse complexities and challenges are commonplace when applying ORV to control rabies in wild meso-carnivores. Nevertheless, intervention has resulted in notable successes, including the elimination of an arctic fox (Vulpes lagopus) rabies virus variant in most of southern Ontario, Canada, with ancillary benefits of elimination extending into Quebec and the northeastern US. Progress continues with ORV toward preventing the spread and working toward elimination of a unique variant of gray fox (Urocyon cinereoargenteus) rabies in west central Texas. Elimination of rabies in coyotes (Canis latrans) through ORV contributed to the US being declared free of canine rabies in 2007. Raccoon (Procyon lotor) rabies control continues to present the greatest challenges among meso-carnivore rabies reservoirs, yet to date intervention has prevented this variant from gaining a broad geographic foothold beyond ORV zones designed to prevent its spread from the eastern US. Progress continues toward the development and testing of new bait-vaccine combinations that increase the chance for improved delivery and performance in the diverse meso-carnivore rabies reservoir complex in the US. PMID:20027214

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions.

PubMed

Zulman, Donna M; Jenchura, Emily C; Cohen, Danielle M; Lewis, Eleanor T; Houston, Thomas K; Asch, Steven M

2015-08-01

Patient eHealth technology offers potential support for disease self-management, but the value of existing applications for patients with multiple chronic conditions (MCCs) is unclear. To understand self-management and health care navigation challenges that patients face due to MCCs and to identify opportunities to support these patients through new and enhanced eHealth technology. After administering a screening survey, we conducted 10 focus groups of 3-8 patients grouped by age, sex, and common chronic conditions. Patients discussed challenges associated with having MCCs and their use of (and desires from) technology to support self-management. Three investigators used standard content analysis methods to code the focus group transcripts. Emergent themes were reviewed with all collaborators, and final themes and representative quotes were validated with a sample of participants. Fifty-three individuals with ≥3 chronic conditions and experience using technology for health-related purposes. Focus group participants had an average of five chronic conditions. Participants reported using technology most frequently to search for health information (96%), communicate with health care providers (92%), track medical information (83%), track medications (77%), and support decision-making about treatment (55%). Three themes emerged to guide eHealth technology development: (1) Patients with MCCs manage a high volume of information, visits, and self-care tasks; (2) they need to coordinate, synthesize, and reconcile health information from multiple providers and about different conditions; (3) their unique position at the hub of multiple health issues requires self-advocacy and expertise. Focus groups identified desirable eHealth resources and tools that reflect these themes. Although patients with multiple health issues use eHealth technology to support self-care for specific conditions, they also desire tools that transcend disease boundaries. By addressing the holistic needs of patients with MCCs, eHealth technology can advance health care from a disease-centered to a patient-centered model.

Operation Protective Edge - A Unique Challenge for a Civilian EMS Agency.

PubMed

Jaffe, Eli; Strugo, Refael; Wacht, Oren

2015-10-01

During July through August 2014, Operation Protective Edge, a military conflict between Israel and the Hamas regime in Gaza, dramatically affected both populations. Magen David Adom (MDA), the Israeli national Emergency Medical Service (EMS) and a member of the Red Cross, faced a unique challenge during the conflict: to continue providing crucial service to the entire civilian population of Israel, which was under constant missile threat. This challenge included not only providing immediate care for routine EMS calls under missile threat, but also preparing and delivering immediate care to civilians injured in attacks on major cities, as well as small communities, in Israel. This task is a challenge for a civilian EMS agency that normally operates in a non-military environment, yet, in an instant, must enhance its capability to respond to a considerable threat to its population. During Operation Protective Edge, MDA provided care for 842 wounded civilians and utilized a significant amount of its resources. Providing EMS services for a civilian population in a mixed civilian/military scenario is a challenging task on a national level for an EMS system, especially when the threat lasts for weeks. This report describes MDA's preparedness and operations during Operation Protective Edge, and the unique EMS challenges and dilemmas the agency faced.

Diversity: The Business Case?

NASA Astrophysics Data System (ADS)

Jones, B.

2013-12-01

Understanding perceptions and managing expectations are learnable skills that do not necessarily come with project funding. Finding life balance as one moves through a STEM career path poses unique challenges that require a certain skill set that is not always intuitive. Some of those challenges include: selecting grad or post doc positions; balancing work and family commitments; and dealing with employer/advisor perceptions and expectations. As in nature, the STEM enterprise requires multiple perspectives to flourish (necessity of peer review), and in a changing environment (e.g., budget, generations, technology, etc.), embracing diversity in thought and application may help drive the evolution of STEM in the U.S. Many Agencies and organizations have ';workforce development' programs that focus on preparing the next generation of scientists and engineers at the graduate and undergraduate level that focus on preparing students in the diverse disciplines that are unique to those Agency and organizational missions. While financial support certainly is critical to assist students in Science Technology Engineering and Mathematics (STEM) and other fields, professional development is just as important to equip students with a balanced arsenal of tactics to be successful professionals in the STEM workforce of today. Success in these efforts requires an honest look at the issue of inequality in the STEM ecosystem... meaning, what initiatives have been successful in addressing the imbalance in sources of thought and application, therefore promoting the importance of diversity.

Mapping water availability, cost and projected consumptive use in the Eastern United States with comparisons to the West

DOE PAGES

Tidwell, Vincent; Moreland, Barbara D.; Shaneyfelt, Calvin; ...

2017-11-08

The availability of freshwater supplies to meet future demand is a growing concern. Water availability metrics are needed to inform future water development decisions. Furthermore, with the help of water managers, water availability was mapped for over 1300 watersheds throughout the 31-contiguous states in the eastern U.S. complimenting a prior study of the west. The compiled set of water availability data is unique in that it considers multiple sources of water (fresh surface and groundwater, wastewater and brackish groundwater); accommodates institutional controls placed on water use; is accompanied by cost estimates to access, treat and convey each unique source ofmore » water, and; is compared to projected future growth in consumptive water use to 2030. Although few administrative limits have been set on water availability in the east, water managers have identified 315 fresh surface water and 398 fresh groundwater basins (with 151 overlapping basins) as Areas of Concern (AOCs) where water supply challenges exist due to drought related concerns, environmental flows, groundwater overdraft, or salt water intrusion. This highlights a difference in management where AOCs are identified in the east which simply require additional permitting, while in the west strict administrative limits are established. Although the east is generally considered "water rich" roughly a quarter of the basins were identified as AOCs; however, this is still in strong contrast to the west where 78% of the surface water basins are operating at or near their administrative limit. There was little effort noted on the part of eastern or western water managers to quantify non-fresh water resources.« less

Mapping water availability, cost and projected consumptive use in the Eastern United States with comparisons to the West

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

Tidwell, Vincent; Moreland, Barbara D.; Shaneyfelt, Calvin

The availability of freshwater supplies to meet future demand is a growing concern. Water availability metrics are needed to inform future water development decisions. Furthermore, with the help of water managers, water availability was mapped for over 1300 watersheds throughout the 31-contiguous states in the eastern U.S. complimenting a prior study of the west. The compiled set of water availability data is unique in that it considers multiple sources of water (fresh surface and groundwater, wastewater and brackish groundwater); accommodates institutional controls placed on water use; is accompanied by cost estimates to access, treat and convey each unique source ofmore » water, and; is compared to projected future growth in consumptive water use to 2030. Although few administrative limits have been set on water availability in the east, water managers have identified 315 fresh surface water and 398 fresh groundwater basins (with 151 overlapping basins) as Areas of Concern (AOCs) where water supply challenges exist due to drought related concerns, environmental flows, groundwater overdraft, or salt water intrusion. This highlights a difference in management where AOCs are identified in the east which simply require additional permitting, while in the west strict administrative limits are established. Although the east is generally considered "water rich" roughly a quarter of the basins were identified as AOCs; however, this is still in strong contrast to the west where 78% of the surface water basins are operating at or near their administrative limit. There was little effort noted on the part of eastern or western water managers to quantify non-fresh water resources.« less

78 FR 76840 - Agency Information Collection Activities; Announcement of Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-19

...] Agency Information Collection Activities; Announcement of Office of Management and Budget Approval... ``Unique Device Identification System'' has been approved by the Office of Management and Budget (OMB... information entitled ``Unique Device Identification System'' to OMB for review and clearance under 44 U.S.C...

Intermediate Outcomes, Strategies, and Challenges of Eight Healthy Start Projects

PubMed Central

Walker, Deborah Klein; Hargreaves, Margaret; Rosenbach, Margo

2008-01-01

Site visits were conducted for the evaluation of the national Healthy Start program to gain an understanding of how projects design and implement five service components (outreach, case management, health education, depression screening and interconceptional care) and four system components (consortium, coordination/collaboration, local health system action plan and sustainability) as well as program staff’s perceptions of these components’ influence on intermediate outcomes. Interviews with project directors, case managers, local evaluators, clinicians, consortium members, outreach/lay workers and other stakeholders were conducted during 3-day in-depth site visits with eight Healthy Start grantees. Grantees reported that both services and systems components were related to self-reported service achievements (e.g. earlier entry into prenatal care) and systems achievements (e.g. consumer involvement). Outreach, case management, and health education were perceived as the service components that contributed most to their achievements while consortia was perceived as the most influential systems component in reaching their goals. Furthermore, cultural competence and community voice were overarching project components that addressed racial/ethnic disparities. Finally, there was great variability across sites regarding the challenges they faced, with poor service availability and limited funding the two most frequently reported. Service provision and systems development are both critical for successful Healthy Start projects to achieve intermediate program outcomes. Unique contextual and community issues influence Healthy Start project design, implementation and reported accomplishments. All eight projects implement the required program components yet outreach, case management, and health education are cited most frequently for contributing to their perceived achievements. PMID:19011959

Financial stability in biobanking: unique challenges for disease-focused foundations and patient advocacy organizations.

PubMed

Bromley, Russell L

2014-10-01

In the last decade, many disease-focused foundations and patient advocacy organizations that support biomedical research have created patient registries and biobanks. This article reviews the motivations behind the creation of those biobanks and how they are different from biobanks sponsored by government or industry. It also discusses some of the different funding models being employed by these organizations. Finally, it highlights some of the unique challenges faced by disease-focused foundations and advocacy organizations that sponsor biobanks, and how they are overcoming those challenges to achieve both financial and operational sustainability.

Assessing teachers' positive psychological functioning at work: Development and validation of the Teacher Subjective Wellbeing Questionnaire.

PubMed

Renshaw, Tyler L; Long, Anna C J; Cook, Clayton R

2015-06-01

This study reports on the initial development and validation of the Teacher Subjective Wellbeing Questionnaire (TSWQ) with 2 samples of educators-a general sample of 185 elementary and middle school teachers, and a target sample of 21 elementary school teachers experiencing classroom management challenges. The TSWQ is an 8-item self-report instrument for assessing teachers' subjective wellbeing, which is operationalized via subscales measuring school connectedness and teaching efficacy. The conceptualization and development processes underlying the TSWQ are described, and results from a series of preliminary psychometric and exploratory analyses are reported to establish initial construct validity. Findings indicated that the TSWQ was characterized by 2 conceptually sound latent factors, that both subscales and the composite scale demonstrated strong internal consistency, and that all scales demonstrated convergent validity with self-reported school supports and divergent validity with self-reported stress and emotional burnout. Furthermore, results indicated that TSWQ scores did not differ according to teachers' school level (i.e., elementary vs. middle), but that they did differ according to unique school environment (e.g., 1 middle school vs. another middle school) and teacher stressors (i.e., general teachers vs. teachers experiencing classroom management challenges). Results also indicated that, for teachers experiencing classroom challenges, the TSWQ had strong short-term predictive validity for psychological distress, accounting for approximately half of the variance in teacher stress and emotional burnout. Implications for theory, research, and the practice of school psychology are discussed. (c) 2015 APA, all rights reserved).

Deployment of a Prototype Plant GFP Imager at the Arthur Clarke Mars Greenhouse of the Haughton Mars Project.

PubMed

Paul, Anna-Lisa; Bamsey, Matthew; Berinstain, Alain; Braham, Stephen; Neron, Philip; Murdoch, Trevor; Graham, Thomas; Ferl, Robert J

2008-04-18

The use of engineered plants as biosensors has made elegant strides in the past decades, providing keen insights into the health of plants in general and particularly in the nature and cellular location of stress responses. However, most of the analytical procedures involve laboratory examination of the biosensor plants. With the advent of the green fluorescence protein (GFP) as a biosensor molecule, it became at least theoretically possible for analyses of gene expression to occur telemetrically, with the gene expression information of the plant delivered to the investigator over large distances simply as properly processed fluorescence images. Spaceflight and other extraterrestrial environments provide unique challenges to plant life, challenges that often require changes at the gene expression level to accommodate adaptation and survival. Having previously deployed transgenic plant biosensors to evaluate responses to orbital spaceflight, we wished to develop the plants and especially the imaging devices required to conduct such experiments robotically, without operator intervention, within extraterrestrial environments. This requires the development of an autonomous and remotely operated plant GFP imaging system and concomitant development of the communications infrastructure to manage dataflow from the imaging device. Here we report the results of deploying a prototype GFP imaging system within the Arthur Clarke Mars Greenhouse (ACMG) an autonomously operated greenhouse located within the Haughton Mars Project in the Canadian High Arctic. Results both demonstrate the applicability of the fundamental GFP biosensor technology and highlight the difficulties in collecting and managing telemetric data from challenging deployment environments.

Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions

PubMed Central

Liddle, Jacki; Hall, Wayne; Chenery, Helen

2015-01-01

Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson’s disease. In this viewpoint paper, we use Parkinson’s disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders. PMID:26474545

Coronary artery aneurysms in acute coronary syndrome: case series, review, and proposed management strategy.

PubMed

Boyer, Nathan; Gupta, Rajesh; Schevchuck, Alex; Hindnavis, Vindhya; Maliske, Seth; Sheldon, Mark; Drachman, Douglas; Yeghiazarians, Yerem

2014-06-01

Coronary artery aneurysm (CAA) is an uncommon clinical finding, with an incidence varying from 1.5%-4.9% in adults, and is usually considered a variant of coronary artery disease (CAD). CAA identified in the context of acute coronary syndrome (ACS) represents a unique management challenge, particularly if the morphology of the CAA is suspected to have provoked the acute clinical syndrome. CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. Once formed, mural thrombus may potentiate the deposition of additional thrombus within aneurysmal segments. Percutaneous revascularization of CAA has been associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malapposition, dissection, and rupture. Presently, there are no formal guidelines to direct the management of CAA in patients presenting with ACS; controversies exist whether conservative, surgical, or catheter-based management should be pursued. In this manuscript, we present an extensive review of the existing literature and associated clinical guidelines, and propose a management algorithm for patients with this complex clinical scenario. Armed with this perspective, therapeutic decisions may be tailored to synthesize patient factors and preferences, individualized clinical assessment, and existing American Heart Association/American College of Cardiology guidelines for management of ACS.

Vagal Reactivity and Affective Adjustment in Infants during Interaction Challenges.

ERIC Educational Resources Information Center

Bazhenova, Olga V.; Plonskaia, Oxana; Porges, Stephen W.

2001-01-01

Evaluated respiratory sinus arrhythmia (RSA) and heart period in 5-month-olds during interaction challenges. Found that during object-mediated challenge, RSA increases were uniquely related to positive engagement. During person-mediated challenge, subjects showed more complex integration of autonomic and behavioral responses such that only infants…

Hurricane risk management and climate information gatekeeping in southeast Florida

NASA Astrophysics Data System (ADS)

Treuer, G.; Bolson, J.

2013-12-01

Tropical storms provide fresh water necessary for healthy economies and health ecosystems. Hurricanes, massive tropical storms, threaten catastrophic flooding and wind damage. Sea level rise exacerbates flooding risks from rain and storm surge for coastal communities. Climate change adaptation measures to manage this risk must be implemented locally, but actions at other levels of government and by neighboring communities impact the options available to local municipalities. When working on adaptation local decision makers must balance multiple types of risk: physical or scientifically described risks, legal risks, and political risks. Generating usable or actionable climate science is a goal of the academic climate community. To do this we need to expand our analysis to include types of risk that constrain the use of objective science. Integrating physical, legal, and political risks is difficult. Each requires specific expertise and uses unique language. An opportunity exists to study how local decision makers manage all three on a daily basis and how their risk management impacts climate resilience for communities and ecosystems. South Florida's particular vulnerabilities make it an excellent case study. Besides physical vulnerabilities (low elevation, intense coastal development, frequent hurricanes, compromised ecosystems) it also has unique legal and political challenges. Federal and state property rights protections create legal risks for government action that restricts land use to promote climate adaptation. Also, a lack of cases that deal with climate change creates uncertainty about the nature of these legal risks. Politically Florida is divided ideologically and geographically. The regions in the southeast which are most vulnerable are predominantly Hispanic and under-represented at the state level, where leadership on climate change is functionally nonexistent. It is conventional wisdom amongst water managers in Florida that little climate adaptation will not occur until a major hurricane hits the region, despite the cost effectiveness of preemptive interventions. It is assumed that after a hurricane the political risks will shift. New policies will be tried and new infrastructure will be built. Many municipalities and agencies are creating "shovel ready" plans in advance to take advantage of post-catastrophe funds. How do the design of these plans reflect perceptions of legal and political risk? Will they do a good job of reducing scientific risk by addressing long term physical threats? In this study we identify specific challenges to climate adaptation in Florida and explore how local and regional water management decision makers balance physical, legal, and political risks in their planning. A primary risk management tool is the strategic use of information. Through targeted interviews with stakeholders we identify key information gatekeepers and their strategies for reducing multiple types of risk.

Technology Challenges in Small UAV Development

NASA Technical Reports Server (NTRS)

Logan, Michael J.; Vranas, Thomas L.; Motter, Mark; Shams, Qamar; Pollock, Dion S.

2005-01-01

Development of highly capable small UAVs present unique challenges for technology protagonists. Size constraints, the desire for ultra low cost and/or disposable platforms, lack of capable design and analysis tools, and unique mission requirements all add to the level of difficulty in creating state-of-the-art small UAVs. This paper presents the results of several small UAV developments, the difficulties encountered, and proposes a list of technology shortfalls that need to be addressed.

Status of Environmental Management Initiatives to Accelerate the Reduction of Environmental Risks and Challenges Posed by the Legacy of the Cold War

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

None

2009-01-01

Fifty years of nuclear weapons production and energy research in the United States during the Cold War generated large amounts of radioactive wastes, spent nuclear fuel (SNF), excess plutonium and uranium, thousands of contaminated facilities, and contaminated soil and groundwater. During most of that half century, the Nation did not have the environmental regulatory structure or nuclear waste cleanup technologies that exist today. The result was a legacy of nuclear waste that was stored and disposed of in ways now considered unacceptable. Cleaning up and ultimately disposing of these wastes is the responsibility of the U.S. Department of Energy (DOE).more » In 1989, DOE established the Office of Environmental Management (EM) to solve the large scale and technically challenging risks posed by the world's largest nuclear cleanup. This required EM to build a new nuclear cleanup infrastructure, assemble and train a technically specialized workforce, and develop the technologies and tools required to safely decontaminate, disassemble, stabilize, disposition, and remediate unique radiation hazards. The sites where nuclear activities produced legacy waste and contamination include the original Manhattan Project sites--Los Alamos, New Mexico; Hanford, Washington; and Oak Ridge, Tennessee--as well as major Cold War sites, such as Savannah River Site, South Carolina; the Idaho National Laboratory, Idaho; Rocky Flats Plant, Colorado; and Fernald, Ohio. Today EM has responsibility for nuclear cleanup activities at 21 sites covering more than two million acres in 13 states, and employs more than 30,000 Federal and contractor employees, including scientists, engineers and hazardous waste technicians. This cleanup poses unique, technically complex problems, which must be solved under the most hazardous of conditions, and which will require billions of dollars a year for several more decades. The EM program focus during its first 10 years was on managing the most urgent risks and maintaining safety at each site while negotiating state and Federal environmental compliance agreements. The program also concentrated on characterizing waste and nuclear materials and assessing the magnitude and extent of environmental contamination. By the late 1990s, EM had made significant progress in identifying and characterizing the extent of contamination and cleanup required and began transitioning from primarily a characterization and stabilization program to an active cleanup and closure program. During that time, EM formulated multi-year cleanup and closure plans, which contributed to cleanup progress; however, reducing the overall environmental risk associated with the cleanup program remained a challenge. In response, the Secretary of Energy directed a review of the EM program be undertaken. The resulting 'Top-to Bottom Review' re-directed the program focus from managing risks to accelerating the reduction of these risks.« less

Australian fly-in, fly-out operations: Impacts on communities, safety, workers and their families.

PubMed

Langdon, Rebecca R; Biggs, Herbert C; Rowland, Bevan

2016-10-17

Australia's mineral, resource and infrastructure sectors continues to expand as operations in rural and remote locations increasingly rely on fly-in, fly-out or drive-in, drive-out workforces in order to become economically competitive. The issues in effectively managing these workforces are becoming more apparent with reported high amounts of turnover and concerns for safety and performance. The issues presented include a range of physical, mental, psychosocial, safety and community challenges. This review aims to consolidate a range of research conducted to communicate potential challenges for industry in relation to a wide variety of issues when engaging and using FIFO/DIDO workforces which includes compressed working schedule design (work schedules), working hours, fatigue, safety performance, employee wellbeing, turnover, psychosocial relationships and community concerns. A comprehensive literature review was performed using EBSCOhost, PubMed and google scholar, with a focus on FIFO or DIDO workforces engaged within the resources sector. Search terms were kept broad in order to capture all national and international research conducted and included: "fly-in, fly-out" "FIFO" "DIDO" "drive-in, drive-out" "mining". There was no date restriction included in the search. Many of the studies were focused on sleep quality, fatigue and the influence of lowered safety performance while at work, presenting an increased risk for health and safety. These issues may be exacerbated for the FIFO workforce when linked to additional research surrounding the extended periods of absence from families influencing workers personal relationships, psychological wellbeing, job satisfaction and the reported high amounts of turnover within the industry. Taken together, this presents a unique implication for the management and continued use of FIFO workforces when considering balancing safety and performance with economic viability of production and operations. The issues of long working hours, fatigue, turnover and job satisfaction are not new to the management of workers. However, FIFO workforces appear to be at an increased risk physically and mentally due to a culmination of other influences, such as extended and frequent periods of absence from friends and families which contribute to feelings of isolation and lowered psychological wellbeing. FIFO workers and their families, engage in a unique lifestyle, rarely are other workers subjected to long hours and compressed work weeks while separated or isolated from their families for extended periods of time. Recently, FIFO interest has shifted to understanding the influences on employee engagement, satisfaction, retention and safety. Considering the management of FIFO workforces from a holistic perspective incorporating all of the issues impacting on these workers may assist to ensure the challenges associated with FIFO employment are understood, addressed and communicated to workers and their families is crucial for safety and health.

The unique contribution of the nursing intervention pain management on length of stay in older patients undergoing hip procedures.

PubMed

Kerr, Peg; Shever, Leah; Titler, Marita G; Qin, Rui; Kim, Taikyoung; Picone, Debra M

2010-02-01

The purpose of this study was to examine the unique contribution of the nursing intervention pain management on length of stay (LOS) for 568 older patients hospitalized for hip procedures. Propensity-score-adjusted analysis was used to determine the effect of pain management on LOS. The LOS for hospitalizations that received pain management was 0.78 day longer than that for hospitalizations that did not receive pain management. Other variables that were predictors of LOS included several context-of-care variables (e.g., time spent in the intensive care unit, registered nurse skill mix, etc.), number of medical procedures and unique medications, and several other nursing interventions. Copyright 2010 Elsevier Inc. All rights reserved.

Insights from a conference on implementing comparative effectiveness research through shared decision-making

PubMed Central

Politi, Mary C; Clayman, Marla L; Fagerlin, Angela; Studts, Jamie L; Montori, Victor

2013-01-01

For decades, investigators have conducted innovative research on shared decision-making (SDM), helping patients and clinicians to discuss health decisions and balance evidence with patients' preferences for possible outcomes of options. In addition, investigators have developed and used rigorous methods for conducting comparative effectiveness research (CER), comparing the benefits and risks of different interventions in real-world settings with outcomes that matter to patients and other stakeholders. However, incorporating CER findings into clinical practice presents numerous challenges. In March 2012, we organized a conference at Washington University in St Louis (MO, USA) aimed at developing a network of researchers to collaborate in developing, conducting and disseminating research about the implementation of CER through SDM. Meeting attendees discussed conceptual similarities and differences between CER and SDM, challenges in implementing CER and SDM in practice, specific challenges when engaging SDM with unique populations and examples of ways to overcome these challenges. CER and SDM are related processes that emphasize examining the best clinical evidence and how it applies to real patients in real practice settings. SDM can provide one opportunity for clinicians to discuss CER findings with patients and engage in a dialog about how to manage uncertainty about evidence in order to make decisions on an individual patient level. This meeting highlighted key challenges and suggested avenues to pursue such that CER and SDM can be implemented into routine clinical practice. PMID:23430243

Financial sustainability of academic health centers: identifying challenges and strategic responses.

PubMed

Stimpson, Jim P; Li, Tao; Shiyanbola, Oyewale O; Jacobson, Janelle J

2014-06-01

Academic health centers (AHCs) play a vital role in the health care system. The training of health care personnel and delivery of health care services, especially to the most complex and financially challenged patients, has been a responsibility increasingly shouldered by AHCs over the years. Additionally, AHCs play a significant role in researching and developing new treatment protocols, including discovering and validating new health technologies. However, AHCs face unique financial challenges in fulfilling their social mission in the health care system. Reforms being implemented under the Affordable Care Act and shifting economic patterns are threatening the financial sustainability of AHCs.The authors review challenges facing AHCs, including training new health care professionals with fewer funding resources, disproportionate clinical care of complex and costly patients, charity care to uninsured and underinsured, and reduced research funding opportunities. Then, they provide a review of some potential solutions to these challenges, including new reimbursement methods, improvements in operational efficiency, price regulation, subsidization of education, improved decision making and communication, utilization of industrial management tools, and increasing internal and external cooperation. Devising solutions to the evolving problems of AHCs is crucial to improving health care delivery in the United States. Most likely, a combination of market, government, and system reforms will be needed to improve the viability of AHCs and assist them in fulfilling their social and organizational missions.

Promises and challenges in solid-state lighting

NASA Astrophysics Data System (ADS)

Schubert, Fred

2010-03-01

Lighting technologies based on semiconductor light-emitting diodes (LEDs) offer unprecedented promises that include three major benefits: (i) Gigantic energy savings enabled by efficient conversion of electrical energy to optical energy; (ii) Substantial positive contributions to sustainability through reduced emissions of global-warming gases, acid-rain gases, and toxic substances such as mercury; and (iii) The creation of new paradigms in lighting driven by the unique controllability of solid-state lighting sources. Due to the powerful nature of these benefits, the transition from conventional lighting sources to solid-state lighting is virtually assured. This presentation will illustrate the new world of lighting and illustrate the pervasive changes to be expected in lighting, displays, communications, and biotechnology. The presentation will also address the formidable challenges that must be addressed to continue the further advancement of solid-state lighting technology. These challenges offer opportunities for research and innovation. Specific challenges include light management, carrier transport, and optical design. We will present some innovative approaches in order to solve known technical challenges faced by solid-state lighting. These approaches include the demonstration and use of new optical thin-film materials with a continuously tunable refractive index. These approaches also include the use of polarization-matched structures that reduce the polarization fields in GaInN LEDs and the hotly debated efficiency droop, that is, the decreasing LED efficiency at high currents.

Methodological challenges in using the Finnish Hospital Discharge Register for studying fire-related injuries leading to inpatient care

PubMed Central

2013-01-01

Background The objective was to examine feasibility of using hospital discharge register data for studying fire-related injuries. Methods The Finnish National Hospital Discharge Register (FHDR) was the database used to select relevant hospital discharge data to study usability and data quality issues. Patterns of E-coding were assessed, as well as prominent challenges in defining the incidence of injuries. Additionally, the issue of defining the relevant amount of hospital days accounted for in injury care was considered. Results Directly after the introduction of the ICD-10 classification system, in 1996, the completeness of E-coding was found to be poor, but to have improved dramatically around 2000 and thereafter. The scale of the challenges to defining the incidence of injuries was found to be manageable. In counting the relevant hospital days, psychiatric and long-term care were found to be the obvious and possible sources of overestimation. Conclusions The FHDR was found to be a feasible data source for studying fire-related injuries so long as potential challenges are acknowledged and taken into account. Hospital discharge data can be a unique and powerful means for injury research as issues of representativeness and coverage of traditional probability samples can frequently be completely avoided. PMID:23496937

Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment

PubMed Central

Hwang, Jessica L.; Weiss, Roy E.

2014-01-01

Summary Since the advent of glucocorticoid therapy for autoimmune disease in the 1940s, their widespread application has led to the concurrent therapy-limiting discovery of many adverse metabolic side effects. Unanticipated hyperglycemia associated with the initiation of glucocorticoids often leads to preventable hospital admissions, prolonged hospital stays, increased risks for infection and reduced graft function in solid organ transplant recipients. Challenges in managing steroid-induced diabetes stem from wide fluctuations in post-prandial hyperglycemia and the lack of clearly defined treatment protocols. The mainstay of treatment is insulin therapy coincident with meals. This article aims to review the pathogenesis, risk factors, diagnosis and treatment principles unique to steroid-induced diabetes. PMID:24123849

Hyperthyroidism and pregnancy.

PubMed

Gargallo Fernández, Manuel

2013-11-01

Association of hyperthyroidism and pregnancy is not an unusual event, and has an impact on both the mother and fetus. After delivery, it may also affect the newborn and the nursing mother. Clinical management of this situation is quite different from that required by non-pregnant hyperthyroid women and poses significant diagnostic and therapeutic challenges. This review addresses aspects related to the unique characteristics of biochemical assessment of thyroid function in pregnancy, the potential causes of hyperthyroidism in pregnancy, and the clinical and therapeutic approach in each case. Special attention is paid to pregnancy complicated with Graves' disease and its different the maternal, fetal, neonatal, and postnatal consequences. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.